Facelift – UF Health

Definition

A facelift is a surgical procedure to restore sagging, sagging and wrinkled skin on the face and neck.

Alternative names

Rhytidectomy? Facelift? Aesthetic facial surgery

Description

The facelift can be done alone or with nose reshaping, forehead lift or blepharoplasty.

While you are drowsy (sedated) and pain-free (local anesthesia) or deeply asleep and pain-free (general anesthesia), the plastic surgeon will make surgical incisions that begin above the hairline at the temples, extend behind the earlobe, and into lower part of the scalp. Often, this is a cut. An incision may be made under your chin.

There are many different techniques. The results for each are similar, but how long the improvement lasts can vary.

During a facelift, the surgeon may:

• Remove and “lift” some of the fat and muscle beneath the skin (called the SMAS layer, this is the main lifting part of the facelift)
• Remove or move loose skin
• Tighten the muscles
• Perform liposuction of the neck and legs
• Use sutures (stitches) to close the cuts

Why is the process running?

Sagging or wrinkled skin occurs naturally as you age. Creases and fat deposits appear around the neck. Deep folds form between the nose and mouth. The jaw line grows “loose” and relaxed. Genes, poor diet, smoking or obesity can cause skin problems to start earlier or get worse faster.

A facelift can help improve some of the visible signs of aging. Correcting damage to skin, fat and muscle can restore a “younger”, more refreshed and less tired appearance.

People get facelifts because they are not satisfied with the signs of aging on their face but are otherwise in good health.

Risks

The risks of anesthesia and surgery in general are:

Risks of facelift surgery include:

• A pocket of blood under the skin (haematoma) which may need to be surgically drained
• Damage to the nerves that control facial muscles (this is usually temporary but can be permanent)
• Wounds that do not heal well
• Pain that won’t go away
• Numbness or other changes in skin sensation

Although most people are happy with the results, poor cosmetic results that may require more surgery include:

• Unpleasant scar
• Unevenness of the face
• Fluid that collects under the skin (serum)
• Irregular skin shape (contour)
• Changes in skin color
• Stitches that are noticeable or cause irritation

Before the Process

Before surgery, you will have a consultation with the patient. This will include a history, physical exam and psychological evaluation. You may want to bring someone (such as your spouse) with you during the visit.

Feel free to ask questions. Make sure you understand the answers to your questions. You must fully understand the pre-operative preparations, the facelift procedure, the improvement that can be expected and the post-operative care.

One week before surgery, you may be asked to stop taking blood thinners. These drugs may cause increased bleeding during surgery.

• Some of these medications are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
• If you take warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), or clopidogrel (Plavix), talk to your surgeon before stopping or changing how you take these drugs.

In the days before surgery:

• Ask what medications you still need to take on the day of your surgery.
• Always tell your healthcare provider if you have a cold, flu, fever, herpes outbreak, or any other illness before surgery.

On the day of your surgery:

• You will probably be asked not to drink or eat anything after midnight the night before the operation. This includes using chewing gum and mints. Rinse your mouth with water if it feels dry. Be careful not to swallow.
• Take the medications you were told to take with a small sip of water.
• Arrive on time for surgery.

Be sure to follow any other specific instructions from your surgeon.

After the Process

The surgeon may temporarily place a small, thin drainage tube under the skin behind the ear to drain any blood that may collect there. Your head will be wrapped loosely in bandages to reduce bruising and swelling.

You should not have much discomfort after the operation. You can relieve any discomfort you feel with pain medication prescribed by the surgeon. Some numbness of the skin is normal and will go away in a few weeks or months.

Your head should be elevated on 2 pillows (or at a 30-degree angle) for a few days after surgery to keep the swelling down. The drainage tube will be removed 1 to 2 days after surgery if it is inserted. Bandages are usually removed after 1 to 5 days. Your face will look pale, bruised and swollen, but in 4 to 6 weeks it will look normal.

Some of the stitches will be removed in 5 days. Stitches or metal clips in the hairline may be left in for a few extra days if the scalp needs more time to heal.

You should avoid:

• Taking any aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) in the first few days
• Smoking and exposure to secondhand smoke
• Stretching, bending and lifting immediately after surgery

Follow the instructions on using the concealer makeup after the first week. Mild swelling may continue for several weeks. You may also have numbness in the face and ears for up to several months.

Outlook

Most people are happy with the results.

You will have swelling, bruising, skin discoloration, tenderness, and numbness for 10 to 14 days or more after surgery. Most of the surgical scars are hidden in the hairline or natural facial lines and will fade over time. Your surgeon will likely advise you to limit sun exposure.

bibliographical references

Niamtu J. Facelift surgery (cervicofacial rhytidectomy). In: Niamtu J, ed. Aesthetic Facial Surgery. 2nd ed.Philadelphia, PA: Elsevier; 2018: chapter 3.

Warren RJ. Facelift: principles and surgical approaches to facelift. In: Rubin JP, Neligan PC, eds. Plastic Surgery: Volume 2: Aesthetic Surgery. 4th ed.Philadelphia, PA: Elsevier; 2018: chapter 6.2.