The continued force of gravity can have a profound effect on the lower face, creating jowls along the jawline, deep folds around the mouth, and excess skin hanging under the chin (the "turkey waddle"). A facelift, or rhytidectomy as the procedure is termed, tightens sagging skin on the lower face and upper neck. This is the most dramatic and direct means of reversing the signs of aging.

A facelift removes the excess skin and often leaves a facial appearance ten years younger. Maintaining a natural appearance rather than an artificial and "wind blown" look is of paramount importance and will remain a top priority throughout the consultation and surgery.

Understanding the Procedure

A facelift, or rhytidectomy in its medical terminology, is usually performed under local anesthesia with sedation. An IV is inserted in the preoperative area and medications are given through this that make you very relaxed and comfortable. In the operating room, a local anesthetic is placed around the face and an extra dose of narcotic is given at this time. Most patients are not awake during the placement of local anesthetics and sleep during most of the procedure. The face and neck areas are thoroughly cleansed in the operating room with special antibacterial soaps. The incision for a facelift is in the hair of the temple, around the ear, and back into the hair behind the ear (Figure 1). Occasionally a small incision is made under the chin in order to gain access to problems in this area. One occasionally removes excess fat or tightens some of the neck muscles of this region. Small modifications are made with men in order to avoid distorties of sideburns and other hair-bearing skin. The only part of the incision that is exposed is immediately in front of the ear and it can be designed to be maximally camouflaged.

Through these incisions the skin and deeper tissues are carefully lifted and pulled up and back in order to tighten the lower face and upper neck regions. The excess skin is then excised from around the ears. Great care is taken to remove the jowls without creating an unnatural or "operated on" appearance. Maintaining a youthful but natural image is of paramount priority in facelift surgery. The incisions are closed in multiple layers. The incisions around the ear are closed with fine sutures that will dissolve by themselves. Incisions within the hair are closed with staples and removed about 10 days after surgery.

What to Expect After the Surgery

A large bandage is placed at the conclusion of the operation in order to maintain pressure on all areas that have been tightened. This bandage is cumbersome but essential in order to achieve an optimal result. Although the bandage is needed for pressure to the lower face areas, a circumferential wrap is necessary in order to ensure that it does not slip off.

Once you return home, it is best to relax with your head elevated, such as in a reclining chair or in bed with multiple pillows. Keeping your head elevated will minimize postoperative swelling. Because of the large bandage, most people find it difficult to eat full meals and softer foods are generally better tolerated. The incisions are all protected under the bandage so no specific wound care is needed. During the first week after surgery, you will visit with the surgeon and he will remove the bandage in order to inspect the incisions and neck areas. At this time, the wounds will be thoroughly clean and a dressing reapplied. This continues for 4-7 days after surgery. This bandage should be kept dry, so bathing can only be performed from the neck down. Once the bandage is permanently removed, an elastic bandage is provided which can be taken on and off as needed. From this point on, it is usually recommended to wear this elastic bandage as much as possible during the second week and you can fully bathe and wash your hair.

Bruising and swelling are inevitable with a facelift and generally occur in the neck and lower facial areas. This bruise is not unlike any other bruise on your body and usually requires a couple of weeks to resolve on its own. Camouflage makeup can be applied over the bruised areas to better conceal them. Once the bandages are removed you will be instructed on specific wound care such as cleaning the incisions and use of a moisturizing ointment.

Frequently Asked Questions

How long will the effects of a facelift last?
There are two ways to view the duration of a facelift. First, they can last forever in the sense that the effects of the operation will remain with you as you continue to age. For example, if a facelift gives the appearance of being 10 years younger, it will continue to do so as time goes by. On the other hand, the force of gravity will act on the tightened skin immediately after the surgery and traces of recurrent sagging may become evident after several years. In reality, the lifted skin probably ages slightly slower than normal skin due toscarring that occurs within deeper layers.

If I have a facelift, will I ever need another one?
Although revision lifts are easily performed, a great majority of patients have only one facelift . The impression is that many people may want to look ten years younger at some point in their lives, however, during more senescent years, they are content with appearing their chronologic age.

What complications can arise from a facelift?
Fortunately, complications are uncommon, but a number of them exist and will be reviewed in greater detail with the surgeon. All-important structures of the face are at some risk during a facelift. This includes damage to the nerve that animates your face, nerves that provide sensation to the face, unusual bleeding, necrosis to patches of skin, and unusual scarring.