What is a Rhytidectomy or facelift?

A Rhytidectomy or facelift is a surgical procedure that removes excess loose skin and wrinkles from portions of the face. Rytid is the medical term for wrinkle, and –ectomy means remove.

It does not treat the entire face, but rather eliminates excessive jowls and tightens the loose neck. It does not by itself improve the appearance of the eyes (even the lower eyes) or the forehead. The corners of the mouth should not be distorted when the procedure is properly performed. The folds from the crease in the nose to the corner of the mouth, known as the nasolabial folds do not disappear, however, the lower portion of the nasolabial folds are improved considerably

What is the goal of facelift surgery?

A facelift is intended to make a person look fresher, not fundamentally different. When properly performed it reverses aging changes without leaving telltale signs. It is an effective way to “turn back the clock” and the beneficial effects will last for about ten years.

What about injectables instead of a facelift?

Restylane® and Juvéderm® are examples of fillers used to treat problems of volume loss, grooves, and wrinkles. BOTOX® and Dysport® are temporary paralyzing agents used to treat wrinkles from hyperactive muscles, like the frown lines between the eyebrows. Neither treats tissue laxity, the main indication for facelift surgery. Overuse of fillers in an attempt to compensate for tissue laxity frequently results in an unnatural appearance without addressing the underlying problem. Using the wrong solution in order to avoid surgery is also incrementally expensive.

Where are the scars in a facelift?

The incision typically starts in the scalp just above the ear, courses downward following the curve of the ear, disappears behind the small protruding cartilage in front of the ear, emerges to course around the earlobe, and runs in the crease behind the ear. It will either stop there in those with little neck laxity, or continue backward into the hair behind the ear in those who are older and have looser neck skin.

A separate scar is often necessary under the chin in order to eliminate the muscle cords in the front of the neck. All facelift scars are permanent but fade with time, most being inconspicuous after one year. It is not necessary to cut the hair at the time of surgery.

What happens under the skin, at the deeper layer?

Facelifts consist of more than just skin tightening. There is an important layer under the skin called the SMAS, which is made of strong fibrous tissue and fat. Tightening the SMAS layer reduces the jowls, restores cheek contour, and softens the nasolabial folds. It also reduces the amount of pull necessary on the skin, thereby greatly aiding in achieving a natural appearance and good quality scars.

There is a thin sheet of muscle in the neck called the platysma. It blends into the SMAS in the lower cheek. This muscle is tightened together with the SMAS to improve neck contour and help reduce neck skin laxity.

How is the loose neck skin under the chin addressed?

Facial aging changes commonly include the development of prominent neck cords under the chin. These bands also contribute to poor neck contour from the side. Minimal bands do not require specific treatment other than pulling the platysma from the side as part of SMAS cheek tightening. However, most patients benefit from sewing the loose muscle edges together in the middle through a separate incision under the chin. This eliminates the visible cords and also improves neck contour on the side view. Removing excess fat under the chin through this same incision further improves neck shape.

Where is the surgery performed and how long does it take?

Facelift surgery is performed in an operating room as an outpatient procedure. Operating time correlates with the severity of the aging changes. A facelift alone usually requires about 3 hours. All surgery is performed entirely by Dr. Sirota, sometimes with the use of a first assistant.

What type of anesthesia is used?

Surgery is usually performed under general anesthesia combined with local anesthesia. There is no awareness. A board certified anesthesiologist is present for the entire procedure and uses state-of-the-art monitoring equipment.

What are the risks associated with facelift surgery?

The most common complication is a hematoma, occurring in about one percent. A hematoma is an accumulation of blood that forms a lump under the skin. It may requires removal in the operating room but does not adversely affect either short-term recovery or the long-term result. Other problems such as infection, delayed healing, or excessive scarring can occur but are unusual. Facial nerve injury with weakness of a part of the face can occur on a transient or permanent basis. This is extremely rare. The vast majority of patients do not have any complications.

Why is smoking so harmful for surgery?

Smoking severely reduces blood supply to the skin and also delays healing. Facial skin loss around the ears can occur in those that smoke. Disfiguring scars can result that may require revisional surgery. It is therefore essential to stop smoking completely for at least three weeks before surgery. Simply cutting back is not enough. Nicotine containing patches and gum are equally harmful.

What is the recovery like?

Patients leave in a head dressing that is typically removed the next morning. Drains are removed by 72 hours if not sooner. There are normally feelings of tightness in the neck, cheek numbness, and generalized discomfort of the face and neck. However, there is typically little actual pain. Patients are encouraged to be out of bed as soon as possible.

Swelling and bruising usually subside in two weeks. Makeup to cover residual facial bruising may be used after one week. Eyelid makeup may be applied after ten days. Hair may be washed several days after surgery and colored four weeks later.

Flying and driving are not recommended for two weeks. Mild cardiovascular exercise without impact such as a stationary bike or walking outdoors can begin several weeks after surgery. It is best to wait as long as six weeks before resuming more intense exercise and activities such as jogging, weightlifting, ball sports, yoga, pilates, skiing, and horseback riding.

What are some of the limitations associated with facelift  surgery?

There are pre-existing conditions that can adversely influence the outcome of facial surgery. These include thin skin, poor skin elasticity, heavy wrinkling and sun damage, fat atrophy with generalized facial hollowing, unfavorable underlying bone structure, poor healing tendencies, prior facial surgery not well done, and previous injections of silicone and other substances into the face. The best surgical effort will likely achieve a more modest result in the presence of one or more of these factors.

What are the costs involved in having surgery?

There are separate fees for surgery, anesthesia, operating room use, and private duty nurses. Costs also include preoperative lab tests and special tests based on a patients medical history.

What are the steps involved in proceeding with surgery?

At the initial consultation your face will be evaluated anatomically and a surgical plan proposed, provided that you are a good candidate for the procedure. Once the plan is agreed upon a surgical date can be scheduled. Photographs and preoperative laboratory studies follow. Patients with significant medical conditions will need to obtain clearance from their internist or specialist beforehand.