Rhytidectomy

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A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a procedure used in plastic surgery to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping the skin on the patient's face and neck. The first facelift was performed in Berlin in 1901 by Eugene Hollander. In 2004, the facelift was the fifth most popular cosmetic surgery performed after liposuction, rhinoplasty, breast augmentation and blepharoplasty (eyelid surgery). [1]

In the traditional facelift, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck.

After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks, chin and neck. At this point, the deeper tissues (SMAS - fascial suspension system of the face) can be tightened with stitches, with or without removing some of the excess deeper tissues.

The skin is then pulled upwards and backwards and the amount of excess skin to be removed is determined by feel. The excess skin is then removed and the skin incisions are closed with sutures and staples.

Facelifts work best in women with thin skin and good bone structure. They are best for eliminating loose skin folds in the neck and wrinkles in the cheeks. The areas not well corrected by a facelift include the nasolabial folds and marionette lines. A facelift leaves long scars. However, the portion of the scars in front of the ear are usually inconspicuous. The scar behind the ear is hidden from casual view. Hair loss in the portions of the incision within the hair-bearing scalp can occasionally occur. In men, the sideburns can be pulled backwards and upwards, resulting in an unnatural appearance. In women, one of the telltale signs of having had a facelift is an earlobe which is pulled downwards and/or distorted. If too much skin is removed (as was common many years ago), the face can assume a pulled-back, "windswept" appearance.

Facelifts are commonly combined with eye surgery (blepharoplasty) and skin resurfacing (chemical peels or lasers). They are typically performed under general anesthesia or deep twilight sleep.

The most common complication is bleeding which usually requires a return to the operating room. Less common (but graver) complications include damage to the facial nerve and necrosis of the skin flaps.

Contraindications to facelift surgery include severe concomitant medical problems. While not absolute contraindication, the risk of postoperative complications in increased in cigarette smokers and patients with hypertension and diabetes. Patients should abstain from taking aspirin or other blood thinners before surgery.