Facelift And Necklift (Rhytidectomy)
A facelift is a surgical technique which aims to reduce visible signs of aging in the face and neck. It maintains its reputation as the ‘gold standard’ procedure for facial rejuvenation.Time and effects of gravity, facial grimacing, sun exposure etc. all leave mark on our facial skin over long period of time. Skin progressively looses elasticity and the underlying muscles slacken so that lines and folds deepen and tissues start to sag.
Facelift should not change your fundamental appearance, neither it can stop the aging process. Patients should understand that facelift surgery is a highly individualized procedure which should be considered if you want your face to look more youthful, not try to be somebody else or fit any sort of ideal image.
The best candidate is usually a patient whose face (and neck) has begun to sag, but whose skin still has some elasticity and whose facial bones are strong and well defined. Most patients are in their 40’s to 60’s, but facelift can be done successfully on people in their 80’s too. Facelift can work well in combination with non-surgical modalities of rejuvenation (peels, injectables, skin farmaceuticals etc). Neck lift is often frequently done with rejuvenation of the lower face, as their tissues function as the same unit.
A facelift addresses addresses signs of aging by removing excess skin, tightening the underlying fascia and muscles and redraping skin on the face and neck leaving more youthful look. It is possible to re-tension the skin of the cheeks, provide a softer contour to the nasolabial fold, reduce fullness over the jawline and tighten the skin on the anterior neck. It can correct sagging of the middle face, marionette lines, jowls and a double chin. Although it is feasible to carry out the procedure under local anaesthetic and sedation, my personal preference is to perform facelift under general anaesthetic, except in very minimal corrections. Operation can take anything up to 4 hours depending on the complexity and severity of the problem, but operation ius rarely executed in less then 2.5 hours.
A full facelift operation involves an incision in front of the ear, back up behind the ear and transversely across the hairline. Redundant underlying connective tissue (so called ‘SMAS’ layer) is tightened and redundant skin is excised. Although facelift incisions are relatively extensive, subsequent scars are largely hidden within the hairline and on the back of the ear so hardly recognizable to the vast majority of people during normal social interaction. Men may find it more difficult to disguise the scars and will need to shave their beard closer to the ear. Occasionally, usually in a younger patients, it is possible to achieve above goals by using a shorter scar and this is known as a MACS lift (minimal access cranial suspension), but this method has it’s specific indications.
Drains are usually inserted on each side, and these will normally stay in for 1-2 days. Wounds are closed by absorbable and non-absorbable sutures in different parts of the face and covered with simple, discrete surgical tape. I rarely use special facelift dressings as those can be cumbersome. At the beginning your face will look a little puffy, you may feel that cheek and ears skin is numb and the whole face stiff, but this is all normal, expectant and improves quickly. Patients should try to sleep in relatively upright position for the first 2-3 days to help reduce swelling and pain.
You should expect to be will in the hospital for 2-3 nights. The wounds will be taped and any sutures in front of the ear removed at one week. Any further sutures (in the hairline) will be removed at 10 days post-operatively. You will be able to shower the day after you leave hospital and then use a hairdryer on a warm setting to dry the tape off. It is important to minimize your activities in the first few weeks. Bending or lifting should be avoided as well as strenuous exercise for 6 weeks. You will usually need to take 3 weeks off work and will return to normal within 6-8 weeks.
Face and neck are often considered as one functional unit, so in many patients the typical ageing changes in the face are accompanied with slack of the skin on the front of the neck too, with loss of the normal youthful angle between the jawline and the neck itself. Although it is occasionally appropriate to operate only on the neck, in most instances the neck is addressed in combination with a lower facelift. This offers the opportunity to deal with the jowls and jawline, tighten the muscle layers on the front of the neck resulting in dramatic aesthetic improvement. If there is a prominent layer of fat in the neck overall or more commonly just under the chin, fine liposuction can be done too, at the same time as the necklifting. This is associated with almost indistinguishable additional 2-3 scars, only 2-3 mm long, hidden within the chin creases. These scars are at the sites where tiny liposuction cannulas are put in. Liposuction not only removes localised fat deposits, but leads to deep tissues tightening as it heals over emptied fat pockets.
Potential risks and complications
Unfortunately, complications can occur following any surgery and patients need to be fully aware of this. I always tend to carry out surgery in a safe manner and take all sensible measures to minimise risks and complication rate. Please note below the commonest complications associated with face and/or necklift:
- Bleeding and haematoma (including need to return to theatre to evacuate large blood clot in approximately 3-4% of patients)
- Infection (3% of patients)
- Skin/scar irregularities
- Delayed wound healing
- Skin numbness and necrosis
- Earlobe numbness and altered positioning
- Widened or hypertropic scars
- Damage to the facial nerve and its branches
- Alopecia (bold patches of skin)
- Clots in the legs/lungs
It can take few weeks for swelling to disappear, scars fade and soften. The scars are initially pink, can be a bit lumpy and/or itchy, but over the course of 3-6 months, they mature nicely and become hardly noticeable white lines. Although scars are permanent and quite extensive, in my experience, they rarely pose problems in the long term. Postoperative infections can delay healing process and prolong remodelling of the scar tissue.
In general, facelift leads to significant improvement in appearance and psycho-logical wellbeing and predictably highly satisfied patients. Essential to that, however are realistic expectations, thorough and honest consultation, surgical expertise and above all, mutual trust.
This leaflet provides only basic and generic information. Full details and explanations are provided at the consultation as no two patients are the same and personal circumstances are highly individual. Patients will be provided with detailed leaflet, comprehensive informed consent on risks and complications associated with this operation, few of which are mentioned above.
If you have any concerns following your surgery please contact:
- Hospital where you were operated:
Ashtead 01372 221 442; St Anthony’s 020 8337 6691; Parkside 020 8971 8000
- Your GP practice
- My secretary on 0845 026 7776 (Monday – Friday, 9:30 – 18:00)
|Hospital stay||1-2 nights|
|Surgery time||2-2.5 hours|
|Wound healing||2 weeks|
|Shower / Bath||from week 1|
|Time off work||average 2-3 weeks; those involved in manual activities might need more then 4 weeks|
|Sports and exercise||6-8 weeks|
|Full recovery||6-8 weeks|
clinical pictures left out intentionally in order not to violate patient confidentiality