Face Lift
What is a Facelift (Rhytidectomy)?
A facelift (rhytidectomy) is a surgical procedure designed to correct age-related changes of the midface, lower face, and neck. With aging, the skin loses elasticity, the superficial musculoaponeurotic system (SMAS) and retaining ligaments weaken, and gravitational descent leads to facial ptosis, deep rhytides, and loss of jawline and neck definition.
Facelift surgery addresses these anatomical changes by repositioning and tightening the SMAS layer, excising redundant skin, and restoring youthful facial contours. The procedure aims to achieve a natural, rejuvenated appearance rather than an artificial or “over-pulled” look.
Indications
Facelift surgery is indicated for patients presenting with:
- Skin laxity and sagging: Most evident in the jowls, mandibular border, and cervical region.
- Deep static rhytides: Particularly in the nasolabial folds, marionette lines, and perioral area.
- Loss of cervicomental angle definition: Due to platysmal banding and subcutaneous laxity.
- Midface descent: Resulting in hollowing of the infraorbital region and flattening of the malar eminence.
- Patient motivation: Desire for comprehensive facial rejuvenation in the setting of realistic expectations and adequate health status.
Surgical Technique
Facelift surgery is performed under general anesthesia and typically requires 3–5 hours, depending on the complexity and whether adjunctive procedures are performed.
Approaches:
- SMAS/Deep Plane Facelift: The SMAS layer is mobilized and repositioned, allowing for vertical and posterior lift of facial tissues. This technique provides long-lasting and natural results by correcting deeper structural aging changes.
- Traditional Facelift: Involves preauricular and retroauricular incisions extending into the temporal hairline. Redundant skin is excised, and scars are concealed within natural creases and the hairline.
- Endoscopic Facelift: Utilizes small incisions and endoscopic assistance to reposition deeper tissues; typically associated with reduced morbidity and shorter recovery.
- Mini Facelift: Limited dissection through shorter incisions, indicated for patients with mild lower face laxity.
In many cases, concomitant procedures such as neck lift, brow lift, blepharoplasty, or autologous fat grafting are performed to optimize overall facial balance.
Preoperative Considerations
- Smoking cessation at least 2–4 weeks preoperatively is mandatory to minimize risk of skin necrosis and delayed wound healing.
- Anticoagulants and antiplatelet agents should be discontinued under medical supervision to reduce intraoperative bleeding risk.
- A full medical evaluation including cardiovascular status, laboratory workup, and imaging if indicated, ensures surgical safety.
Postoperative Course
- Hospitalization: Most patients are discharged within 24 hours.
- Drains: Often placed to prevent hematoma and seroma formation; typically removed within 24–48 hours.
- Sutures/Staples: Removed in 7–10 days.
- Bruising and edema: Peak within the first week, resolving substantially within 2–3 weeks.
- Return to normal activities: Light activities resume after 2 weeks; full recovery, including resolution of residual swelling, may take 6–8 weeks.
Patients are advised to avoid strenuous exercise, direct sun exposure, and trauma to the surgical site during the recovery phase.
Risks and Complications
As with all surgical procedures, facelift surgery carries potential risks:
- Hematoma (most common complication)
- Infection
- Skin flap necrosis (higher risk in smokers)
- Transient or, rarely, permanent facial nerve injury (particularly marginal mandibular branch)
- Hypertrophic or widened scars
- Alopecia along incision lines
When performed by an experienced surgeon and combined with strict adherence to postoperative protocols, complication rates remain low and outcomes are highly satisfactory.
Outcomes
Facelift surgery reliably improves midface fullness, jawline definition, and cervicomental angle contour. Results typically last 8–12 years, depending on patient age, skin quality, and lifestyle factors.
Long-term success is maximized through ongoing sun protection, smoking avoidance, and adherence to a healthy lifestyle.
