Aging is unavoidable; unfortunately the outward signs usually appear while you still feel young and have productive years ahead. The appearance of an aging face can interfere with a happy, full life in these valuable years. The outward manifestations of aging need not be accepted as a matter of course. Facial rejuvenating procedures are highly rewarding and satisfying procedures for appropriate patients.

Face lift or rhytidectomy is operative procedure designed to remove the major folds or wrinkles of the skin on the face and neck which naturally occur with aging. It frequently is done in conjunction with a similar procedure for the eyelids called blepharoplasty since the aging process is usually present in this region also. A forehead lift may be recommended to elevate the eyebrows and remove deep creases.

Contrary to some articles in popular newspapers and lay journals, a face lift is not as simple as having a hairdo. The procedure is accomplished by an operation and as in all operations there is risk involved. Cosmetic surgery is an art and not a science; consequently no assurance or guarantee of results can be given. All surgeries have a possibility of complications and poor results; cosmetic surgery is no exception. Fortunately, complications in this field of surgery are uncommon. The procedure is designed to produce a maximum benefit in the appearance of the face by removing major wrinkles and sagging of the skin. It is impossible to remove every wrinkle regardless of the treatment and too much surgery would result in a pulled or plastic look. Fine wrinkles, particularly those about the mouth, may require additional treatment, such as dermabrasion, chemical peeling or fat injection.

The face lift can be done in combination with removal of fat from beneath the chin (submental lipectomy) and/or rearrangement of the platysma muscle of the neck to give a more youthful chin line.

Where are the incisions? These vary to some degree depending upon whether the patient is male or female, the hairstyles, hairline, age, previous surgery, etc. Generally the incision starts in the temple, in front or within the hairline. It continues in front of the ear, sometimes partially hidden with the ear (tragus). It then goes under the earlobe, behind the earfold and ends wither within the hairline or at the hairline behind the ear. Frequently another incision is made under the chin in a natural skin fold. This allows fat removal and tightening of the platysma muscle in the neck.

Where is the surgery performed? Face lifts and ancillary procedures are usually performed at outpatients in a surgicenter. A one night stay in post-operative care facility may be advisable in some cases. Local anesthetic combined with intravenous sedation is usually used. This will allow the patient to sleep through most of the procedure. General anesthesia is available upon request but usually is not necessary.

How will I look after surgery? You should expect swelling, discoloration, and bruising of the skin for several weeks after a face lift. Individuals vary a great deal in their response, but commonly the patient will be presentable within 3 weeks. Make-up can be applied shortly after surgery. The marks left by the incisions are often noticeable at first, but these gradually improve as the wounds mature. The scars are not usually mature for about 6-12 months. A face lift will reduce the sagging and loose skin and give a more youthful appearance to the face. The facial features themselves are generally not appreciably changed. The fine lines and wrinkles of the face are usually not much affected by a face lift. Dermabrasion or chemical peel of the skin are sometimes used to reduced fine lines during or after a face lift. Fat injections may also be recommended.

How long will it last? Because people vary so much, an exact time is difficult to give. An average figure given is 5 to 10 years. You may repeat the face lift procedure at that time if you wish. There is always an improvement compared to not having the procedure, even though the aging process continues in the future. In occasional patients with very loose skin, early sagging may be seen as soon as the first year and require a secondary procedure to tighten the loose skin.

What are the risks of surgery?

General Risks of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site,) bleeding, reactions to anesthetic.

Bleeding. When blood collects beneath the skin it causes excessive discoloration. Sometimes lumps which last many months may occur. If blood collection is discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it. If bleeding continues it is sometimes necessary to return to the operating room to stitch the bleeding vessels. This risk is increased in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing product for two weeks before and two weeks after surgery. (See list of medications which may increase bleeding.)

Loss of Skin: The skin may lose its blood supply. While uncommon when this happens, an area of skin will fail to survive and number of weeks are needed for healing. Rarely, a skin graft may be needed to obtain healing. This risk in increased in smokers; therefore, you must stop smoking a least 2 weeks before and 2 weeks following surgery.

Infection: Infection in facial surgery in uncommon but can occur. This requires antibiotics, possible hospitalization, and there is an increased risk toward skin loss as mentioned above.

Facial Nerve Injury: Permanent injury to the facial nerve is very rare. It is not uncommon for branches of the facial nerve to be bruised from the operation and for the muscles of the forehead or the corner of the mouth to lose some or even a great deal of their activity temporarily. Activity usually returns to normal within a few weeks. In extremely rare instances, it may take months or more.

Discoloration: Sometimes the skin remains discolored for many months. This may be related to the absorption of blood pigments during the healing process. Permanent discoloration is rare.

Asymmetry: Every effort is made to keep both sides even, but since no face is symmetrical to begin, mild asymmetry may remain after surgery. Some changes in the earlobe shape may occur as result of skin tension and scars.

Numbness: Parts of the face, forehead, eyes, ears and scalp may feel numb for weeks or months after surgery; this is normal and expected. On occasion, loss of sensation my be prolonged or permanent.

Scars: Every operation creates some type of scar. Facelift incisions are planned to hide and minimize visible scarring. Scars, however, are not predictable and infrequently patients will develop scars which are widened, thickened, raised, more red or generally more visible than anticipated (hypertrophic or keloid). Normally, scars go through a maturation process which takes months. This includes an expected period of thickness, redness and firmness, during the first 4-6 months. (More information on scars is available upon request.)

Hair loss: On occasion hair loss in the temple area or the hair behind the ear may occur. This is usually temporary and the hair regrows in several months. These situations are more the exception than the rule but they do occur.

Pain: Generally facial operations have surprisingly little pain. however, pain is very subjective. On occasion a patient will experience tightness and discomfort for a prolonged period of time. Scars may remain sensitive for months. These situations are more the exception than the rule but they do occur.

Depression: Some patients may experience an emotional let down after this surgery. This may be related to the normal chemical changes after extensive surgery or overly high expectations. It is usually self limited and does not require treatment

Alternatives: Other procedures which may improve an aging face but are less extensive include chemical peels, collagen or fat injections or liposuction technique.

Photography: Photographing, filming or videotaping of the treatment or procedure for education or diagnostic use is standard and required part of patient care.

No Guarantee: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.

Complications and Additional Surgery: Any of these problems or disorders noted above may require additional surgery, hospitalization, and time away from work. If this occurs, there will be additional cost for surgical fees, supplies, anesthesia, etc. depending upon the required operation. Complications of cosmetic surgery generally will not be covered by medical insurance.

The better known complications are discussed above. Please ask your surgeon if you want to know about remote complications, or if you have any other questions.