FAQ's - Facelift (Rhytidectomy)

In time, gravity, sun exposure, genetics and the stresses of daily life take their toll on our faces and necks. The face develops deep creases, and the skin stretches and sags. Jowls develop and the neck slackens. Facelifts counteract these signs of aging by tightening muscle, removing or repositioning excess fat, trimming excess skin and restoring key facial structures to their proper location on the face, giving your face a fresher, youthful look. After surgery, some patients look ten or more years younger.

What changes occur as the face ages?
What can a facelift do for me?
What won't a facelift correct?
Am I a good candidate for a facelift?
How is a rhytidectomy performed?
What is a MACS facelift and how does it differ from other facelift techniques?
What is the recovery from a facelift like?
How long do the effects of a facelift last?
What are the risks of rhytidectomy?

What changes occur as the face ages?

As the face ages, we develop lines due to muscle pull, lines due to atrophy of the deeper layers of our skin (loss of volume), wear and tear on the surface of the skin, sagging of facial structures, and stretched, excess skin. A facelift helps mainly with the last two on the list: sagging of skin and excess skin. Facelifts can also restore volume to portions of the face, not changing the thickness of our skin, but rather by repositioning structures on the face. Fine lines and wrinkles due to muscle pull are best treated by Botox and lines due to loss of volume may be treated by injectable fillers and/or surgery.

What can a facelift do for me?

A facelift, also known as a rhytidectomy (rhytide = wrinkle), can address many of the following areas:

Deep creases under the eyes
Midface sagging
Deep creases between the nose and mouth (nasolabial folds)
Jowling due to loss of volume/sagging of facial structures
Excess areas of fat
Loose skin and fat under the chin and jaw and neck

What won't a facelift correct?

Facelifts can produce a dramatic improvement in appearance for patients with the problems mentioned above. However, facelifts do not stop the aging process; in time, signs of aging will gradually appear once again. Further, facelifts will not rejuvenate the brow, eyelids, nose, and some of the midface. Patients who want to improve these areas may consider combining a facelift with a brow lift or eyelid surgery (blepharoplasty). Injectable soft-tissue fillers, facial implants and skin resurfacing can also enhance the effects of a facelift.

Am I a good candidate for a facelift?

The best candidates for rhytidectomy:

Wish to improve one or more of the signs of aging indicated above
Are men or women whose faces have begun to sag, but whose skin still has some elasticity
Are generally healthy
Do not smoke
Have realistic expectations
Are considering a facelift for personal reasons, not because someone else is pressuring them to do so

How is a rhytidectomy performed?

Facelifts are typically outpatient procedures and may be performed in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about two hours. This does not include ancillary procedures such as eyelift, browlift or rhinoplasty, all of which may be performed at the same time as rhytidectomy.

The way a facelift is performed varies depending on the surgeon, the patient's facial structure, and the extent of correction desired. The three most common incision techniques are:

Traditional facelift: The "full" facelift for rejuvenating the face, jowls and neck, including fat sculpting, lifting and repositioning of muscle and deeper tissues, and skin trimming and redraping. The incision begins at the temples and travels down to the front of the ear, around the earlobe, and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin.
Limited-incision facelift: For limited rejuvenation around the eyes and mouth, including nasolabial folds and other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip as well.
Neck lift: A neck lift concentrates on jowls, loose skin on the neck, and fat under the chin. The incision is made around the ear lobe and behind the ear to the lower scalp.

What is a MACS facelift and how does it differ from other facelift techniques?

Traditional facelifts are similar in that they all bring the facial and neck skin upward and back. This necessitates an incision behind the ear to take up the slack from the excess skin and permit excision of it. However, gravity does not pull our skin down and forward, merely down. So why pull the skin back? It simply makes no sense at all. Ever see someone with a "bad facelift"? Maybe they have a tight, windblown look about them? The reason they are "bad facelifts" is because you can recognize them. It is possible to have a natural looking facelift, with results that last as long as any of the other techniques, with less visible scarring, less risk of complications and less downtime.

One of the reasons for forming a bad scar is wound tension. The tighter a wound is closed, the stronger the forces upon it to pull it apart. Although most wounds do not pull apart, as the wound is healing, these constant forces of distraction cause the forming scar to widen, often taking a thin, hard-to-see scar to one that is unsightly. So how do you get a good lift from a facelift if you cannot put tension on the skin closure? The answer is the MACS lift. MACS stands for Minimal Access Cranial Suspension. Sounds complicated. It really isn't. Personally, I can't believe it took so long for plastic surgery to discover this technique. And, even more interestingly, it was developed by two friends and colleagues of mine, Drs. Patrick Tonnard and Alexis Verpaele in Gent, Belgium, who were actually early in their careers when they developed this procedure. They have written two excellent textbooks on the subject, and having read both and visited with them in their operating room in Belgium, I will try to highlight the procedure in lay terms.

The MACS lift is a pure vertical lift. Skin is pulled straight up, not back. This means that you are directly reversing the pull due to gravity and eliminating the need, in all but the most severe cases, for an incision behind the ears. The facial structures are lifted not by the skin, but by a series of either two or three pursestring sutures in the face. This is not a thread lift, the longevity of which is only about one year or so. If you picture a change-purse, like the one my grandmother had, when you cinch down the pursestring, the circle becomes smaller, tightening the bag. The first suture loop, or pursestring is placed along the side of the face, from a point in front of the ear to the upper neck and back again forming a narrow, long loop. When the suture is tightened, the neck is tightened and elevated. The second loop is oval shaped and starts at the same point in front of the ear as the first loop, then passes around the cheek and back again. This suture, when tightened, brings up the anterior cheek, flattens the nasolabial fold (the "parentheses" or smile lines) and adds volume to the cheeks. The last suture, considered optional but I like it in almost everyone, starts just lateral to the outer corner of the eye and passes down to the malar fat pad. This is the pad of the upper cheek, just below the outer eye. This suture brings fullness back to the upper cheek over the cheekbone. All three loops are anchored to the deep connective tissue of the face (the "cranial suspension") using a smaller skin incision (the "minimal access"). Furthermore, the neck does not need to be opened with an incision, rather, liposuction of the neck is done whereas before a more formal opening of the neck was required. At this point, the face is lifted. So what about the skin? The excess skin is marked and removed so that when removed, its cut edge lies right on top of the edge of the skin on the other side of the wound. This ensures that there is no tension on the wound, which in turn results in a fine , very hard to see scar. In fact, the design of this procedure puts the scar back behind the hairline by a few millimeters, so that the scar actually heals behind the hairline! As an aside, less skin needs to be lifted off the face and the surgery takes place further away from the delicate nerves of the face that work our muscles of facial expression, making the surgical procedure less risky overall!

Ancillary procedures such as eyelift and browlift can be performed at the same time to augment the results of the procedure. Less scarring, more natural, better scars and less risky. Ever hear the old saying "quick, easy and cheap – you can have any two but not all three"? Well, here you can have all three!

What is the recovery from a facelift like?

After your rhytidectomy, Dr. Epstein will wrap the incisions in bandages and may place drainage tubes in the area. The tubes will be taken out the next day, at your "clean up visit". There will be some swelling and maybe some bruising as well.

At first, you may experience swelling, numbness, bruising, and a feeling of tightness or tension in the face and neck. Your face may look uneven or distorted, and your facial muscles may feel stiff. Most of these usually resolve within 3-6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy or itchy in time. Many patients return to work by the third week. Camouflage cosmetics can be used to minimize the appearance of bruising. You should be gentle with your skin and hair as you recover. Men may need to shave behind the neck and ears where areas of beard-growing skin have moved.

How long do the effects of a facelift last?

Results of a facelift do not last forever. You may want to have another procedure in five or ten years. But in another sense, the effects are permanent; years later, your face will continue to look better than if you had never had a facelift.

What are the risks of rhytidectomy?

Possible complications of facelift include: bleeding, infection, bruising, uneven swelling or discoloration, allergic reaction to the anesthesia, skin blistering (usually only seen in smokers), and temporary or permanent loss of sensation in the face. Dr. Epstein will discuss the risks and benefits of a facelift with you before your surgery.