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Facelift (Rhytidectomy)

What Is It?

Facelift is a procedure that contours the face and neck, reducing the sagginess and wrinkles that accompany increasing age. It does not change the appearance of one's face, but provides a fresher, more youthful appearance. Facelifts are frequently done for people in their 40s, 50s and 60s. However, some patients find they have premature aging and go ahead with surgery in their 30s, while still others wait until their 70s and 80s before deciding they would like to have the procedure.

People elect to have facelift surgery largely because they want to look as youthful as they feel. It is important for the patient to realize that they are doing the surgery for their own sense of well being, and not for others.

A facelift can achieve a contouring effect on loose jowls, a smoothening out of the folds that go from the corners of the nose to the corners of the mouth, or smoothening of those lines that extend downward from the mouth. Very importantly, a facelift is usually required to tighten the loose skin and muscles of the neck. In some younger patients, a neck lift can be done in isolation, but in older patients the two procedures generally go together.

A facelift does not tighten the forehead or eyelid skin. It also does not remove the fine wrinkles around the lips.

Patient Examples

Click on any photo for larger version and more views of that patient.

Before Surgery Consultation

Dr. Neu will take a detailed history of the patient’s past health and will determine whether or not they are a good candidate for the procedure. He will want to know exactly what the patient hopes to achieve from the surgery.

The goal is to obtain a result that looks as natural as possible, and provides the sense of well being that the patient desires.

Dr. Neu will carefully examine the skin and muscle laxity of the face, and the fat distribution. There are many variations to facelift procedures, and he will review the procedure that will best fulfill the patient’s goals. Sometimes a simple skin tightening procedure is sufficient, but this can lead to the picture of tight skin with an aged-looking face (an artificial windswept look). More commonly, the state-of-the-art facelift involves a tightening of the tissues (fat and muscle) beneath the skin, and then a gentle redraping of the skin itself. This promotes a more natural look and a longer-lasting effect.

Occasionally, some liposuctioning of the neck and jowls may be advisable but it is important to remember that a youthful face has adequate layers of fat, and nowadays fat injection is a common consideration (with fat liposuctioned from other parts of the body). Other injectable fillers may also be advisable, particularly when addressing the wrinkles around the lips as they are not influenced by a facelift. Botox of the frown lines, or crow’s feet lines, is another option.

The advisability of a forehead and eyelid lift—at the same time or at a later date—will also be discussed.

A frequent question is how long the effects of the facelift will last. A facelift will have a permanent enhancement on the face. If for example, a person has a facelift and their identical twin does not, and it is felt that the patient looks at least 10 years younger than the twin, in one year’s time each will probably develop another small wrinkle. The aging process never stops. However, even decades later, the patient will still look substantially younger than the identical twin who did not have surgery.

The Surgery

Facelifts are usually done under a general anesthetic or local anesthetic with sedation. Most facelifts are day surgery procedures, but sometimes involve an overnight stay, particularly when combined with other procedures such as an eyelid or forehead lift. Prior to anesthesia, Dr. Neu will apply markings on the face, following the operative plan that had been discussed prior to surgery.

The scar in front of the ear usually angles behind the cartilage that sits in front of the ear. Whenever possible, Dr. Neu does the new short-scar facelift, avoiding the traditional scar that extends into the hairline from behind the ear. (This traditional scar is bothersome because it is visible and it is a “give away” that a facelift has been performed. It often prevents a woman from wearing her hair “up” after surgery.) Occasionally, there is a small incision below the chin to tighten the neck muscles.

Facelift surgery is a common operation in Dr. Neu’s practice, and he is noted to spare no effort in creating the most natural result in the procedure. After the operation is completed, a facial compression dressing is applied, and this dressing is removed a day or two later.

Resumption of Activity

Because of visible bruising and swelling, most patients will wish to avoid social or professional events for three weeks. Generally, they can resume sedentary activities in two weeks, and vigorous sports in three weeks.