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Facelift Surgery Guide

Written by: Dr Kristie McNealy                                      Reviewed 28 June 2010

Our face makes an important impression on the people around us, but unfortunately, aging, gravity, the sun and climate cause the skin of the face and neck to wrinkle and sag.  Facelift surgery, otherwise known as rhytidectomy, can tighten the skin and give the face a more youthful look.

To get a realistic idea of how you would look after a facelift, try lying down on your back and looking up into a mirror. This will cause any loose skin to fall backwards into folds in front of your ears and the back of your neck, and make the face and neck appear firmer. This is what surgeons are trying to achieve with a facelift.

There should be no tension around your eyes or mouth. The mask like, tight look, which many of us associate with the procedure, is unnatural and undesirable. Instead a facelift should give a younger, refreshed and natural – looking appearance with minimal evidence of surgery having been done.

Facelift Surgery Overview

A facelift is a surgical procedure which removes excess facial skin, making the face look smoother, tighter and more youthful.  A facelift can be combined with other procedures including liposuction, neck liposuction, neck, brow or eyelid surgery, chemical peels and facial implants to produce even better results.

Is a Facelift for You?

The best facelift candidates are in good health, and have realistic expectations about the results that facelift surgery can produce.  The best possible results are obtained with patients whose skin has started to sag, but still has good elasticity.  Good underlying facial bone structure also makes the procedure easier.  Facelift candidates must understand that while facelift surgery can improve their appearance, it cannot halt the aging process, and their skin will continue to wrinkle and sag over time.

How is facelift surgery performed?

Essentially a facelift involves moving deeper tissue in the face to a more youthful level. The movement of underlying muscle tissue has a smoothing effect on the skin, which is then repositioned and excess skin removed.

It’s important to realize that a facelift is not just a rearrangement of the skin on the face. To get the best possible results in the neck area and under the chin, the deeper tissue in the cheeks, the SMAS (superficial muscular aponeurotic system) must be moved up and secured as well as being tightened behind the ear and under the chin.

Sometimes, particularly in the case of younger women with good skin elasticity only a minor tightening of the deep tissue in the cheeks and removal of excess skin is required to achieve good results. The lesser procedure is known as a meloplasty (cheek smoothing) or mini-facelift. Variations on the mini facelift include the S lift or MACS lift.

Men can often achieve a worthwhile improvement in the dewlap (the hanging tissue in front of the throat by having a tissue correction under the chin and removal excess tissue behind the ear, without having to do a complete facelift. A skilled surgeon will be able to assess individual expectations and requirements and expectations and advise the operation that is best suited to the patients needs.

What to Expect with Facelift Surgery


Before scheduling a facelift, you'll need to have a consultation with a qualified plastic surgeon.  The surgeon will discuss your expectations for plastic surgery, as well as why you want a facelift, and what changes you are trying to achieve.  They will then examine your face and skin, and decide whether you are a good candidate for a facelift.  They may recommend other procedures instead of, or in addition to a facelift to help you achieve the results you desire.  Once your exam is complete, your surgeon will give you instructions to help you prepare for your surgery.

Before Facelift Surgery

Your surgeon will give you specific instructions for the things you need to do before surgery.  If you smoke, they will advise you to stop, because smoking can interfere with healing.  They may also advise you to stop taking certain medications which could cause problems with bleeding during surgery or healing after surgery.

Since facelifts are often done under general anesthesia, you will need to stop eating between 6 and 12 hours before surgery.  You may be able to drink water or other clear liquids until closer to surgery time, but you surgeon will provide you with specific instructions.  If you will be having a different type of anesthesia, like IV sedation, your surgeon will give you other instructions.

You may need certain blood or urine tests performed before surgery to make sure that you are healthy, and not pregnant.  You will probably also have your blood pressure, heart rate and breathing rate checked by a nurse.

Shortly before your operation, your surgeon will examine your face again.  They may take measurements, or mark on your skin with a marker to help guide them during surgery.

During Facelift Surgery

Facelift surgery typically lasts 2 to 4 hours.  Once you are in the operating theatre, the anesthesiologist will use special medications to put you to sleep, or to help you relax, depending on the type of anesthesia being used.  Then your surgeon will clean the skin around your incision sites and begin the surgery.  Incisions are typically made starting in the hair or at the hairline near the temple.  The incision continues downward in front of the ear, then comes around under the ear and up, ending in the hair or hairline behind the ear.

Next, the skin and fatty tissue are separated from the muscle and connective tissue.  The muscle can be tightened with sutures if needed.  Then, the skin is pulled back and excess skin is trimmed off.  The incisions in the kin are closed with stitches or staples.  Some surgeons will leave plastic tubes in place to allow fluid to drain.  After surgery, your face will be bandaged

At this point, the anesthesiologist will wake you up, and you'll be moved to a recovery room.

After Surgery

After facelift surgery, you'll experience some mild pain and discomfort.  You'll be given pain killers to help you feel comfortable.  You may be told to use cold compresses or ice to help reduce or prevent swelling.

If drains have been left in place, they'll be removed after a day or two.  After 5 to 10 days, any stitches that need to be removed will be taken out.

Most patients can resume social activities in just a few days, and will be able to use their hair and makeup to disguise scars.  You'll be able to return to work in about 2 weeks, and you'll be able to resume vigorous activities in about 6 weeks.

Risks of Facelift Surgery

Facelifts carry many of the same risks as other surgical procedures, including excess bleeding, scarring, infection and anesthesia complications.  Risks that are specific to face lift surgery include:

  • Areas of numbness due to cutting or damage to facial nerves (usually temporary)
  • Loss of facial muscle control due to damaged nerves (usually temporary)
  • Hair loss along incision areas
  • Facial asymmetry, usually correctable with additional surgery
  • Skin necrosis – death and loss of skin ad tissue

Next: Is a facelift right for me?


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