Cosmetic Surgery

Face-lift (Rhytidectomy) at Mayo Clinic

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Face-lift surgery (rhytidectomy) removes excess skin from the neck and lower jaw line (jowl) to give the lower two-thirds of the face a more youthful and rested appearance. A face-lift treats loose, sagging skin. It does not get rid of wrinkles. Face-lift scars are hidden behind the ears in the hair and under the chin.

Face-lifts are most commonly performed on people age 40 to 70. Depending upon aging changes present before surgery, results from a face-lift can range from subtle to dramatic.

With age, the skin begins to wrinkle and lose elasticity. Over time, creases deepen and jowls may appear along the jawline, and creases from the nose to the corner of the mouth (nasolabial folds) become more apparent. Years of prolonged sun exposure damage the skin. In advanced facial aging, loose skin dangles under the chin creating the effect commonly known as "turkey wattle." In addition, smoking damages the skin by decreasing blood flow to it, and in some people, causes creasing, sometimes called marionette lines.

A person may be a candidate for face-lift surgery if any of the following conditions are present:

• A deep crease or fold running from the corner of the nose to the corner of the mouth
• An undefined jawline with excess skin (jowls)>
• Loose skin and excess fatty tissue at the neck

Limitations
A face-lift alone will not reverse changes in the eye or forehead region. This may require eyelid surgery or a forehead lift. A face-lift will not remove fine wrinkles, such as those around the lips and eyes, that are part of naturally aging skin. Skin resurfacing procedures such as chemical peel or laser treatment may be needed to address these.

A face-lift can help a person feel better about how she or he looks. How long the effects of the procedure last is influenced by such factors as exposure to sun and tobacco products, as well as the genetic make up.

What to Expect

A face-lift is usually done under general anesthesia, but can be done under local anesthesia with intravenous sedation (sedating is medication delivered into a vein). The surgery is performed through incisions made in existing skin creases and hair-bearing areas surrounding the ear, with the goal of hiding scars as much as possible. The incisions are made in the scalp above the ears. They extend to the front of the ears, continue under the earlobes and curve behind the ears into the hair-bearing scalp. Minimal or no hair is trimmed from the scalp along the incisions. The surgeon may adjust underlying tissue to create a smoother and more defined contour to the neck and jawline. Excess skin is then removed.

If necessary, the surgeon will trim or liposuction localized deposits of fat along the jawline or under the chin. Sometimes an incision in the shaded area under the chin is necessary. The surgeon tightens the tissue by moving the skin and often the deeper subcutaneous tissues and muscles to achieve the best possible symmetry. Excess skin is removed and the incisions are closed with sutures and staples.

Risks

As with any operation, there are risks. These may include, but are not limited to:

• Problems related to anesthesia
• Infection
• Ear numbness, facial numbness or paralysis
• Numbness or weakness in moving the eyebrow or corner of the mouth (usually subsides in weeks, but may last for several months or rarely may be permanent
• Hair loss or changes in the hairline
• Skin discoloration or irregularity
• Blood under the skin (hematoma), fluid under the skin (seroma), blood clots in veins (deep vein thrombosis) or lungs (pulmonary embolism)
• Less than optimal healing of scars, especially among people who smoke

Patients can help avoid complications of surgery by:

• Abstaining from all nicotine products for at least six weeks before and after surgery. This includes cigarettes, cigars, chewing tobacco, nicotine gum, patches and avoiding secondhand smoke. These products impair circulation and contribute to poor wound healing.
• Controlling blood pressure. High blood pressure may contribute to or cause bleeding.
• Avoiding aspirin, vitamin E, nonsteroidal anti-inflammatories and anti-coagulants for three weeks before and after surgery. These medications may also promote bleeding.

This procedure is offered by specialists in Facial Plastic and Reconstructive Surgery (Otorhinolaryngology) and Plastic and Reconstructive Surgery.