A face-lift (rhytidectomy) is a cosmetic surgical procedure to improve the look of your face and neck.

During a face-lift, facial soft tissues are lifted, excess skin is removed and skin is draped back over the newly repositioned contours. A neck lift (platysmaplasty) is often done as part of a face-lift.

You might choose to have a face-lift if your facial skin is beginning to droop — a common occurrence with aging. A face-lift might also boost your self-confidence.

A face-lift, however, won't affect the quality of your facial skin. If you have wrinkles or sun damage, you might also consider a skin-resurfacing procedure. A face-lift can be done in combination with some other cosmetic procedures, such as a brow lift or eyelid surgery.

As you get older, your facial skin changes — sagging and becoming loose. This can make the lower part of your face appear rectangular in shape. A face-lift can give your face a more youthful heart-like shape.

You might consider a face-lift if:

  • Your facial skin has become loose
  • Your cheeks are sagging
  • The creases below your lower eyelids and around your lower lip and chin are becoming deeper
  • You have excess skin hanging from your lower jaw line (jowls)
  • You've lost definition and have excess fat in your neck
  • Vertical bands of skin in your neck (platysmal bands) have become visible

A face-lift isn't a treatment for superficial wrinkles, sun damage, creases around the nose and upper lip, or irregularities in skin color.

A face-lift poses various risks, including:

  • Scarring. Incision scars from a face-lift are permanent but typically concealed by the hairline and natural contours of the face and ear. If you have short hair, you might consider growing your hair before a face-lift to cover your incisions while they heal. Rarely, incisions can result in raised, red scars. Injections of a corticosteroid medication (Kenalog-10) or other treatments might be used to improve the appearance of scars.
  • Swelling and bruising. Expect swelling and bruising for several weeks. Swelling might distort your facial features or stiffen your facial movements. This is a normal part of recovery that typically goes away after several weeks. Keeping your head elevated and applying cold compresses can help.
  • Changes in skin sensation. During a face-lift, the repositioning of your facial and neck tissues can affect superficial sensory nerves. You'll likely feel some numbness in your cheeks, scalp and neck for a few months up to two years.
  • Hair loss. You might experience temporary or permanent hair loss near the incision sites. Areas affected by temporary hair loss will begin to recover in about three months. Permanent hair loss can be corrected by transplanting skin with hair follicles from your scalp to the area or by removing the bare area of skin. If the area of hair loss is large, a portion of your scalp with hair can be moved to the bare area.
  • Facial nerve injury. Rarely, a face-lift can damage the facial nerves. This can result in temporary or permanent weakness of facial muscles due to facial nerve paralysis.
  • Skin loss. Rarely, a face-lift can interrupt the blood supply to your facial tissues. This can result in skin sloughing. Smoking increases the risk of skin loss after a face-lift.

Like any other type of major surgery, a face-lift poses a risk of bleeding, infection and an adverse reaction to anesthesia.

A face-lift isn't for everyone. Your doctor might caution against a face-lift if you:

  • Take blood thinners. Use of blood thinners (Coumadin, Plavix, others) can affect the blood's ability to clot and increase the risk of bleeding after a face-lift.
  • Have a medical condition. If you have a medical condition, such as an unusual tendency to bleeding, you won't be able to have a face-lift. If you have a condition that might interfere with your ability to heal after a face-lift, such as uncontrolled diabetes, your doctor might urge caution. If possible, your doctor will work with you to manage your condition in preparation for a face-lift.
  • Have a history of repeated weight gain and loss. Repeated stretching of the facial skin can cause your skin to prematurely become loose again after a face-lift.
  • Smoke. Smoking increases the risk that you'll experience skin loss after a face-lift. If you smoke, your doctor will recommend that you stop smoking before surgery and during recovery.

Initially, you'll talk to a plastic surgeon about a face-lift. During your first visit, your plastic surgeon will likely:

  • Review your medical history. Be prepared to answer questions about current and past medical conditions, such as high blood pressure. Talk about any medications you're taking or have taken recently — especially those that might affect your blood's ability to clot — as well as any surgeries you've had.
  • Do a physical exam. To determine your treatment options, the doctor will examine your facial skin, facial bone structure and neck. Patients who have thin, angular faces are likely to achieve better results from a face-lift than are patients who have round faces, low cheekbones or short jawbones. The doctor will also note any scars, skin irregularities or asymmetry in your face before recommending a specific technique. He or she might also take pictures of your face for your medical record.
  • Discuss your expectations. Explain why you want a face-lift and what you're hoping for in terms of appearance after the procedure. Make sure you understand the benefits and risks, including scarring and hair loss.

Before a face-lift you might also need to:

  • Follow medication directions. You'll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding. You might need to start taking antibiotics before a face-lift to prevent an infection after the procedure. Also, if you're prone to high blood pressure, you might need to take blood pressure medication before a face-lift.
  • Wash your face and hair. You'll likely need to bathe and wash your hair the night before and the morning of your face-lift.
  • Avoid eating. You'll be asked to avoid eating anything after midnight the night before your face-lift.
  • Arrange for help during recovery. If your face-lift is done as an outpatient procedure, make plans for someone to drive you home after surgery and stay with you for at least one to two days.

A face-lift can be done in a hospital or an outpatient surgical facility. Sometimes the procedure is done with sedation and local anesthesia, which numbs only part of your body. In other cases, general anesthesia — which renders you unconscious — is recommended.

During the procedure

Techniques used to remove facial skin and reposition facial and neck tissues vary depending on your desired results. The specific technique your plastic surgeon chooses will determine the location of the incisions and the resulting scars.

Your doctor might use one or more of the following techniques:

  • Traditional face-lift. Your doctor will make incisions in your hairline starting at your temples, continuing down and around the front of your ears and ending behind your ears in your lower scalp. An incision might be made under your chin to improve the appearance of your neck.
  • Limited-incision face-lift. Your doctor will make short incisions in your hairline starting at your temples and continuing down and around the front of your ears. Incisions might also be made in the lower eyelids or under the upper lip.
  • Neck lift. Your doctor will make incisions starting in front of your earlobes and continuing around behind your ears in your lower scalp.

After making the incisions, your doctor will sculpt or redistribute fat from your face, jowls or neck and redistribute the underlying tissues. He or she might also use a suction technique to remove fat (liposuction). In some cases fat suctioned from other areas of your body might need to be added to specific areas of your face.Your skin will then be draped over the new contours and excess skin will be removed. Stitches or tape will be used to close the incisions.

A face-lift generally takes two to four hours but might take longer if other cosmetic procedures are done at the same time.

After the procedure

After a face-lift, your incisions will likely be covered with bulky bandages that provide gentle pressure to minimize swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid.

In the first few days after a face-lift:

  • Rest with your head elevated and take pain medication as recommended by your doctor
  • Avoid exposing your incisions to excessive pressure or motion
  • Don't wear clothing that needs to be placed over your head

Avoid drinking alcohol — which can cause blood vessels to widen and lead to bleeding — for at least two weeks.

Ask your doctor when it's OK to resume daily activities, such as washing and drying your hair, bathing and other routine physical activities.

You'll probably see your doctor the day after your face-lift. The doctor will likely remove your drainage tube, apply antibiotic ointment to your incisions and place new bandages on your face. Two to three days after your face-lift, you'll likely be able to switch from wearing bandages to an elasticized facial sling.

Your doctor will likely remove your stitches during separate visits within five to 14 days after your face-lift. He or she will also carefully check your incisions for ingrown hairs, which need to be removed to prevent infection and inflammation.

Your incisions will crust as they begin to heal. Don't pick at the crusts.

You might prefer to remain home while you're recovering from a face-lift. A week after your face-lift, you can begin using makeup to the edge of your scars to conceal any redness or bruising. Avoid unprotected sun exposure until your scars are no longer pink.

After a face-lift, contact your doctor immediately if you have:

  • Pain on one side of your face or neck within 12 hours of surgery
  • Shortness of breath
  • Chest pain
  • Irregular heartbeats

By smoothing loose skin, a face-lift can give your face and neck a more youthful appearance.

Women typically achieve better results after a face-lift than do men. This is because men have thicker facial skin and larger parotid glands — a type of salivary gland located in the cheeks — than do women. As a result, men's cheeks might still appear full after a face-lift.

Keep in mind that face-lift results aren't permanent. As you age your facial skin might begin to droop again. Sun damage can also age your skin.

Aug. 16, 2012