Rhytidectomy
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A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. The first facelift was performed in Berlin in 1901 by Eugene Hollander. According to the most recent 2007 statistics from the American Society for Aesthetic Plastic Surgery, facelifts were the seventh most popular aesthetic surgery performed after liposuction, breast augmentation, blepharoplasty (eyelid surgery), abdominoplasty (tummy tuck), breast reduction, and rhinoplasty.
In the traditional facelift, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck. After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck. At this point, the deeper tissues (SMAS - fascial suspension system of the face) can be tightened with sutures, with or without removing some of the excess deeper tissues. The skin is then redraped, and the amount of excess skin to be removed is determined by the surgeon's judgement and experience. The excess skin is then removed, and the skin incisions are closed with sutures and staples.
Facelifts work best in women with thin skin and good bone structure. They are helpful for eliminating loose skin folds in the neck and laxity of tissues in the cheeks. The areas not well corrected by a facelift include the nasolabial folds and marionette lines which are more suitably treated with injectable fillers. A facelift requires skin incisions; however, the incisions in front of the ear are usually inconspicuous. The incisions behind the ears are hidden from casual view. Hair loss in the portions of the incision within the hair-bearing scalp can occasionally occur. In men, the sideburns can be pulled backwards and upwards, resulting in an unnatural appearance if appropriate techniques are not employed to address this issue. Achieving a natural appearance following surgery in men can be more challenging due to their thicker, bearded skin. In women, one of the telltale signs of having had a facelift can be an earlobe which is pulled downwards and/or distorted. If too much skin is removed (as was common many years ago), the face can assume a pulled-back, "windswept" appearance.
Facelifts are commonly combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.
The most common complication can be bleeding which usually requires a return to the operating room. Less common, but potentially serious, complications may include damage to the facial nerve and necrosis of the skin flaps.
Contraindications to facelift surgery include severe concomitant medical problems. While not absolute contraindications, the risk of postoperative complications is increased in cigarette smokers and patients with hypertension and diabetes. Patients should abstain from taking aspirin or other blood thinners around the time of surgery. Patients should consult either an otolaryngologist, maxillofacial surgeon, or a plastic surgeon for more information.