Over time, gravity and sun exposure take their toll on the face and neck. Deep creases that run from each side of the nose to the corners of the mouth appear; the jawline slackens; and the neck develops loose folds and fat deposits. Rhytidectomy (facelift) counteracts these signs of aging by tightening muscle, removing fat, and trimming excess skin.
Rhytidectomy improves the look of the lower and middle areas of the face, and the neck. It is most effective for correcting the following:
- Mid-face sagging
- Deep creases under the eyes
- Nasolabial folds
- Jowls
- Sagging fat
- Loose skin and fat under the chin and jaw
Although rhytidectomy removes or reduces signs of aging, over time, they will gradually reappear. Rhytidectomy does not improve the look of the brow, eyelids and nose, and some parts of the mid-face. A patient who wants to improve those areas might combine rhytidectomy with a brow lift or eyelid surgery, and/or with injectable soft-tissue fillers, facial implants and skin resurfacing.
Candidates for Rhytidectomy
The best candidates for rhytidectomy want to correct one or more of the signs of aging indicated above; have some facial sagging, but still have elasticity in their skin; are generally healthy; do not smoke; and have realistic expectations about what rhytidectomy can do.
It is very important that the surgeon ascertains whether the patient is only interested in rhytidectomy because of pressure from someone else.
Types of Rhytidectomy
Rhytidectomy is typically performed as an outpatient procedure in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about 2 hours. The way a facelift is performed depends on the surgeon, the patient's facial structure, and the extent of correction desired.
Traditional Rhytidectomy
A traditional rhytidectomy is a "full" facelift that rejuvenates the face, jowls and neck, and includes sculpting and redistributing of fat; lifting and repositioning of muscle and deeper tissues; and trimming and re-draping of skin. The incision begins at the temples and travels down to the front of the ear, around the earlobe and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin.
Limited-Incision Rhytidectomy
A limited-incision rhytidectomy improves the area around the eyes and mouth by reducing nasolabial folds and other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip.
In both methods, incisions are closed with stitches or tissue glue. Scars are hidden in the hairline and natural contours of the face.
Recovery from Rhytidectomy
After rhytidectomy, the surgeon wraps the incisions in bandages, and may insert drainage tubes; if so, they are taken out the next day. If surgical clips are holding some incisions closed, they are removed, along with any stitches, 1 week after the procedure.
Post-rhytidectomy, swelling, numbness, bruising and a feeling of tightness or tension in the face and neck may be felt. The face may look uneven or distorted, and facial muscles may feel stiff. Most of these side effects resolve within 3 to 6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy and itchy over time.
Many patients return to work by the third week. Camouflage cosmetics can be used to minimize the appearance of bruising.
Results of Rhytidectomy
Results of rhytidectomy are not permanent, and some patients choose to undergo another in 5 or 10 years. In some sense, however, effects are permanent; years later, the face continues to look better than if rhytidectomy had not been performed.
Risks Associated with Rhytidectomy
Possible complications of rhytidectomy include bleeding, infection, bruising, swelling or discoloration, allergic reaction to the anesthesia, skin blistering (usually only in smokers), nerve injury, and temporary or permanent loss of sensation in the face.
Neck Lift
A neck lift is a surgical procedure that smooths and tightens the neck's skin, which can sag from aging or weight loss. There are usually two components to a neck lift: cervicoplasty, which removes excess skin, and platysmaplasty, which removes or tightens muscles in the neck. A neck lift can be performed alone or as part of a facelift. A neck lift candidate is in good physical and emotional health, and has realistic expectations about the outcome of surgery. The results of a neck lift can last up to 10 years.
Neck Lift Procedure
A neck lift begins with a small, inconspicuous incision directly below the chin (platysmaplasty) and/or in front of the ear lobes, looping behind the ears and ending in the scalp near the back of the neck (cervicoplasty). Sagging skin is trimmed away and lifted during cervicoplasty; loose muscles that cause the "bands" around the neck to be prominent are tightened during platysmaplasty. In some cases, it is necessary to perform only one of the two procedures. Liposuction is sometimes used to remove excess fat; if so, it is performed before the neck lift. Incisions are glued and/or sutured closed.
A neck lift usually takes 2 to 4 hours to perform, and the patient is given either general anesthesia or local anesthesia with sedation. Most neck lifts are performed on an outpatient basis. Bandages covering incisions are removed after a few days; sutures are typically removed after 7 to 10 days.
Recovery from a Neck Lift
Swelling and bruising from a neck lift can last up to 10 days. Applying cold compresses and keeping the head elevated for the first 48 hours following surgery minimizes swelling. Keeping the head still, and avoiding turning or twisting it for the first few days post-surgery, is recommended. Medication is prescribed to help alleviate discomfort.
Most people return to work and other normal daily activities within 2 weeks, after which bruising and swelling have subsided. More strenuous activities should be avoided for 4 to 6 weeks.
Risks and Complications of a Neck Lift
Although rare, possible risks and complications of a neck lift include the following:
- Scarring
- Excessive bleeding
- Hematoma
- Tissue death
- Blood clots
- Numbness
- Intense itching
- Skin discoloration
- Persistent swelling
A more serious complication, also rare, is facial nerve damage that can lead to muscle paralysis.
