Facelift surgery is a broad phrase that can mean anything to do with restoration of the changes of facial aging. The aging face has a number of components such as changes in the underlying bone with resorption as we age, atrophy of the subcutaneous and orbital fat, change in position and support of the orbital and facial fat, laxity of the skin and changes in the musculature and accumulation of rhytids, sun damage, pigment irregularities and neoplasms of the skin. Restoration of these changes often involves a complicated combination of available techniques depending on the most noticeable problem for any given individual. If we divide the patient into the upper one-third, which would be forehead or brow lift, the central one-third which is lower lid blepharoplasty and mid face advancement, and the lower one-third of the face which is the cheek, jowl and neck area. The tightening of the lower one-third of the face and neck as part of this total rejuvenation phenomenon and is the most common use of the word facelift today. The perioral area, the area around the mouth, is often not directly affected by facelift and requires yet another set of techniques.
Facelift surgery is almost always performed as an outpatient and involves release of the skin from the underlying muscles and ligaments which form the support structure for the soft tissues. This is usually performed through an incision which runs both in front of and behind the ear and often extends up into the temporal hairline. As part of this procedure, often the support tissue of the deeper face (the SMAS) is also tightened as are the platysma muscles of the neck. Because of loosening of the entire face and neck skin, it is common for drain tubes to be necessary for a short time although not universal. The surgery is not as painful as most people would imagine and often can be carried out with a low level of discomfort. Although narcotic pain medication is usually prescribed it is often not necessary. A major contraindication to facelift surgery is cigarette smoking and to some extent diabetes or other underlying known metabolic diseases. In cigarette smokers, diabetics or people with other medical problems, often modifications to the facelift procedure to minimize the amount of surgery (and usually the results you could expect) can be made. Often normal day-to-day activities remain uninterrupted but often people refrain from social activities, church and work for up to two weeks because of associated swelling and potential for bruising. Complications from this surgery are quite rare but can include any of the possible complications from a general anesthetic (if that has been used) or damage to the underlying facial nerves which control muscle action or damage to the sensory nerve which control feeling of the facial skin or asymmetries or incomplete correction of the original deformity. The goal of a properly done facelift is to result in a more refreshed and youthful look but yet natural without any pulling, distortion, abnormal or “operated” appearance. Facelift surgery is generally very long-lasting but once performed normal changes of aging continue and so no operation could ever be considered permanent. Anyone interested in facelift surgery needs to consult a fully qualified, Board Certified plastic surgeon in order to discuss not only the facelift itself but facial aging in general and the unique constellation of features that make each individual unique. An individual treatment plan can be determined that is right for any given person which may include other adjunctive procedures and other surgical procedures such as eyelid, mid face or forehead type procedures.