A facelift (rhytidectomy) is designed to help undo some of the effects of gravity and skin laxity that are an inevitable part of the aging process. Facelifts are often advertised as restoring one’s youthful appearance, but this is an over simplification.
Not even the most talented surgeon can turn back the clock, and a facelift does not deal with every component of the aging processcess. However, a well-designed and executed facelift can help to refresh a person’s appearance. The features that usually cause a person to consider a facelift are sagging and wrinkling cheek tissues, deep folds of the central face, prominent jowls, and excess tissue on the neck.
The term “facelift” refers to procedures intended to improve contours of the mid- and lower face and neck.
A brow lift may be added, as may be any number of additional procedures to correct problems not addressed by the facelift per se. There are many different types of facelifts, and a good surgeon will choose a procedure that fits the patient rather than give everyone his or her signature operation. Facelifts range from procedures performed through a few small incisions in which the tissues of the face are suspended to a higher position using deep sutures (sometimes called a thread lift) or absorbable barbed implants to traditional operations in which long incisions are made, deep layers are tightened, and excess skin is removed. A multitude of lesser facelift procedures are marketed as requiring less downtime, but most of them are not suitable unless the patient is young, has good quality skin, and understands that choosing a lesser procedure may in fact make it more difficult and riskier to undergo a full facelift in the future.
Facelifts are performed with general anesthesia or local anesthesia and sedation. In the traditional operation, a portion of the incision is in the scalp and a portion loops around the ear and extends along the back of the hairline. There may also be an incision under the chin. Traditional facelifts take several hours, and a patient having multiple simultaneous procedures may spend most of the day in the operating room. Some patients will go home the same day, but those patients having more extensive surgery may stay overnight in a postoperative facility. After the initial bandages are removed, the patient may be required to wear a facial sling for weeks, and swelling and bruising may persist for up to six weeks. Patients undergoing lesser procedures will have a shorter downtime. Most facelift patients can return to work within two weeks but may need camouflage cosmetics to cover residual bruising.
Any activity that causes increased blood flow to the face, such as drinking alcohol, sex or other strenuous activity, or saunas, will increase facial swelling and will be quite uncomfortable for several weeks. The facial and neck skin will feel temporarily numb, tight, and dry, and hair growth may be stunted near the incisions. The final results of a facelift may not be evident for six to nine months. Postoperative asymmetry is common and may be related to asymmetry that was present but unnoticed by the patient before surgery.
Severe wrinkling and skin redundancy usually cannot be entirely removed with one operation. The risks of facelift surgery increase with the extent of the procedure. Injury to the facial nerve, although not common, can lead to permanent facial paralysis. Scars may be visible. Skin loss can occur in areas where the skin has been extensively lifted or if a hematoma (blood collection) develops. This can be a very deforming complication because significant scarring may be the end result. Permanent, noticeable hair loss may occur. The “operated look” is a common complication of facelift surgery and is often the result of patients and their surgeons not knowing when to quit.
Postoperatively, facelift patients can experience a variety of emotions. Some patients feel anxiety or guilt about their vanity. Many patients will experience a period of letdown fatigue, disappointment, or even depression in the early weeks after a facelift. These symptoms usually resolve as the swelling and bruising subside.
Psychiatrists note that early depression is common in patients with controlling personalities; later depression, when the extra emotional support by family and friends wanes, is more common in patients with dependent personalities. For the majority of patients, lifestyle, physical stamina, and relationships are unlikely to change signifi- cantly after a facelift. However, patients may experience increased confidence and an improved sense of well-being without undergoing any actual personality change.
In other words, the aging processcess, gravity, and simply the processcess of being alive continue to affect the appearance of one’s face.
The bottom line: A facelift can reduce some of the signs of aging, but the end result is very dependent on the quality of tissues before surgery and the nature of the procedure that is chosen. Patients who opt for less dramatic changes often have a more attractive and natural result. Patients should not underestimate the lengthy recovery period after facelifting.
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