Reviewed By : Dr. Aarti Joshi
The first facelift surgery was performed by Dr. Holland in 1901. This surgery added a new feather to the cap of plastic or cosmetic surgeries.
Listed below is the step by step procedure of face lift surgery:
- What is Facelift Surgery?
- Why is Facelift Surgery Required?
- Pre-operative Preparation
- Planning and Precautions
- Procedure Day
- Methods/Techniques of Facelift Surgery
- Post Procedures
- Risks and Complications
What is facelift surgery?
Facelift surgery, also known as rhytidectomy (Greek – rhytis 'wrinkle' + ektome 'excision, removal,' is a procedure that that gives a more youthful appearance to the skin. It improves the visible signs of aging in the face and neck, making you look 10 to 15 years younger.
In facelift surgery, excess facial skin is trimmed or removed and the underlying tissues are tightened. After this, the skin is redraped on the person's face and neck and sutured (stitched). Brow- lift surgery and eyelid surgery may be performed together with facelift to improve the aesthetics of the upper half of the face.
Why is facelift surgery required?
Everyone wishes to look their best. With time, cells of the skin age, dehydrate and begin to show up in the form of wrinkles. The muscles and fat beneath sthe skin degenerate and thus loosen up the skin. If you have the following complaints, you are very likely to be considered as a candidate who needs facelift surgery.
- Lines running from corner of nose to corner of mouth
- Wrinkles, extra fat and loose skin on the neck
- The jaw line is not well defined.
- Loose or sagging skin near the cheekbones
Before any surgery, your doctor will assess your general health status before giving the green signal, A series of tests and investigations will be performed:
Tests that are performed prior to surgery:
- Lab tests
- CBC – complete blood count (Red Blood Cells and White Blood Cells)
- Blood Grouping
- Sugar – Random Blood Sugar, Fasting Blood Sugar, Post-prandial Bloood Sugar
- Urinalysis – for color, contents, presence of sugar, proteins, cells, microbes,
- specific gravity
- ECG – for monitoring heart status
- History of previous treatments & medications taken, if any
- Allergies to certain medications and materials
- Imaging studies: While imaging studies have no specific value in facelift surgeries, Chest X-rays or MRIs may be taken if there is any indication of a pre-existing chest pathology. It may not be needed otherwise. However, proper documentation of the case with good quality photographs is essential.
Planning and Precautions
A few points should be kept in mind before proceeding to the surgical stage;
- Do not consume food or drinks 8-12 hours before the surgery.
- If you are a smoker, you must stop it few weeks before the day of surgery, as it is known to interfere with the healing process.
- If you are currently on certain medications, discuss them with your doctor.
- He/she may advise you to discontinue them 1 week before the surgery. Aspirin, ibuprofen and vitamin-E should be avoided in this period. Most of anti-cold medications contain these. Also include your general physician in this discussion.
- If you are pregnant, then this surgery can be rescheduled for a later time.
- If planning for a haircut, do so at least 3 weeks before the surgery.
On this day, you have to reach the operatory well in time. You can take a nice bath and wash your hair, but do not wear any makeup or use gels, nailpolish, etc. After your arrival in the hospital, the nurse will again measure all your vitals and take other necessary readings. This is important in order for sedatives and anesthetics to act effectively. Then you are asked to wear a loose gown and taken to the operation theatre.
Then the doctor will administer medications and anesthesia for your comfort during the surgical procedure. It is administered either via an injection or inhalation and takes a few seconds to a minute to act. Before you realise, you are already numb. The following types of anesthesia are employed during cosmetic surgical procedures:
- Local anesthesia - Used to block sensation in a very specific area of the body. You will be awake throughout the entire procedure and not even feel a thing. It can be given to you in the form of a spray, ointment or an injection. Minimal dose is used for the surgery.
- Regional anesthesia - also known as a regional block, this technique can numb a larger area as compared to a local anesthetic, such as maxillary nerve block, mandibular nerve block, sphenopalatine nerve block, spinal block during childbirth, etc.
- General anesthesia - If you are administered general anesthesia, you will be put into a state of unconsciousness where you won't be able to feel any pain. It is given either by injecting intravenously or by inhalation of an anesthetic agent (desflurane, isoflurane, halothane, etc). An anesthesiologist will remain throughout the entire procedure to monitor your vitals. This procedure, though entirely painless, can bring about a few complications as nausea, headache, vomiting, confusion, nerve damage, embolism, shock, cardiac arrest (heart attack) and coma.
The operatory and instruments are sterelised and incisions are marked on the face. Depending on the degree of change you’d like to see, your facelift choices include a traditional facelift, limited incision facelift or a neck lift.
A traditional facelift incision often begins in the hairline at the temples, continues around the ear and ends in the lower scalp. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is re-positioned, commonly the deeper layers of the face and the muscles are also lifted. Skin is redraped over the uplifted contours and excess skin is trimmed away. A second incision under the chin may be necessary to further improve an aging neck.
Sutures (stitches) or skin adhesives are used to close the incisions. The important thing to be kept in mind is that these sutures are placed without any tension, so as to prevent a 'windswept look'. The material used can be resorbable or non-resorbable.
After closure with stitches, the face is bandaged from head to chin with a cotton-wool padding. Medications such as antibiotics and pain-killers are given to help with the healing without any scope of infection.
Methods/ Techniques of facelift surgery
The various approaches used are explained below -
- SMAS LIFT – SMAS or Superficial Musculo Aponeurotic System consists of ligaments that encases cheek fat, hence maintaining its position. With age and gravity, the SMAS loses its elasticity causing laxity. Repositioning the ligaments to their original position will bring about rejuvenation of the face.
- Deep-place Facelift - This technique is used for the correction of the area connecting the corner of the mouth and corner of nose. Some cheek fat and muscles are freed from their bony attachments. Risk of damage to facial nerve is high with this technique.
- Composite Facelift – When there is a need to mobilise and reposition deeper layers of tissue, this technique is used. The problem of under eye bags (malar crescent) can be solved with this approach.
- Mid Facelift - A flat area between the cheeks make a woman's face appear more masculine. Midface- lifts are indicated in these cases, but without a significant amount of jowling (slack flesh) or sagging of the neck. In these cases a mid face-lift is sufficient to rejuvenate the face opposed to a full facelift, which is a more drastic surgery. The ideal candidates for a mid face-lift is when a person is in his 40s, or if the cheeks appear to be sagging and the nasolabial area has laxity or skin folds. The incisions here along the hairline and inside the mouth, leaving no room for scars. Thus, the nose to mouth lines look better and cheeks appear rounder.
- Mini Facelift – A very good alternative for prematurely aging people. It is the least invasive type of facelift but similar to a full facelift, without any neck lift. It is also known as the S-lift because of its shape of the incision used for a short scar face lift. It is indicated in people having deep nasolabial folds, sagging facial features but with a firm and well – contoured neck. Incisions are made along the hairline around the ear giving coverage to the scars within the natural creases of skin. It is performed with an endoscope.
- Thread Lift – If you only need to improve the sagging around the eyes, the forehead or the nasolabial fold area, this approach may be used. This technique is performed under loacal anesthesia, so you wouldn't need to worry about going numb throughout the body! Using barb sutures, the skin is repositioned and held in place. The only drawback is that these threads are not
reabsorbed or removed, meaning they will stay on your face permanently. Puckering ( tightly gather or contract into wrinkles or small folds) of the skin may happen, making this technique a less favourable option.
- Subperiosteal Facelift – This facelift offers long term effects, since the tissues to be repositioned are lifted vertically from the undedrlying facial bones and placed in an aesthetically pleasing way. Acceptable mode of treatment in all age groups. The main difference between this technique and others is that a subperiosteal facelift will have a longer duration of swelling.
- Skin-only Facelift - A method offering short term (6-12 months) benefits, a skin-only facelift literally is a skin-only lifting procedure, without any manipulation of the muscles, ligaments or any other structure associated with it. It is also less technique sensitive, but the results are temporary. However, the use of certain special needles can modify the outcome of the
- MACS Facelift - Also known as MINIMAL ACCESS CRANIAL SUSPENSION, this technique is that of 'minimum investment and maximum returns.' It uses a small incision that in is made in front of the ear along the hairline. After this, the sagging tissues are corrected by elevating them vertically, because of the 'suspending' effect. It offers a range of benefits such
as shorter duration of operation (2.5 hours instead of 3.5 hours), lesser recovery time and better aesrtetics.
MACS surgery is performed as follows:
- Anesthesia is given
- Inscision is made in front of the ear and extended a little along the hairline
- The skin and tissues are lifted off
- Depending on amount of tissue to be repositioned, two or three sutures are woven into the deeper tissues.
- The first suture corrects the problem of tightness of upper and middle neck and gives a round contour to the joining point of neck and jaw.
- The second suture corrects the jowl and sagging nasolabial fold
- The sagging cheek is corrected with the third suture and eyelids are 'tweaked'.
- Excess skin is now removed and the remaining skin is sutured in place.
Post operative procedures
You may notice a few changes:
- Numbness – This occurs due to effect of anesthesia and repositioning of the tissues, numbness of the face can persist for one or two weeks.
- Swelling – Like any other healing process, swelling is commonly seen. The degree of swelling may vary from person to person and increases in the first few days after surgery.
- Discoloration – It occurs in the portion of face where stitchesare given after the surgery and resolves in 2-3 weeks.
Recovery post facelift surgery (at the hospital)
After the procedure, a bandage will be tied around the head to help in healing of the incisions. It is important that it is not removed for the first 24 hours. This surgery is performed on an outpatient basis i.e. you are free to go home if you want to. But a few doctors recommend an overnight stay because anesthesia and other medications given before the surgery may cause post operative nausea and vomiting (PONV). This may 'undo' the surgery and its beneficial effects, so its best staying in your treatment facility for the day.
Precautions to be taken
Your surgeon will ask you to abide by a few instructions to promote better healing:
- Keep your head elevated most of the time. Even while sleeping it is best to do so on a recliner or put two pillows underneath your head.
- Your sutures will be removed on the 7 th day after surgery. Then you can start washing your face very gently using a mild soap. The hair and scalp dried as a result of anesthetic solution and bandaging can be cleaned using baby shampoo. But you can resume bathing the next day after surgery.
- Try to avoid lifting heavy weights
- Strenous activities are a strict no-no
- Head turning exercises and pull over clothings can be done only after 3 weeks.
- Yawning and chewing hard foods can reverse the effects of surgery, so its best not to do them.
- Alcohol consumption should be avoided for the first week, as this aggravates bleeding.
- Keep your dressings dry and clean incisions around your ears and chin using peroxide and applying polysporin ointment later.
Physical activities like running can be resumed after 2 weeks of surgery, but without exertion. 3 rd week onwards you can resume your normal exercise routine including heavy weights, with caution.
Recovery time (at home)
During recovery, you may experience slight pain or discomfort for sometime due to pressure of the bandage. It can be relieved by pain medications. Drink a lot of fluids and eat very soft foods to avoid pressure on the jaws and facial musculature. It is important to stay happy and stress free to relax the muscles. Also, don't compare your progress with other patients because each individual is different and unique. Its best to contact your doctor and clarify your concerns.
Commonly surgeons prefer to see their patients routinely after a week, a month, 6 months then after a year, depending on the status of the healing. If you happen to find any of the following abnormalities, contact your surgeon at the earliest:
- High fever
- Pain not relieving with medications
- Swelling, redness, persistent bleeding
- A lot of nausea or vomiting
Risks and Complications
Like every surgical procedure, facelifting may present with a few problems:
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- Bleeding after surgery is a common complaint
- Hematoma formation (localised collection of arterial blood) can occur in some cases
- Damage to the facial nerve and great auricular nerve is a rare but possible outcome.
- Hypertrophic (large size) scar formation. Smoking increases the risk of poor healing and scarring.
- Skin necrosis or skin death due to compromised blood flow to the repositioned