A facelift, or rhytidectomy, is the surgical removal of excess facial and neck skin to give a more youthful appearance to the face. A wrinkle or rhytide, is a crease in the skin that typically appears because of aging. Other factors that lead to an aged face includes age spots, sun ray effects, tissue sagging and volume loss. The effect of each factors depends on the skin type of individual.
Wrinkles usually appear in the facial area with thinnest skin such as around the eye. As an individual ages, skin and subcutaneous fat lose its volume and connective tissue loses its elasticity, resulting in appearance of wrinkles.
PROCEDURE
A comprehensive consultation is performed which includes a medical history, physical examination and informed consent.
There are multiple facelift techniques. Your surgeon will discuss the best option for you based on a detailed assessment including realistic expectations from both the patient and surgeon.
Generally, a facelift procedure begins with the administration of anaesthesia. A traditional facelift incision often begins in the hairline at the temporal region, continues around the ear and ends in the lower lateral occipital area. Fat may be sculpted or redistributed from the face, jowls and neck and underlying tissue is repositioned. Commonly the deeper layers of the face and the muscles are also lifted and re-aligned. Skin is re-draped over the uplifted contours and excess skin is trimmed away. A second incision under the chin may be necessary to address areas of concern in the neck.
The incisions are closed with either absorbable or non-absorbable sutures. Non-absorbable sutures are removed after several days. Once healed, the scars from a facelift are concealed within the hairline and in the natural contours of the face and ear.
CANDIDATES
The appearance of wrinkles, folds, and creases on an individual’s face is discussed during a comprehensive consultation. Skin drooping of the cheeks and jowls are among the factors indicating a person may be a suitable candidate for a facelift procedure.
PRE-OPERATIVE PREPARATION AND ASSESSMENT
Patient evaluation and selection are of vital importance before proceeding to surgery. Patient’s chief complaints, underlying medical illnesses, past medical history will be obtained by the surgeon and documented. The surgeon and patient must have complete understanding of the procedure and the expectations of the patient is discussed. The patient is informed of different options available, advantages and disadvantages of each options as well as risks involved. A complete medical history of the patient must be made known to the surgeon. Supplements such as Vitamin E and isotretinoin have adverse effects on wound healing. Therefore, a surgeon will discuss with the patient whether the benefits outweigh the risks. NSAIDs or aspirin as well as anticoagulants should be avoided before any invasive procedure due to risk of bleeding. Smoking and alcohol consumption should be stopped 2 months before the surgery as smoking and alcohol prolong healing period and cause skin flap necrosis.
Next, the surgeon will assess the patient’s facial profile as well as skin laxity in this region and suggest the best treatment modality possible. In some cases, facelift surgery alone is not enough for attaining optimal results, therefore, other resurfacing procedures must be discussed with the patient that might be needed in the future.
RISKS
Most common complication after facelift surgery is haematoma (rates of 1-15%). Facial haematoma may cause tissue ischaemia as well as prolonged swelling of the face. Other complications include scar hypertrophy, facial telangiectasia, stitch abscess, neck hyperpigmentation, skin necrosis, nerve damage, temporal alopecia cutaneous sloughing or necrosis, seroma, wound dehiscence, hypertrophic scarring, contour irregularities, dimpling, and infection.
Infection occurs in 0.05-0.18% of cases while nerve injury occurs in 0.07-2.5% of cases. Systemic vascular complications, such as venous thromboembolism, can occur as well especially in patient with body mass index (BMI) of more than 25.
POST-OPERATIVE EXPECTATIONS
Patients are advised to be in complete bed rest for the first 24 hours. The dressing will be kept in place during this time. The patient’s head will be placed in an elevated position to reduce post-operative swelling. Adequate analgesia will be given to relieve post-procedural pain.
Post-operative nausea and vomiting may occur as side effects of general anaesthesia. Patients are encouraged to take fluids and appropriate diet as tolerated. Mild bleeding from the surgical site may occur. Compressive dressing and placement of cooling packs may be necessary. Swelling and bruising around the face is also expected in post-operative period and will usually resolve within the first week. Antibiotics may be prescribed when necessary to reduce wound infection. Patients are advised to keep the surgical wound clean and to apply antibiotic ointment. Removal of sutures may be done on post-operative day 5-10. The result of facelift will be visible after the swelling has subsided.
