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A face-lift (rhytidectomy) is a cosmetic surgical procedure to create a younger appearance in your face. The procedure can reduce the sagging or folds of skin on the cheeks and jawline and other changes in the shape of your face that occur with age.
During a face-lift, a flap of skin on each side of the face is pulled back, and tissues below the skin are surgically altered to return the contour of the face to a more youthful shape. Before the flap is sutured closed, excess skin is removed.
A neck lift (platysmaplasty) is often done as part of a face-lift to reduce fat deposits and sagging skin on the neck.
A face-lift won't decrease fine creases or wrinkles in your skin or damage from sun exposure. Other cosmetic procedures can address the appearance or quality of the skin itself.
Why it's done
As you get older, the appearance and shape of your face is altered because of normal age-related changes. Your skin becomes less elastic and looser, and fat deposits decrease in some areas of your face and increase in others. Age-related changes in your face that may be reduced with a face-lift include the following:
- Sagging appearance of your cheeks
- Excess skin at your lower jawline (jowls)
- Deepening of the fold of skin from the side of your nose to the corner of your mouth
- Sagging skin and excess fat in the neck (if the procedure includes a neck lift)
A face-lift isn't a treatment for superficial wrinkles, sun damage, creases around the nose and upper lip, or irregularities in skin color.
A face-lift surgery can cause complications. Some can be managed with appropriate care, medication or surgical correction. Long-term or permanent complications, while rare, can cause significant changes in appearance. The risks include:
- Hematoma. A collection of blood (hematoma) under the skin that causes swelling and pressure is the most common complication of face-lift surgery. Hematoma formation, which usually occurs with 24 hours of surgery, is treated promptly with surgery to prevent damage to skin and other tissues.
- Scarring. Incision scars from a face-lift are permanent but typically concealed by the hairline and natural contours of the face and ear. Rarely, incisions can result in raised, red scars. Injections of a corticosteroid medication or other treatments might be used to improve the appearance of scars.
- Nerve injury. Injury to nerves, while rare, can temporarily or permanently affect nerves that control sensation or muscles. Temporary paralysis of a select muscle, resulting in an uneven facial appearance or expression, or temporary loss of sensation can last a few months to a year. Surgical interventions may offer some improvement.
- Hair loss. You might experience temporary or permanent hair loss near the incision sites. Permanent hair loss can be addressed with surgery to transplant skin with hair follicles.
- Skin loss. Rarely, a face-lift can interrupt the blood supply to your facial tissues. This can result in skin loss (sloughing). Sloughing is treated with medications, appropriate wound care and, if necessary, a procedure to minimize scarring.
Like any other type of major surgery, a face-lift poses a risk of bleeding, infection and an adverse reaction to anesthesia. Certain medical conditions or lifestyle habits also can increase your risk of complications. The following factors may present a significant risk or result in unfavorable results, and your doctor may advise against a face-lift.
- Blood-thinning medications or supplements. Medications or supplements that thin the blood can affect your blood's ability to clot and increase the risk of hematomas after surgery. These medications include blood thinners (Coumadin, Plavix, others), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), ginseng, Ginkgo biloba, fish oil and others.
- Medical conditions. If you have a medical condition that prevents blood clotting, you won't be able to have a face-lift. Other conditions, such as poorly controlled diabetes or high blood pressure, increase the risk of poor wound healing, hematomas and heart complications.
- Smoking. Smoking significantly increases the risk of poor wound healing, hematomas and skin loss after a face-lift.
- Weight fluctuation. If you have a history of repeated weight gain and loss — factors that affect the shape of your face and condition of your skin — the outcome of the surgery may not be satisfactory or may be satisfactory for only a short time.
How you prepare
Initially, you'll talk to a plastic surgeon about a face-lift. The visit will likely include:
- Medical history and exam. Prepare to answer questions about past and current medical conditions, previous surgeries, previous plastic surgeries, complications from previous surgeries, history of smoking, and drug or alcohol use. Your surgeon will do a physical exam, may request recent records from your doctor or order a consultation with a specialist if there are any concerns about your ability to undergo surgery.
- Medication review. Provide the name and dosages of all medications you regularly take, including prescription drugs, over-the-counter drugs, herbal medications, vitamins and other dietary supplements.
- Facial exam. Your plastic surgeon will take photos of your face from different angles and close-up photos of some features. The surgeon will also examine your bone structure, shape of your face, fat distribution and quality of your skin to determine your best options for face-lift surgery.
- Expectations. Your surgeon will ask questions about your expectations for the outcomes of a face-lift. He or she will help you understand how a face-lift will likely change your appearance and what a face-lift doesn't address, such as fine wrinkles or naturally occurring asymmetry in your face.
Before a face-lift:
- Follow medication directions. You'll receive instructions about what medications to stop taking and when to stop. For example, you'll likely be asked to discontinue any blood-thinning medication or supplement at least two weeks before surgery. Talk to your doctor about what medications are safe to take or whether the dosage should be adjusted.
- Wash your face and hair. You'll likely be asked to wash your hair and face with a germicidal soap the morning of the surgery.
- Avoid eating. You'll be asked to avoid eating anything after midnight the night before your face-lift. You will be able to drink water and take medications that have been approved by your surgeon.
- Arrange for help during recovery. If your face-lift is done as an outpatient procedure, make plans for someone to drive you home after surgery and stay with you the first night after surgery.
What you can expect
A face-lift can be done in a hospital or an outpatient surgical facility.
Before the procedure
Sometimes the procedure is done with sedation and local anesthesia, which numbs only part of your body. In other cases, general anesthesia — which renders you unconscious — is recommended.
During the procedure
In general, a face-lift involves elevating the skin and tightening the underlying tissues and muscles. Fat in the face and neck may be sculpted, removed or redistributed. Facial skin is then re-draped over the newly repositioned contours of the face, excess skin is removed, and the wound is stitched or taped closed.
The incisions for the procedure depend on the techniques that will be used and the patient's preferences. Options include:
- A traditional face-lift incision starts at your temples in the hairline, continues down and around the front of your ears and ends behind your ears in your lower scalp. An incision might be made under your chin to improve the appearance of your neck.
- A limited incision is a shorter incision that begins in your hairline just above your ear, wraps around the front of your ear, but does not extend all the way into the lower scalp.
- Neck lift incision starts in front of your earlobe and continues around your ear into your lower scalp. A small incision also is made under your chin.
A face-lift generally takes two to four hours but might take longer if other cosmetic procedures are done at the same time.
After the procedure
After a face-lift, you may experience:
- Mild to moderate pain
- Drainage from the incisions
Contact your doctor immediately if you have:
- Severe pain on one side of your face or neck within 24 hours of surgery
- Shortness of breath
- Chest pain
- Irregular heartbeats
Your incisions will likely be covered with bandages that provide gentle pressure to minimize swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid.
In the first few days after surgery:
- Rest with your head elevated
- Take pain medication as recommended by your doctor
- Apply cool packs to the face to ease pain and reduce swelling
You will have several follow-up appointments scheduled during the next two months after surgery. They will include the following:
- The day after surgery, your surgeon will likely remove your drainage tube, apply antibiotic ointment to your incisions and place new bandages on your face.
- Two to three days after your face-lift, you may be able to switch from wearing bandages to wearing an elasticized facial sling.
- About a week after surgery, your doctor will remove your stitches and assess the wound.
- Subsequent visits will likely be scheduled to monitor your progress.
Self-care at home during the first three weeks will help your recovery and minimize the risk of complications:
- Follow wound care instructions as directed by your surgeon.
- Do not pick at crusting scabs that develop on your wound.
- Follow instructions on when you can begin using shampoo and soaps and what kinds you can use.
- Wear clothes that fasten in the front (rather than clothes that are pulled over the head).
- Avoid excessive pressure or motion on and around the incisions.
- Avoid using makeup.
- Avoid vigorous or aerobic activity or sports.
- Avoid direct sun exposure to the incision for three weeks and use a sunscreen of SPF 30 or higher thereafter.
- Avoid coloring, bleaching or perming hair for at least six weeks.
In the weeks after a face-lift, you might style your hair to hide any remaining signs of the incision. You may also choose to delay attending major social events for a couple of months, when you are likely to feel back to normal.
A face-lift can give your face and neck a more youthful appearance. Face-lift results are not permanent. With age, the facial skin may begin to droop again. In general, a face-lift can be expected to last 10 years.
Frequently Asked Questions
You may be a candidate for a facelift if you are in overall good health and have enough excess skin or sagging in the face and neck to make the operation beneficial. The average facelift patients are in their 40's to 60's, but a facelift can be successfully done on people in their 70's or 80's, as well.
A facelift cannot stop your face from aging, but it can improve your appearance by "setting the clock back." Factors such as bone structure, heredity, skin texture, sun exposure, smoking history and others all play a role in the extent of improvement one obtains, as well as influencing how long it will last.
A facelift tightens the skin, removes excess fat and tightens underlying muscles in the lower two-thirds of the face and neck, providing a more youthful, fresher appearance. The end result of a facelift will look natural; it is not designed to pull the skin so tight that it would alter the corners of your mouth.
The facelift does not alter the appearance of the upper third of the face, in particular the excess skin and lines around the eyes, nor does it help sagging of the brow. If you are concerned about the appearance of your eyes or brow, a brow lift or eyelid surgery may be right for you. Your surgeon will review your aesthetic concerns with you and recommend the facial rejuvenation procedure, or combination of procedures, right for you.
Incisions for a facelift usually begin above the hairline at the temple and extend in a natural line just inside the cartilage at the front of the ear and continue behind the earlobe to the lower scalp inside the hairline. These are generally hidden behind the hairline or in a natural crease. Once the scars have softened and matured over a period of several months, they are generally not very noticeable. If work is being done in the neck area, a small incision made under the chin may also be used.
When the incisions are placed back behind the hairline, a small amount of hair is shaved. At the end of the procedure, when the skin is pulled back and tightened, the area that has been shaved is removed so there is no missing hair.
A facelift usually takes several hours, depending on the extent of the work that is done. The average length of a facelift is between 2 1/2 to 3 1/2 hours. Frequently, procedures such as blepharoplasty and forehead lift are combined with a facelift, making the procedure several hours longer.
After your facelift procedure, some numbness of the skin in the cheek area and neck is quite normal. Feeling will usually return in 1-2 months.
For the first few days after a facelift, your activities should be significantly restricted and you should rest with your head elevated. As a general rule, you should plan on taking it easy for the first week after surgery. In several days your dressing will be removed and you may be allowed to wash your hair gently but have to be especially careful around your incisions. Most surgeons recommend avoiding any type of strenuous activity for the first 2-3 weeks after surgery. You should limit your exposure to the sun for several months and allow plenty of time for rest, so your body can heal the various incisions.
Immediately after surgery your face will be swollen and bruised. Your features may be distorted from the swelling and your facial movements may be slightly stiff as well. Some of the swelling and bruising may persist for 2-3 weeks. Most patients are back at work 10-14 days after surgery; however, you still may have some residual bruising and swelling that may need to be camouflaged with makeup.
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