Aesthetic plastic surgery of the face Facelift

The term facial rhytidectomy, commonly known by its English term facelift, describes the procedure which aims to reposition the soft tissues back to their anatomical place (fat, muscles) and to pull the skin that has lost its elastic properties. There are three levels at which it can be performed: at the skin, at the muscles and their aponeuroses (SMAS), and at the periosteum. The most common type is at the level of the SMAS.

At the same time as the face, correction of neck laxity is also performed, known as cervical rhytidectomy or necklift. The techniques used are combined with small-scale liposuction of the lower jaw.

Finally, the face and neck lift can be combined with browlift (forehead-eyebrow lift), with fat transfer to the face, with skin resurfacing treatments (peelings and fractional lasers), as well as with the use of injectable hyaluronic acid or botulinum toxin type A.

As we do not all age in the same way, we are not all candidates for the same rhytidectomy. The procedure is designed based on the needs and expectations of the patients and requires proper preoperative assessment. After a clinical examination, the doctor will explain the type of surgery for which you are suitable candidates.

Candidates for rhytidectomy are patients whose skin shows laxity, whose underlying bony facial structures remain strong, and whose skin retains some elasticity. Patients are usually between 40 and 60 years old, but facelifts can be successfully performed at older ages as well. A successful facelift is not obvious to others and patients simply look younger and more “fresh.”

As with all cosmetic procedures, patients with unrealistic expectations should be discouraged from surgery, while those with serious health problems, such as diabetes, hypertension, angina, or heavy smokers should be prevented.

Facial and cervical rhytidectomy is performed under general anesthesia or with local anesthesia and sedation in an organized clinic. The duration of the surgery is 2.5 to 4 hours and it can be combined with other aesthetic procedures such as blepharoplasty and forehead/eyebrow lift. After the surgery, it is considered advisable to remain in the clinic for a few hours and for patients to mobilize immediately.

In all rhytidectomies (face and neck) there is an incision which begins in front of the ear and continues backwards, following the natural folds of the face. The incisions are initially covered by the hair, later they mature and, provided healing is unobstructed, after 8–12 months they are difficult to distinguish.

The purpose of a facelift is to make your face look 15 to 20 years younger. The results can have long-lasting duration, but their maintenance also depends on you. You will receive instructions for avoiding photoaging and dehydration, but you must remember that a facelift does not stop time and that the mechanisms of aging continue to operate. Over time, the skin again loses its elasticity and the underlying tissues relax, resulting in the need for the surgery to be repeated after 10–15 years.

The facelift will not correct deep nasolabial folds and the wrinkles around the eyes and mouth, it will not improve the appearance of the eyelids and the position of the eyebrows, and of course it will not change the texture, color, and elasticity of the skin. However, each of the above can be achieved with procedures that may take place at the same time as the facelift. The issue of patient expectations must be thoroughly discussed, and their preoperative and postoperative appearance must be analyzed.

The doctor will assess your general condition and medical history and, if she deems you suitable for surgery, she will inform you about the possible complications and what needs to be done to reduce the likelihood of their occurrence. You will also be asked to stop smoking and to refrain from using supplements that affect blood clotting. Then the anesthesiologist will talk to you about the type of anesthesia you will receive and the possible complications.

Depending on your age and medical history, you will be given instructions regarding medications you are taking that must be discontinued or replaced, as well as for the additional tests you need to do. Your weight must remain stable.

The doctor will stress the importance of stopping smoking for 4 weeks before and 4 weeks after the surgery. This is perhaps the only aesthetic surgery in which the scar and the healing are so greatly affected by smoking. One week before surgery you will be photographed, a special bandage will be ordered, and you will sign the consent form.

You will remain in the clinic for the first 24 hours, but the time off from work should be calculated at 2 weeks. This does not mean you will not be able to do light tasks much earlier, but in general you will feel fatigued, have swelling, bruising, and reduced sensation in the face. It is recommended to abstain from sports and smoking for 1 month.

Upon leaving the operating room, you will wear a special bandage, which you will keep for 6 weeks. You may have a drain which will be removed within the first 24 hours, while you will need to mobilize as soon as possible. If you are diabetic or a smoker, you will receive antibiotic treatment. Pain, when present, is easily managed. By contrast, swelling and bruising subside slowly, and you must be particularly careful not to aggravate them. Stitches are removed between the 5th and 12th day.

The cost of rhytidectomy is calculated by adding the cost of the clinic where the patient is operated on and hospitalized, the fee of the Plastic Surgeon and the Anesthesiologist. The purchase of the special bandage must also be included in the expenses.