Facelift

A facelift or rhytidectomy is surgery that corrects sagging of the face and neck by repositioning tissues that have descended with age and removing excess skin. Unlike aesthetic medicine treatments, it does not fill or temporarily tighten the skin: it repositions the deep structures of the face, so its effect is the longest-lasting of all facial rejuvenation treatments.

History

The first facelifts, in the early 20th century, simply removed and pulled the skin, with unnatural, short-lived results. The major breakthrough came in the 1970s, when Tord Skoog proposed mobilising the deeper layer and Mitz and Peyronie described the SMAS (superficial musculoaponeurotic system) in 1976, the fibromuscular layer that supports the tissues of the face. In 1990 Sam Hamra described the deep plane facelift, which releases the retaining ligaments and moves skin, fat and SMAS as a single unit.

Indications

It is indicated when sagging cannot be corrected with non-surgical treatments: descended cheeks, deep nasolabial folds and marionette lines, loss of jawline definition (jowls), double chin and neck bands. Patients are typically between 45 and 70, although the degree of sagging matters more than age.

Techniques

• Skin-only lift: treats only the skin. Rarely used today because it does not last.
• SMAS lift: tightens or folds the SMAS layer as well as the skin. The basis of most current techniques.
• Deep plane facelift: releases the ligaments and moves the tissues beneath the SMAS. It better corrects the midface (cheeks and nasolabial folds) with less tension on the skin, which favours a natural result.
• Cervicofacial lift: treats face and neck in the same operation.
• Neck lift: focused on the neck and double chin.
• Upper-third lift: forehead and brows.

It is often combined with blepharoplasty or fat grafting to restore volume.

Risks and complications

The most common complication is haematoma, more frequent in men and in patients with high blood pressure. Others include injury to branches of the facial nerve (uncommon and almost always temporary), altered skin sensation, skin compromise (much more likely in smokers), visible scars, hair loss near the incisions and asymmetry.

Recovery and results

Swelling and bruising are most intense in the first week and improve over two or three. Social activity usually resumes after two or three weeks. The result settles over a few months and is long-lasting: a facelift turns back the clock, although the face keeps ageing from that point.