Face
Lift (Rhytidectomy)
Indications
With increasing age the face undergoes characteristic changes
which are secondary to loss of elasticity in the skin and
loosening of the underlying muscles. The effects of sun-exposure,
gravity and smoking are reflected in the aging face. Loss
of skin elasticity, combined with the effects of gravity
causes the skin to sag and tissues underneath the skin to
bulge. In the face the first signs of aging are fine wrinkles
around the mouth and at the corners of the eyes; the upper
eyelids develop redundant skin, crow’s feet lines
deepen; deep wrinkle lines appear between the eyebrows,
across the forehead and run down from the side of the nose
to the chin; with increasing age the neck becomes more wrinkled
and the jaw line less distinct.
A face-lift operation corrects some of these aging changes.
A face-lift
is usually a cosmetic operation; however, it is occasionally
used in patients who have rare disorders which cause premature
skin aging and sometimes for treating patients with facial
weakness.
Anaesthetic
- General anaesthetic; may be done under
local anaesthetic with intravenous sedation.
Technique
A cut is made starting in the hair-line above the ear; this
continues downwards in the crease line in front of the ear,
or behind the cartilage at the front of the ear; then passes
around, and close to, the ear lobe onto the back of the
ear, carries upwards for a way before passing backwards
into the scalp.Through this cut various techniques of face-lift
can be carried out: the skin alone can be lifted after it
has been separated from the underlying layer of tissue;
more commonly the underlying layer (SMAS) is also lifted
- this may be lifted as a separate layer from the skin or
lifted together with the skin as a single layer. Whatever
layers are lifted they are pulled upward and backwards to
produce the desired effect; excess tissue is cut away. The
SMAS layer and the skin layer are stitched to tissues behind
and in front of the ear to produce the desired effect. Metal
clips are often used to close the incision in the scalp.
A drainage tube may be used for 1 or 2 days and the face
loosely bandaged to reduce swelling and bruising.
Length
of operation - Varied; may take several hours, particularly
if other procedures are performed.
Time
in hospital - 2 - 3 days
Postoperative
discomfort/limitations
There will be some discomfort; significant pain is unusual.
Swelling and bruising are common, bruising may take 2 -
3 weeks to settle. Stitches/staples are removed between
5 and 10 days postoperatively. Numbness of cheek skin and
ears is common and settles over a few weeks or months. The
face looks puffy and feels stiff initially. Scars are mostly
good and can be hidden by the hair. In men the sideburns
are moved closer to the ears; men may have to shave behind
their ears where skin has been lifted.
A face-lift produces most improvement in the lower half
of the face, jaw-line and neck; sagging eyebrows, forehead
wrinkles, fine wrinkles and deep lines around the mouth
are not usually improved. With time the effects of age and
gravity will become apparent again. A face-lift procedure
puts the aging clock back - but the clock keeps ticking;
even so a face-lift will always have some noticeable benefit.
Stop aspirin, non-steroidal anti-inflammatory drugs &
smoking two weeks before surgery.
Time
off work - 3 - 4 weeks.
Risks
and complications
General complications: bruising, swelling and bleeding which
may be heavy and need a return to the operating theatre
to stop; bleeding may cause pressure on the lifted skin
and cause wound healing problems if not recognised and treated
early; chest and wound infections and unsatisfactory scarring
may occur.
Rarely
a nerve responsible for moving parts of the face can be
damaged, this causes weakness or paralysis of part of the
face. Another nerve, carrying feeling from part of the ear,
can also be damaged; this results in numbness. These nerve
problems are usually temporary and recover over a few months.
Occasionally
some skin can die, this leaves a wound, which heals, often
slowly, to leave a widened scar; if the scalp is affected
a bald patch may result. This problem and other wound healing
problems are most common in smokers and the surgeon may
insist you stop smoking before surgery.
Bald areas may result due to hair follicle damage or due
to over tightening of the wounds.
