FACELIFTS A facelift is called a rhytidectomy. The term rhytidectomy is derived from the Latin words rhytid, which means wrinkle and ectomy, which means removal of; thus, rhytidectomy is the removal of wrinkles. These wrinkles can be related to age, hereditary or environmental factors. Not everyone ages at the same rate. A great deal of aging process relates to your tissues and what you do to care for them. Smoking and exposure to ultraviolet light (sunlight or a tanning lamp) can increase this aging process. A facelift is considered a major operative procedure. Like any extensive surgery, incisions and complicated suturing are required. Contrary to popular belief and despite some newspaper and magazine articles, it is NOT possible to remove ALL the folds and eliminate ALL the wrinkles of the face, regardless of the treatment applied. You must accept the judgment of your plastic surgeon and realize that he will only remove the skin of the face that can be done safely and suitably for your particular facial contour. The facelift procedure is directed toward improvement and cannot in any way guarantee that each and every wrinkle and fold of skin will be removed. The type of skin and the age of the patient are important factors in the final result. The most common question in regard to a rhytidectomy is HOW LONG WILL IT LAST? This is impossible to state, as there are many factors involved-the amount of skin removed, age and general condition of the patient, type of skin as well as it’s condition and texture, amount of previous sun and wind exposure, as well as healing ability. Skin aging continues after this operation even though the excess skin and wrinkles have been removed. On rare occasions, a minor secondary revision may be advisable. The operation does NOT stop the aging process. The facelift operation is commonly done in our Surgicenter under general anesthesia or with local anesthesia and heavy sedation. The patient, under sedation or general anesthesia, has no appreciation of the operation as an anesthesiologist keeps them asleep and at rest throughout the procedure. These patients are also closely monitored by our circulating nursing staff and our operating room monitoring equipment. Patients are not allowed breakfast the morning of surgery and they are also asked to refrain from taking Vitamin E and Aspirin products for two weeks prior to their surgery. These drugs tend to thin the blood and increase the chance of postoperative bleeding. Patients who smoke must refrain from nicotine products including Nicoret gum for two weeks prior to their operation and for one week after the procedure. Nicotine has been shown clinically and in the laboratory to affect the small vessel blood supply to the facial skin. Nicotine causes a considerable decrease in this blood supply and a much greater chance of skin death or loss. SURGICAL PROCEDURE: Immediately prior to surgery, the patient is instructed to shampoo the hair. No hair is shaved. The incisions are within the temple area, in front of the ear, behind the ear and back into the scalp over the mastoid areas. After the incisions are made, the skin is pulled in the proper lines of tension and excess removed. Sutures are placed in deeper facial tissues to assist in maintaining the uplift of the facial tissues. The incisions are then closed with sutures. A suction drain may be placed in the neck or facial area. This drain is usually removed within 48 hours after surgery. A compressive or turban like dressing is applied after the procedure and is removed the day after surgery. Patients may then shower and shampoo after the dressing removal. The patient can expect some swelling of the face, neck, eyelids, and some black and blue discoloration is common. This is usually most notable on the second and third days and diminishes in approximately ten days to two weeks. This swelling and discoloration also depends on your type of skin, age, and healing ability. POSTOPERATIVE CARE: The operative procedure is followed by a period in the recovery area following which the patient is discharged to home in the care of a friend or relative. Patients usually require close attention for the first 24 to 48 hours and then are usually able to care for themselves in terms of their basic needs. The patient is seen 24 hours after surgery when the compressive head dressing is removed. Follow-up visits are scheduled accordingly to remove sutures and drains and check the wounds. The patient is then asked to shower and shampoo daily. Patients will sleep on two to three pillows in order to minimize the swelling and discoloration of the facial area. Hydrogen peroxide (full strength) is used four times a day to clean your incisions following a cleaning of soap and water. In some cases an ointment or cream is prescribed. If you shave, you may begin to do so after surgery within 48 hours, but be aware that your facial and neck skin will be numb from the procedure and you have a higher incidence of nicking yourself. Sutures are removed at seven to fourteen days after surgery. Make-up can be worn when the final sutures are removed. As no hair is shaved at the time of surgery, a permanent or hair dying treatment can be performed on patients with the removal of the last sutures. Some patients are able to return to their usual homebound activities three to four days after surgery although the average is about one week. Patients can usually return to meeting the public in three to four weeks after the surgery. POSSIBLE SIDE EFFECTS OF SURGERY: Some blood may accumulate under the skin. This can be removed by needle aspiration or in some cases insertion of a drain. In rare situations a return to the operating room may be necessary to control a bleeding site. Occasionally, minor crusts will appear on the incisions, however, this is a temporary problem. Another problem of the operative procedure is scarring. The scars are fairly well camouflaged by being placed in the skin in the temple area, across the front of the ear, but hidden behind the tragus of the ear, (in women only), and then coming around the earlobe, behind the ear and into the posterior hairline. All incisions are, therefore, placed in anatomical creases, which, if at all visible, are usually easily covered by make-up. In male patients the incision is the same except that it passes in the crease in front of the ear. Sometimes the incision in males continues in front of the side burn and into the temple. These scars occasionally thicken, particularly those behind the ear. Scar formation on the facial area usually does not correspond with a history of scar formation elsewhere, i.e., hypertrophic or keloid scars. When scars do thicken, they may require cortisone injections and very rarely re-excision. Some lumpiness under the skin flaps can be observed after surgery, but this subsides with time, manual massage, and use of an electric massager or vibrator. The other notable side effect from this surgery is an effect upon the nerves of the face. There are two types of facial nerves: a motor nerve, which innervates the muscles of facial expression, and another which leads to sensation in the head and neck area. During the operative dissection, the latter sensory nerves are separated from the overlying skin, particularly across the cheeks, ears, and neck. This makes all patients numb immediately after surgery. For this reason, extreme cold or heat cannot be appreciated with a numb face and these temperature conditions can injure these facial flaps. We recommend avoidance of ice packs to the skin as well as heating pads. Also, use of hair dryers must be limited to the cool setting as the ears and scalp tissues are still numb from the operation and can be burned from the warmer settings. It takes several weeks to months before this area is reinnervated. In some instances, the separation of the sensory nerves with the skin causes an uncomfortable sensation in the neck region or behind the ears. This occasionally requires cortisone injection to the scars and very rarely re-operation to literally cut the scar tissue around these nerves. Again, this is extremely rare but something of which you should be informed. In regards to the motor nerves, it is extremely rare to injure these nerves. Since the continuity of the nerve is usually not disrupted, the injury to the nerve is usually temporary and therefore, it is a matter of days, weeks, and perhaps months before innervation is returned. A permanent paralysis is extremely rare. This operative procedure relies upon the blood supply to the dissected facial flaps. In cases with flaps with hair, there may be some loss of hair growth owing to poor blood supply. There can also be some changes in the pigmentation of the skin with compromised blood supply. With tension pulling up the skin flaps or tension from collection of fluid underneath these flaps, this blood supply can be compromised and some of the flap tissue has been reported not to survive. Under these circumstances, the patient may require excision of the tissue and in rare cases, skin grafting. Although this phenomenon of skin loss is rare, it must be mentioned. As mentioned, extreme cold or heat can injure these flaps and we recommend at most cool compresses to the skin. As noted in clinical and laboratory studies, skin loss and smoking has a high correlation. Infection is a very infrequent entity found in facial surgery. However, infections will occasionally occur which may require further antibiotic treatment or even drainage of fluid collections. Extremely rare but severe infections have caused loss of facial hair and skin. In cases of fat collections under the chin, neck or in the jowls, fat suction (liposuction) is used to further supplement the result of the listed procedures. A submental lipectomy, (removal of “turkey gobbler neck”) is often done along with a facelift. The incision for this procedure goes underneath the chin line. Collections of fat underneath the chin and neck are removed. The underlying muscles of the chin and neck are partly resected and are then sewn to the posterior neck muscles to give a smoother and more contoured neck. When this operative procedure is performed along with a facelift, it further compliments the facial up pulling by an uplifting of these neck muscles. Again, problems of infection and bleeding can be seen in the submental lipectomy area, but otherwise, the scar is fairly well hidden under the chin line.
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