Rhytidectomy | Facelift

Attributes of the beautiful face include ample volume and fullness in the “apples” of the cheeks, a well-defined jaw line, and a well-defined transition as the jaw line transitions into the neck line (referred to as the cervico-mental angle). While aging is inevitable, it does not typically proceed uniformly.  A number of years may elapse during which time one feels as though he / she looks about the same. Conversely, evidence of relatively rapid age-related changes may unfold over fairly brief periods of time. Regardless of the absolute chronology, predictable changes in the facial soft tissues occur over time.  The facial skin gradually loses elasticity, imparting the appearance of “sagging” skin. The fat compartments underneath the skin descend, producing the following effects:

  • Volume loss and hollowing over the cheekbones
  • Increasing prominence of the nasolabial folds (the mounds of tissue separating the cheeks from the upper lips)
  • Formation of jowls along the jaw line

Anatomical changes in the soft tissues of the neck occur with aging as well:

  • Fat may accumulate under the chin (submental adiposity)
  • Vertical cords may develop in the front of the neck (platysmal bands, which arise from the gradual separation of the edges of the platysma (“grimace”) muscle
  • The jaw line – neck line transition becomes blunted and obscured

When signs of facial aging first become bothersome, non-surgical procedures in the office may prove beneficial. Examples include placement of dermal fillers (e.g., Restlyane™), chemical peels, laser peels, laser skin resurfacing, and dermabrasion.  However, in the setting of moderate to advanced facial aging, when one continues to “look older than I feel,” when one seeks to “look as young as I feel,” and when more substantial and permanent degrees of improvement are desired, facelift (rhytidectomy) and necklift surgery emerge as the treatments of choice.

Through a facelift and / or necklift procedure, a number of measures can be taken to restore a more youthful, natural look:

  • Restoration of volume to the cheekbones / midface by elevating the cheek fat pads into their native positions
  • Enhancement of the jaw line by reducing the jowls with liposuction
  • Smoothing and conservative tightening of the facial and neck skin via reduction of excess loose skin and suspension of the supportive fascial tissues underneath the skin
  • Restoration of a well-defined jaw line – neck line transition via reduction of excess loose skin and suspension of the underlying supportive fascia and platysma muscle
  • Reduction of excess fat accumulation under the chin via liposuction
  • Reduction of vertical neck cords / platysma bands by reattaching the edges of the platysma muscle to one another

The decision to proceed with a facelift / necklift can be difficult. We recognize this and strive to guide you through the decision-making process. Several examples prove illustrative of the many nuances that may bear consideration:

  • While one may be principally bothered by age-related changes to the neck, laxity in the facial soft tissues must oftentimes also be addressed to achieve an optimal, natural result in the neck. An isolated neck lift can be performed, but only in select circumstances.
  • Multiple techniques of facelifting and necklifting exist, including myriad variations of traditional techniques as well as newer “minimally invasive” procedures that employ novel technologies. We use a modified, deep-plane approach to facelift surgery. The modified deep plane approach is an effective, long-lasting technique that has proven to withstand the test of time. Our philosophy holds that when a facelift and / or necklift is the proper operation to meet a patient’s goals, there is simply no comparable substitute. We do vary our techniques depending on individual goals and anatomical findings. For example, some patients with only moderate facial skin laxity are excellent candidates for “short incision” or “short scar” facelifts.  The point remains that we use techniques that have proven reliable over time.
  • People are busy. People lead complex lives within an increasingly complex society. In this context, minimally invasive procedures that offer relatively brief periods of recovery are obviously appealing. Our experience finds that these techniques, while producing less “down time” do not replicate the durability of a modified deep-plane facelift technique.

Pre-Surgical Consultation

During the pre-surgical consultation, the facial rejuvenation goals and desires of each patients are discussed in detail. A detailed examination and analysis of the face and neck is performed. Digital photographs of the face and neck are reviewed on our advanced computerized imaging software to facilitate communication of the changes desired and to illustrate the expected post-surgical outcomes. A comprehensive surgical plan customized to address each patient's concerns is ultimately developed and carefully explained.

Intra-Operative Course

Facelift and necklift surgery is performed on an out-patient basis under general anesthesia.

Facelift incisions start in the pre-auricular crease at the ear-cheek junction, then extend around the earlobe to end behind the ear in the temporal scalp hair. The incisions can also extend along the border of the temporal tuft (sideburn) hair. Incisions are thus placed along normal anatomic borders and creases to maximize the ability to camouflage scars. Great care is taken to preserve the hairline position and maintain the pre-operative shape and position of the ear lobe.

Necklifting with or without neck liposuction sometimes requires an additional small incision placed in the shadow line underneath the chin. Again, great care is taken to maximally camouflage the scar by hiding it underneath the chin.

Specific techniques commonly used during facelift and necklift surgery include:

  • Excision of excess loose or sagging skin to improve skin tone
  • Re-suspension of the cheek / malar fat pads to improve cheek volume
  • Re-suspension of the superficial musculoaponeurotic system (SMAS) of fascia to improve soft tissue tone. This strengthens the “fabric” upon which the overlying skin is re-draped, and enhances jaw line definition
  • Reduction of jaw line jowls with liposuction
  • Reduction of fat underneath the chin (submental adiposity) via liposuction
  • Suturing of the neck platysma muscle to reduce vertical neck “bands” or “cords,” improve neck line contour, and improve jaw – neck line transition

Post-Surgical Course

Patients are discharged home on the day of surgery, with close follow-up in the office thereafter.  Post-surgical dressings are changed in the office on post-operative day #1.  Surgical drains are typically removed at this time as well.  Incisions are gently cleansed, and care instructions are reviewed.  The majority of sutures are removed at 1 week post-operative, with the remainder removed at 2 weeks post-operative.  Post-operative bruising is markedly improved by this visit. Post-operative swelling gradually subsides throughout the recovery period. Follow-up office visits are then typically scheduled at the 1 month, 3 month, 6 month, and 1 year post-operative time intervals.

Facelift and necklift surgery should ultimately produce a durable result that helps patients look as young as they feel. Discernible, significant improvements in facial skin tone, neck skin tone, midfacial / cheek volume, jaw line definition, and jaw – neck line definition transpire naturally, without appearing excessively “pulled” or “stretched.”  After an appropriate amount of time elapses for recovery, patients are expected to look refreshed and rejuvenated without appearing “operated.”