Facelift (Rhytidectomy)

What is a facelift (rhytidectomy)?

A facelift (also known as a rhytidectomy) is a general term for any surgical procedure that improves signs of aging in your face and/or neck by repositioning or removing skin, fat and/or muscle. Signs of aging that a facelift can restore include:

• Relaxed, sagging skin on your face.
• Deep fold or crease lines between your nose and the corners of your mouth.
• Facial fat that has fallen or is lacking.
• Drooping skin on your cheeks and/or jaw (known as jowls).
• Loose skin and extra fat in your neck that looks like a “double chin.”

Facelifts are considered cosmetic restorative surgeries and cannot fundamentally change your appearance or stop the aging process. They also can’t treat superficial wrinkles, sun damage or irregularities in your skin color. Facelifts are very individualized surgeries that are unique to each person’s face and their result goals.

What are the different kinds of facelifts?

There are many kinds of facelift surgeries depending on which areas of the face and neck are targeted. Types of facelift surgeries include:

• Traditional facelift: A traditional facelift surgery involves incisions around your ears, hairline and below your chin. A surgeon separates your skin from the underlying tissues and tightens the muscles and other supporting structures of your face and neck. The surgeon also removes excess fat in your neck and jowls as needed. The surgeon then re-positions your skin over your face in a natural way and removes any excess skin. This surgery is generally recommended for people who want optimal improvement of moderate to significant facial aging.
• SMAS facelift (SMAS rhytidectomy): A SMAS (superficial musculoaponeurotic system, the muscular layer of your face) facelift targets the lower two-thirds of your face. In this surgical procedure, a surgeon tightens your muscle and trims excess skin and/or fat in your cheeks and lower face. A SMAS facelift is a variation of a traditional facelift.
• Deep plane facelift: In a deep plane facelift surgery, a surgeon lifts the SMAS (the muscular layer of your face), fat and skin as a single unit. Deep plane lifts generally address multiple areas of your face at the same time.
• Mid-facelift: A mid-facelift surgery treats the cheek area of your face. A surgeon repositions the fat in your cheek and tightens the skin in your cheek area.
• Mini-facelift: Mini-facelift surgeries focus on lifting your lower face and neck area. It’s a quicker and less invasive surgery than other facelift surgeries. Surgeons usually recommend mini-facelifts to people who are younger and only have early signs of facial sagging.
• Cutaneous (skin) facelift: Cutaneous facelifts involve your skin only and usually focus on your neck and lower face.

In many cases, people who get a facelift undergo other procedures at the same time as their facelift surgery, including:

• Blepharoplasty (eyelid lift).
• Rhinoplasty (nose job).
• Facial implants.
• Brow lift.
• Liquid facelift with injectable dermal fillers.
• Jawline rejuvenation.
• Chemical peel.
• Laser skin resurfacing.

Who gets facelifts?

In general, you’re a good candidate for facelift surgery if:

• You’re physically healthy and don’t have a medical condition that affects your body’s ability to heal.
• You don’t smoke.
• You’re mentally healthy and have realistic expectations for facelift results.

The best candidates for facelift surgery are those patients who have signs of facial aging, but who still have some skin elasticity. Generally, this includes patients who are in their 40s to 60s, although people who are younger or older than that range can sometimes be candidates for surgery.

How common are facelifts?

Facelifts are one of the most common cosmetic surgeries. Each year, more than 131,000 people in the United States get a facelift.

What happens at a facelift consultation?

Every facelift surgery is specific to the person’s unique face and goals, so it’s important to have a thorough discussion with your plastic surgeon before your surgery. At your facelift consultation, you and your surgeon will discuss the following topics:

• Your wants and goals for the facelift surgery.
• Any medical conditions, allergies and/or medical treatments you have.
• Your current medications, vitamins, supplements, alcohol, tobacco and drug use.
• Previous surgeries you may have had.

During the consultation, your surgeon will also:

• Evaluate your overall physical health.
• Evaluate your psychological and emotional health.
• Discuss facelift options.
• Examine, measure and take clinical photographs (with your permission) of your face and neck to aid in surgical planning.
• Recommend certain facelift procedures.
• Discuss the probable outcomes of your facelift and any risks or potential complications of the surgery.
• Discuss the type of anesthesia that you’ll take before surgery.

It may be helpful to ask your surgeon the following questions during your facelift consultation:

• Are you certified by the American Board of Plastic Surgery?
• How long have you been a plastic surgeon?
• How often do you perform facelift surgeries?
• Can I see some before-and-after pictures of facelift surgeries you’ve performed?
• What surgical technique do you recommend for me?
• How long will my facelift results last?
• What are the risks and possible complications of facelift surgery?
• What can I expect from recovery after surgery?
• What will happen if I’m not satisfied with the results of my facelift?

How do I prepare for facelift (rhytidectomy) surgery?

In preparation for facelift surgery, your surgeon may have you:

• Get a blood test and/or a medical evaluation.
• Take certain medications or adjust your current medications.
• Apply certain products to the skin on your face.
• Stop smoking.
• Avoid certain foods or beverages.
• Avoid taking aspirin and certain anti-inflammatory drugs, since they can increase bleeding.
• Stop using recreational drugs.

It’s crucial to follow the instructions that your surgeon gives you before your surgery. Following their guidelines will help the surgery go more smoothly and help you heal properly.

You should arrange for someone to drive you to your surgery and home after your surgery. You should also have someone stay with you for the first 48 hours after your surgery at least. If you have a more invasive facelift, such as a traditional facelift, you may need to take up to three weeks off work. Less invasive surgeries, such as a mini-facelift, usually require five to seven days off work. Be sure to discuss this with your surgeon before your surgery so you can plan accordingly.

Setting up a home recovery area

Before you undergo facelift surgery, make sure you take the time to establish a recovery area in your home that includes the following:

• Gauze, clean towels and washcloths.
• A cell phone or telephone that’s within reach of the area where you will be sitting or lying most of the time.
• Ointments or creams as recommended by your surgeon.
• Materials for entertainment that you can use while resting, such as magazines, books or handheld games.
• A supply of loose, comfortable button-down shirts.
• A thermometer to check for fever.
• Ice (only if recommended by your surgeon).

What happens during facelift (rhytidectomy) surgery?

There are many steps involved in facelift surgery. Here’s an explanation of the steps.

Anesthesia

Your surgeon will perform the surgery while you’re under general anesthesia (you'll go to sleep) or through IV sedation. Your surgeon will recommend the best option for you and your type of surgery.

The incision

Depending on the type of facelift you get, your surgeon could make incisions on these place during surgery:

• In your hairline at your temples.
• Around your ears.
• At your lower scalp.
• Under your chin.
• In your mouth.

The size of the incisions will also vary based on the type of facelift you’re getting. Your surgeon will discuss all of this with you before the surgery.

The procedure

Facelifts generally involve repositioning and/or removing facial skin and/or fat and tightening facial muscles. Depending on the type of facelift you’re getting, your surgeon may just do one of these actions or all of them. You and your surgeon will discuss the process in detail before your surgery.

Closing the incisions

After the procedure, your surgeon will close the incision(s) with one of the following options:

• Dissolvable stitches.
• Stitches that will need to be removed after a few days.
• Skin glue.

What happens after facelift (rhytidectomy) surgery?

Right after your facelift surgery, a healthcare provider will take you to a room for observation while you wake up from the surgery. You’ll be able to leave the hospital once you’re stable. This usually takes a couple of hours.

You may have a bandage around your face to help minimize swelling and bruising. You may also have small drainage tubes.

Before you leave, your surgeon will give you specific instructions for your facelift surgery recovery, including how to care for your incision site(s) and drains, and schedule a follow-up appointment. Your surgeon will give you a prescription for medication to control pain, if necessary.

What are the benefits of facelift (rhytidectomy) surgery?

People usually get facelifts to improve signs of aging and have a more youthful appearance. This may help increase your confidence and self-esteem.

What are the possible complications and side effects of facelift (rhytidectomy) surgery?

As with any surgery, there are side effects, and you do risk certain complications. Risks for facelift surgery, while rare, include:

• Anesthesia issues.
• Infection.
• Wound healing issues.
• Hematoma (blood collection in the surgical area).
• Changes in skin sensation or numbness.
• Facial nerve injury.
• Temporary or permanent hair loss at the incision sites.
• Scarring.
• Prolonged swelling.
• Skin color irregularities.

Other important considerations include:

• The results of facelift surgeries usually last around seven to 10 years, and you’ll continue to age after your surgery.
• Facelift surgeries can’t dramatically change your fundamental appearance.
• Facelifts can’t treat superficial wrinkles, sun damage or irregularities in your skin color.
• If you decide to get a facelift, be sure to go to a board-certified surgeon.

What should I expect during recovery from a facelift (rhytidectomy)?

After your facelift surgery, you’ll experience bruising and swelling that’ll last for about two to three weeks. Some people heal more quickly and others heal more slowly. Even though you may not wish to go out in public during the early recovery period, you should begin to feel fine in the first several days after surgery.

In most cases, your surgeon will remove your bandages just a few days after the facelift surgery. Your surgeon will want to see you several times during the two to three weeks after surgery to assess your bruising and swelling and to remove your stitches.

What is the recovery time for a facelift?

The time it takes to recover from a facelift depends on what kind of surgery you had and your overall health. You may have bruising and swelling for a couple of weeks. However, it could take two to three months before your face feels “back to normal.”

When can I return to work or other activities after a facelift?

Most people who have more invasive facelifts can return to work in two to three weeks. If you have a less invasive procedure, such as a mini-facelift, you can usually return to work after five to seven days. Your surgeon will likely recommend that you don’t do strenuous exercise for at least three weeks after your surgery.

When should I see my healthcare provider if I’ve had a facelift?

If you’ve had a facelift surgery, you should contact your healthcare provider or surgeon immediately if you have any of the following symptoms or experiences:

• Bleeding that saturates your bandage.
• Extreme swelling.
• Fever.
• Abnormal discharge from the incision site(s), such as pus.
• Extreme pain.
• Your sutures have come out before you’re due to have them removed.

Does insurance cover facelift surgery (rhytidectomy)?

Insurance carriers generally do not cover surgery that is cosmetic or elective, so you probably will have to pay out-of-pocket for facelift surgery. Make sure that you receive all of your surgeon's costs in writing. It’s a good idea to ask for detailed charges that you will incur for anesthesia, follow-up care, any required prescriptions, etc.

What is the best age for a facelift?

Most people who get a facelift do so in their 40s, 50s or 60s when signs of aging begin to appear. There’s no “best age” to get a facelift because everyone ages differently from various factors such as genetics, lifestyle and environment. It’s important to remember that facelifts usually last seven to ten years. Some people get an initial facelift in their mid-40s to early-50s and then get a second facelift “update” in their 60s.

What type of facelift is right for me?

There are many types of facelift surgeries, and each surgery is as unique as you are. Some target specific areas of your face while others target most or all of the areas of your face. A board-certified surgeon can discuss all the facelift options with you and together you can decide on a surgery that works for you and your goals.

In general, the more loose and excess skin you have, the more significant the surgery will likely be. In these cases, surgeons often recommend a full, or traditional, facelift. If you have minimal skin looseness and just early signs of aging, you may opt for less invasive surgery, such as a mini-facelift. Other procedures can be paired with a facelift, such as eyelid surgery or a brow lift, to achieve a more complete rejuvenation. Again, it’s crucial to meet with a board-certified surgeon to fully understand all of the options.

A note from Cleveland Clinic

Facelifts are a common cosmetic surgery and usually have high satisfaction rates. However, it’s important that you’re in good general physical and mental health and to consider all the risks and of having facelift surgery. Be sure to consult a board-certified plastic surgeon and discuss all of your wants, needs and concerns. Together you’ll decide on the type of surgery that works best for you and your goals.