Table of Contents
According to the American Society of Aesthetic Plastic Surgery survey, facelift was the third most popular cosmetic surgery in 2019, surpassed only by nose plastic surgery and eyelid surgery.
Therefore, it is important for cosmetic surgeons to understand its history, relevant anatomy and technical differences. These surgeons should not only perform surgical techniques, but should also have excellent surgical skills to achieve the desired patient results.
Face lift is performed for beautifying and rejuvenating the skin, and in the following years, there have been vast improvements in surgical techniques.
Loss of muscle tone and facial wrinkles cause people discomfort, and face lift surgery has an amazing effect on restoring self-confidence. In full face lift, the surgeon is concentrating in revealing the signs of aging in the face, cheeks, angle of the jaw and neck.
The face lift operation creates a younger appearance and reduces skin sagging, and also causes the disappearance of lines and wrinkles on the skin.
Currently, only highly specialized plastic and cosmetic surgeons, as well as head and neck surgeons who have completed the face lift course, have scientific and practical qualifications for face lift surgery.
A facelift, technically known as a rhytidectomy, is a type of cosmetic surgery used to create a more youthful appearance.
In ancient Greek, rhytids means wrinkle and ektome means cut
Therefore, rhytidectomy or face lift means the surgical removal of facial wrinkles.
In the first 70 years of the 20th century, facelifts were performed by pulling the facial skin and cutting loose parts.
The first documented facelift was performed by Eugen Hollander in 1901 in Berlin, which involved removing excess skin and reconstructing it with minimal damage.
An elderly Polish noblewoman asked him to lift his cheeks and the corners of his mouth. After much discussion, he finally decided to cut a piece of oval skin around the ear.
The first textbook on facial cosmetic surgery was written in 1907 by Charles Miller in Chicago, entitled Correction of Appearance Defects.
After the end of World War in 1918, the demand for reconstructive surgery increased and the cultural acceptance of plastic surgery in general increased.
In 1919, Dr. Passat published one of the first articles on face lifting, which mainly involved highlighting and repositioning the facial skin. After this, many others began to write articles on lifting in the 1920s. Since then, cosmetic surgery was performed on a large scale, which was based on reconstructive surgery.
In 1968, Swedish plastic surgeon Trod Skoog was the first to report a facelift procedure with dissection of the superficial fascia of the face, which resulted in a good result and longer lasting results. In the 1976 anatomical studies by Matz and Peroni, this fascia was called the superficial aponeurotic muscular system.
After Skoog died of a heart attack, the concept of the superficial muscular aponeurotic system (SMAS) quickly emerged to become the standard facelift procedure, the first innovative change in facelift surgery in over 50 years, a surgical technique now known as It is known as SMAS rhytidectomy.
In 1983, Dr. Hamra introduced a three-level facelift to improve neck contouring. However, this surgical method does not improve the appearance of lip folds or the relaxation of the soft tissues in the middle of the face.
In 1990, Dr. Hamra introduced the deep-plate rhytidectomy to further dissect the muscles and ligaments supporting the cheek in order to reposition the malar fat and thereby eliminate lip folds.
In 1991, Prof. Hamra changed his technique to the “composite facelift” to surgically focus on the periocular muscle, improve the appearance of the eyelid and cheek, and allow the repositioning of the undereye fat to correct the hollowing of the lower eyes.
Today, there are countless variations of facelift techniques that are designed to address specific patient preferences based on a physical examination by a plastic and cosmetic surgery specialist.
Anatomy and physiology
During of time and increasing age due to different environmental conditions, type of nutrition, sunlight and genetics, the skin of the face undergoes many changes and the appearance of a person moves towards middle age and older age.
Facial aging is due to the effect of gravity on soft tissues, weakening of suspensory ligaments along with skin laxity, resorption of subcutaneous fat and bone loss.
This process leads to hollow appearance in the temporal areas, sagging cheeks, deepening of the fold around the lips.
Sagging facial fat pads and surrounding hanging ligaments deepen the nasolabial folds.
Gradual bone resorptions in the bones of the upper jaw and around the eyes also highlights the eyelid-cheek groove and causes the soft tissues of the lower eyelid to droop.
The lowering of the buccal fat pad causes the formation of a lip and the deviation of the soft tissue border of the lower jaw and is a common reason why people seek facelift surgery.
Mandibular soft tissue prolapse can often be treated with a SMAS facelift alone.
However, if mid-facial structures such as cheek folds and around the lips need rejuvenation, deep plate or composite facelift surgery may be more appropriate.
A thorough understanding of anatomy, especially knowing the layers of the face together, is critical to the success of any surgery and avoiding complications. A plastic surgeon must have the necessary training and experience in facial anatomy.
In recent years, the recognition and identification of the superficial fascia covering the facial muscles in particular has had a great impact on the current understanding of the aging process of the face as well as on the evolution of face lift surgery techniques.
Another important point in any facial surgery is the location of the facial nerve.
The facial nerve exits the temporal bone of the skull through the stylomastoid foramen and passes through the parenchyma of the parotid gland and divides into its main branches.
Classically, the branches of the facial nerve are described as having 5 main divisions:
- Marginal mandible
In face lift surgery, the frontal and marginal branches of the lower jaw are the most common motor nerves that may be injured.
Neck lift surgery is often performed at the same time as a face lift to achieve a more balanced and youthful appearance.
Why face lift?
Aging is inevitable and more visible in the face; it probably has the greatest psychological and social impact in today’s society. These external changes often do not reflect our inner spirit and personality.
A facelift is a surgical procedure that addresses these concerns to a varying degree and helps reverse some of the changes associated with aging.
Rhytidectomy is performed to rejuvenate the face and reduce the effects of aging.
A facelift is a cosmetic surgery to create a more youthful appearance in the face.
This method can reduce skin sagging. It can also help smooth skin folds on the cheeks and jawline.
Face lift is also called rhytidectomy.
During a facelift, a flap of skin is pulled back on each side of the face. The tissues under the skin are changed and excess skin is removed. Therefore, it gives a younger appearance.
A neck lift is often performed as part of a face lift. Reduces fat and sagging neck skin.
A rhytidectomy, also known as a facelift, is a surgical procedure that aims to rejuvenate the soft tissues of the face to achieve a more youthful and harmonious appearance.
Rhytidectomy is the only treatment available for aging facial patients to reposition soft tissue that has sunk over time and reduce the amount of excess skin.
The type of facelift will be based on the patient’s aesthetic concerns.
A thorough evaluation of skin quality, facial wrinkles, fat deposition and atrophy, and skeletal analysis should be performed during the preoperative consultation to develop realistic expectations of surgical outcomes.
Analysis and photography of the face with frontal, lateral, oblique, and base views and paying particular attention to facial asymmetry, facial angle irregularities, and hairlines should be documented to ensure that the patient and surgeon have shared expectations.
SMAS rhytidectomy and cervicoplasty may be offered to patients who are primarily concerned about neck laxity or prolapse with or without a platysma band.
If deep lip folds or cheek fat loss are one of the main aesthetic concerns, a deep surface face lift or an auxiliary mid face lift is a suitable surgical technique.
Composite rhytidectomy, which involves a deep surface surgery with additional repositioning of the SOOF, is suitable to further improve the eyelid-cheek connection.
Therefore, the surgical approach is dictated by the patient’s aesthetic concerns.
Different rhytidectomy techniques can be combined with adjunctive treatments such as:
- Eyebrow lift
- Cervicoplasty surgery
- Nek VASER Liposuction
- Subcutaneous fillers
- Fat transfer
- Laser exfoliation
It combines a multi-level therapeutic approach to manage facial aging.
The advantage of face lift
Among the features and benefits of a full-face lift, the following can be mentioned:
- Removal of excess skin in the facial area
- Correcting and improving sagging appearance of the cheek
- Correction of excess skin in the jaw area.
- Removal of sagging skin and laxity in the neck area
- Removal of wrinkles and facial lines
- Removal of deep skin folds from the sides of the nose to the corners of the mouth
- Face contouring
- Freshness of the skin
- Tightening of the facial skin layer
- Youth and increased self-confidence
Face lift (skin lifting) is a new method in the direction of facial rejuvenation and is a conventional method in the field of medicine, which of course must be performed by a specialist in plastic, cosmetic and reconstructive surgery.
Different methods of face lift
In fact, full face lift is divided into two categories: surgical lift (invasive) and non-surgical lift (non-invasive), which are examined and performed by a specialist in plastic and cosmetic surgery depending on the individual’s condition and facial skin.
Lift with surgical-invasive method (Rhytidectomy) This method is suitable when the skin is too loose or the wrinkles on it are so deep that non-invasive methods cannot restore it. Of course, this method has an age limit, which is between 45 and 65 years old.
Based on facial examination, physical conditions and face-to-face consultation, you will benefit from various surgical methods.
Lift with non-surgical – non-invasive method This method is related to the time when a specialist in plastic and cosmetic surgery or a dermatologist determines that rejuvenation and facelift through non-surgical methods are effective and can be
performed. In this style of skin rejuvenation, different methods are used, which we will discuss below.
Methods of face lift surgery
Many different methods are used for rhytidectomy.
The differences are mostly in the type of incision, aggressiveness and the area of the face that is treated.
Each surgeon performs different types of facelift surgery.
In a consultation, a method with the best result is chosen for each patient.
The patient’s expectations, age, possible recovery time and areas of treated are some of the many factors that are considered before choosing a rhytidectomy procedure.
Skin-only facelift by removing excess skin
In the first 70 years of the 20th century, facelifts were performed by pulling the skin of the face and cutting loose parts, which was not associated with long-term results.
In this face lift, only the facial skin is lifted and the underlying SMAS and other muscles or structures remain intact.
As the elastin fibers break down, the skin itself loses its elasticity in elderly patients.
A skin-only face lift requires skill in understanding the safe amount of skin removal and the tension vector to achieve the desired result.
This can be done with a simple ellipse of skin and minimally invasive skin flaps, or more extensively with large skin flaps.
The reason for paying attention to this option is that it has fewer complications and a faster recovery.
In fact, this type of lift is associated with a short time life and poor results.
SMAS rhytidectomy (superficial muscular aponeurotic system lift)
The SMAS layer (superficial muscular aponeurotic system) consists of suspensory ligaments that cover the fat of the cheek, thereby keeping it in its natural position.
Resuspension and tightening of the anatomical layer of the SMAS can lead to facial rejuvenation by counteracting aging and gravity-induced laxity.
In a conventional facelift, an incision is made in front of the ear that extends to the hairline.
The cut curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck.
After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors on the cheeks and neck.
At this point, the deeper tissues of the SMAS (superficial muscular aponeurotic system) layer can be tightened with sutures, with or without removing some of the additional deeper tissues.
The skin is re-draped and the amount of excess skin to be removed is determined by the surgeon’s judgment and experience. Then the excess skin is removed and the skin incisions are closed with stitches and staples.
In this method, it can be done with two different techniques based on pre-operative examination and considerations:
Plication (folding): face lift by strengthening the aponeurotic system of the facial muscles is a method in which the fascia covering the facial muscles is strengthened and sewn together.
Imbrication: In this method, the weakened part of the fascia is removed and then strengthened.
Deep-plane rhytidectomy face lift
In order to correct the deepening of the nasolabial fold more accurately, a deep facelift was designed. It differs from SMAS lift in releasing cheek fat and some muscles from their bone surface.
This technique has a higher risk of damaging the facial nerve, and the surgeon must have sufficient experience and knowledge in this face lift surgery method.
The SMAS lift is an effective method to change the position of the platysma muscle.
However, according to some surgeons, nasolabial folds are better addressed with a deep facelift or composite facelift.
Minimal Access Cranial Suspension (MACS) lift
It allows correction of sagging facial features through a short, minimal incision and lifts them vertically by hanging them from above.
There are advantages to a MACS facelift over a traditional facelift.
MACS-lift uses a shorter scar in front of the ear, which is much easier to hide.
In general, MACS lift surgery is safer because less skin is lifted.
This means there is less risk of bleeding and nerve damage.
The procedure also takes less time, lasting 2.5 hours instead of the 3.5 hours required for a traditional facelift.
There is also a shorter recovery period, 2 to 3 weeks instead of 3 to 4 weeks.
MACS-lift results are very natural, while conventional facelifts often result in the appearance of tighter skin.
The MACS-lift has been successfully used to correct complications after a thread facelift.
As with the deep facelift, in the composite facelift, a deeper layer of tissue is mobilized and moved.
The difference between these operation techniques is the additional repositioning and stabilization of the eye muscle in the composite face lift operation.
Facelift at the level of subperiosteal bone facelift
With the benefit of subperiosteal facelift endoscopic technique, by vertically lifting the soft tissues of the face, completely separating it from the underlying bones of the face and bringing it to a more beautiful position, correction of deep nasal folds and sagging cheeks is done.
This technique is often combined with standard techniques that provide long-term facial rejuvenation and is performed in all age groups.
The difference between this lift and other lifts is that the subperiosteal face lift has a longer period of facial swelling after the operation.
Face lift with fat injection
Surgeons are beginning to take more care to minimize scars, restore subcutaneous volume lost during the aging process, and benefit by injecting one’s own fat simultaneously with or without a facelift.
Mini face lift Mini face lift
A midface lift is recommended for people with aging changes occurring in the midface, without significant degrees of drooping of the neck.
An ideal candidate for a midface lift is when a person is in their 40s and the cheeks appear to be droopy and the nasolabial folds have laxity or skin folds.
Mini face lift is the least invasive type of face lift, which is similar to a full-face lift, the only difference is omitted the removal of the neck lift in the mini lift method.
Because of the shape of the cut used or face lift with a short scar, it is also called S lift.
This facelift is a more temporary solution to face aging with less downtime and is performed on people who have deep nasolabial folds, sagging facial structures, but still have a stiff and curvy neck.
To achieve a more youthful appearance, the surgeon makes several small incisions along the hairline and inside the mouth, so layers of fat tissue can be lifted and placed in right place.
In this way, there is practically very little scarring.
The fat layer on the cheekbones is also removed and repositioned.
This improves the lines of the nose to the mouth and roundness on the cheekbones.
The incision is usually made from the hairline around the ear with scars hidden in the natural fold of the skin.
A mini-lift can be performed with an endoscope, which is used to reposition soft tissues. After this, the skin is repositioned by the surgeon with small stitches.
This type of lift is a good alternative to a full-face lift for people with premature aging.
Recovery time is relatively short and this procedure is often combined with blepharoplasty (eyelid surgery).
Neck muscle lift (platysmaplasty)
In cases where the platysma muscle of the neck is aging and losing its shape, it is a suitable technique to restore youth in the neck area.
non-surgical methods of face lift
Everything you need to know about non-surgical facelift:
What are the advantages and disadvantages?
how much does it cost
Who is a good candidate?
What to expect from treatment options?
How is the recovery process?
Below we will talk briefly about the non-surgical lifting methods used:
What is a non-surgical face lift?
A non-surgical facelift is a combination of non-invasive or minimally invasive skin rejuvenation treatments designed to rejuvenate aging and damaged skin.
It usually involves a number of cosmetic procedures that smooth fine lines and wrinkles, exfoliate or remove damaged surface skin, stimulate the production of new collagen and elastin, and create a lifting effect.
You can address skin concerns such as sun damage, loose skin, acne scars, and more.
This allows you to avoid invasive procedures like facelifts and the incisions, anesthesia, and scars of plastic surgery while still getting modest anti-aging benefits.
What are the advantages and disadvantages of face lift without surgery?
There is a minimum downtime. Non-invasive treatments may leave you swollen or bruised for a few days, but they’re still less time-consuming than facelift surgery, which can take you out of work for up to three weeks.
The only form of anesthesia you will need for any of the treatments involved is local anesthetic cream (not general anesthesia or sedation).
Because these treatments are less invasive than surgery, they have fewer potential health risks.
The average cost of a non-surgical face lift is usually lower than a face lift surgery.
After the consultation and physical examination of your skin, you must choose the right treatment method, otherwise you will not benefit from the non-surgical method.
You will not get the same degree of lift and tightening as you would expect from a surgical facelift.
It is unlikely that your non-surgical facelift will be done in one session.
You cannot do all your individual treatments in one day and some of them require a series of treatment sessions for optimal results.
All non-surgical treatment options often require ongoing maintenance treatments three to four times a year to maintain results.
While the initial investment for a non-surgical facelift is significantly less than surgery, maintenance treatments can quickly add up to just as much (or more) than the cost under the knife.
What is the cost of face lift without surgery?
Because a non-surgical facelift is a group of treatments tailored to your specific needs, it can be difficult to determine a one size fits all cost estimate.
The best way to estimate your cost is to consult with two or more plastic surgeons to get specific practice recommendations and cost estimates.
What are the benefits of non-surgical face lift treatments?
The right combination of non-invasive cosmetic procedures can create a fresher, more youthful appearance for people with mild to moderate signs of aging.
We usually treat patients between the ages of 30 and 50 with a non-surgical face lift.
Talk to your dermatologist or plastic surgeon to determine the best non-surgical facelift options for you.
They can recommend the most appropriate procedures for your specific skin concerns, while taking into account your skin tone and skin type, recommending procedures that have the fewest possible side effects.
Just keep in mind that non-invasive techniques like a facelift or neck lift can’t help with severe sagging or tightening of the underlying muscles, especially along the neck.
It may be helpful to consider a non-surgical facelift not as a replacement for a surgical facelift, but as a preventative treatment.
Fixing some damage and taking good care of the skin can eliminate the need for a face lift for many years.
Who is the right candidate for a non-surgical facelift?
How non-invasive facelift options work for you depends on your anatomy, skin elasticity, and concerns, but a combination of these treatments is usually used.
Like Restylane and Juvéderm based on hyaluronic acid, they can add volume to the cheeks and restore the curve of the cheeks and slightly lift the lower part of the face.
They can also fill in hollow temples, smooth marionette lines (extending from the corners of the mouth to the chin), enhance a weak or sunken chin, and define the jawline. Some dermal fillers, such as Sculptra and Radiesse, can also stimulate collagen production for up to three years, slightly tightening the skin and increasing its radiance.
Like Botox, Dysport, Xeomin, and Masport temporarily relax muscles to minimize the appearance of lines and wrinkles, especially frown lines and forehead wrinkles.
A combination of fillers and neuromodulators is often called a liquid facelift.
Like chemical peels and lasers, they can regenerate the surface of the skin by exfoliating the top layers and increasing cell turnover. They can even out skin tone and texture, repair sun damage, and minimize the appearance of wrinkles.
Skin tightening treatments:
Including FaceTite and Ultherapy, they use radio frequency and ultrasound energy respectively to deliver heat to collagen and elastin producing cells in the dermis. This initiates a repair response that produces more key structural proteins for firmer, more toned skin over time.
Another non-surgical option is to place dissolvable sutures under your skin to act as an internal scaffold that raises and stimulates collagen production.
What happens during a non-surgical facelift?
They are injected to increase volume and shape or smooth deep wrinkles. The process is quick (15-30 minutes) and tolerable, although deeper injections cause more damage. Some patients choose numbing cream, especially in sensitive areas such as the lips and chin.
Some fillers are pre-mixed with the local anesthetic lidocaine. For the injection, the doctor uses a tiny needle or a small tube called a microcannula. After each shot, they massage the area to spread the filler for a natural effect.
Botox and other neuromodulators involve quick, relatively painless injections. Your doctor can apply numbing cream, but most people skip this step. After the injection, you will be given an ice pack to apply to the injection site for 5 to 10 minutes to minimize bruising and swelling.
Chemical peels for non-surgical facelifts are usually superficial. Before light or medium depth peels, you may be given a local anesthetic.
The skin is then cleansed to remove any makeup or oil that may be preventing the exfoliation from penetrating.
The chemical solution is then used for a certain period of time (from a few minutes to an hour) before being neutralized with water and wiped off.
After that, a layer of moisturizer is placed on the skin to relief and protect the newly treated skin.
During a non-surgical facelift, it is usually non-ablative, meaning it leaves the surface layer of the skin intact, requiring less time.
Laser ablative has a longer recovery period, almost like surgery.
After local anesthesia, the doctor uses a water-based gel to protect your skin, and then rotates the laser over the skin, stimulating cell turnover and collagen production. Non-ablative laser treatment usually takes about 30 minutes.
Skin-tightening treatments, such as Ultherapy and Thermage, are uncomfortable, so additional pain medication and anesthesia are required. After applying the conductive gel, your provider uses a hand-held device to deliver energy to the deeper layers of the skin, causing micro-damage and increased collagen production.
A focused facial session should last between 45 and 60 minutes.
Dr. Gholamhossein Ghorabi, facial plastic surgeon, answers:
A big question for patients is what order should they be treated with?
With access to several treatment options, an experienced physician can recommend your beauty care plan based on your goals:
I usually recommend patients to undergo Botox treatment before skin treatments.
The stimulating effects of laser collagen or exfoliation should be done in a way that the skin does not create any dynamic wrinkles.
If people are undergoing Ultherapy, I suggest Ultherapy before fillers around the cheeks and jawline, due to the potential for Ultherapy to destroy the underlying filler.
These were the fine points that I recommend to my dear clients through years of training and experience.
Consultation before face lift operation
Each facelift is an individual procedure, the results of which depend on patient selection, surgical approach, and postoperative management.
It is important to obtain a complete medical history and perform a thorough physical examination in order to identify suitable candidates for this procedure.
Medical co-morbidities such as diabetes and high blood pressure or behaviors such as smoking or using herbal supplements can significantly increase the risk of complications.
Additionally, outcomes and satisfaction are improved when a strong doctor-patient relationship and realistic expectations are established before surgery.
The surgical approach depends on the patient’s aesthetic goals and the effects of aging on soft tissues. Types of rhytidectomy such as:
SMAS face lift
MACS face lift
Deep face lift
They pay attention to different sub-units of the face to different degrees.
It is also important to understand that a facelift is only one of the treatments available for facial rejuvenation.
Auxiliary treatments such as blepharoplasty, neck lift, face and neck VASER Liposuction, injection treatments and skin exfoliation should be considered at the time of surgery in order to obtain a favorable result.
Finally, post-operative care is very important. Ensuring that instructions are followed and that patients have easy access to a surgeon or nurse in case of complications will help reduce adverse effects through timely intervention.
Conditions and measures before face lift
Facial skin lifting is only one of the treatment methods available for aging facial patients to reposition the soft tissue that has sagged over time and reduce the amount of excess skin.
The type of facelift will be based on the patient’s aesthetic concerns.
A thorough assessment of skin quality, folds and wrinkles, scars, fat loss and atrophy, and skeletal analysis should be performed during the preoperative consultation to develop realistic expectations of surgical outcomes.
Analysis and photography of the face (basal, frontal, lateral and oblique views) with special attention to facial asymmetry, irregularities of facial angles, and hairlines should be documented to ensure that patient and surgeon have shared expectations.
SMAS rhytidectomy and neck lift may be recommended for patients who are primarily concerned about laxity or sagging of the neck skin with or without a platysma band.
If deep lateral folds or receding cheek fat is one of the main features, a deep level rhytidectomy or an auxiliary midface lift is recommended.
Composite rhytidectomy, which involves a deep surface approach with additional repositioning of the SOOF, is suggested to further improve the eyelid-to-cheek connection.
Therefore, the surgical approach is dictated by the patient’s aesthetic concerns.
Various rhytidectomy techniques can be combined with adjuvant treatments such as brow lift, blepharoplasty, cervicoplasty, subcutaneous fillers or fat transfer and laser resurfacing to manage facial aging with a multi-level therapeutic approach.
Major medical comorbidities such as diabetes, immunodeficiency, steroid requirements, bleeding disorders, and connective tissue disorders can impair wound healing.
Smoking is also a major risk factor for skin flap necrosis due to its adverse effect on perfusion. It is recommended that you quit smoking at least 2-4 weeks before surgery and continue for up to a month after surgery to allow for optimal recovery.
Radiation therapy can have a similar effect and should preferably be avoided in these patients.
In some cases, a history of intense sun exposure with multiple burns can also predispose patients to wound healing problems.
Bleeding disorder or the need for blood thinners can be especially problematic because they increase the risk of hematoma formation, which is currently one of the most common complications of facelift surgery.
The use of medicines and herbal supplements with anticoagulant properties should be stopped 2 weeks before the operation if possible.
Avoid aspirin or other blood thinners for at least a week before surgery.
Preoperative assessment of any psychiatric history is also important to assess the motivation of the patient requesting surgery.
Patients with body dysmorphic disorder should be evaluated by a qualified mental health professional before considering surgery.
In addition, any significant disease that can have a negative impact on surgery should be considered before performing a cosmetic procedure.
For patients who are generally poor candidates for surgery, rhytidectomy should probably not be performed.
Hospitalization and face lift anesthesia
Communication and coordination with primary care providers and specialists in the management of comorbidities is critical in facelift surgery, as performing elective surgery without minimizing preoperative cardiopulmonary risks is unnecessarily dangerous.
During surgery, a team effort of circulating nurses, surgical technicians, anesthesiologists, and surgeons is required to provide high-quality surgical care.
The patient is placed in the supine position on the operating table. If the patient is intubated, the endotracheal tube is fixed in the mouth with special adhesive tape to help secure the airway while allowing adequate access to both sides of the face and neck.
Povidone-iodine or isopropyl alcohol may be used to disinfect and prepare the skin.
Significant amounts of local anesthetic or swelling solution are injected with diluted local anesthetic before and during the procedure to minimize the need for anesthetic and maximize hemostasis and prevent postoperative bruising.
Intravenous antibiotics and steroids are also prescribed.
Anesthesia for facial lifting surgery can be performed using local anesthesia or general anesthesia based on the surgeon’s choice and the patient’s physical condition. In most cases, rhytidectomy is performed under general anesthesia.
The use of propofol during general anesthesia may help reduce postoperative nausea. Accurate control of blood pressure during facelift surgery helps to reduce the risk of postoperative hematoma.
Based on the surgical technique and required measures, the duration of face lift surgery is approximately 4 to 5 hours.
Regarding hospitalization, these beauty seekers are usually monitored for several hours, although based on the patient’s condition and the surgeon’s diagnosis, there may be a need for one night of hospitalization in a clinic or hospital.
Care after face lift surgery
The incision site is covered with a special dressing, which applies gentle pressure to minimize swelling and bruising.
A small drain may be placed under the skin behind both of your ears to drain excess blood or fluid during the first 24 hours.
After a facelift, you may experience the following:
- Mild to moderate pain
- Evacuation of blood from the drain
Call your doctor right away if you have:
- Severe pain on one or both sides of the face or neck within the first 24 hours after surgery
- Chest pain
- Irregular heartbeat
In the first few days after surgery:
- Rest with the head at least 30 degrees above the level of the heart.
- Take antibiotics and pain relievers as recommended by your doctor.
- To relieve pain and reduce swelling after surgery, use a cold compress on your face as directed by your doctor.
- Avoid intense physical activity and sports.
Other notable points include the following:
- The day after surgery, the surgeon will probably remove the drainage tube. The surgeon will also likely apply antibiotic ointment to the incisions and place a new dressing on your face.
- 48 hours after the surgery, bathing and washing the head, face and hair with neutral shampoo is safe.
- Two to three days after the facelift, you may be able to change the dressing to using a facial strap.
- About a week after surgery, your doctor will remove the stitches and evaluate the wound.
- Follow-up visits may be scheduled to monitor your progress.
- Self-care at home during the first three weeks will help you recover and reduce the risk of complications.
- Follow wound care instructions as prescribed by your surgeon.
- Do not manipulate the crusts that form on your wound.
- Wear clothes that fasten in the front. Avoid clothes that pull on the head.
- Avoid excessive pressure or movement on and around the incisions.
- Avoid using cosmetics during the first week after surgery.
- Avoid direct sun exposure to the incision site for four weeks. After that, use sunscreen with SPF 30 or higher.
- Avoid dyeing, bleaching or straightening your hair for at least six weeks.
- In the weeks following a facelift, you may style your hair to hide the incision marks.
You may need to postpone participation in important social events for a few weeks.
Side effects of face lift surgery
After a facelift, you may experience the following side effects:
- Mild to moderate pain in the surgical area
- Swelling of the face and around the eyes
- Brief bruising of the face and neck
- Numbness of surgical incision areas
- Evacuation of blood from the drain
Most patients who undergo facelift surgery experience very little pain or discomfort. After the operation, slight swelling and bruising along with a slight tingling sensation occurs naturally, which usually heals within the first week after the operation.
In men, according to the surgical method, it is possible to move the beard line.
Complications after surgery are exactly the reason to find a face lift surgeon and specialist with experience and medical knowledge who can provide the best possible advice, surgery and finally monitoring the patient until the stage of complete recovery.
Possible risks of face lift
As with any other surgical procedure, despite careful optimization of preoperative comorbidities and precise intraoperative techniques, complications may occur in facial skin retraction surgery.
As with any cosmetic procedure, the most common adverse outcome is dissatisfaction with the cosmetic result, which can be caused by a number of issues, usually scarring, asymmetry, contour, irregularities, or an unnatural appearance.
Building a strong relationship with the patient before surgery helps the surgeon guide the patient through any post-operative challenges and improves patient satisfaction.
Hematoma is the most common complication after face lift, the incidence of which is reported between 0.2 and 8%.
Hematomas can be classified into major or minor categories.
Major bleeding events often occur within 24 hours after surgery with symptoms of subcutaneous mass, pain, and ecchymosis, skin discoloration.
These require surgical intervention to control bleeding. If this happens in the neck, the airway may be compromised and the wound should be opened urgently.
In contrast, minor bleeding tends to be delayed and may result from subcutaneous tissue discharge. These events can often be managed with watchful waiting or bedside evacuation.
The risk of hematoma is increased by several factors, including high blood pressure, male gender, blood clotting or use of anticoagulants, post-anesthesia nausea, vomiting, and pain.
Men’s skin is more vascular than women’s due to its hair follicles, which leads to a greater risk of bleeding.
Use of antiplatelet or anticoagulant medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) and herbal supplements that increase bleeding such as ginkgo, biloba, turmeric, yeast, ginseng, high-dose vitamins C and E, fish oil, Garlic and glucosamine should also be stopped 2 weeks before surgery.
High blood pressure is still the most important risk factor for hematoma formation. The goal is to maintain blood pressure below 150/90 mmHg.
Before surgery, sympatholytic drugs such as valium or clonidine may be prescribed.
During the operation, careful hemostasis should be performed before closure. Postoperatively, factors that can increase restlessness in recovering patients, such as nausea and pain, should also be addressed promptly.
The effect of drain placement on hematoma formation is unclear. However, drains may be able to reduce seroma formation.
This is often due to microvascular damage from seroma or hematoma formation and associated conditions such as smoking and diabetes.
Skin necrosis can involve partial thickness or full thickness dermis with scar formation.
In partial thickness necrosis, patients present with skin discoloration and scaling. This usually resolves with conservative wound care and heals well without scarring.
Some drugs such as nitro paste or dimethyl sulfoxide (DMSO) may be considered to improve perfusion.
Full-thickness necrosis leads to prolonged healing time with skin abnormalities such as ugliness, contour irregularities, and scarring that require further intervention.
It is important that wounds are first managed without aggressive debridement to prevent further damage. Patients undergoing rhytidectomy and skin peeling during the same anesthesia may be at increased risk for skin necrosis.
One of the main risk factors for skin necrosis is smoking.
Cigarette smoke contains nicotine, carbon monoxide, hydrogen cyanide, and nitric oxide, all of which have detrimental effects on microvascular oxygen transport and impair wound healing.
Due to the increased risk of skin necrosis with smoking, some plastic surgeons feel that deep-level facelifts are safer in smokers because the thicker flap allows for better blood supply.
Most surgeons now agree that smoking cessation 2-4 weeks before and after surgery is highly recommended to prevent skin necrosis.
Medications such as chemotherapy and steroids that can alter wound healing are also important to consider before rhytidectomy and may delay or cancel the procedure.
Finally, skin closure should be performed without tension to avoid ischemia at the wound edges. The distal parts of the flap, in the preauricular and posterior upper ear areas, are the most susceptible to blood supply disorders and as a result, have the highest probability of necrosis.
Of note, patients undergoing revision facelifts may have a lower risk of developing skin necrosis because their skin flaps are effectively delayed from previous surgery, improving flow through collateral vessels.
The probability of nerve damage during face lift surgery is about 0.7% to 2.5%. Nerve damage can be avoided by understanding the relevant anatomy and careful surgical technique.
Although the use of intraoperative nerve monitors can help prevent nerve damage, nerves are often injured by invasive surgery and electrocautery, especially when a vessel, such as the facial vein or external jugular vein, is near the mandibular nerve and sensory nerve and the area around the ear starts to bleeding.
If the nerve is severed during surgery and identified, immediate epineural repair with microsurgery is recommended.
Motor nerve injuries may take up to a year to heal, or they may never fully heal, but they can often be treated by injecting botulinum toxin into the muscle groups on the opposite side of the face to improve symmetry, especially in the case of a frontal or marginal branch injury.
The most common sensory nerve injured during facelift surgery is the periauricular sensory nerve, especially during posterior auricular skin flap elevation and reported in patients who have difficulty putting on earrings, using the telephone, or combing their hair.
The frontal and marginal branches of the mandibular facial nerve are the most common motor nerves injured during rhytidectomy.
Fortunately, in face and neck skin removal surgery, cellulitis or abscess formation is a rare complication due to strong facial blood flow. Wound infections are usually caused by gram-positive cocci, such as staphylococcus or streptococcus, and are usually resolved with antibiotics that target the skin flora.
Scars and skin irregularities
While the incisions used for facelifts are usually long, making the surgical incision in the right place can minimize their visibility after the operation.
Broad, pigmented, or erythematous scars in the preauricular area can be treated with laser, steroid injections, or potentially with hydroquinone.
Avoiding sunlight during the first year after surgery also helps prevent significant scarring.
Hypertrophic or keloid scars may also benefit from silicone sheeting or surgical revision after 6 to 12 months.
Subcutaneous contour irregularities
Another related complaint is subcutaneous irregularities, which are often caused by flaking or shedding of the SMAS, especially when the subcutaneous flap is very thin. Steroid injections and massage usually alleviate these concerns.
In addition, there are a number of named anomalies that may result from improper soft tissue manipulation.
Pixie ear deformity
It happens when there is too much tension across the skin closure below the earlobe. In this case, the lobule is pulled down and creates an appearance in the form of a stretched and stuck earlobe.
Cobra neck deformity
It happens when too much fat tissue is removed from the central area under the chin without removing the appropriate volume from the sides under the chin and above the neck.
This cavity under the chin is reminiscent of the shape of the head and neck of a cobra, hence its name. Fat transfer by grafting or injection improves the problem.
The appearance of excessive stretching of the corner of the mouth
which may occur especially after a deep facelift, can be the result of excessive lateralization of the cheek fat pads or excessive tension on the cheek flaps, resulting in widening of the oral cleft.
Alopecia and hairline abnormalities
This is often caused by damage to the hair follicles during cutting, aggressive use of an electric cautery, or closure under excessive tension. Cutting the scalpel blade, parallel or perpendicular to the hair follicles, may minimize the appearance of scarring.
Patients should also be aware of the possibility of postoperative telogen effluvium, in which diffuse hair loss occurs approximately 3 months after surgery. This condition can be treated with minoxidil, but usually resolves on its own within 6 months.
Pain syndrome while eating
This has been reported with deep-surface facelifts and may be the result of damage to post-ganglionic parasympathetic nerve fibers to the parotid gland, aberrant reinnervation leading to painful hypercontraction of the myoepithelial cells in the parotid gland at the onset of eating.
The pain usually subsides as you continue to eat.
While this condition is uncomfortable for patients, it can often be relieved with botulinum toxin injections and generally resolves on its own within 6 to 12 months.
Dissatisfaction of patients with the result of surgery
It is important to consider the patient’s preoperative psychiatric history because it may indicate a risk for postoperative depression, which can contribute to dissatisfaction with the surgical outcome.
In some cases, dissatisfaction may be unavoidable and many patients will require surgical or non-surgical intervention within 1 to 2 years after the initial surgery, especially for areas of soft tissue prolapse.
Usually, to maintain the desired result, an interval of 5 to 10 years is expected between facelifts.
Recovery after face lift surgery
- 1 to 2 days after surgery, the dressing is removed and bathing is allowed.
- One week after surgery, the patient can return to work.
- Most of the patient’s sutures can be absorbed, and if necessary, stiches removal is done one week to 10 days after surgery.
- Most patients can return to their daily activities 2 to 3 weeks after the operation.
The best plastic and cosmetic surgeon in Tehran, Dr. Gholamhossein Ghorabi, has a board specialized degree from Beheshti University and a subspecialist in cosmetic surgery from Shiraz University, and she is the most experienced person in this specialized field.
Results of face lift surgery
Results may vary based on each individual’s unique anatomy.
A facelift can make your face and neck look younger. But the results of facelift are not permanent.
As you age, the skin on your face may begin to sag again.
In general, it can be expected that based on genetics, nutrition and environmental conditions, most face lift surgeries last between 8 and 10 years.
The cost of face lift surgery
The cost is different based on the experience and expertise of the surgeon, the surgical center, the economic conditions and the regulations of each country where the surgery is performed.
Below is the cost of face lift in Tehran and different countries in the last few years:
Canada – US$10,000-15,000
Pakistan – 5500 USD
Malaysia – 6400 USD
Panama – 2500 USD
Iran- 2500 US dollars
Russia – 10,000 USD
Singapore – US$7,500
South Korea – 6650 USD
India – 3500 USD
Taiwan – US$8,500
Thailand – 5000 US dollars
United States – $10,000-15,000
Belgium -4000-8000 pounds
Italy – 5000 pounds
UK – £4,000 to £9,000
Serbia – £4000
Question and answer with Dr. Gholamhossein Ghorabi
- At what age can a face lift be performed?
Normally, based on the conditions and physical examination of your face, your expectations and the opinion of the plastic surgeon, it is recommended from the age of 45 and after.
- Can the creams on the market that are distributed as lifts cause a face lift?
No, the penetration rate of these creams is limited to the skin. While most of the face drooping is related to the loosening of the subcutaneous soft tissue.
- I am a 60-year-old woman who is being treated with cardiovascular and blood pressure medications. Can I apply for a face lift?
Yes. Provided that you get the approval of the cardiologist to perform the surgery.
Your blood pressure should be controlled at least one month before the face lift surgery and stop blood thinners such as aspirin and warfarin at least 5 to 7 days before the surgery.
4.Knowing the above, I want my face to change a lot after the operation. Is it possible?
It is difficult to answer this question. The level of your expectations of the result of the action should be realistic, and the answer to this question is not the same for different people.
In the case of people who want to make their appearance similar to other people, this request can indicate the inner motivations and moods of the applicant.
Although the applicant knows in the before and after photos that his mother and aunt look older than their actual age, and one of the reasons for the disproportion between the person’s age and appearance is genetic, his expectation is certainly not reasonable.
One of the most important advantages of consulting with an experienced and committed surgeon is that he tells the applicant the facts and discourages the person from having unattainable dreams.
- Do you tighten the facial muscles while pulling the facial skin?
I am always happy to hear this question because it shows that applicants have enough information about their application.
The answer to this question is positive. Loose muscles under the skin are tightened and excess skin is removed. Tightening the muscles prevents the phenomenon of “turkey neck” and gives the person a younger appearance.
Due to the elasticity of the skin, if only the skin is removed, the results of the operation will be temporary and the face will soon return to its original state in less than 8 to 10 weeks after the operation.
A skilled and successful surgeon will correct both aspects of muscles and skin at the same time.
- Does facial skin removal surgery remove dark shadows and bags under the eyes?
If this condition exists, it is better to perform eyelid surgery.
Because this type of surgery reveals the hidden and invisible beauty of your eyes.
Although facial surgery makes corrections in this field, it does not meet the expectations of such people.
It is better for people who have the mentioned conditions to apply for facial skin lifting, blepharoplasty and skin smoothing at the same time.
- Why revision of facial surgery is more difficult than primary surgery?
The difficulty of revision compared to the initial surgery has several reasons. After any surgery, the scar caused by the surgery creates a thick and rough layer that is much more difficult to work with than the original tissue.
The main and anatomical location of the desired points has changed, and the skill and knowledge needed to perform a revision is beyond the skill and knowledge of performing primary surgery.
Revision of facelift surgery may require more time due to the need to make corrections to the results of the initial surgery. It is better for the patient to be completely informed about the events and complications of the initial surgery so that he can be revised with full knowledge.
- What is informed consent during a face-to-face consultation with a plastic and cosmetic surgeon?
It means that you have obtained complete information about all aspects of surgery, including possible benefits and risks, measures before and after surgery, and your decision is based on this information and with full knowledge and personal request.
- Can you explain more about the stitches?
In the first examination on the morning after the operation, the drain and dressing are removed.
You should take good care of the stitches near your ears and to disinfect and keep them clean, wash them with cotton soaked in peroxide and apply antibiotic ointment on them once a day.
Stitches that are dissolved by the ointment will cause less pain when removed. After 5 to 7 days, you can return to have the stitches removed.
- Does it hurt to remove the drain?
Removing the drain causes a mild and temporary burning sensation with numbness. According to patients, drain removal causes more discomfort than pain.