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Facelift

By

Sarah Lewis, PharmD

What is a facelift?

A facelift is the surgical correction and improvement of the signs of aging on the face and neck. Your face and neck are often the first places where signs of aging appear. Most people seek a facelift for cosmetic or aesthetic reasons. Your doctor may also recommend this procedure as part of a medically necessary facial reconstruction.

A facelift is a common but major surgery with significant risks and potential complications. You may have less invasive cosmetic or treatment options. Consider getting a second opinion about all of your choices before having a facelift. 

Types of facelift

There are many facelift techniques. The basic types of facelift include:

  • Traditional facelift incisions start at your temple, run down in front and around your ear, and end in your lower scalp. This is usually one continuous cut. Your surgeon can redistribute fat, reposition deep tissues, lift muscles, and trim excess skin. He or she may also make an additional incision under your chin.

  • Limited incision facelift involves smaller cuts than a traditional facelift. The incisions may be located at your temple, around your ear, within the lower eyelids, and under your upper lip.

  • Neck lift incisions usually start in front of your ear lobe and continue behind your ear to end in your lower scalp. Neck lifts correct signs of aging in your lower face, chin and neck.

Other procedures that may be performed

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Your doctor may perform other procedures in addition to a facelift. These include:

  • Brow lift, also called a forehead lift, to tighten sagging skin in the forehead area

  • Eyelid surgery to improve the look of your upper eyelids, lower eyelids, or both

  • Facial implants to augment areas of your face such as your chin, cheekbones or jaw

  • Facial liposuction to remove fatty deposits in the face

  • Resurfacing to improve the texture and tone of your skin

  • Rhinoplasty to repair or reshape your nose

  • Soft tissue augmentation to recontour your facial structure

  • Wrinkle reduction with injections to smooth fine wrinkles

Why is a facelift performed? 

Your doctor may recommend a facelift if you want to improve the look of your face for cosmetic reasons. Your doctor may also recommend it as part of a medically necessary facial reconstruction. 

Your doctor may only consider a facelift for if other options with less risk of complications are not appropriate for you or have not produced desirable results. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a facelift. 

Your doctor may recommend a cosmetic or aesthetic facelift if: 

  • You are dissatisfied with or bothered by the signs of aging that are seen in your face.

  • You are physically healthy. 

  • You have realistic expectations of improvement, not perfection.

  • You do not smoke.

Your doctor may recommend a medical facelift if you have: 

  • Facial asymmetry or skin laxity due to nerve paralysis or a known skin condition

  • Genetic facial deformity

  • Traumatic injury

Who performs a facelift?

Plastic surgeons and facial plastic and reconstructive surgeons, and cosmetic surgeons perform facelifts. Plastic surgeons specialize in aesthetic and reconstructive surgery. Facial plastic and reconstructive surgeons initially train as plastic surgeons or otolaryngologists (ear, nose and throat doctors and surgeons) before further specialization in facial plastic and reconstructive surgery. A cosmetic surgeon focuses on aesthetic surgery—most procedures are elective and not medical necessary. A cosmetic surgeon performs some of the same surgeries as a plastic surgeon, including facelift, but the surgeons’ education and training are different.

How is a facelift performed?

Your facelift will be performed in a hospital or outpatient setting using one of the following approaches:

  • Minimally invasive facelifts have many names and involve various techniques. They range from the limited incision facelift that is similar to a traditional facelift, to nonsurgical techniques, or “thread” facelifts. Thread lifts involve the placement of fine surgical thread in the layer of fat and tissue under your skin, which are then pulled taut to give the appearance of tighter skin. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues. Your surgeon will make small incisions instead of a larger one used in open surgery. Minimally invasive facelifts also offer a more subtle change in appearance than open surgery facelifts.

  • Open surgery facelifts involve making a large incision that starts at your temple, runs down in front of the ear, continues around the back of the ear, and ends at the lower scalp. An open surgery incision allows your surgeon to see and access the surgical area directly. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different facelift procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used

Your surgeon will perform a facelift using either general anesthesia or regional anesthesia, depending on the specific procedure. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb nerves in your face. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your facelift

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member.  Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have. Surgeons may perform some types of anesthesia.

  • A surgical team member will start an IV.

  • The anesthesiologist, nurse anesthetist, or surgeon will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a facelift? 

As with all surgeries, a facelift involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during the surgery or recovery. 

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of a facelift

Complications of a facelift include:

  • Changes in skin color or contour

  • Damage to the nerves controlling your face. This is usually temporary.

  • Facial asymmetry

  • Fat necrosis, or death of fat in the skin. This may change the appearance of your face.

  • Fluid collection under the skin

  • Hematoma or a collection of blood under the skin. Hematomas sometimes need to be drained.

  • Numbness or changes in skin sensation

  • Persistent pain

  • Poor wound healing

  • Surgery to revise unsatisfactory results

  • Sutures that may surface and become visible or cause irritation. This may require removal of the sutures.

  • Unfavorable scarring

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Avoiding straining, bending and lifting as directed by your healthcare provider

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

  • Informing your doctor or anesthesiologist if you are nursing or if there is any possibility that you may be pregnant

  • Keeping your head elevated, even when lying down, as directed by your healthcare provider

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies 

How do I prepare for my facelift? 

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. 

You can prepare for a facelift by:

  • Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a physical exam, blood tests, and other tests as needed.

  • If you are overweight, talk to your doctor about losing weight before the surgery through a healthy diet and exercise plan.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment.  Contact your doctor with concerns and questions before a facelift and between appointments.  

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Am I a good candidate for a facelift? Are there any other options for me?

  • Which type of facelift procedure will I need?

  • What results can I expect? How long will the results last?

  • What options do I have if I am not satisfied with the results?

  • How long will the surgery take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • When can I shower and how should I care for my incisions?

  • What kind of assistance will I need at home?

  • How should I take my medications? 

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my facelift?

Knowing what to expect can help make your road to recovery after a facelift as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

Most patients go home on the same day. A hospital stay of one day is sometimes needed. 

You may have small tubes attached to your face to drain fluids. Your doctor will usually remove them within one to two days. 

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes two to three weeks. Any facial numbness will generally resolve over the course of several months.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after a facelift. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion

  • Chest pain, palpitations, or uneven heart beats

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate, pass gas, or have a bowel movement

  • Pain that is not controlled by your pain medication

  • Unexpected drainage, pus, redness or swelling of your incisions or face

How might a facelift affect my everyday life?

The new appearance of your face and neck may give you increased satisfaction with your appearance and increase your self-confidence. Many surgeons caution that it is important to be realistic about how much a facelift may improve your self-image. In addition, a facelift will not stop the aging process. Be aware of what a cosmetic facelift can and cannot do for your overall appearance.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 31, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Clinical Policy Bulletin: Cosmetic Surgery. Aetna. http://www.aetna.com/cpb/medical/data/1_99/0031.html.
  2. Facelift (Rhytidectomy). American Society for Aesthetic Plastic Surgery. http://www.surgery.org/consumers/procedures/head/facelift.
  3. Facelift Surgery. American Academy of Facial Plastic and Reconstructive Surgery. http://www.aafprs.org/patient/procedures/rhytidectomy.html.
  4. Facelift Surgery: Rhytidectomy. American Society of Plastic Surgeons. http://www.plasticsurgery.org/cosmetic-procedures/facelift.html.
  5. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf.
  6. Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty. Independence Blue Cross. http://medpolicy.ibx.com/policies/mpi.nsf/e94faffabc7b0da68525695e0068df65/7D2401BBCF1C797B852578FE0...

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