Cosmetic facial surgery - face lift

Facelift

This factsheet is for people who are considering having a facelift operation.

A facelift (also called a rhytidectomy) is an operation to lift up the facial skin and tissues and/or the underlying muscle, to make the face tighter and smoother.

Why have a facelift?

As we age, our facial muscles become slacker and the skin on the face becomes less elastic and looser, creating folds and lines. A facelift can reduce saggy skin and wrinkles to produce a more alert and youthful appearance.

Facelifts are sometimes performed on the whole face (a full facelift) and other times just on the brow area, lower face, or neck only.

The effects of a facelift last for about 7 to 10 years.¹ The best results are achieved in people who maintain a stable body weight, have skin with good levels of elasticity and a strong bone structure.^1,2 In older people, or people who spend a lot of time in the sun, the effects tend to last less well.¹

It is important to discuss with your surgeon what you are hoping to gain from the operation, and the results you can realistically expect. A facelift will not affect the fine lines around the lips for example.

What are the alternatives?

Other treatments may be used either as alternatives, or in combination with a facelift. Some of the options available include those listed below.

• Resurfacing techniques reduce surface wrinkles.³ A chemical peel can also improve and smooth the texture of the facial skin by removing its damaged outer layers.
• Tissue augmentation plumps out deep wrinkles with fillers to make up for the loss of fullness to the skin that tends to occur with aging.³
• Anti-wrinkle injections, where botulinum toxin (eg Botox) is injected into the facial muscles, can flatten out skin wrinkles. This is particularly suitable for forehead wrinkles and "crows' feet".³
• Many creams, gels and beauty treatments claim to be able to tighten the skin. However, there is no scientific proof that they work permanently.

What happens before a facelift?

Your surgeon will discuss how to prepare for your operation. For example, you may be asked to:

• give up smoking as smoking increases the risk of infection and slows the healing of wounds, as well as increasing the risk of blood clots in the legs^2,4,5
• stop taking medicines such as aspirin and anti-inflammatory medicines two weeks before surgery as they increase the risk of excessive bleeding²

What should I expect in hospital?

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your face will be examined and you will usually have a photograph taken before the operation so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

The operation

A facelift generally requires a one or two night stay in hospital. The operation lasts around three to four hours and is usually done under a general anaesthetic.

There are a number of different facelift techniques. Your surgeon will explain the options available to you.

Traditional facelift

For a typical facelift, once the anaesthetic has taken effect, your surgeon will make a surgical cut right around your hairline, past the front of your ears. Cuts may also be made under your chin, if you want to lift a sagging jaw line.

Your skin will then be carefully separated from the underlying muscles of your face. Excess fat will be removed and the muscles will be tightened. The skin will then be lifted up, pulled back and any excess will be trimmed off. It will then be stitched back to the line where the cut was initially made.

Other techniques

Sometimes your surgeon will perform a facelift using keyhole (endoscopic) surgery, particularly for a brow lift (where your forehead is lifted). Several tiny cuts are made that allow an endoscope (a small, flexible tube with a light and a camera lens at the end) to be placed under the skin. The operating instruments are inserted through other tiny holes. The surgeon watches a TV monitor to see what he is doing under the skin.⁶

Another type of facelift surgery is minimal access cranial suspension (MACS). Shorter cuts, compared to a traditional facelift, are made in the temple and in front of the ears. Fibrous tissues under the skin are tightened with permanent stitches that are fixed to tissue close to the cheek bone or the fibrous connective tissue under the skin. Both endoscopic facelift and MACS have the advantages of smaller scars and usually a shorter recovery time.

At the end of a facelift operation, your face is tightly wrapped in bandages. Depending on the exact procedure carried out, these may run under your chin, around your ears and/or over your head. They are usually taken off after about one or two days.² Stitches are removed after 5 to 10 days.²

What to expect afterwards

When you wake up after the operation you may have tubes running from the operation site to drain fluid into a bag beside your bed. These are usually removed a day or two after surgery.²

You will be given painkillers to help relieve any discomfort as the anaesthetic wears off.

Before discharge, your nurse will give you advice about caring for your face, hygiene and bathing.

If you have had a general anaesthetic you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.

Recovering from a facelift

Generally the pain after a facelift is mild² but once home, further painkillers may be taken if needed, as advised by your hospital.

Applying a cold compress, such as ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. You should not apply ice directly to your skin as it can give you an 'ice burn'.

There are some important things to remember while recovering from a facelift:

• keep your head elevated for a couple of days to reduce swelling²
• avoid bending or straining¹
• avoid saunas and massage for at least two weeks²
• avoid the sun for a few weeks

Vigorous activity should be avoided for four or five weeks.¹ Most people feel like returning to work after about three weeks¹, once the bruising and swelling have gone down.

Deciding on treatment

It's important not to rush into the decision to have a cosmetic operation. And it is sensible to discuss the issue with your GP, who may be able to recommend reputable surgeons or give advice about how to choose where to be treated.

A facelift is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to give informed consent, anyone deciding whether or not to have this procedure needs to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Specific side-effects of a facelift include:

• a swollen, bruised and sore face after surgery, which can take a few weeks to subside²
• scars which usually fade over the course of a year, but do not completely disappear
• the position of your hairline in front of, and behind, your ear may be raised
• in men, the beard may lie closer to the ear²

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic. It's also possible for a blood clot to develop in a vein in the legs (deep vein thrombosis or DVT).

Specific complications of a facelift are uncommon but can include those listed below.

• Bleeding under your skin, causing a painful swelling called a haematoma. A further operation may be needed to stop the bleeding and remove the blood clot. Antibiotics may be needed to help prevent infection.¹
• Damage to your facial nerves, which can cause numbness and muscle weakness in your face. Occasionally this can be permanent.²
• Irregular ears where the face-lift may leave your earlobes hanging at an irregular angle. The doctor can correct this problem with further surgery.¹
• You may have temporary hair loss around the incision, which can be permanent if your hair follicles are cut, or your scalp is stretched too tightly where the incision is sewn together.¹ Further surgery to remove the spot where hair is missing and sewing the edges together will help, or tiny plugs of your hair can be moved to the area.¹
• Some people have an inherited tendency to form unusually red or raised scars (keloids).

The risk of complications depends on the exact type of procedure that is being performed and other factors such as your general health. Your surgeon will be able to explain how the risks apply to you.

References

1. MayoClinic.com, Saving face: The nips and tucks of facelifts. Viewed 02/03/2005.
2. British Association of Aesthetic Plastic Surgeons (BAAPS), Facelift, www.baaps.org.uk, viewed 02/03/2005.
3. Hruza GJ, Rejuvenating the aging face, Archives of Dermatology. 2004;140;1383.
4. Smoking and wound healing. Am J Med, 1992 Jul 15;93(1A):22S-24S.
5. British Heart Foundation factsheet on DVT, www.bhf.org.uk, viewed 21/02/2005.
6. British Association of Aesthetic Plastic Surgeons (BAAPS), Endoscopic Plastic Surgery, www.baaps.org.uk, viewed 02/03/2005.

Published by BUPA's health information team, healthinfo@bupa.com, April 2005