As people grow older, the natural aging process, genetic influences, exposure to the sun and other factors cause the skin to wrinkle and sag. In the younger individual, the face is firm and smooth due to fatty tissue directly beneath the skin. The tissue, which fills out the contours of the face, gives it an even, rounded appearance. As an individual ages, the skin begins to sag and fit more loosely. Skin folds become more prominent, particularly around the chin, on the jaw line, and on the neck.
In recent years, a remarkable procedure, rhytidectomy or facelift, has been developed to correct these conditions and give people the youthful appearance they desire. This procedure involves the tightening of facial and neck skin and muscles and the removal of excess skin. Often a rhytidectomy is done in conjunction with other facial cosmetic surgeries such as brow and forehead lift, blepharoplasty (eyelid surgery), chin augmentation, liposuction, and other procedures. A facelift can be performed any time after signs of aging appear.
Prior to surgery, a medical history of the patient is taken in order to evaluate the general health of the patient. A careful examination is also conducted. The physician and patient discuss together how the face should look and what results can realistically be expected. The goal of the surgery is to produce a pleasing natural appearance. Photographs are taken before and after surgery in order to determine the amount of improvement. The type of anesthesia to be used, the procedure, and possible risks and complications are also discussed by the physician and patient.
Preoperative instructions may include the elimination of certain drugs containing aspirin for several weeks before surgery in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed to prevent infection. Patients may be instructed to shampoo their hair the night before surgery, and a small amount of hair at the temples or around the ears may be shaved.
The surgery can be performed in a physician’s office, an outpatient surgical facility or a hospital, depending upon the physician’s and patient’s preference. It can be done under general anesthesia with the patient asleep or local anesthesia in which the area is numbed and the patient remains awake. Premedication is usually administered to relax the patient.
In the basic procedure, the surgeon works on one side of the face at a time. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. Loose skin is separated from underlying tissue and is pulled up and back and excess skin is removed. Connective tissue and sagging muscles are tightened, and in some cases, fat deposits are removed from beneath the chin and neck. This may necessitate an additional small incision under the chin. Tiny sutures are used to close the incisions. A rhytidectomy may take from three to five hours or more depending on whether other procedures are done at the same time.
After surgery, loose bandages which are applied to the area are removed within a few days. (Fig. A) Patients who are operated on in a hospital are released the day of surgery or after an overnight stay. Pain connected with the surgery is minimal to moderate and is controlled with oral medication. The surgeon determines when sutures are removed. This may be done in stages in order to minimize scarring. Scars from the incisions fade significantly with time and are, for the most part, inconspicuous because they are made within natural creases. Swelling and discoloration disappear in three or four weeks. Swelling can be reduced by keeping the head in a slightly elevated position when reclining. A tightness or numbness of the treated area may be present for awhile, and there may be slight changes in the normal hair pattern around the incision. A limited amount of blood collection under the skin may occur temporarily but does not affect the overall results.
For several weeks after surgery, patients are advised to avoid the sun as much as possible and to wear sunscreen when going outdoors. Healing is gradual and final results may not be apparent for several weeks. The amount of improvement varies, depending on the initial condition of the patient and the extent of surgery. In most cases, a single procedure achieves the desired results, while in some cases, additional procedures may be indicated. Most patients who have had a facelift are delighted with their more attractive, rested appearance.
Each year thousands of rhytidectomies are successfully performed. Complications connected with this surgery are rare; however, there are certain inherent risks connected with every surgical procedure which should be discussed with the physician prior to surgery. Patients can minimize complications by carefully following directions given by the physician.
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