What is a face lift?
A face-lift, known as a rhytidectomy is an operation performed to restore your face and neck to a natural, more youthful looking state. The procedure is best suited to treating the lower half of the face. It addresses the deepening folds running from the corner of your nose to your mouth (the nasolabial folds), sagging jowls, wrinkles and a sagging neck. If droopy eyebrows and forehead wrinkles are a problem, a brow lift may also be required. Similarly if the eyelids are a problem then a blepharoplasty is needed. These can be performed simultaneously, or at a later stage.
What does the surgery involve?
In general, incisions are made inside the hairline at the temple, extending down along the natural curve of the front of ear, back behind the ear and horizontally back into the hairline. In a less extensive lift, a shorter incision can sometimes be made. If surgery is required around the jaw line and neck, a small incision under the chin may be needed.
A modern face-lift goes beyond just tightening the skin. It often extends below the skin to the deeper more fibrous layers. Tightening this deeper SMAS layer (superficial musculo-aponeurotic system) allows the underlying facial muscles to be lifted as well. These muscles, just like the skin, droop with age. The surgeon may also move, remove and in some cases add fat to the face, as needed, for each patient’s rejuvenation plan.
The skin is redraped, carefully removing any surplus before closing the incisions. Small metal staples are often used in the hairline, while the scars around the ears are stitched with thin nylon thread.
Face lifts are most commonly performed under a general anaesthetic ( you will be completely asleep).The operation takes between two to five hours to perform depending on the area(s) to be treated and whether or not other procedures are carried out at the same time. You are likely to stay in hospital for one night.
There will be some discomfort following surgery but it is not a painful operation. Expect to feel swollen and bruised for a few days afterwards. Simple painkillers are usually sufficient to control any discomfort.
What are the risks and side effects of surgery?
Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor. However, face lift surgery is a moderately big procedure and not without risk. It is important that you are given a clear picture.
Your face will be swollen, numb, tender and bruised following surgery.
Formation of a haematoma (bleeding into the tissues underneath the skin) can occur. If this does occur, it is likely to happen within four to six hours of surgery. Any increase in swelling or pain around the face should be reported immediately so that treatment can be given. Sometimes patients need to have this blood removed with another short operation.
Wounds can be slow to heal, particularly if they become infected. Whilst this problem is rare, it is more likely to happen in smokers. There is a risk that a small patch of skin behind the ear may form a black scab which falls off after a few weeks. This leaves behind an open wound which heals quickly but may result in a less than satisfactory scar. This can often be improved at a later stage.
For most people, the scars will soften and fade and become almost invisible. Rarely, scars become raised and red.
Temporary hair loss (which can become permanent) at the incision sites can occur, although this is not common. New hair usually appears within four to six months.
All patients get some reduction in sensation of the cheek skin which usually recovers completely after a few months.
Another risk is injury to the nerve that works the muscles of the face (the facial nerve). Weakness in parts of the face can occur. This is a very rare complication and usually, but not always, corrects itself in a few weeks once the injured nerve has had chance to recover.
There are general risks associated with all operations. Very occasionally a blood clot can form in the leg (deep vein thrombosis or DVT) which would require medical treatment. Part of these clots can also break off and move up to the lungs, causing acute shortness of breath and pain in the chest. This is known as a pulmonary embolus (P.E). This is very rare but can be life threatening. Developing a chest infection is uncommon but more likely to happen to people who smoke.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with your surgeon. Decisions about cosmetic surgery should never be rushed.
How do I prepare for surgery?
If you smoke, you need to give up at least two weeks before your operation and be able to refrain from smoking for four weeks after surgery. The longer you can give up beforehand, the better. Smoking reduces the amount of oxygen in the blood and increases the risk of healing problems after your operation. Be confident that you can stop smoking before you book your surgery.
Following your consultation, if you decide to proceed with an operation, a range of dates will be offered to you. You may be invited to attend the hospital for a pre-operative assessment with a nurse. Depending on your age and general health, routine blood tests and a heart tracing (ECG) may be taken. You will be given the opportunity to ask any questions you may have or raise any concerns.
You will be admitted to the hospital on the day of your operation. If you are having a general anaesthetic, you will be asked not to eat anything six hours before surgery. Black tea/coffee or non-fizzy drinks (nothing containing milk) can be taken up to two hours before surgery. Chewing gum should also be avoided six hours before your operation.
It is important to inform your surgeon, anaesthetist and nurse of any medicines (self or GP prescribed) or recreational drugs you take. Medicines containing aspirin should be avoided for two weeks before the operation since they increase the risk of bleeding during surgery. If there are any other medications that may affect surgery then this will be discussed with you at your first appointment.
If your hair is short, you are advised not to have it cut too short before your operation. Otherwise, it may be difficult to cover up the new scars. If you like to perm or colour your hair, it is better to do this before rather than after surgery. A three week wait is recommended before any hair treatments can be applied.
You will not be able to drive yourself home from hospital and ideally, you should have someone to stay with you for a few days to lend a hand.
What happens after the operation?
Once you have recovered from the anaesthetic, you will be encouraged to sit up in bed supported by several pillows. Sitting upright will help to reduce some of the swelling. Your face is likely to feel tight and tender around the ears. However, there should not be any severe pain and this will be controlled with simple analgesia.
You may feel drowsy following surgery. Expect to wake up and doze off for the remainder of the day.
Many surgeons put on a bandage (around the head and under your chin) for the first 24 hours. After this, you may be given a support garment to wear. Your surgeon and nurse will show you how to put this on.
Sometimes, small plastic tubes, called drains, are placed just under the skin by the operation site to allow any blood in the wound to escape. These tubes are usually removed the next day.
You will be able to have a shower and wash your hair the next morning before leaving hospital once any bandages have been removed.
Before you leave the hospital, you will be given a follow up appointment to remove any stitches and staples.
What is the estimated time for recovery, absence from work and return to usual activities?
Recovery times vary from one person to another so use the times below are given as a guide only. If you have any concerns during this period, do contact the hospital team for advice.
Remember to wear a high factor sunscreen over the scars (minimum factor of 15) when you go outside. This prevents pigmentation of the scars.
Face lift post surgery timeline
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1 to 4 days
Swelling is at its worst days 2 and 3 after surgery. Sleep upright in bed supported by pillows. Ice packs will be soothing.
Wear any support garment as instructed.
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5 to 14 days
Gradually increase your activity but nothing too strenuous. Light housework and gentle walks are fine.
Stitches around the ear will be removed.
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2 weeks
Any remaining staples will be removed.
Can think about returning to work after two weeks.
Continue to wear support garment at night.
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4 weeks
All the visible swelling and bruising should have gone by now.
Should be able to discard any support garment.
Will be fine to restart any exercise you do.
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6 to 9 months
Scars will have softened and faded.
Can start to judge the final result.