A facelift can be performed as an outpatient procedure in a hospital, ambulatory surgical facility, or office-based surgical setting. However, in some cases, your facelift surgeon may recommend an overnight stay in a special care facility or hospital. Facelifts are usually performed under general anesthesia, though local anesthesia with sedation can be used in some cases. Your surgeon will recommend the best choice for you. Depending on your personal circumstances, the procedure can last anywhere from two to six hours.
Before the actual surgery, the surgeon will evaluate your skin consistency and then explain what you can expect during and after the procedure. Patients who smoke will be advised to quit at least a week or two before the surgery and then refrain from smoking for a few weeks more after the surgery. The reason behind this is that smoking tends to inhibit blood flow to the skin and can therefore disrupt the healing process. Patients will also be asked to avoid taking aspirin and other medications that can cause excessive bleeding.
The standard facelift, or rhytidectomy, starts with the careful placement of the incisions in the area of natural creases – just inside the hairline at the temple, extending down along the natural curve of the ear and behind it, then horizontally into the hairline. The incisions allow the facelift surgeon to visualize the underlying facial structure and make the appropriate manipulations. The surgeon will reshape and sculpt the face, tighten the muscles, restore fat to where it has lost volume, and pull the skin into its new position. In most cases, a layer of tissue known as the superficial musculoaponeurotic system (SMAS) is also tightened by the surgeon by folding it and then pulling the layer back over itself. This helps to lift the cheeks and give more definition to the jawline.
If the neck area is also being treated, your facelift surgeon will conceal a small incision under the chin, and manipulate vertical bands in the neck for a smoothing and complete effect. If necessary, fat pockets can also be corrected during this stage of the facelift surgery.
Finally, your surgeon will drape the skin over the new, sculpted foundation to remove the excess skin and close the incision sites with sutures or skin adhesives. Facelift patients generally go home from two to 24 hours after the procedure. Once healed, the incision lines are virtually invisible as they are well concealed within the hairline and in the natural contours of the face and ear. Most patients are able to return to work and perform light activities in one to two weeks. The improvements of a facelift become more apparent as swelling and bruising subside.
Surgical Facelift: The Different Techniques
Mini Facelift Technique
A mini-facelift is particularly popular among younger individuals in their thirties and forties who are just starting to notice the first signs of aging, though older patients also can benefit from the procedure. A mini-facelift addresses neck and jawline issues, specifically tightening the skin on the neck and fixing jowls. Though the results are comparable to what’s possible with a lower facelift, the downtime is remarkably less and patients who opt for a mini-facelift experience a much faster recovery.
The mini-facelift procedure typically takes around 1.5 hours to complete. The surgeon creates incisions that are hidden beneath the chin and behind the ears and then trims excess skin in the target areas. Liposuction is used to sculpt the underlying tissues and then the neck muscles are tightened. The surgeon will correct any issues with the jawline, removing jowls while giving the neck a more toned, younger-looking appearance. Following the procedure, patients typically spend about 2 hours in a recovery room before being permitted to go home.
The surgeon use a specially developed fibrin sealant that can significantly diminish a patient’s downtime following surgery. This sealant is responsible for decreasing bruising and swelling associated with the mini-facelift surgery as well as markedly diminishing pain associated with the procedure.
Skin Facelift or Subcutaneous Facelift
One of the earliest facelift procedures to make a debut in the general public is the skin facelift, otherwise known as the subcutaneous facelift. This procedure was particularly popular in the decades leading up to the 1970s. Patients who are at their ideal weight with excess skin on the face, but good positioning of the facial muscles are most appropriate for this procedure. Also, patients who have had another, more invasive procedure performed could benefit from the skin facelift as a way to revitalize their look.
Having only excess skin and no underlying tissues like muscle or fat contributing to aesthetic issues is the key to finding successful subcutaneous facelift candidates. Because a skin facelift does not address problems with the musculature or fatty tissues underneath the skin, this type of procedure may not produce desirable results in all people.
The skin facelift procedure involves an incision around the ear that allows the surgeon to release the skin from the underlying fascia and muscle tissue. The skin is then pulled tight to produce a more youthful appearance.
SMAS (Superficial Musculoaponeurotic System) Facelift Technique
Superficial musculoaponeurotic system or SMAS facelift is used to treat sagging cheeks or jowls by removing excess skin and addressing the deeper SMAS layer, which is a sheet of muscle and connective tissue joined together in the cheek. Over time, there is a gradual loss of elasticity in the top layer of the skin and the SMAS can become lax and sag, resulting in jowls as well as deepening of the nasolabial folds. The end result is a familiar look of an aging face.
A SMAS facelift is performed by making an incision at the temple above the hairline and extending it downward in front of the ear. The surgeon then continues to cut below the ear lobe and then behind the ear. The next step involves lifting the skin, cutting the excess, and tightening the SMAS tissues. The surgeon then sutures the areas back in place. This technique provides adequate correction to jowls and skin laxity. When done correctly, the facial skin looks tight, but not pulled. Also, the result is more extensive and tends to last longer than a skin-only facelift.
Deep Plane Facelift Technique
The deep plane facelift technique was specifically designed to address the deficiencies and limitations of the previous generation facelift procedures. Today, it is one of the most effective techniques used to give patients long-lasting correction of the jawline as well as excess skin and fat in the neck. It is also useful for correcting the signs of aging in the mid-face and upper cheeks since the surgeon can reposition the tissues in those areas. The results are achieved by cutting deeper to adjust and reposition thicker planes of the face. The surgeon is also able to release the suspensory ligaments below the mid-face to correct mid-facial drop and to soften the nasolabial folds.
Because of the deep incision, the flap is thicker than in the subcutaneous or SMAS techniques, and some surgeons believe that a deep plane facelift could be a safer option for smokers because of the better blood supply in the flap. But still, smokers are more susceptible to complications, regardless of the technique. Lastly, the deep plane facelift can be performed along with the mini-facelift to achieve the maximum amount of correction during a single facelift surgery while using the tiniest incisions.
Threadlift or Feather Lift Facelift Technique
For busy patients who want a noticeable change without incisions or a long recovery period, thread lift or feather lift facelift techniques are a viable alternative. The thread lift technique utilizes a long thread with barbs attached to it. The barbed thread is designed to latch onto tissues after it had been placed under the skin. This thread is carefully and strategically inserted through tiny holes in the skin. The surgeon moves these barbed threads into a precise position under the skin (in the cheek or jaw areal, for example) and then allows the barbs on the thread to catch hold of loose skin that needs to be tightened. The barbed thread, along with the sagging skin is pulled tight and left behind to provide support, reducing wrinkles and shaving years off the appearance of the face.
Threadlift isn’t appropriate for all patients. The thread lift technique is popular among younger individuals who are just starting to notice the first signs of aging as well as older individuals with relatively good skin tone who simply don’t have time to endure the rigors of a complete facelift.