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Facelift

Definition

Facelift (rhytidectomy) is an operation intended to rid the skin of wrinkles and folds around the face and under the chin, many of which may be the natural effects of aging.

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Description

To some extent, a face-lift represents a form of rejuvenation for many patients, and in addition to enhancing the appearance may also improve morale and self-image, leading to an overall improvement in lifestyle.

Sagging, wrinkled skin is caused by overexposure to sunlight and ultraviolet light. This type of radiation affects the structural collagen in the skin, causing it to lose elasticity. The skin is further stretched by the layer of subcutaneous fat beneath it, a layer that may increase in thickness as the skin loses elasticity and takes on the characteristic sag patterns represented by folds of skin that progressively hang downward, eventually falling over the angle of the jaw and forming jowls.

Subcutaneous fat is responsible also for the loss of the contour around the cheekbone, a feature of the youthful face. Conversely, loss of subcutaneous tissue together with natural stretch eventually give rise to short, deep, vertical lines in the upper lip which tend to become progressively more marked.

The major principle behind the facelift is simple. To be taut, the skin must be freed from its underlying tissue ("undermined"), and pulled backward and upward. Redundant skin can then be snipped off and discarded.

A face-lift can be an expensive procedure and is usually not covered by insurance plans.

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Surgical Procedure

A facelift usually takes several hours. Every surgeon approaches the procedure in his or her own way and has different techniques and instrumentation. Some complete one side of the face at a time, others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on the facial structure and the surgeon's technique.

Incisions usually begin above the hairline of the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may be made under the chin.

In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.

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Post-operative Recovery

Following surgery, a small, thin tube may be temporarily placed under the skin behind the ear to drain any blood that might collect there. The face may be puffy and discolored with bruising. The drainage tubes inserted through the main incisions guard against the possibility of blood accumulations (hematomas). The surgeon may also wrap the head loosely in bandages to minimize bruising and swelling.

Provided that there is no further danger of hematomas, the drainage tubes can come out within two days or so. A temporary change of hair style can probably disguise the line of stitches until the hair grows back.

The bruising may last for 10 days to 2 weeks. Much more quickly, one will feel comfortable with the unaccustomed tautness of the facial skin and improved smile. There will be some scars from the facelift, but they are usually hidden by the hair or in the natural creases of the face and ears. The scars will fade with time and should be scarcely visible.

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Questions to Ask Your Doctor

What improvement in appearance can be expected from the surgery?

Will this be done on an outpatient basis, or will hospitalization be required?

Is there some type of preparation needed for surgery?

How will the procedure be performed?

How many face-lifts have you done?

Will there be scarring afterwards?

Will the scars be obvious, and how can they best be concealed?

How long does the healing process take?

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