Facelifts and a Guide to Facelift Surgery
A facelift (or a rhytidectomy*) is an aesthetic surgical procedure to address sagging and excess skin on the face. The procedure involves the removal of skin from the face, and the repositioning of muscles under facial skin. In some cases, fat is taken from other areas of the body and used to plump up sunken areas of the face.
Because having a facelift involves surgery, the procedures are always performed in a hospital under general anaesthetic. A local anaesthetic is occasionally also used. Although surgeons will sometimes perform other procedures on the face during surgery, a facelift itself is only performed on the jowls, jawline and cheeks, and takes around three to four hours.
Before making an incision, the surgeon will draw a line along the temple hairline, round the front of the ear, and behind the earlobe. This is sometimes extended into the hair behind the ear.
The surgeon then makes his incision along this line. The skin is then separated from the underlying muscle, which is called the Superficial Muscular Aponeurotic System (SMAS). These muscles are repositioned and then stitched tightly to solid fibres around the ear. Fat may also be removed by liposuction at this point of the surgery.
The skin is then stretched back up, over the ear, and the surgeon cuts away the now excess segments of skin from the temple and behind the ear, which draws up the skin covering the neck. The incision is then stitched along the contours of the ear, minimising how much of a scar is visible after surgery.
Drainage tubes may be inserted at this stage. These remove serous fluid and blood. The serous fluid is released by the body as a reaction to having the skin separated from the SMAS. The blood is usually minimal from the surgery. These drains can be in place from a couple of days, and up to a few weeks.
Commonly an overnight stay in hospital is recommended after surgery. After discharge it takes at least two weeks to recover sufficiently to go back to work. However it takes four months before the full effects of the surgery are obvious, and it can take nine months before any numbness from the surgery has completely disappeared.
Your Recovery from Facelift Surgery in more detail
A night in hospital is usual immediately after a facelift, where trained nurses and doctors are on hand to provide immediate post-operative care. The bandages from surgery are usually removed before leaving hospital, and are often replaced with a stretchy supportive strap.
Although a small number of people prefer to spend their recovery period in a retreat, or in the private hospital where their surgery took place, the majority of people go home to recover.
Support from a friend or relative (or a hired nurse) is essential when recovering at home. As with any surgery, a facelift means you have to take it easy. The general advice is that it takes two weeks before you would be ready to go back to work, and the same can be said for doing heavy chores around the home.
Going to the gym is also out, as is any form of normal exercise. However, some movement is recommended after the first 24 hours to prevent deep vein thrombosis. A gentle walk around the house or garden is sufficient.
Bruising and swelling continues to increase around the eyes, ears, jaw and neck during the first week. The neck feels stiff and the face feels tight. However, these should subside around 7 days, and it is usual to have a follow-up visit to the plastic surgeon at this point to check on progress.
Any pain felt should be managed according to your surgeon’s directions. It’s necessary to take pain relief medication, without it blood pressure can increase, which in turn can cause more bruising, and, in some cases, cause bleeding. . Excessive pain, infected wounds, or a fever are a sign something is wrong. Anyone suffering from these symptoms should notify their surgeon immediately.
Feeling low and depressed is a common reaction to cosmetic surgery. Reasons vary, but in the majority of cases the low comes from not seeing an instant improvement, being alone whilst recovering, the discomfort from surgery, anxiety about what family and friends will think.
However, there are a small percentage of people whose desire for cosmetic surgery is driven by more complicated psychological issues. In these cases surgery rarely improves their self image and it is advised to seek out alternatives such as therapy to address the problem.
In some cases drains are fixed to the face to remove serous fluid to reduce the build up of serous fluid. This is a fluid released by the body as a reaction to the separation of the underlying facial muscles and the overlying skin.
If drains have been fixed, they will be removed between a couple of days and a couple of weeks after surgery. If recovery is being done at home, this will be require visiting the clinic or hospital where the surgery took place to have them removed.
It is necessary to sleep propped up on more pillows than normal, and on your back to allow your surgical scars to heal properly. Elevating the head around 30 degrees, and with pillows under the top of the shoulders, reduces the pressure on surgical wounds. Some surgeons suggest sleeping on a reclining chair, others recommend using bed wedges, which are made with memory foam and come with removable covers
Applying ice-packs to the face helps reduce swelling and bruising in the first 2-3 days after surgery. However, it is important to wrap the ice carefully so that it doesn’t come into direct contact with the skin.
The skin will be delicate and more prone to infection after surgery, so it’s recommended to wait 2 weeks before using make-up, 4 weeks until dyeing hair, and six weeks before have a facial massage. Cosmetic surgeons will recommend the best cream to keep the scar tissue moisturised.
Face lift surgery and driving don’t mix well, which is why it is common to be told not to drive for at least a week after a facelift. Apart from the face and neck being stiff and sore, requiring time to heal, turning the neck around sharply can cause the sutures to tear.
Don’t exercise for at least 3 weeks after surgery. This includes heavy lifting around the house and office. The sutures need to be given time to sew the skin together and physical strain my result in torn stitches. However, surgeons generally advise patients to move around after the first day, take a turn around the house, or go for a short walk if the weather is fine. This will also help improve bowel movements.
Eating a normal, low salt, healthy, balanced diet after surgery is essential to the healing process. If you usually take supplements it is advisable to discuss these with your surgeon and your GP, as some supplements impede the healing process. As one of the effects of having pain medication is that it can cause constipation, drinking fruit juice is advised. One fruit in particular, pineapple, can help reduce swelling because of the enzyme it contains, bromelain. But speak to your surgeon as this enzyme is known to increase the effect of blood-thinning medications, and can cause stomach upset and diarrhoea.
Once you are ready to go outsides, it is recommended covering scars with an SPF 50+ sunblock. This prevents hyperpigmentation (darkening) of the skin. Although there are no strict guidelines on how long, most clinics will suggest protecting the scar with sunscreen for 12 months post surgery.
Avoid going into a swimming pool and resist the temptation to jump in the hot tub after surgery. Bugs and fungi breed in the warm water and can infect your healing scars. The warmth of a hot tub can also dilate arteries and cause haematomas.
Keep the area clean at all times and try to avoid going near dusty, dirty or sandy places. Check the incision regularly to make sure that there is no redness, or discharge such as green or yellow pus.
Click on the boxes below to learn more about the questions you should ask a cosmetic surgeon when deciding to undergo facelift surgery, the risks involved, and the full details on recovering from facelift surgery.