Facelift (Rhytidoplasty) is performed
to tighten and lift excess face and neck skin. Wrinkles can be
smoothed and sagging reduced.
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 will 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.
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 at 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 usually removed the next day. 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 a week or two. 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
For several weeks after surgery, patients are advised to avoid the
sun as much as possible and to wear sunscreen when going out of
doors. 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
Each year thousands of rhytidectomies are successfully performed.
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.
A. Botta, M.D. Coraopolis, PA
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