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Rock Street, San Francisco

A facelift is a surgical procedure to reverse the aging
signs in the face and the neck in which sagging facial skin is elevated, pulled
upwards, and sutured back. By removing excess skin and fat from the face and/or
neck, the procedure reduces or eliminates many wrinkles, giving patients a
younger, rejuvenated appearance.  

The word “rhytidectomy” derives from the Greek “rhytis,”
meaning wrinkle, and “ektome,” which means excision: excision of skin to remove
wrinkles. While the operation originally entailed tightening just the skin, it
soon became clear that significant, lasting results required that deeper layers
of tissue also be restructured or excised. Today the operation incorporates
plastic surgery techniques addressing the layers under the skin, and is
sometimes called rhytidoplasty. The term facelift applies to the
area from the cheeks down to the neck; the eyes and the forehead are treated in
separate procedures (although they may be performed concurrently). 

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How is a facelift performed?

Facelifts usually begin with an incision at the temples just
above the hairline. This incision is extended downwards in front of the ear,
below the earlobe, and behind the ear. Placement varies slightly between men
and women. 

The surgeon then separates the skin of the face and the
muscle from deeper tissues.  Depending on
the person’s needs, tissues are reshaped and/or excised.

In some cases the surgeon may perform liposuction to remove
excess fat from the cheeks, nasolabial fold, or chin, for example.  The underlying muscle may be tightened
separately, or in conjunction with the skin. The skin is then redraped in its
new position and sutured, either with stitches or staples. 

Some patients opt to undergo concurrent procedures such as
eyelid tightening (blepharoplasty),
chin implants, or forehead lifts (in which the skin of the forehead is
tightened in the same fashion as during a facelift). Surgeons in this
department perform endoscopic brow lifts, a minimally invasive technique that
minimizes scarring and side effects. 

Drainage tubes may be placed beneath the neck skin or behind
the ears to minimize swelling during the initial recovery period. The surgery
usually takes several hours to perform. 

Anesthetics during Facelifts

In our department, we often perform facelifts using general

Recovering from a Facelift

After surgery, patients will experience swelling of the face
and eyelids, and marked discoloration.  A
large fluffy dressing is applied after surgery, and this is replaced by a thin
elastic wrap after the first day. Pain is usually surprisingly moderate and
easily controlled with medications. Pain in and around the ears is also common
during the first two weeks.  

Patients should rest with their head elevated for the
first 2 days. By the 2nd or 3rd day, patients may shower
and shampoo (carefully).  Strenuous
activity must be avoided until swelling and bruising have subsided, which may
be approximately 4 to 6 weeks. 

Patients look and feel much better after two weeks. The skin
may be dry and rough for several months, and hair near the temples may be thin.
Men whose beard-growing skin has been moved may need to shave in new places
such as behind the neck or ears.  

How effective are facelifts?

Most patients are very happy with their results. Patients
can expect many wrinkles to be reduced or eliminated, and to appear younger
than before surgery. Every single wrinkle will not be eliminated, however,
especially more superficial ones. Final results will depend on factors
including prior sun damage, smoking status, age, aging rate, and type of skin.
Patients may wish to consider subsequent treatment of superficial wrinkles with
techniques such as chemical peels, dermabrasion, or laser resurfacing. 

It is not possible to say how long the effects of a facelift
will last, but some degree of rejuvenation will be permanent. It is important
to understand that while facelifts bring the skin back to an earlier stage in
the aging process, it can not stop the aging process from occurring. Skin aging
and stretching will take place, and some looseness of the neck may become
apparent within three months. Those with very loose skin in the neck may
require a second operation to achieve optimal results. 

What are the risks associated with

As with any surgery, facelift involves some risks. The
primary risks are swelling, bruising, bleeding, scarring, or injury to the 7th
cranial nerve (controlling movement of the face). Such injury may cause
numbness or pain.   

Facelifts and Smoking

Smokers are at risk for skin loss during facelifts. Because
nicotine and carbon monoxide reduce skin oxygen levels and the flow of skin
into skin flaps, approximately one in ten smokers will experience death of skin
cells at the incision site. Avoiding smoking for two to four weeks prior to
surgery and a month after surgery can improve, but will not eliminate, this

About our Physicians

All surgeons in this division are
certified otolaryngologists who have done additional fellowship training in
facial plastic and reconstructive surgery, and are board certified by the American Academy of Facial Plastic and
Reconstructive Surgery. Having limited the scope of their practice solely to
the face, they offer the highest level of knowledge and experience available


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