Rhytidectomy, commonly called facelift, is a cosmetic surgical process that is used to change the facial appearance to make a person appear younger. A number of different techniques and procedures are collectively grouped under facelift operations. These procedures are performed usually under general anesthesia and may be combined with other cosmetic surgical procedures like blepharoplasty.
The first facelift was reported to have been performed by Eugene Hollander in 1901. Till about 70 years afterwards, facelift procedures involved lifting and stretching the facial skin and regrafting it behind the ears. In 1968, a new idea of subfacial dissection was put forth by Tord Skoog, where he focused on lifting the deeper and stronger facial layers instead of just the skin. Later called Superficial Musculoaponeurotic System or SMAS by Paul Tessier, it became very popular and widely used. Tessier further expanded upon this concept to create the subperiosteal dissection method of facelifts. Since the beginning of 1990s, a number of different techniques are being incorporated into facelifts, making the results longer lasting and more natural.
Various different techniques are employed to perform a facelift, the basic concept of which is to excise a small part of the skin and stretch the remaining. This may or may not be accompanied by underlying tissue tightening and recovery of subcutaneous volume. Other cosmetic surgical procedures may be performed together with rhytidectomy.
Rhytidectomy or facelift follows a simple basic procedure, where a part of the skin is excised and the remaining stretched and grafted behind the ear and neck so as not to be very visible. Other techniques improve upon this basic traditional procedure to also include the underlying stronger tissues in the lift and stretch. Other variations are based on the location of the incision and area of the face being treated.
The Superficial Musculoaponeurotic System of facelift consists of lifting and tightening of the SMAS layer of suspensory ligaments to rejuvenate and maintain the natural youthful appearance of the face. Modifications of SMAS facelift are the deep plane facelift, where facial skin and muscles are lifted from the underlying bone and stretched, and the composite facelift, where the orbicularis oculi muscles are lifted and positioned. The mid face lift is performed for those who develop sagging in the nasolabial region without excessive sagging of the neck. The mini face lift or the S facelift is also performed in this demographic group, where the difference lies in the very little invasiveness of the procedure as it can be performed with an endoscope and a very tiny S shaped short scar. The Subperiosteal facelift involves complete lifting of the soft facial tissues separating them from the underlying bones, followed by repositioning it to a more suitable appearance. The skin only facelift is essentially the traditional facelift where only the skin is lifted and repositioned. The Minimal Access Cranial Suspension Lift or MACS lift is the most advanced form of facelift with many advantages including a very small incision in front of the ear which makes it easier to hide, less chance of facial nerve damage, less time required, and more natural resulting appearance.
The natural aging process causes physical sagging of the facial skin at varying degrees in everybody at different rates. Usually the skin rejuvenates itself well before 40-45 years of age, after which the sagging and wrinkles become prominent. The most visible sagging and wrinkles appear around the nose and lips, beside and under the eyes, and under the chin on the neck. Anybody whose skin is sagging and wrinkling visibly and wish to maintain or regain a more youthful appearance are eligible for facelift.
Sagging and wrinkling of the skin occurs with age and young people below the age of 30 usually do not require the treatment. People with certain physical or mental diseases are not eligible for the procedure. Smokers and patients of diabetes or hypertension are usually not eligible for the procedure. People with allergic response towards anesthesia are also not eligible for the treatment.
Bleeding is the most common side effect of a facelift operation, including hematoma. Nerve injury may also occur sometimes, with both sensory and motor nerves of the face being affected either temporarily or even permanently. Skin necrosis can sometimes occur, the chance of which is greater in smokers. Scar formation is another side effect. Hair loss may occur in the area of the incision causing hairline distortion, especially in the facial hair pattern of males. Position and angles of ears may change. A very rare chance of infection exists.
There are no specific post treatment guidelines after the facelift procedure.
After the facelift procedure, it usually takes about 1 – 2 weeks for the scars to heal.
Facelift procedure usually costs between Rs. 15,000 – Rs.50,000, with the costs going up further for more intricate operations.
The results of a facelift operation are usually long lasting, with some procedures producing longer lasting results than others. However, the aging process cannot be stopped, so the procedure results, no matter how long lasting, are not permanent.