What is it?

A full face-lift, or Rhytidectomy, is an operation to improve the loose skin of the neck, the jaw line, the deeper wrinkle lines, and the corners of the mouth. It may be combined with other procedures to improve the fine wrinkles on the face and also with blepharoplasty (baggy eyelids). These options should be discussed with the surgeon at the initial consultation.

The Operation

There are a number of different techniques used to tighten the skin on the face. The surgery is usually performed under general anaesthesia and may be aided by using endoscopic surgical techniques.

Any Alternatives

Some improvement in the fine wrinkles of the face can be achieved temporarily by skin hydration. Deep furrows and wrinkles may be helped by the use of Botox injections, which paralyses the underlying muscles and prevents wrinkling of the skin. However, the excess saggy skin will still be noticeable.

Before the Operation

It is most important to give up smoking. This can have a serious effect on the blood supply to the skin and cause areas of skin on the face to become black and scarred following surgery. It is also useful to be at one’s chosen weight or even somewhat underweight, as weight loss subsequent to the surgery can allow further wrinkling to occur. One should avoid taking Aspirin or Aspirin containing pain medication as this can increase bleeding following surgery and cause blood clot formation underneath the skin, and interfere with wound and skin healing. The operation itself takes between two and three hours to perform and your surgeon would assess if you are fit to undergo such a procedure.

After in Hospital

The surgery is performed through an incision that starts in the temporal hair area, downwards in front of the ears, curving underneath the ear lobe, and then extends up behind the ear sometimes into the hairline. Depending on the extent of surgery performed you can be in hospital from one to three days. After you wake up it is likely that you will have soft padding around your face and you may have drains. It is also likely that there will be an intravenous drip to provide fluid. The nurses will check your blood pressure, pulse and temperature on a regular basis and observe the colour of the skin of your face. It will also be likely that you will be asked to keep upright, avoid coughing, stooping and straining. If eyelid surgery has been performed at the same time, your eyes may also be initially covered. Staying semi upright also helps reduce the swelling and enables better observation by the nurses. Maximum swelling tends to occur within forty-eight hours. To decrease the swelling further, cold bandages or packs may occasionally be applied during the day. Pain killer tablets or injections will be available. The drains and dressings are removed prior to discharge to hospital and further dressings or scarf may be applied.

After at Home

You may have numbness on your face and neck for several weeks and this can sometimes last longer. It is important again to avoid any bending or heavy lifting for two weeks following surgery. You should not smoke, not take alcohol or Aspirin for at least two weeks following surgery. Continuing to sleep upright at night will help to decrease swelling of the face. On the third or fourth day following surgery you can start washing your hair and blow-drying it gently. You should avoid stooping or straining or bending over as this can cause a rushing of blood to the face, discomfort and occasionally some minor bleeding. The sutures from around the ear are usually removed between five and ten days following surgery depending on the extent of surgery. Bruising may be obvious for two to three weeks following surgery.

Cosmetic make-up may be used but should avoid the suture line itself until it is well healed some two to three weeks following surgery. Perming and hair colouring can be used from four to six weeks, depending on the extent of the surgery. As with any major surgery, you may feel tired for a few days after the operation and this can last for two to three weeks. Serious physical or gym activity, aerobics are probably best avoided for up to one month following surgery although one can do gentle exercises such as swimming once the wounds are soundly healed. You may also notice, over a period of time, numbness of the face and potentially some numbness of the ear, particularly on the posterior aspect.

Complications

The blood supply to the face is very good. Because of this, wounds heal very well but during any surgery bleeding can occur. Your surgeon is very careful to stop bleeding at the time of surgery and drains are usually left in afterwards. If heavy bleeding occurs following surgery underneath the skin, it is likely that you will need to return to the operating theatre in order to have this controlled. Small episodes of bleeding are likely to occur and this can result in areas of thickening underneath the skin flaps. This will settle with time, particularly with gentle massage for a few weeks following surgery. Infection is unusual but can occur and can cause problems with wound healing. It is also important that surgery should not be performed if there is evidence of any cold sore or Herpes at the time of surgery. The nerves of facial expression are underneath the muscle layer of the face and these can very occasionally be bruised or injured when doing face-lift surgery. This particularly occurs with the nerve that goes to the side of the mouth and so can result in a weakness here. It is unusual for this to occur and usually settles over a period of a few months. Numbness of the ear may also be noted as the nerve that gives sensation to the ear is quite close to the surface of the skin in the neck region. Although the blood supply to the skin is very good, in order to get a good result a certain amount of tension has to be placed on the skin. This can sometimes interfere with the circulation of the skin, particularly in smokers, and should the circulation be badly affected some of the skin can become necrotic and die. This can result in areas of skin loss and very occasionally skin grafting may be required. When the surgery involves some of the hair-bearing scalp, hair thinning or hair loss may occasionally occur. The scars in front of the ear are usually not that noticeable, but scar spread can occur as time progresses. Occasionally if the wound does not heal up satisfactorily underneath the earlobe, the earlobe itself may be pulled down and a scar can become noticeable in this region. It may take two to three months for the swelling and discomfort on the face to settle down entirely. You may also find it comfortable to wear a light bandage at night-time to prevent your ears from bending forward initially.

General Advice

A face-lift may be part of a number of procedures to try and rejuvenate the ageing face. The type of face-lift procedure will depend on the individual, the excess skin and the overall facial appearance. Significant weight loss can also precipitate a problem with excess skin on the face.

Face-lift operations last for from five years upwards depending on the age at which it is performed. It also depends on whether or not excess weight gain or weight loss occurs subsequent to the surgery. It can be performed again. Best results are in non-smokers.