Facelift (Rhytidectomy)

There are several variations of a facelift procedure, or rhytidectomy, each tailored to meet specific skin needs and desired results. After assessing your skin and determining your unique needs, your surgeon will recommend a procedure that will address your individual concerns. The goal of each facelift technique is to essentially “lift up” portions of the face and neck that are showing unwanted signs of aging through the use of plastic surgery, thread lift surgery, or dermal filler injections.

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Medically Reviewed by Dr. William A. Kennedy III, MDLast Reviewed 02.04.2019

Overview

Although a facelift is unable to stop the aging process altogether, it can inhibit the effects of aging and gravity you see, and will restore a youthful appearance to the face and neck. A facelift benefits facial rejuvenation and will tackle signs of aging such as sagging of the face and neck by removing or tightening the jowls and correcting issues such as a double chin. Facelifts focus mainly on the mid-to-lower portions of the face and neck, but they can also be used in conjunction with brow lifts, eyelid surgery, dermal fillers or resurfacing treatments (such as chemical peels) to further enrich your overall facelift results.

The majority of facelift options require incisions necessitating the use of anesthesia. The type of anesthesia used is determined by the facelift procedure you will undergo. Many facelifts call for general anesthesia while others use an intravenous form, and a few others give you the option of local anesthesia. Your surgeon will discuss these options with you, however, if undergoing anesthesia is a concern for you, it would be helpful to bring this to your surgeon’s attention during your consultation before the options are discussed. This will allow your surgeon to determine a procedure that you will be comfortable with, although discussing the procedures in detail may even help to alleviate your fear of anesthesia altogether.

Different facelift procedure types include SMAS Facelift, Awake Facelift, Subperiosteal Facelift, Cutaneous Facelift, Plicated SMAS Facelift, Endoscopic Facelift, Deep Plane Facelift, Weekend/Mini Lift/Short Scar Facelift, Threadlift, Liquid Facelift, and Vampire Facelift. Do not be alarmed by the daunting list of procedure choices. Your surgeon will be able to provide you with a narrowed list of options upon seeing your skin and hearing your concerns.

Facelift Cost Overview

Facelift surgery costs vary as much as the procedures themselves with expenses ranging from $400 per treatment to a $20,000 procedure. Something minimally invasive and temporary, such as Liquid Facelifts (Juvenderm Ultra, Juvederm Ultra Plus, Juvederm Voluma, Radiesse, Sculptra and Botox) cost approximately $400-$1,800 per treatment, and will need to be maintained every few months or so to continue seeing results. Other types of minimally invasive procedures will cost more, depending on the type of procedure, the experience of the surgeon and the anesthesia used, but many of these options will need to be maintained

Something with medium-lasting results, such as a Cutaneous Facial, which lasts 4-5 years, will cost between $6,000-$8,000. This type of facelift is especially helpful in patients who only need to address the issue of excess skin.

Other, more invasive procedure types, such as a Deep Plane Facelift, have a facelift price of $10,000-$20,000, but the results are expected to last an average of 10-15 years. These have a greater risk involved as their invasive nature makes you more susceptible to possible nerve damage.

Keep in mind that no facelift surgery can promise permanent results as the face and neck, and the body in general, will continue to naturally age and be affected by gravity. While some procedure types offer longer-lasting results, your skin will continue the natural process of maturing and you should expect even the most permanent results to last approximately 15 years. During that time, you might find that you will want other procedures, such as a brow lift, to enhance your original results.

Recovery Overview

Contrary to popular belief, the recovery process following a facelift is a direct result of the surgical technique used, and not the anesthesia type. Almost all facelift patients experience a period of bruising, swelling and even redness around the incision or injection site. The duration of these after effects vary according to the procedure, the invasive nature of the facelift and the natural healing capacity of each person’s unique skin. You should expect these things to occur, though, and be prepared to ice, rest and take proper care of the area as it heals.

Most of your recovery will take place within the first 8-10 weeks, although it is common for facelift patients to experience residual swelling and changes in skin sensation for up to a year with some procedures types, such as with an SMAS Facelift. Other procedures require less recovery time, such as a liquid facelift, which uses dermal filler injections.

You will be in contact with your plastic surgeon during your follow-up visits which will help to monitor any complications or side effects you might experience during your healing process. As with most things, it is always better to take the necessary time to recover, and to avoid trying to neglect or speed up the steps required for your best healing.

Before & After Overview

You will want to take care to follow your surgeon’s before and after care instructions carefully to ensure the best possible outcome for your facelift. All cosmetic surgeries instruct you to avoid any alcohol or smoking and to limit sun exposure. They also require that you avoid taking medications, particularly those with blood-thinning properties, such as Aspirin, as this will inhibit your healing capacity.

It is also necessary to inform your provider of any related medical histories, including herpes infections around the mouth, prior to surgery. This will help them to give you your best care as they may need to make additional provisions, such as writing a specific prescription, before your facelift takes place.

The specific requirements for each procedure type are discussed in detail during your consultation. Your plastic surgeon will also provide you a list of things to know for your facelift.

Facelift Goals and Procedure Details

There are several facelift options available, and while your plastic surgeon will advise you on the route that will work best for your skin type and needs, it is helpful to have a working knowledge of what they entail before your consultation. The available facelift surgeries are summarized for you below:

SMAS Facelift SMAS stands for superficial musculoaponeurotic system. This refers to the thin, fibrous layer that covers the anterior (or “front”) face and neck, supports the mimetic muscles of the face, and runs continuous with the platysma muscle (from the chin to the collar bone) that covers the anterior neck. Your “mimetic muscles” control facial expression. In other words, the SMAS Facelift addresses the mid and lower front of the face and neck, specifically focusing on areas that are experiencing signs of aging directly related to facial expression. This includes flattening the nasolabial folds (“smile lines”) as well as sagging cheeks or jowls (the loose skin between the cheek and chin along the jawline).

A plastic surgeon performs the SMAS facelift by making an incision that starts at the edge of the hairline at the top of the forehead. This temporal hair tuft-sparing incision runs down the side of the face, in front of ear, and behind the earlobe where it extends behind into the hairline slightly below the mid-conchal region. This type of incision allows for adequate re-draping and maximizes the amount of hairline preserved.

Once the incision is made, your surgeon will begin a superficial dissection using facelift scissors which preserves the hair tuft and avoids injuring your neck and facial nerves. This type of facelift surgery uses a general, local anesthesia with sedation.

The goal of the SMAS facelift is to give your face and neck a rejuvenated, more youthful look. By “lifting” sagging cheeks and skin around the jawline, excess skin is removed and the underlying facial tissues and muscles are tightened.

The results of an SMAS facelift typically last 10-15 years. Recovery for the SMAS Facelift lasts 2-3 weeks and costs anywhere from $10,000-$15,000 per treatment.

Awake Facelift Some people who might benefit from a facelift might find themselves uncomfortable with the idea of needing anesthesia. An awake facelift could be a solution for you, if that is the case, as it offers an alternative to general anesthesia during a facelift procedure. An awake facelift doesn’t necessarily refer to the type of surgical procedure being used. Instead, an awake facelift refers to the type of anesthesia, which is a local or local with sedation anesthesia.

You are not able to have an awake facelift for all facelift procedures. Whether or not you can have one will be determined by your doctor who will review the extent of the procedure, the length of time required to complete the procedure, and your anesthesia desire. If you are able to utilize an awake facelift, a doctor will use tumescent anesthesia – subcutaneous injection of a tumescent fluid composed of saline, a numbing medication (such as lidocaine), and epinephrine – combined with either oral or IV sedation in place of general anesthesia to anesthetize the treatment area.

The epinephrine (adrenaline) is used to constrict the blood vessels and reduce bleeding while lidocaine works to numb the injection site. Once the area is sufficiently numbed, your facelift procedure will continue.

The goal of an awake facelift is to offer patients an alternative to general anesthesia during a facelift procedure.

The results from an awake facelift vary depending on the type of surgical technique used, but are typically noticeable immediately after surgery. They are long lasting, but not permanent. An awake facelift offers the advantage of a shorter recovery time (averaging between 2 and 3 weeks), especially compared to a longer, more invasive facelift. The cost of an awake facelift is usually $7,000-$8,000.

Subperiosteal Facelift The subperiosteal facelift focuses its attention on the upper 2/3 of the face, providing a vertical lift to the soft tissues of the face. This type of facelift allows soft tissue remodeling and repositioning of the soft tissues at the level of their bony origins. The subperiosteal facelift removes a small amount of hair close to the hairline to allow for a 5cm lateral incision to be made across the front of the forehead. This facelift focuses on 3 main points of the face which will be lifted and stretched to correct a drop in the cheek region and enhance the nasolabial (smile line) groove.

The skin will then be sutured and a compressive dressing will be applied. This dressing can be removed in 7 days at the time the stitches are removed. You should expect to wear a compressive bandage for the first 6-10 hours after your surgery.

By “lifting” sagging cheeks and jawline skin, the goal of a subperiosteal facelift is to remove excess skin and tighten underlying tissue and muscle. It rejuvenates the face for a more youthful look and corrects sagging in the upper 2/3 of the face. It would be a good option for those who would like a forehead lift or an eyelid lift.

The subperiosteal facelift, or mid-facelift, only requires one treatment to see immediate results. Although not permanent, it is common for the results of the subperiosteal facelift to last for 10-15 years. This type of facelift requires a longer recovery time due to the depth of the incisions. The external stitches are removed after 1 week, however, expect to see continued bruising and swelling for several weeks. This procedure will require a 3 week break from work, which might be an important factor to consider as recovery for the subperiosteal facelift may take 1-3 months for complete recovery. This facelift type costs between $6,000-$10,000.

Plicated SMAS Facelift Like the SMAS facelift, the plicated SMAS facelift focuses on the mid and lower face and aims to flatten nasolabial folds and treat sagging cheeks or jowls. A plicated SMAS is a variation of the SMAS facelift, differing in the way suspension is performed. It still works to reduce wrinkles and sagging skin on the face and neck that are caused to aging or weight loss by removing excess skin, tightening the underlying muscles and re-draping the skin in a higher position.

Although an incision is made starting in the temporal hairline and moving around the frontal edge of the face, the plicated SMAS facelift varies from an SMAS facelift, and is completed by using plication techniques for the SMAS suspension. This avoids further incision and undermining of the SMAS flap. The SMAS fascia is folded over on itself and held together with permanent buried sutures. These sutures serve to pull the SMAS in 3 upward and outward directions. Excess SMAS in the infra-lobular region is excised and the excess skin is trimmed. The wound is then closed and covered by a facelift dressing.

The goal of the plicated SMAS facelift is to rejuvenate your skin, creating a more youthful appearance by “lifting” and correcting midface sagging, marionette lines, jowls and double chins.

Patients see results from the plicated SMAS facelift immediately after surgery with results lasting 7-10 years depending on the effects of gravity and continued aging of your skin. Recovery often last 2-3 weeks and the cost fluctuates between $10,000-$15,000.

Endoscopic Facelift An endoscopic facelift is a minimally invasive surgery that focuses on the skin around the forehead, eyes, and cheeks. It is a great option for those who are unhappy with the appearance of their skin or those with moderate imperfections caused by fatty tissue and loose facial muscles in those areas. It is rarely done in facelifts where it is generally best to reposition underlying muscle and remove excess fat and skin or do a fat transfer.

An endoscopic facelift begins with a dissection of the midface region via lower the lower eyelid area. The surgeon continues to concentrate efforts around the upper portion of the face and split incisions are eventually closed without removing skin, except in the lower eyelid region, which generally requires excision of skin muscle. Once the operation is complete, the surgeon applies a front and midface taping.

The goal of the endoscopic facelift is to correct facial sagging by focusing on the upper part of the face. Results from this type of procedure typically last about 5-10 years, although results are obvious immediately. Recovery typically takes 1-2 weeks, and the procedure itself costs between $6,000-$10,000.

Deep Plane Facelift A deep plane facelift goes deeper than a traditional facelift and improves upon the lift seen in the SMAS facelift as the long-term results it delivers along the nasolabial folds are superior to the SMAS facelift. A deep plane facelift happens below the muscular and soft tissue layer (below the SMAS level). Because the plane facelift takes place in the deeper tissues, it carries a higher risk of nerve damage.

The deep place facelift begins with the same incision as the SMAS facelift, and a submental lipectomy and playsmaplasty are performed in the submental region. The dissection takes place in 3 different areas, depending on the area of the face or neck in need of lifting. It can be done in the neck, in the mid-face, or in the lower face.

The goal of a deep plane facelift is to correct midface sagging, marionette lines, jowls and double chins.

Results from a deep plane facelift are noticeable immediately after surgery and last 10-15 years. The results vary from person to person depending on gravity and aging factors. Recovery lasts approximately 2-3 weeks and costs anywhere from $10,000-$20,000.

Mini-Facelift The mini-facelift involves suspension of the SMAS, but through a much smaller incision. It restores a youthful appearance by rejuvenating the cheeks and jowls. The mini-facelift goes by several different names including the “s-lift”, “weekend facelift”, “ponytail lift”, “lunchtime facelift” and “short scar facelift”. The name depends on the variation of the procedure, which may include either adjusting the length of the incision or the depth of the tissue affected.

Unlike the traditional facelift, the incision of a mini-facelift does not extend into the temporal region after the initial incision is made. Like the short-scar face lift, the SMAS layer is elevated along with the subcutaneous tissues. The SMAS is then able to either be plicated or imbricated. After the surgery, your incision will be closed and you will receive a head dressing.

The goal of a mini-facelift is to correct midface sagging, marionette lines, jowls and double chins.

The results of a mini-facelift are noticeable immediately after the surgery and last 5-10 years. Recovery takes 3 days to 2 weeks and costs between $4,000-$7,000.

Thread Lift A thread lift involves the subcutaneous placement of threads that are lifted and pulled to achieve the desired skin lift. It focuses on midface, jowl, and neck-lifting. When performing a thread lift, a plastic surgeon inserts a needle in a curved direction into the targeted area within the subdermal level. Another needle is inserted 1-1.5cm above this needle. These needles insert bi-directional threads of polypropylene which use barbs (which act like cogs) to grasp, lift and suspend the targeted facial area. As the needle is withdrawn, the tissue is “gathered” over the thread. Once the desired lift has been achieved, the ends of the thread are cut off.

Sutures dissolve naturally within 6 months leaving no residual material. During that time, new collagen and fibrous tissues form around the sutures and continue to hold up and tighten the skin.

The goal of a thread lift is to reposition facial and neck tissues to restore youthful proportions and appearances to the treated area. Thread lifts are also useful in for brow lifting, butt lifting and knee lifting.

The results of a thread lift are obvious immediately, however, maintenance treatments will be needed every 6-12 months. Texturized threads will produce more instantaneous results while smoother threads have less immediate results. Both thread types aim to stimulate collagen and produce a youthful appearance over time.

Liquid Facelift A liquid facelift restores volume and youthful contours to facial features through fillers that gently lift the face, reducing wrinkles, lines and folds. It also restores natural, curved facial contours to provide a more rested and energetic look. Different methods include Juvederm, Radiesse, Sculptra and Botox.

Juvederm Ultra is a cross-linked hyaluronic acid dermal filler used to smooth moderate to severe facial wrinkles and folds, especially the nasolabial folds. Results typically last up to 1 year.

Juvederm Ultra Plus is more cross-linked than Juvederm Ultra and is used to treat deeper wrinkles.

Juvederm Voluma is a hyaluronic acid injective gel used to add volume to the cheek area. It lasts longer than other hyaluronic acid dermal fillers and lasts up to 2 years.

Radiesse uses a gel that provides a scaffold for collage production once it dissipates.

Sculptra is a collage-replacing dermal filler that works well for those with deep wrinkles or excessive fat loss in the face. It will not provide instant results as it stimulates collagen growth over time rather than filling immediately. Sculptra requires an average of 3 treatments over several months.

Botox is one of the most well-known dermal fillers, and is commonly used in conjunction with the above injectable fillers to prolong the duration of results.

The goal of a liquid facelift is to rejuvenate the face for a more youthful appearance.

1-2 treatments are needed to see results, and you will need to plan for an upkeep treatment cycle of once every 3 months. Afterwards, liquid facelifts last no more than 1-2 years and cost between $400 and $1800 per treatment.

Vampire Facelift As the name implies, the vampire facelift uses blood collected from your own arm as the key ingredient. This blood is spun through a centrifuge to spin apart the blood from the platelet-rich plasma (PRP). The PRP is then combined with a hydoluronic acid based dermal filler (ex: Restylane or Juvederm) to create a longer-lasting platelet-rich fibrin matrix (PRFM). A topical cream is then applied and will numb your face in about 30 minutes. The gel is then injected in different areas of the face to enhance facial volume.

The goal of a vampire facelift is to achieve healthy, youthful and rejuvenated skin during a quick, non-surgical procedure.

Vampire facelifts typically give noticeable results after the first procedure with continued benefits lasting from a few months to a few years. Results are temporary, though, and maintenance treatments will be needed approximately every 6 months for a continued effect. Any symptoms that you may experience typically resolve within 24-72 hours after surgery. Vampire facelifts cost between $1,500-$2,500.

Side Effects, Risks, and Complications

Almost all facelift procedure types share the following side effects: bruising, swelling, bleeding, numbness, discomfort or tightness, possible infection, potential hair loss, redness around injection site (liquid and vampire facelifts, potential facial nerve injury/damage, and facial asymmetry. Temporary loss of sensation or a feeling of tightness might occur due to the body adjusting to the feeling of newly repositioned connective tissues.

Necrosis of the skin flap, scarring, edema and ecchymosis are potential risks and complications of the SMAS facelift and the plicated SMAS facelift.

The superiosteal facelift might potentially cause nerve palsy or delayed wound healing.

Choosing a Plastic Surgeon

Do your homework before selecting a facial plastic surgeon. It is helpful to research surgeons in your area and see what others are saying about the surgeons on your list. You may also want to ask friends about their experiences with different plastic surgeons.

Either way, though, one of the most important things to check is whether or not the surgeons you are interested in are board-certified. You can determine that by looking to see if they are members of one of the following organizations:

Questions to Ask During a Consultation

Many plastic surgeons offer free consultations to their prospective patients. Once you have selected your surgeon, and determined your procedure type, you will have the opportunity to hone in on any specific questions you would like addressed before your scheduled facelift procedure. Be specific and thorough in your questions, taking care to address any areas of concern. This is also a great opportunity to ask for any clarification you might need regarding your cosmetic surgery. Make a list of your questions to bring with you to the consultation so that you are prepared and able to make effective use of the allotted time.

  • Here are some things you might want to consider adding to your list:
  • Are you board certified?
  • How often/how much experience do you have performing this type of surgery?
  • What form of anesthesia will you be using?
  • What should I expect in terms of recovery?
  • How much will this procedure cost?
  • How do you handle any unexpected complications?
  • Why am I a good candidate for this particular procedure?
  • Do you have before and after photos of this procedure?
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