According to statistics gathered in 2004, rhytidectomy or a “face lift” was the fifth most popular cosmetic procedure performed in the United States. Normally candidates are men and women aged 40 or older who desire to reverse the most obvious signs of aging including loose folds of skin on the neck and wrinkles on the cheeks. Individuals considering the procedure should understand, however, that while the surgery can give them a more youthful appearance, it will not get rid of all facial wrinkles and does not address those adjacent to the eyes, nose and lips.

First performed in 1901, rhytidectomy seeks to remove excess facial skin and may or may not include the tightening of the underlying tissue of the face. A long incision is made from the hairline at the back of the neck, curving around the back and in front of the ear, and across the hairline, down along the far ear, and to the back of the neck on the other side. This allows the surgeon to separate the skin from the deeper tissues on the cheeks, chin, and neck with scissors or a scalpel, removing the excess and/or tightening the underlying areas with sutures before the skin is pulled up, back, and repositioned. The procedure leaves long, thing scars, but those in front of the ears and along the hairline are usually impossible to detect on casual observation.

Note that a somewhat unnatural asymmetrical appearance to the hairline can occur and men should be prepared for the need to shave behind their ears. As with any procedure, the skill of the surgeon will effect the degree to which these effects are problematic. It is also possible for women’s earlobes to be pulled down somewhat and distorted or, in instances when too much skin has been removed, for the face to assume an extreme “pulled back” appearance. To avoid these undesirable after-effects, face lift candidates are urged to engage in extensive consultations with one or more surgeons before electing to undergo the procedure and to maintain realistic expectations about the outcome of the surgery. It is not unusual for a face lift to be combined with blepharoplasty to tighten the area around the eyes or with chemical peels or laser treatments to resurface the skin.

Rhytidectomy is performed under general anesthesia or with the patient in a state of deep twilight sleep. The work takes several hours with bleeding being the most common complication although nerve damage and skin necrosis (dying tissue) are possible though less likely. The incision is closed with small sutures and it is routine for a drain to be placed behind the ear. Both the incision and the drain will be removed within days: 1-2 for the drain, 5-10 for the stitches. Patients are cautioned not to take aspirin or blood thinners prior to the surgery and smokers should stop weeks before the procedure and if possible, not return to the habit afterwards as cigarette smoke impairs healing and ages the skin. Those with high blood pressure or diabetics should consult with their primary care physician to insure that steps are taken to avoid any post-operative complications.

When recovering from a face lift patients should not drink alcohol or use steam baths or saunas for several months. Exposure to the sun should be severely limited. There will be considerable facial bruising and swelling after the procedure that is often extremely distressing to patients. These effects will disappear in 2 to 3 weeks and the surgeon will advise the patient to keep their head elevated and may prescribe appropriate medications such as antibiotics or an anti-inflammatory. Thankfully there is little pain from the procedure although the face may feel tight and unnatural for several weeks and numbness may be present. The skin may also have a roughened texture. It is important to follow the care regimen prescribed by the surgeon in charge of the case.

Individuals who have undergone a facelift should return to normal activity in 10 to 14 days although some elect to wait longer until they are comfortable with the degree to which the post-surgical swelling and bruising have diminished. Strenuous activity should be avoided for a minimum of two weeks. Health care insurance does not cover the cost of rhytidectomy and its associated expenses (anesthesia, facility use, supplies for post-operative care, and similar issues). Patients should expect to pay approximately $6,000 for the surgery alone although in some instances the cost can run as high as $12,000 with additional associated fees attached in the range of $4,000 to $6,000.