Facelift or Face Lift (Rhytidectomy)

Once you’ve decided to have a facelift, you will work with your surgeon to decide on the type of facelift you need. Different needs will require different techniques.

The Deep Plane Lift

The deep plane lift is a procedure that can rejuvenate the mid and lower face as well as the neck. Results can be dramatic and usually last a long time.

This procedure involves lifting, releasing and repositioning all muscle layers of the face and neck. Once these muscles have been repositioned, the facelift is completed by removing excess skin to make the skin taut and firm once again.

Incisions are made along the hairline, to the temple area and along the natural creases going inside the ears at the front, dipping below the ear lobe and ending behind the ears. Through this incision muscles and fatty tissue can be removed or tightened. Excess skin is also removed at this incision, avoiding visible scars.

The deep plane lift procedure is suitable for those with severe sagging in the face. It is popular because, compared to alternatives, it provides a long-lasting lift; between 10 and 15 years. A deep plane lift produces results by improving the mid-face, including the cheeks, jawline, chin and folds that run between the nose and lips.

The SMAS Lift

The SMAS facelift gets its name from the superficial musculoaponeurotic system, a collection of fibrous connective tissue binding the muscles to the bone. The SMAS lies below the skin on your face, surrounding the muscles used in smiling, frowning and other facial expressions. The SMAS lift involves lifting the skin and  deeper tissue layers of the face and neck, which tend to loosen and sag with age. Unlike the deep plane lift, which involves releasing muscles beneath the SMAS layer, during the SMAS lift only the SMAS and the skin are lifted and tightened.

Usually incisions are made above the hairline at the temple and extended down along the natural creases of the skin, continuing in front of the ear or at the edge of the ear, dipping below the ear lobe to extend behind the ear. Your surgeon will tighten the SMAS layer with sutures, remove excess skin and then stitch up the incision.

There are a number of popular SMAS lift techniques. The exact SMAS lift technique used depends upon the surgeon’s preferences. Overall results as well as the length of surgery, recovery period and incision placement vary depending on the technique used.

The Short Scar Lift

As the name indicates, the short scar lift is an umbrella term that covers a number of facelift techniques involving minimal lengths of incision and hence shorter scars. Usually these incisions do not extend behind the ears.

One such technique requires an S-shaped incision in front of the ear or at the temple. Your surgeon will use this short incision to resuspend facial tissues, improving smile lines and reducing jowls by tightening the skin. Another technique, called minimal access cranial suspension lift or MACS, requires an incision that ends at the earlobe.

Short scar lifts are best suited for those in their 40s and 50s who have low to moderate levels of excess skin and whose necks show minimal signs of aging. This technique means a much smaller scar than other techniques.

Endoscopic Face Lift

An endoscopic facelift is a procedure performed with the aid of an endoscope, a small probe with an attached camera, which transmits video images of the facial structures onto a screen. The surgeon uses these images as a guide in performing the operation. The endoscope is inserted through a number of small incisions hidden in the hairline. The procedure may be carried out on an outpatient basis using either local or general anaesthesia.

Small incisions limit the scope of this procedure to the lifting of sagging cheeks.

Cheek or Midface Lift

A cheek or midface lift targets the middle third of the face, lifting sagging cheeks and improving nose-to-mouth lines, resulting in subtle improvements with little downtime. Incisions at the hairline and inside the mouth are used to lift and reposition the natural fatty tissue layers over the cheekbone. This procedure can be performed on its own or in combination with eyelid surgery (blepharoplasty).

There are other variations of the facelift, depending on the area of the face to be treated, the type of incision, how much lift needs to be achieved,and the level of invasiveness of the procedure. Your surgeon will determine which procedure is best for you, after considering your appearance and the extent of required change.

You will also have to decide whether a liposuction procedure is needed in order to remove excess fatty tissue. Your surgeon will guide you in this decision process.

The technique your surgeon chooses will also determine the length of time the procedure takes. Usually, a facelift takes several hours; longer if you are having a number of procedures in conjunction with the facelift surgery. In some instances, if a lot of work is to be completed, your surgeon may schedule more than one session.

Facelift surgery is mostly performed in a hospital under general anaesthetic. Even if you are able to go home after the effects of the anaesthesia have worn off, your surgeon may want you to stay in overnight to be monitored.

After your surgeon has completed your facelift, and any facial incisions have been closed with sutures or mini staples, your face will be wrapped in a bandage. This will put pressure on the wound areas and minimise bruising and swelling. A small, thin tube may be placed under the skin to drain the excess fluids that build up after surgery. Tubes, bandages and sutures are removed a week following surgery.

You should expect some swelling and bruising on the face to last between 3 to 6 weeks. During this time your facial muscles may feel stiff and as if they are not working properly. You may feel that your face looks distorted. These impressions are only superficial and will go away as the swelling subsides. You can use camouflage makeup to hide bruises.

Scarring is natural following cosmetic surgical procedures. Your scars may take many months or longer to heal. The healing process can go on for as long as two years. During this period, raised, lumpy, itchy or red scars will fade in colour and flatten, making them less obvious.

There are things that you can do leading up to any kind of surgery that will improve the experience.

There are a number of things that you can do following any surgery.

Specific things to do after your facelift procedure:

• You can get back to light activities within a day or two. Avoid strenuous or tiring activities for at least two weeks after full facelift surgery. This rest time is shorter for short-scar facelifts.
• Avoid touching your skin, as it may be tender following surgery and you may also run the risk of causing an infection under the skin.
• Take care in brushing or combing your hair to avoid touching the surgical wounds in or near the hairline and behind the ears.
• Wash your hair daily as instructed, using a mild shampoo, taking care to avoid the stitched area.

As with any surgical procedure, there are risks involved in having a facelift. You should be fully aware of these before you consider surgery.

The best way to reduce risk is to find a surgeon who is fully qualified, has received formal training in facelift procedures and has performed the procedure many times.

Make sure you familiarise yourself with the full list of complications as a result of any surgery.

Specific complications that may occur after facelift surgery:

• Change in skin sensation including numbness. This usually goes away with time, but for some people it can take many months to return to normal.
• Injuries to facial nerves, leading to loss of sensation and weakness. This will also improve with time.
• Dryness or roughness of skin. This will slowly fade after a few months. For temporary relief, consult your surgeon for the best treatments.
• Facial asymmetry, where the two sides of the face may not look visibly similar.
• Loss of hair along the surgical scar lines.
• Dissatisfaction with results of the facelift.
• Need for revision surgery, including scar revisions.

Just as you would discuss potential benefits before surgery, it is always advisable to ask your surgeon to address the potential risks as they apply to you.

The cost of a facelift will depend on the type of facelift you have. Once that is decided, costs will also vary depending on the surgeon and the facilities used. Your surgeon will help you estimate potential costs after a consultation.

An endoscopic facelift will cost around $12,000 (AUD). This includes the surgeon’s and assistant surgeon’s fees, fees for the anaesthetist and the hospital costs.

A short-scar facelift costs around $12,000 (AUD) with all associated costs.

Expect to pay around $20,000 – $25,000 (UD) for a full facelift, including all associated costs and follow up visits.

Some Australian private health insurers may help pay for the hospital bed and theatre fees. Getting a doctor’s referral will enable you to make a claim on these costs.

You should expect the costs to be higher if you are having combined procedures at the same time.

Read our article What Does A Facelift Cost in Australia for more detailed information on all costs associated with facelift.

This information is correct as of 2013.