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Surgery of the Ageing face
Blepharoplasty-for baggy eyelids (In
Detail) A facelift, or rhytidectomy, is aesthetic surgery to improve and sometimes eliminate evidence of aging, such as wrinkles and sagging skin on the face and neck. Preoperative Considerations: A consultation with a plastic surgeon is the first step an individual should take if considering rhytidectomy. The patient should discuss candidly his or her expectations about looking and feeling better after surgery, while keeping in mind that the desired result is improvement, not perfection. Emotional stability is one of the most important factors to be established before any aesthetic surgery is undertaken. A "new" face does not guarantee a new life. Rhytidectomy can improve your appearance and renew your self-confidence, but the rest is up to you. After examining you, the surgeon will discuss other variables that influence the decisions involved in the procedure. It is often said that a facelift will take five to ten years off a person's age, however, it is impossible to pinpoint the exact result. More realistically, a successful facelift can make a person look good for his or her age. The degree of improvement will be determined by such factors as age, heredity, bone structure and various individual characteristics of the skin; and personal habits such as alcohol intake, nutrition and smoking. These same factors, to some extent, will determine how long a facelift will last. During the initial visit, the surgeon will explain specific details of your case, including the surgical technique to be used, the anesthesia and where the operation will be performed. Additional factors to consider before electing rhytidectomy, such as risk and cost, should be discussed with the surgeon at this time. Thousands of rhytidectomies are performed successfully each year. Nevertheless, you should be aware of the potential risks of surgery and specific complications associated with rhytidectomy. Post-operative complications such as delayed healing, infection or localized collections of blood are uncommon. Poor healing may increase excessive scarring and occasionally necessitate a second operation. Risk of complications can be minimized by closely following your surgeon's advice on follow-up care during the healing process. Fees and operative facility costs of rhytidectomy vary widely. A recent study that surveyed member surgeons and the hospitals with which they are affiliated, determined total surgical fees range from $3,000 to $5,000 or more, depending on the length and complexity of the operation. Additional expenses will depend upon the anesthestic used and where the operation takes place. Since facelift surgery generally is carried out on an elective basis, most insurance plans normally do .not offer coverage. However, costs may be deducted as a medical expense on your income tax return. Fees for elective surgery usually are paid prior to the operation. The Surgical Procedure: Rhytidectomy typically is performed to remove excess or loose, sagging skin from the face and neck. (Fig. 1) The extent of the procedure depends on what changes are desired and what your surgeon deems appropriate. When removal of pouches around the eyes is desirable, eyelid surgery, or blepharoplasty, may be done in conjunction with the facelift operation or as a separate procedure.
On your surgeon's recommendation you may be operated on in the surgeon's office, in an outpatient surgical facility or you may be admitted to a hospital Rhytidectomy may be performed under a local anesthetic which numbs the area to be treated or a general anesthetic may be used Medication to relieve tension is given before the anesthetic is administered The sedative and local anesthetic allow you to be comforrable during surgery If a general anesthetic has been administered, you will sleep through the entire operation Rhytidectomy is performed first on one side of the face and then the other. Some of the hairline will be shaved before incisions are made Incisions frequently areindividualized to fit the patient's needs and the surgeon's methods In most cases an incision is started inside the hairline at the temples, continues downward in a natural line around [he earlobe and extends into the back of the scalp or nape of the neck (Fig 2) Occasionally an incision may extend inside the front of the ear. A small incision frequently is necessary under the chin to provide access to excess neck skin.
Working through the incision, the surgeon separates the skin from underlying fat and muscle. (Fig. 3) The skin is pulled up and backward in the temple area, as well as in the front and back of the ear, and the excess is excised. In some cases, accumulations of fat are removed from beneath the chin and neck, and sagging muscles and connective tissues are tightened. (Fig. 4)
If blepharoplasty is to be performed during the same operation, the surgeon will make incisions on the upper and lower eyelids, generally extending into the "crow's feet" at the outer edge of the eyes. Subsequently excess skin and underlying fat will be removed. Sutures close the incisions along the natural skin lines and creases. Although the surgeon has made every effort to keep scars as inconspicuous as possible, they are the inevitable result of surgery. In most patients scars will fade gradually and become barely visible. Those that are most noticeable, in back of the ear, can be covered conveniently by the individual's hair. (Fig. 5) Following surgery, a small thin tube may be placed in the back of the ear to allow drainage of any blood collecting under the skin. Large loose dressings will be applied to the face and neck. (Fig. 6) Depending on the extent of the surgery, with or without blepharoplasty , the procedure usually lasts from two to four hours or longer. Most rhytidectomy scars are hidden in the hairline above the ear or in normal skin lines and creases.
Postoperative Recovery After surgery, there is some pain that is easily controlled by medication. You will be asked to keep your head slightly elevated for a few days. If a drain has been inserted, it will be removed in a day or two following the operation. Dressings commonly are removed in a few days. A patient who was admitted to a hospital will be released in two to four days. Swelling and skin discoloration are common and usually will subside within a week or two. Many patients report a sense of tightness or numbness of the face and neck after surgery. The intensity of these conditions and how long they will last varies with the individual. The objective of a facelift operation is a natural, younger, more attractive appearance. (Fig. 7) However, normal healing is a gradual process, with final results not fully realized for at least three weeks. Using cosmetics is permitted after the sutures have been removed. Exposure to the sun should limited for a few months following surgery, and accompanied by a sun screen with a high protection factor.
This brochure is intended as an introduction to rhytidectomy. When considering plastic surgery, you should feel comfortable asking your surgeon for any additional information you might need.
Crow
Feet Wrinkles
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Facelift
(Rhytidectomy)
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