Facelift / Lower Face & Neck Lift | Montgomery
A rhytidectomy is a medical term for a facelift. A facelift typically addresses the lower face and neck. More specifically referring to the jowls, jawline, and loose skin and tissue of the neck. The anterior of the face is more mobile than the side of the face, which has extensive strong retaining ligaments that stabilize the tissue. As we age the forces of gravity cause the mobile tissue in the anterior face and neck to sag inferiorly. Volume loss also occurs in many and much like letting the air out of a balloon cause even more loose redundant tissue. This is one of Dr. Nizam’s favorite procedures offered at Alabama Surgical Arts. In fact, he has recently published on his techniques for reshaping the neck in the American Journal of Cosmetic Surgery.
The procedure itself consists of incisions that start in the hairline on the side of the face, track downward and slightly inside the ear, then around the earlobe, back behind the ear, and into the posterior hairline. An additional incision is placed hidden underneath the chin to gain access to the neck. These incisions typically are imperceptible by 6 months and due to there location are well hidden in the healing period. The skin is then lifted off the deeper tissues. The deeper tissue know as the SMAS is then utilized to transfer volume back vertically into the face where it was located during youth. For patients whom have lost volume of the face fat transfer is used to restore the contours of youth. The neck skin is raised in a similar fashion. Excess tissue is removed if present from the deeper structures of the neck. Once this is accomplished the tissues are resuspended to recontour the neck and provide a more acute angle. The skin is then redraped back over the new contour that was created in the deeper structures and any excess is removed. Facelifts are performed under general anesthesia and vary in length from 4 to 5 hours.
The above described procedure is analogous to the making of a bed where the pillows are strewn about under the covers. The covers are raised (skin), the pillow (deeper tissue and fat) are moved back to their original positions, and the sheets (skin) are laid back over taking out the excess slack. This is far different from the procedures of the past where surgeons merely tightly pulled skin posteriorly, often resulting in a windswept look. The goal is to turn back the clock 10 years without looking overdone or artificial.
It is necessary to have someone drive you home and stay with you for the first 24 hours. Social downtime is typically 7-10 days. A compressive dressing and drains are typically placed for the first 24 hours. You are seen after 24 hours and these are removed and the surgical site examined. An elastic head wrap is worn for all day for the first week. The face and neck may initially feel tight. At 1 week the first set of sutures are removed. The following week an elastic head wrap is worn at night. At 2 weeks staples and remaining sutures are removed. Make up is able to be worn after the dressing is removed on all areas except the incision lines. Minor contour irregularities are common in the initial few weeks and gradually disappear as swelling and edema subsides over the first 1-2 months.
Complications following facelift are rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and scarring. Infection is rare due to the large blood supply to the face. The risk of wound complications increases in diabetics, persons with a history of radiation, autoimmune and collagen disease as well as in smokers.
An often asked question is how long does the procedure last? The goal as mentioned earlier is to turn back the clock 10 years. The face continues to age from the date of surgery onward. Additionally, minimally invasive maintenance procedures may be recommended to maintain the result.