As people grow older, the natural aging process, genetic influences, exposure to the sun and other factors cause the skin to wrinkle and sag. In the younger individual, the face is firm and smooth due to fatty tissue directly beneath the skin. The tissue, which fills out the contours of the face, gives it an even, rounded appearance. As an individual ages, the skin begins to sag and fit more loosely. Skin folds become more prominent, particularly around the chin, on the jawline and on the neck>

In recent years, a remarkable procedure, rhytidectomy or facelift, has been developed to correct these conditions and give people the youthful appearance they desire. This procedure involves tightening of facial and neck skin and muscles and the removal of excess skin. Often a rhytidectomy is done in conjunction with other facial cosmetic surgeries such as brow and forehead lift, blepharoplasty (eyelid surgery), chin augmentation, liposuction and rhinoplasty (surgery of the nose). A facelift can be performed at any time after the signs of aging appear.

Before Surgery
Prior to surgery, a medical history of the patient is taken in order to evaluate the general health of the patient. A careful examination is also conducted. The physician and patient discuss together how the face should look and what results can be realistically expected. The goal of the surgery is to produce a pleasing natural appearance. Photos are taken before and after surgery in order to determine the amount of improvement. The type of anesthesia to be used, the procedure and possible risks and complications are also discussed at this time.

The Procedure
The surgery can be performed in a physician's office, an outpatient surgical facility or a hospital, depending on the surgeon's and patient's preference. It can be done under general anesthesia, or local anesthesia in which the area is numbed and the patient remains awake. Premedication is usually administered to relax the patient.

In the basic procedure, the surgeon works on one side of the face at a time. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. Loose skin is separated from underlying tissue and is pulled up and back and excess skin is removed. Connective tissue and sagging muscles are tightened, and in some cases, fat deposits are removed from beneath the chin and neck. Tiny sutures are used to close the incisions. The surgery may take from three to five hours, depending on whether other procedures are performed at the same time.

Following Surgery
After surgery, loose bandages which are applied to the area are removed within a few days. Patients who are operated on in a hospital are released the day of surgery or after an overnight stay. Pain connected with the surgery is minimal to moderate and is controlled with oral medication. The surgeon determines when sutures are removed. This may be done in stages in order to minimize the scarring. Scars from incisions fade significantly with time and are normally inconspicuous because they are made within natural creases. Swelling and discoloration will disappear within a week or two. Swelling can be reduced by keeping the head in a slightly elevated position when reclining. A tightness or numbness or the treated area may be present for awhile, and there may be slight changes in the normal hair pattern around the incision. A limited amount of blood collection under the skin may occur temporarily but does not affect the overall results.

Patients are advised to avoid the sun for several weeks following surgery. Healing is gradual and final results may not be apparent for several weeks. The amount of the improvement varies depending on the initial condition of the patient and the extent of the surgery. In most cases, a single procedure achieves the desired results, while in some cases additional procedures may be indicated. Most patients who have had a facelift are delighted with their more attractive, rested appearance.

Each year thousands of rhytidectomies are performed successfully. Serious complications are rare; however there are certain inherent risks connected with every surgical procedure and should be discussed with the physician prior to surgery.