Facelift (Rhytidectomy)


What is a Facelift?

Dr. Guy is a facial plastic surgeon practicing in Shenandoah, located right in the heart of The Woodlands, Texas.  As a double board-certified surgeon, fellowship trained in facial plastic surgery, practicing only facial plastic & reconstructive surgery, it puts him in a unique position to offer high quality, specialized care for all of the faces of The Woodlands.  When it comes to something as precious as your face, why would you trust it to anyone other than a facial plastic surgeon?  One of our most common procedures performed is the facelift, a procedure designed to help turn back time and restore you to a more rejuvenated appearance.  Read below to learn more about what you can expect with a facelift.

The Greek word for wrinkle is “rhytid.” The suffix -ectomy means “to remove.” Thus rhytidectomy is the medical term for the operation designed to remove or lift wrinkles and sagging tissues from the forehead, face, and neck. The term “face lift” is often used incorrectly in the media. This may be to help market some new fad or it can be used to describe a total facial rejuvenation, which, in reality, consists of an eyelid surgery, a face lift, and possibly skin resurfacing. While a true face lift provides the foundation for the rejuvenation process, other procedures may add the finishing touches. By no means, however, does this mean that every patient who requests a face lift should have any additional procedures. These are only recommended if they would provide further benefit, and if the patient is interested in these procedures.

Face lifting may be done for one or two reasons.   The first reason is to help prevent the advancement of aging, i.e., to help relatively young individuals (about 40 or less) to appear to stay young. The second reason is to assist one who is already showing more advanced signs of aging or whose skin sags to appear younger and more rested.

The goal of the face lift operation is to reduce the signs of aging. In the face these manifest as alternating ridges/bulges and hollows with each bulge having previously filled in the hollow above it. With time, the once full and youthful face begins to sag and the skin loosens. The youthful face has more of a triangle shape with the apex at the chin.  With age the triangle flips creating a heavier bottom half of the face.  Common physical signs associated with aging includes the development of crepey skin in the neck, the presence of bands or lines on the front of the neck running from the chin to the breastbone representing a muscle called the platysma, sagging jowls, sagging cheeks, loss of volume below the cheek bones, and an overall heavy appearance.

A face lift is designed to counteract each of these findings and forces by lifting the tissues and restoring them to their more youthful position. This includes not only lifting the skin but more importantly the underlying muscles and fatty tissues. It is important to realize that a face lift does not correct problems in the upper or lower eyelids, or the wrinkles or creases in the lips—other procedures (blepharoplasty, skin resurfacing, and/or lip enhancement) are required for these conditions. The folds extending from the nose to the lateral corners of the lips may be improved but not eliminated with a facelift. They can be further improved by using your own collagen as a filler in this area.  This procedure can be performed at the same time as a facelift.  

However, not all facelifts are the same – nor should they be! The reason is that not all faces are the same. And, at different ages, the same person has different conditions of aging that develop. The facts are plastic surgery is very much an art form and can be tailored by an experienced surgeon/artist to meet the needs of each individual who presents for treatment.

The facelift has become one of the most popular cosmetic operations performed in the head and neck because as medical advances and new technology increase the average life span, many women, and men, find that they look older than they feel. The antiquated stigma previously associated with having plastic surgery is disappearing. Men and women from all walks of life are seeking ways to look as good as they feel. The techniques I use produce results which result in “natural” and “un-operated” looks as can be seen in the before and after photos.

The operation itself may be divided into three parts: the forehead or eyebrow lift (the upper one-third), the cheek lift (the middle one-third), and the neck lift (the lower one-third). Most people require all three components but occasionally only one or two portions are needed or recommended. The most common isolated request is a “neck lift.” Most people seeking “neck lifts” require some lifting of the cheeks in order to avoid “puckering” of the skin around the ears. In select patients, it is possible that a neck lift is all that is required. I will recommend what would be of benefit during your consultation.

When it comes to a facelift, for marketing purposes many surgeons will "claim" to create a particular lift.  The most important structure in the facelift is the "SMAS" or skin-muscle aponeurotic system.  This is the layer in the face that connects the muscles to the overlying skin.  More importantly for lifting, it is a very strong layer that helps to support the longevity of the lift.  Any facelift that is meant to last must address this layer.  Procedures that address this include the SMASectomy, deep plane lift, composite lift, and sub-SMAS dissection. Each of these lifts addresses the SMAS in an appropriate way, with nuances between each.  

As some patients are wary of the term facelift, people have created many names for procedures that have been around for awhile.  This includes the "S lift, mini lift, lifestyle lift, short scar lift, twilight lift, deep plane facelift, etc."  Some of these are less invasive and others are more invasive.  What really matters is your surgeon is skilled in the procedure, is performing the right procedure for the right reason on you, and is addressing the SMAS layer.  

Dr. Guy has been trained extensively in the various surgical approaches for rejuvenating the face to give you the best aesthetic outcome which can be discussed with Dr. Guy in consultation

Facelift Surgery and Recovery

Technically, the face lift operation consists of repositioning and supporting the sagging skin and the underlying tissues of the face and removing the excess skin and fat.

There are several locations where the incisions can be placed during a face lift based on your anatomy. The scars in the hair and around the ear may be camouflaged with the adjacent hair or by the natural creases and folds of the ears. Incisions that are next to hair lines are beveled to allow the hairs to grow through the scar and camouflage it even better. The incisions within the hairline are made in such a way to minimize trauma to the surrounding hair. On rare occasions, there may be some thinning of the hair around these incision lines. If this were to occur, the area can be covered by combing adjacent hair over it, or by a minor “touch-up” procedure. However, I employ techniques designed to protect and preserve hair and to minimize this risk.

If a temporal or forehead lift is performed, the hairline may be altered. If the hairline is high, the pretrichial incision (in front of the hairline) can help to lower the hairline. If the hairline is low, the coronal incision (behind the hairline) can help to raise it and create more of a forehead.  For the temporal extension approach, the incisions are tailored to minimize hairline alterations and avoid the telltale sign of a facelift with a loss of hair above the side burns. Essentially, the operation is “customized” to fit the needs and desires of each patient seeking surgery as discussed in the brow lift section.

During preparation for surgery, we do not shave any hair as we feel it does not assist us and only creates concerns for the patients. Instead, the hair is placed into tiny pigtails to allow me to be able to work around it. Because I close those incisions made in the scalp with small metal clips, it is not necessary to shave the hair. Obviously the fact that one has had surgery is easier to camouflage when hair shaving is avoided. Another distinct advantage of the metal clip closure is that patients may wash their hair the next day after surgery. As a matter of fact, we recommend daily shampoos following face lift surgery starting on day number two (2) after surgery.

Some degree of tightness, numbness or weakness of surrounding tissues is expected following surgery. It is usually temporary, disappearing as healing progresses. The tightness will increase for the first few days as the swelling increases. This is not an “overdone” surgery but merely the body’s response to any surgery. As the swelling dissipates the tightness will improve. The numbness is most common in front of and below/behind the ears. If a brow lift was performed, depending on the technique then the scalp may also be numb. As the nerves regenerate it is normal to feel little pings, zings, and itches. This is the body healing and it is important not to itch these areas.

The operation may be done either under “twilight” anesthesia or general anesthesia. I am trained and have operated under both conditions. Certain candidates are better for one type over the other. The final decision as to what type is used will rest with the anesthesia team, although we can provide our preferences to him or her. More than 95% of the face-lifts we perform are done in outpatient facilities, but even if the surgery is performed in the hospital, patients are usually discharged the following day. If the surgery is performed in an outpatient facility instead of the hospital, the total cost is usually considerably less. These arrangements will be discussed during the consultation and depend on your overall health.

A head bandage is worn the night following surgery. I do not leave drains in place as they can be uncomfortable to remove and can stimulate bleeding when they come out. As a result, the head bandage is kept snug for your safety, but it is generally removed the next morning when a much more loose fitting supportive garment is used to help with cold compresses. The face may be swollen and some discoloration may be present. This discoloration usually fades away within about 10-14 days but not before it increases for the first two to three days. Patients can return to most of their “normal routine” within two (2) weeks. But the face and neck may feel “tight” and movement will be restricted. This is to be expected as long as the tissues are swollen.

The patient returns to the Clinic in about a week to have the sutures and clips removed. Makeup may be worn by ten (10) days and he/she should be able to return to work and carefully drive an automobile in fourteen (14) days if work was performed on the neck or in seven (7) days if a neck lift was not performed. Patients must not pull against tightness, lie on their sides or engage in heavy lifting during this time. Doing so can interfere with healing and lead to less than favorable results. Specifically, scars will defend themselves and if you pull against them with the above activities then the scar will likely widen. For best results and better scars these activities (other than driving) should be avoided for at least 6 weeks following surgery.

Dr. Guy has been trained extensively in the various surgical approaches for rejuvenating the face to give you the best aesthetic outcome which can be discussed with Dr. Guy in consultation

Who is a Good Candidate for a Facelift

After learning what a facelift is, are you a good candidate for a facelift?  

Men and women from all walks of life are having face lifts; however, not everyone seeking improvement is an acceptable candidate for surgery. Those with known serious medical problems may not be surgical candidates depending on the condition and how well it is under control. Patients who are obese with a short, thick, neck have little chance for a worthwhile result. The severe “turkey gobbler” deformity which occurs in the neck of some individuals may best be corrected by a direct excision in the midline of the neck under the chin.

Each individual who wants to look “better” presents a different set of problems. Consequently, the corrective procedures indicated vary with each case. For example, one person may require only elevation of sagging eyebrows or improvement in the eyelids. A very young individual may need only correction of an early double-chin with liposuction. On the other hand, a partial or complete face and neck lift followed by a skin resurfacing procedure may be called for in more advanced cases. Skin resurfacing including a chemical face peel, dermabrasion and/or laser resurfacing procedure may provide the “icing on the cake.” 

Many people will ask if he or she is the right age.  When it comes to the surgical procedure, there is no set minimum or maximum age.  Assuming you show the signs of aging that are addressed by a facelift, then you are a candidate.  The most common age for the first facelift is around 55.  For patients looking to maintain a youthful, "never aging" appearance they will undergo a facelift at an earlier age.  Those who wait until a later age when the signs of aging are more advanced will have more of a rolling back of the clock following surgery.  

Although there is no "perfect" candidate, there are certain traits that will help you achieve a better, a longer lasting result.  

First, you want to be within about 15 pounds of your realistic weight.  This does not mean within 15 pounds of your goal weight, but if you are losing weight and have a little more to go, it is best to have the weight off before the surgery.  The reason is that surgery addresses what is present on the day of surgery.  If you continue to lose weight then the skin that was being pushed out by the fat will begin to sag.  Gaining a lot of weight after surgery won't lead to sagging tissue, but it will push out the skin more so the definition achieved at surgery may not be as noticeable.  

Along the same lines as weight loss, those patients who start out with a much heavier face because of excess weight will not achieve the same results as someone who is thinner.  It has to do with how much definition can be achieved with liposuction to the face and how the heavier tissue minimizes how much of a lift can be achieved.  This does not mean patients with heavier faces cannot or should not have a face lift.  If you do start out with a heavier face you can still have dramatic results with a face lift, but the results could be that much greater if you were able to lose some of the excess weight.  

Realistic expectations are an important part of any surgery.  A facelift can remove what is present at the time of surgery.  It does not prevent further aging from taking place.  It also does not address the skin texture, although by removing the slack in the skin it can improve them to some extent.  A facelift doesn't address the eyes.  This is improved with an eyelid surgery or blepharoplasty.  At the time of consultation we will discuss what can be realistically achieved for you.  

Lastly, the most important factor to determine if you are a good candidate for surgery is your overall health.  This is truly the only limitation.  This doesn't mean you need to be in perfect health, and the surgery does not require you to be put completely to sleep (general anesthesia) which does make it safer.  But if you have a condition that any type of anesthesia would be dangerous, then surgery may not be the route for you.  

Before and After Facelift
Before and after facelift
 actual patients

actual patients

Surgery went well. Results better than expected. Well worth it! Swelling was pretty minimal after first week. People who work with me had no idea I even had surgery . Followed post operative instructions closely and made sure to take it very easy that first week. Was surprised by how little pain there was.
I had surgery in February of 2015 and had a total face procedure. Even though I was nervous about surgery I was not nervous about having Dr Guy as my surgeon. He made me confident in the process of healing and I am pleased with what he preformed on me . I don’t look like I had surgery .I look like myself ,just minus the sagging signs of age. He just brought out what I look like before things started to breakdown on my appearance. I really appreciate his talent and appreciate him. He pays attention to detail and is a very talented doctor I’m glad I met him.
— Sharon S.