Rhytidectomy or “face lift” is still the first line of defense against the changes of aging in the face. First described in 1917, it still remains the same operation although many refinements have been added since. Through cleverly hidden incisions around the ear, sagging and loose facial tissues are lifted to reverse the changes from the ravages of time.
The question I am most commonly asked is: “When is the best time to have a facelift?” My answer has always been: “The earlier the better.” This is because younger individuals have better, healthier facial tissues, including more robust collagen and elastin fibers. As a general rule, the better the tissues, the better the result.
For instance, elastin is a protein responsible for the stretchiness in skin. It begins to disappear from the face when a person is roughly in their mid-thirties — about the time that most people start to notice unwelcome changes in their face. So a facelift in the mid-thirties will last longer, and also be less-conspicuous.
For example, if you had a pair of identical twins, and one had a facelift at age 35 and the other did not, by age 60 you may not be able to identify them as twins. Surgery tends to form scar tissue which reinforces the skin and resists future stretching. This principle is borne out from skin dynamic studies as well as from personal experience. However, a facelift at any age tends to hold back time.
Today’s facelift is not entirely like the procedure of yesterday. We often combine this with a procedure called a “submental lipectomy” to remove excess neck fat and produce a much improved neckline. I like to include this surgery with a facelift, as the neck tends to age worse than the rest of the face, as well as earlier. We may also include “muscle lifts” to further improve the general facial appearance, in addition to a fat transfer procedure to contour what has been lost from fat drop-off, since some faces lose much more fat over time than others.
I perform these surgeries under general anesthesia, and a typical lift will take from 3 to 4 hours. Post-operative pain is virtually nonexistent and I encourage my patient to carefully follow simple instructions for about 3 weeks (basically, take care of yourself and don’t be too active). I also use a fascinating product known as Evicel, which is a natural glue that adheres the lifted skin to the underlying structures; this reduces the risk of most of the major complications of facelift surgery, such as bleeding, hematoma formation, circulatory problems, and skin flap loss. For this reason, I also do not use drains. Rhytidectomy is a very personal experience for both the patient and the surgeon and I encourage anybody interested in this procedure to come in for consultation.