Rhytidectomy

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org], Paul C. Zwiebel, M.D., D.M.D., FACS [mailto:pz@pzwiebel.com]

Overview
A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. The first facelift was performed in Berlin in 1901 by Eugen Holländer. According to the most recent 2007 statistics from the American Society for Aesthetic Plastic Surgery, facelifts were the seventh most popular aesthetic surgery performed after liposuction, breast augmentation, blepharoplasty (eyelid surgery), abdominoplasty (tummy tuck), breast reduction, and rhinoplasty.

In the traditional facelift, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck. After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck. At this point, the deeper tissues (SMAS, the fascial suspension system of the face) can be tightened with sutures, with or without removing some of the excess deeper tissues. The skin is then redraped, and the amount of excess skin to be removed is determined by the surgeon's judgement and experience. The excess skin is then removed, and the skin incisions are closed with sutures and staples.

Facelifts are helpful for eliminating loose skin folds in the neck and laxity of tissues in the cheeks. The areas not well corrected by a facelift include the nasolabial folds and perioral mounds marionette lines which are more suitably treated with Botox or liposculpture, respectively. A facelift requires skin incisions; however, the incisions in front of and behind the ear are usually inconspicuous. Hair loss in the portions of the incision within the hair-bearing scalp can rarely occur. In men, the sideburns can be pulled backwards and upwards, resulting in an unnatural appearance if appropriate techniques are not employed to address this issue. Achieving a natural appearance following surgery in men can be more challenging due to their hair-bearing preauricular skin. In both men and women, one of the signs of having had a facelift can be an earlobe which is pulled forwards and/or distorted. If too much skin is removed, or a more vertical vector not employed, the face can assume a pulled-back, "windswept" appearance.

Facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.

The most common complication can be bleeding which usually requires a return to the operating room. Less common, but potentially serious, complications may include damage to the facial nerves and necrosis of the skin flaps, or infection.

Contraindications to facelift surgery include severe concomitant medical problems. While not absolute contraindications, the risk of postoperative complications is increased in cigarette smokers and patients with hypertension and diabetes. Patients should abstain from taking aspirin or other blood thinners for at least one week prior to surgery. Patients should consult either an otolaryngologist, maxillofacial surgeon, or a plastic surgeon for more information.

Costs
Cost varies by country where surgery is performed (2008) : Additional Notes on Costs in Europe (2009) :
 * India - US$4,800
 * Malaysia - US$6,400
 * Panama - US$2,500
 * Singapore - US$7,500
 * South Korea - US$6,650
 * Taiwan - US$8,500
 * Thailand - US$5,000
 * United States - US$4,000-$6,000
 * Belgium - UK£1,650
 * Italy - UK£5,000
 * United Kingdom - UK£4,000-£9,000