Introduction
The causes of age are well documented – the effects of gravity, exposure to the sun, and the stresses of daily life. The effects are apparent – deep creases between the nose and mouth; a slack and a jowly jaw–line; folds and fat deposits around the neck.So what can be done to prevent aging? Well, nothing actually. Although you continue to age with a face lift, or “Rhytidectomy”, it does appear to set back the clock, improving the most visible signs of aging. It achieves this by removing excess fat, tightening underlying muscles, and re–draping facial and neck skin. As face lifts treat the bottom two–thirds of the face, it is not uncommon to combine another procedure, such as a forehead lift, eyelid surgery or nose reshaping. Clearly, a face lift can take you towards looking younger and fresher and increasing your self–confidence. What it can’t do is give you “A totally different look”.The best candidate for a face lift is a man or woman whose face and neck have begun to sag but whose skin still has some elasticity and whose bone structure is strong and well–defined. As for age, most patients are in their 40s–60s, but face lifts can be done successfully on older people as well.

Face Lift Surgery
With the aging process, there is loss of elasticity in the skin, decreased muscle tone, and loss of fatty tissue immediately beneath the facial skin. Conversely there may be an accumulation of fatty tissue and relaxed muscle under the chin. Heredity and sun exposure definitely influence the progression of facial aging. A face lift surgery (cheek–neck lift surgery) can be performed to improve the aged appearance of the lower two–thirds of the face and the neck. The amount of improvement with surgery depends upon the extent of sagging, the bone structure of the face and wrinkling of the skin. The goal of this surgery is a more rested, vibrant and natural look – not a pulled, mask–like appearance. In the past, face lift surgery involved only the removal of excess facial and neck skin. Today there are several techniques used in a face lift, depending upon the problems that each patient has and what the patient wants to achieve.The most common patient concerns are jowls that occur along the jaw line, lax skin in the neck, bands or “Turkey gobbler” appearance of the neck under the chin, and accumulation of fat immediately beneath the chin. In order to correct these problems, all of the involved tissues must be corrected. That is to say, not only is excess skin excised and fat removed with liposuction, but the platysma muscle is lifted and tightened as well (called the platysma cervical lift).

Surgeons can remove excess muscle which causes bands under the chin and elevate the muscle to decrease or eliminate the jowls. By pulling the sagging muscle up, surgeons can tighten those muscles and avoid tension on the skin. A much better, longer lasting result can be achieved with this deeper plane lift. This eliminates the unnatural, mask–like look that can occur when the skin is pulled tightly. With the platysma lift, we are able to re–sculpt the frame of the face and neck, and delay the recurrence of the physical signs of aging. Patients are sometimes interested in “Mini–lifts.” The surgery is less extensive, and consequently the period of convalescence is shorter. Beware, however, that a mini–lift gives a mini–result. The improvements are not as significant, nor do they last as long. Surgeons can improve the deep folds and creases of the face with face lift surgery but the fine lines such as those occurring in the upper lip are untouched. In order to correct these problems, other procedures such as dermabrasion, chemical or laser peel, or collagen injections are necessary.

Procedure
The incisions start below the tuft of hair in front of the ear. In this way the excess skin can be removed without elevating the tuft, which would cause an obvious bald spot. The incision progresses into a natural crease and then it can be hidden within the ear canal. It is extended around the ear lobe onto the back side of the ear and into the hair immediately behind the ear. When it is necessary to remove excess fat or muscle under the chin, they place a separate incision in a crease under the chin. In this manner they place all the incisions in natural creases or are hidden within the ear and hair–bearing scalp. Discomfort is minimal and treated with analgesics for a very short period of time after surgery. A dressing is kept in place for three to four days. The sutures around the ears and under the chin may be removed about six days after surgery. Those within the hair are removed in ten to twelve days. You should allow approximately two weeks for recovery from the temporary bruising, swelling and discoloration that occurs. Makeup can be worn seven days following surgery. Cosmetologists who specialize in helping patients improve their appearance during the short period of convalescence can be approached. There is some numbness around the face which resolves over several weeks. The patients experience tightness in the face and neck, which prohibits strenuous activities for a few weeks.


Complications with Face Lift
Just like any other cosmetic surgery procedure, face lifts can have complications. The facial nerve, which supplies movement to the face, creates the most problems. But this occurs in fewer than 1% of face lifts. Deep plane facelifts – those that go deeper than the skin – are associated with a higher rate of injury to the facial nerve (from 1%–20%). Even so, the American Society of Plastic and Reconstructive Surgeons points out that most problems resolve without surgery.
As we all look different, face lifts are “Individual” procedures. In an initial consultation the surgeon will evaluate the face, including the skin and underlying bone, and discuss with the patient the goals of the surgery, explaining the techniques and the anesthesia that will be used, the type of facility where the surgery will be performed, and the risks and costs involved.

Patients are advised to refrain from smoking for two to three weeks before and after surgery. Smoking decreases circulation within the skin and may cause complications in terms of persistent swelling and bruising, increasing the risk of skin loss. One potential complication of face lift surgery is the collection of blood or tissue fluids under the skin resulting in a “Hematoma.” If this collection of fluid should develop, it is removed, but it may prolong the period of recovery. Although unusual, pigment changes in the facial skin or loss of sensation in the skin around the ears are possible. The complication of facial weakness or paralysis is extremely rare because the facial nerve is usually located deeper than the tissues involved in face lift surgery. The goal of face lift surgery is a more rested, vibrant look, not the appearance of a 20–year–old. The improvement lasts forever. Although the patient continues to age after face lift surgery he/she will never look as old as if the surgery had not been performed. However, once you see how good you look after a face lift, you may want a “Touch–up” after eight to ten years to maintain that appearance

Anesthesia
Most facelifts are performed under local anesthesia, combined with a sedative to make the patient drowsy. He or she will be awake but relaxed. The face will not be sensitive to pain. Occasionally some tugging or discomfort will be felt. Some surgeons prefer a general anesthesia, in which their patients will sleep through the operation.A facelift can take a few hours or longer with additional procedures. For extensive work, some surgeons may schedule two separate sessions. Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on person’s facial structure and the surgeon’s technique.Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin. In general, the surgeon separates the skin from the fat and muscle. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp. A small, thin tube may be temporarily placed under the skin behind the ear to drain any blood. The surgeon may also wrap the head loosely in bandages to minimize bruising and swelling.

A number of surgeons agree that the key to a good facelift is to put tension on the muscle layer and to minimize the tension on the skin to avoid a pulled, stretched appearance. They say that the overlapping excess skin should be removed comfortably and that too much tension can result in widened scars when normal facial activity resumes. A telltale sign of a poor facelift is when the hairline is pulled too high at the temples. Surgeons view the critical issue as being not where the hairline starts out, but where it will end up.There isn’t usually significant discomfort after surgery. If there is, it can be lessened with a painkiller. Some numbness of the skin is quite normal, but it will disappear in a few weeks. To keep the swelling down, the head should be elevated and as still as possible for a couple of days. Drainage tubes, if one has been inserted, are removed one or two days after surgery. Bandages, when used, are usually removed after one to five days. A pale, bruised, and puffy face will emerge. But it takes only a few weeks to return to normal. Most stitches are removed after about five days. A scalp may take longer to heal, and the stitches or metal clips could be left in a hairline for a few days longer. Most of the scars are hidden within the hair and in the normal creases of the skin.

After the Face Lift
After a facelift, the patient is up and about in a day or two. Invariably he or she is advised to take it easy for the first week and to be especially gentle with their face and hair, as their skin will be both tender and numb and may not respond normally at first.At the beginning, a face lift may look and feel rather strange. Features may be distorted from the swelling, facial movements may be slightly stiff and there may be a degree of self – consciousness about scars. Some bruising may persist for two or three weeks. It’s not surprising that some patients are disappointed and depressed at first. The third week marks the return of “Feeling normal”. Most people are back at work about ten days to two weeks after surgery. Special camouflage makeup can mask most bruising that still remains. Even after the swelling and bruises have gone, the hair around the temples may be thin and the skin may feel dry and rough for several months. Men may find they have to shave in new places behind the neck and ears where areas of beard–growing skin have been repositioned.Some scars from the facelift will remain, but they’re usually hidden by the hair or in the natural creases of the face and ears. They’ll fade within time and should be scarcely visible.Having a facelift doesn’t stop the clock. Faces continue to age with time. It’s not uncommon to repeat the procedure one or more times, perhaps five or ten years down the line. But to look at the positive side, for most people the effects of one facelift will make them look and feel better for years to come.