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FACELIFT

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SUMMARY

  • Rhytidectomy is a powerful procedure for face and neck rejuvenation.

  • Shortcut procedures generally yield shortcut results.

  • Combining facelift with other treatments, such as blepharoplasty and skin resurfacing, is ideal.

  • Anesthesia options include tumescent anesthesia, sedation, and general anesthesia.

image Beginner Tips

  • Addressing the SMAS is absolutely critical for long-term cosmetic improvement.

  • SMAS plication is generally the simplest approach.

  • Do not overcut the flap when delivering the ear.

image Expert Tips

  • SMAS plication vectors may have a profound impact on ultimate cosmesis and avoiding the windblown effect.

  • Midface augmentation can be accomplished by wisely choosing SMAS plication vectors and locations.

image Don’t Forget!

  • Meticulous suturing technique will help minimize the appearance of postoperative scarring.

  • Bevel the incision in hair-bearing areas to permit natural postoperative hair growth.

image Pitfalls and Cautions

  • A thorough understanding of multiple anatomical danger zones is an absolute prerequisite for facelift surgery.

  • Patients must be warned regarding the risk of permanent nerve damage and other serious postoperative complications.

image Patient Education Points

  • Controlling patient expectations is critical.

  • Facelift itself does not address wrinkles; always consider concomitant or serial resurfacing.

  • An enlarging hematoma is a surgical emergency and the patient must call immediately if they notice undue swelling.

  • A reliable and helpful caregiver at home is a must.

image Billing Pearls

  • Patients may benefit from combining facelift with other procedures, and sometimes they can see cost savings by doing this.

  • Significant patient savings in anesthesia and facility costs can be seen when combining procedures.

INTRODUCTION

Facelift is a misunderstood word, with different meanings to different patients and surgeons. Cervicofacial rhytidectomy was described a century ago, and its basic principles remain unchanged. As with all procedures, surgeons have attempted to change the procedure to make it easier, less invasive, faster—or simply for hype. If patients have excess skin in the jowls and neck and platysmal banding, there is no contemporary procedure that can match the degree of improvement, natural appearance, and longevity of a standard cervicofacial rhytidectomy.

Shortcut procedures generally produce shortcut results, and this principle certainly applies to facelift surgery. Although minimally or less invasive facelift techniques exist, they are rarely appropriate for patients in their fifth and sixth decades. Small lifts provide small results, and performing a small lift on a patient that needs a more substantial lift—something applicable to almost anyone over 50—may provide disappointing results.

Traditional facelifts leave incisions in the sideburn, in front of and behind the ear, and under the chin. Less invasive facelifts (frequently referred to as “short scar” lifts) generally do not have postauricular and submental incisions, and are therefore limited in their ability to properly address the neck. While not every patient needs a traditional facelift, most candidates for a facelift procedure would likely benefit from a traditional facelift.

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