Definition and Overview

A facelift, also known as a rhytidectomy (derived from a combination of two Greek words: rhytis or wrinkle, and ektome or excision), is a medical procedure that involves the surgical removal of wrinkles on the face. This procedure is typically cosmetic in nature and prescribed to patients seeking a more youthful appearance.

As early as the 1900's, surgeons have been performing this procedure mostly by pulling the sagging parts of the face tight and cutting the excess skin away. According to medical lore, the first facelift was performed in 1901 in Berlin, where a surgeon named Eugen Hollander responded to an elderly patient's request to have her cheeks and the corners of her mouth lifted. Hollander proceeded to cut off the skin around the ears in an oval shape. Six years after what is considered to be the first facelift procedure, Charles Miller, a surgeon from Chicago, wrote the first textbook on the subject of cosmetic surgical procedures on the face. The textbook was titled The Correction of Featural Imperfections.

Despite its relatively short history, facelift procedures are, at present, one of the most sought-after cosmetic surgical procedures. As of 2011, the American Society for Aesthetic Plastic Surgery declared facelifts as one of the most popular aesthetic procedures, right after liposuction, breast lifts and implants, tummy tucks, and eyelid surgery.

Rhytidectomy is prescribed to patients who are experiencing sagging or loose skin in different parts of the face, including the cheeks, the mouth area, or the jaw. Other patients who can be candidates for rhytidectomy are those with:

  • Deep creases underneath the lower lids;
  • Deep creases in the nasolabial fold or under the nose and around the mouth;
  • Jowls or sagging of the skin in the lower face as a result of a significant loss in skin tone; and
  • The presence of excess fat deposits and loose skin underneath the jaw and chin, which could appear like double chins, even in people with normal weight.


The primary objective of rhytidectomy is to restore the youthful appearance of the face. As people grow older, the firmness and flexibility of their skin—including the skin on the face—significantly decreases. Age can also cause significant changes in the face's deep anatomical structures, including cheek fat, the platysma muscle, and the orbicularis oculi muscle.

There are many kinds of facelift procedures, varying from incisions, the level of invasiveness, as well as the area of the face where the procedure is performed. Different types of facelift procedures include:

  • Traditional Lift. In this type of facelift, the surgeon makes an incision on the front of the ear, which extends up into the patient's hairline. As the incision approaches the bottom of the ear, it will be curved up to the back of the ear, where it will end at the patient's nape. The loose skin will be separated from the deeper tissues of the patient's face and will be pulled taut before suturing or stapling.
  • SMAS Lift. The Superficial Musculo Aponeurotic System Lift or SMAS Lift is a facelift procedure that involves the realignment of suspensory ligaments with the aim of encasing the cheek fat and keeping them in place.
  • Deep-Plane Facelift. This is typically recommended to patients who want their nasolabial folds lifted or re-aligned. This technique evolved from the SMAS Lift, but the procedure is quite different. Instead of realigning the SMAS, a deep-plane facelift typically involves freeing the muscles and cheek fat from the bone they are attached to. Of course, this type of facelift does not come without risks and when done incorrectly, a patient can suffer from damaged facial nerves.
  • Composite Facelift. In this technique, the surgeon typically targets the repositioning and mobilization of deeper tissue layers. In a composite facelift, the patient's orbicularis oculi muscle, as well as its fixation and repositioning will be of a main concern.
  • Mid-Facelift. This technique is often prescribed for women whose mid-face areas have flattened due to age. However, it is important to note that only those who do not have a significant degree of sagging of the neck and jowl qualify for this technique.
  • Thread Lift. Considered by many surgeons as one of the least invasive procedures that rejuvenate the face, it is recommended for patients who want to have minor improvements done on their faces. A thread lift often targets drooping or sagging of skin around the eye area, the nasolabial fold, and the forehead. This technique can be performed under local anaesthesia, with the threads used in the procedure remaining in place even years after the procedure.
  • Skin-Only Lift. As the name suggests, the skin-only facelift does not target the deeper tissues, muscles, ligaments, or any other facial structures. This is often recommended to patients whose only problem is inelastic or lax facial skin. However, the effects can only last from six months to a year.
  • Superiosteal Lift. This technique involves the vertical lifting of the soft facial tissues and completely moving it away from the facial bones underneath.
  • MACS Lift. Also known as the Minimal Access Cranial Suspension Lift, this technique aims to correct the sagging of facial features with tiny incisions to elevate and suspend tissue from above. The MACS lift is generally considered to be a great alternative to a traditional facelift because the incisions are smaller.

When should you see a cosmetic surgeon for a Facelift

If the aim is to improve your facial features because of sagging or lax skin and tissue, then you should consult a qualified and trained cosmetic surgeon specializing in this procedure. The surgeon will assess the current condition and will recommend the techniques that will best address your problems.

References:

  • Cosmetic Surgery Today. Grahame Larkin
  • Plastic Surgery: New Methods and Refinements. Saunders.
  • Transactions of the Seventh International conference on Plastic and Reconstructive Surgery
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