There are several factors that can lead to the drooping or sagging of the skin around the face.  Gravity, aging, sun exposure, and smoking: all of these can damage the skin, making it cling less tightly to the neck and face.  A facelift can help tighten the skin by allowing facial tissue to be tightened and skin to be pulled smooth and tight across the face and neck.

How It's Done

In most instances facelifts are performed under local anesthesia with a sedative, which leaves the patient awake yet relaxed and oblivious to pain, although some surgeons prefer general anesthesia.  From there the surgeon makes a long incision that usually begins above the hairline at the sides of the forehead, extends down bellow the ear and circles around to the back of the hairline.  If tightening of the skin around the neck is desired, an incision is also made at the chin.

The skin is then lifted from the face, and the exposed muscle and tissue is tightened.  If pockets of fat need to be removed some liposuction may be used.  The skin is then stretched back across the face and the excess is cut away.  Stitches or metal clips are used to hold the skin together at the site of the incision.  Surgery usually lasts several hours and is performed as an outpatient operation in a surgical suite, although some may be performed in a hospital with a stay of a day or two.

Technology

There are many different techniques and particulars involved with facelift surgery.  The patient's individual need and the doctor's preferred technique are the two main factors that will determine exactly how the procedure will be performed, the exact incision sites, and whether or not liposuction will be necessary.  All of this should be discussed with your surgeon prior to surgery.  New technology has brought about the appearance of less invasive types of facial rejuvenation including FeatherLift and the so-called "weekend facelift," but for patients seeking permanent results, the traditional surgery is the only option.

Recovery / Post Op

After surgery your face will be covered with bandages that are removed about 1 or 2 days afterwards, and stitches are removed within a week to 10 days.  Pain is usually minimal and medication is prescribed to help.  Swelling, bruising, and some numbness should be expected (this will disappear with time), and you will be instructed to keep your head elevated and use cold compresses to help alleviate these problems.

Smoking within the first month could cause some of the skin along the incision to die and can interfere with the healing process.  With a normal recovery you can expect to be back to your daily routine, excluding strenuous exercise, within 2 weeks or less.

Complications

As with any major surgery there are risks involved.  Infection, adverse reaction to anesthesia, and blood clots are always possibilities for any operation.  In addition, patients should be aware that hair loss, nerve damage, skin damage, tissue loss, and excessive scarring are all possible (though rare) risks associated with facelifts. 

Am I A Candidate?

Candidates for surgery usually experience a slight loss in skin elasticity, along with sagging skin around the neck and face.  Patients that smoke are at greater risk of surgical complications, and in some instances, patients that have undergone cosmetic injections such as Botox, Restylane, Radiance, or others may not be ideal or may have to wait for the effects to wear off before considering surgery.

Cost

The national average surgeon fee for 2003 was $5,283 according to the American Society of Plastic Surgeons (ASPS).  When additional costs including facility fees and anesthesia are considered, and depending upon the extent of surgery, the cost will range between $6,000 and $12,000 with the average falling somewhere around $8,000.