A classical facelift, or rhytidectomy, separates the skin from the underlying tissue and pulls this skin upwards and backwards removing the excess. During the 1970s it became popular to go into a deeper layer and tighten the underlying muscle of the face ( the SMAS or platysmal layer). This muscle is close to the skin and is the same muscle used by horses and other animals to twitch the skin.
In the late 1990s some surgeons felt that going even deeper) into the layer adjacent to the bone) would be more effective and performed a tightening of all the layers of the face.
Since 2000 less aggressive but highly successful techniques are becoming popular including the short scar, shortlimb and MACs lift, that leave no scar behind the ear.
Today most surgeons perform a modification of these procedures and tailor the surgery to the needs of the patient.
The range of operations that are described as a facelift is amazing. Some surgeons modify the term and describe "full facelift" or "lower facelift". So it is important to understand what operation is going to be done before surgery. Today alternatives to surgery exist for some patients and the scarless facelift such as a Threadlift™, using barbed stitches, appeal to many patients.
The incision is placed in a similar location for most patients. It begins above the ear, either in the hairline or in the scalp, and then comes along the creases in front of the ear. In many cases (especially in women) the incision is taken inside the the middle third of the ear behind the protruding cartilage called the tragus. This serves to hide the incision and make it less noticeable. It is less common to do this in men because it can bring hair bearing beard skin on to the ear. The incision then continues just below the earlobe and in standard operations up and behind the ear. Some surgeons continue the incision horizontally into the scalp while others prefer to go along the hairline of the neck.
The skin of the face, or the skin and muscle, are then separated from the deeper tissue. The amount of dissection and separation depends on the needs of the patient. It is not uncommon to extend the dissection within an inch (2.5 cm) of the corner of the mouth. Some surgeons perform liposuction of the cheek, nasolabial fold or chin. The underlying muscle is then tightened as a separate later or in conjunction with the skin.
In the neck the separated platysma muscle that appears as a band may be repaired or divided.
The excess tissue is then redraped in its new position and the excess removed. The skin is closed with stitches although some surgeons use staples in the scalp area. Drains are sometimes used, especially if there has been significant bleeding.
Surgeons vary in whether or not they use bandages. These days it is common for no bandages to be used, but some surgeons apply a Velcro® wrap or compression bandage for several days.
The operation is done under either local anesthetic (you are awake) or general anesthetic (you are asleep). It is often combined with other operations including eyelid tightening and forehead lifting. Most surgeons feel that it is dangerous to peel or laser the whole face at the same time as a facelift although areas not undermined in the facelift, such as round the mouth, can be resurfaced at the same time.
This is usually an outpatient operation, and a stay in the hospital is not usually needed.