Since each face has a unique shape and contour, the surgery will be slightly different for each patient. Before the procedure, the doctor will evaluate the patient's skin consistency and explain the surgery. People who smoke will be asked to stop at least a week or two before the surgery and stay off of cigarettes for a couple of weeks after the surgery, because smoking inhibits blood flow to the skin and can interfere with healing. Patients are also asked to avoid aspirin and other medications that can increase bleeding.
A facelift can be performed either in a plastic surgeon's office or in a hospital. Most patients are given a local anesthesia combined with a sedative, so that they are awake but unable to feel the procedure. Some doctors use general anesthesia, which puts the patient to sleep.
During a traditional facelift, the doctor makes an incision that typically begins around the hairline from the temple and curves around the earlobe, ending at the bottom of the hairline. The surgeon may also make a small incision under the chin to specifically tighten the skin of the neck.
The doctor first separates the skin from the fat and muscle underneath. He or she may suction out (via liposuction) or trim excess fat to give the face a sleeker look. Underneath the skin is a layer of tissue called the SMAS (superficial musculoaponeurotic system). The doctor tightens this layer by folding it -- pulling it back over itself. Tightening the SMAS layer lifts the cheeks, gives the jawline more definition, and firms the neck.
Finally, the doctor pulls the skin back up over the area and removes any excess skin with a knife or laser, similar to the way that you would pull a carpet to tighten it over the floor and trim the excess. The incision is closed with stitches, sutures, or tissue glue. The stitches are usually placed within the hairline so they are hidden by the hair.
The surgery can take between two to four hours, depending on the extent of the tissue and muscle work, and the number of different procedures being performed.
Next we'll learn about different facelift techniques.