The operation is carried out either under a twilight anaesthesia. Many different techniques and variations of basic procedures are used in Rhytidectomy, but for the purposes of these notes for guidance, we will explain the operation in simple terms. In the standard facelift procedure for the lower face, an incision is made in front of and behind each ear, and the skin is then stretched backwards and upwards, the excess is removed and the skin sutured into position at the incision points.

For a brow lift, the excess skin is trimmed via incisions just inside the natural hairline before lifting the remaining forehead skin upwards and suturing in place to remove the frown lines. A double-layered lift (supra-facial musculoaponearotic system - SMAS) works along the same lines. The SMAS procedure involves working on the facial muscle and fatty tissue below the skin.

It should be noted that in any facelift operation the skin is not drastically stretched, it is only put under a similar tension comparable to that previous to ageing and sagging. This is a rejuvenating process.

The operation time is two to three hours, or more, for a standard facelift procedure. The time varies depending on the complexity of the case. An overnight stay in the hospital is required. Sometimes two nights are required but the surgeon will decide on these points in discussion with you. After the operation, the face is bandaged in compression dressings and facial movements must be restricted for the first few days. Stitches are removed between five to twelve days after surgery, and normally after about two weeks you will be able to return to work and to socialise as normal.

Patience is required however, as the time it takes for the facelift to settle down properly and for the full effect to be achieved is three to six months. Post-operatively it is helpful to massage the face with moisturising cream. It is very important to carefully follow the surgeon's directions on aftercare to ensure the best results.

As with any surgery there are risks, but fortunately complications are rare and can be treated by routine procedures, and are not hazardous to the patient's health.

Possible complications

When a facelift is performed by a qualified plastic aesthetic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

The most common complications following a facelift include the following:

1. Haematoma

Abnormal collection of blood under the facial skin (comprises 70% of all facelift complications): You should expect a small amount of bleeding from your incision line during the first 24 to 36 hours after your surgery. Any type of surgery may result in excessive bleeding in the operated area. This may be due to a temporary increase in blood pressure, for example due to coughing. It can also occur from the effects of medication like aspirin or anti-inflammatory drugs. Bleeding is usually manifested by acute swelling of the area, discolouration of the skin, pain and a feeling of tension. External compression of the wound usually stops it. If the accumulation of blood is small, it may be allowed to absorb by itself or aspiration may be indicated However, if it is large, formal drainage in an operating room may be necessary.

2. Post operative swelling

Some swelling after your operation is normal. Time and elevation of the head are the two most important factors in reducing swelling. Ice may also be carefully used to decrease swelling.

3. Bruising

If you bruise easily, discolouration may remain for several weeks after surgery. You should advise us of any past history of bleeding disorder. In rare cases, discolouration may be permanent.

4. Nerve injury

In general, nerve injuries following facelift are rare. All patients have a temporary loss or alteration of sensation in the area of the facelift, as well as the earlobes and ear margins. Sensation spontaneously returns within a relatively short period of time and is usually complete in 3-4 months. Only in rare instances will sensation fail to return. The reported incidence of nerve injury is less than 1%.

5. Unsightly scarring

The normal healing of wounds is a physiological process which continues to take place in the depths of the tissues for many months before final resolution. At first, the surgical scar is almost invisible. Then it becomes red and somewhat elevated for about 3 months. Factors that can influence the quality of healing include smoking, obesity, infection and nutrition.

Sun exposure of a new scar should be avoided for the first year following your operation. An immature scar exposed to sun may become more visible and pigmented.

6. Skin slough

It represents death (necrosis) of tissue resulting in delayed healing. When blood circulation is inadequate to bring sufficient oxygen to the tissues, some of the tissue furthest away from the blood supply may be lost. The skin will become discoloured and form a dark dry crust which will eventually separate off. The underlying normal tissues heal by themselves. This may leave a wide scar.

7. Fluid collection (seroma)

This is a collection of serum in small pockets beneath the skin, in most cases in the cheeks. Generally, the seroma will spontaneously resorb. Occasionally, needle aspiration is necessary.

8. Infection

Infection following a facelift is rare. The incidence is less than 1% and severe infections are extremely uncommon. However, any surgical wound can become infected. An infection usually will become apparent a few days after the surgery. The signs are: pain, redness, heat and swelling. Antibiotics and dressing changes will often control it.

Procedure	Face / Neck Lift (Rhytidectomy)
Anaesthesia	Twilight with local or General
Hospital stay	1 night, or more if necessary
Removal of stitches	7 - 10 days
Return to work	2 weeks
Full recovery	3 - 6 months
After care	Massage face with moisturising cream
Possible complications	Numbness on face Infection Scarring