Facelift surgery generally takes between two and four hours, though it may take longer when combined with other procedures. More extensive procedures may require two separate sessions. The surgery can be performed in a hospital, surgical center, or office, and is most typically done on an outpatient basis while the patient is under some combination of local anesthesia, mild sedative, and/or mild intravenous anesthesia. Under this form of anesthesia, patients may feel some occasional tugging or discomfort. Some surgeons may choose to hospitalize patients for a night or more, particularly when using general anesthesia or performing the procedure on those patients with conditions requiring additional post-operative care such as diabetes or high blood pressure.

The specific procedure, technique, and sequence of events will vary from surgeon to surgeon, but on the whole you can expect the following: The surgeon will begin by making the incisions. While the exact placement of incisions may vary, they are typically hidden behind the hairline or within the scalp, inside of the ear, and/or behind the ear, thus allowing for minimal visible scarring. The incision line typically begins in the area of the temples about the hairline and just above the ear, extending downward in a natural line either in front of the ear or just inside of the cartilage at the front of ear, then continuing around and behind the earlobe and ending at the lower scalp. If the neck needs additional work, small incisions may also be made beneath the chin.

Once the incision is made, the skin is raised outward and separated from the fat and muscle below. Fat may be trimmed from or suctioned out of the areas around the neck and chin, while underlying muscle and connective tissue may be tightened or repositioned. The surgeon will then pull the skin back, lifting it and bringing it tighter, then trim any excess skin before closing the incisions. Stitches will secure the layers of tissue and hold the incisions closed. Metal clips may be used on the scalp, reducing the need to shave any hair from the incision sites. For men, incisions are typically placed in such a way as to accommodate the natural beard lines.

Following surgery, a dressing is typically applied to protect the entire area where the incisions have been made. This may include wrapping the head loosely in bandages, which helps to minimize bruising and swelling. A small tube may be temporarily placed underneath the skin behind the ear in order to drain any blood that can collect there.

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VARIATIONS ON THE TRADITIONAL FACELIFT:

There are several variations on the traditional facelift surgery.  In fact, of all cosmetic procedures, facelift surgery has some of the most options in terms of available techniques.

The traditional facelift is designed to lift sagging skin and sometimes its deeper structures.  Incisions are typically placed along or behind the hairline, then excess skin is excised and the skin of the face is brought tighter, lifted, then sutured.  This procedure typically will not correct problems around the eyelids, at the corners of the mouth (except sometimes when undergoing a mid-face lift), or the creases at the lips.  Variations on the traditional facelift may include the following: the S-Lift, a smaller facelift surgery mainly involving the lower third of the face; the SMAS Lift, which involves the Superficial (or Sub-) Muscular Aponeurotic System; The Platysma or Neck Lift, involving the Platysma muscles and often performed in conjunction with the SMAS lift; The Mini-Lift; The SOOF or Suborbicularis Oculi Fat Lift; The Temporal Lift, or lateral brow lift; The Subperiosteal Facelift, mainly involving the sub-orbital and mid-face areas; and the Deep Plane Lift. For more information ask your surgeon; he or she will best be able to determine the appropriate facelift technique for you.

• S-Lift:  This procedure was invented in the late 1960's, though it has since been perfected.  Incisions are typically placed directly in front of the ear, then layers are moved and pulled laterally.  This procedure targets the lower third of the face, including the jawline, the jowls, and the neck, while the upper areas and eye wrinkles are not affected. 
• SMAS, Superficial (or Sub-) Muscular Aponeurotic System, Lift:  The SMAS is responsible for your facial movements, such as smiling.  This technique involves lifting the area of the SMAS up and out, or diagonally.  The SMAS lift can be performed in conjunction with the platysma lift. 
• Platysma, or Neck, Lift: Performed in conjunction with the SMAS lift, some consider this to be the best facelift procedure, though it tends to be more expensive and have a longer operating time.  For this procedure, the platysma muscles are tightened and then sutured, while hanging skin and excess fat is removed, resulting in a more youthful-looking neck. 
• Mini-Lift:  The mini-lift may help with nasolabial folds (lines running from the sides of the nose to the corners of the mouth).  This procedure is a lateral lift only with incisions directly in front of the ear.  There is also a mini-lift with suture suspension, in which sutures are anchored into the underlying muscle, though some consider this technique to be unethical. 
• SOOF: The Suborbicularis Oculi Fat Lift.  A type of facelift which may yield better results in the central third of the face, from the center of the brows to the frown lines and folds adjacent to the nose and mouth (the nasolabial folds).  The mid-facial tissues at the deep layer (the periosteal layer) are lifted and repositioned, allowing the sagging cheek to be lifted in a vertical direction thus smoothing the nasolabial folds while enhancing the volume of the upper cheeks.
• Temporal or lateral brow lift:  This procedure targets the upper one third of the face and is usually superficially supported by the skin at the temporal area, or the area of the temples above the ears.  The brow is raised to a higher level, removing lines across the forehead and running vertically between the eyebrows.  The temporal lift may also aid in the correction of upper eyelid ptosis (drooping).  This lift may be performed independently or in combination with a traditional facelift.
• Subperiosteal facelift: A technique designed to lift the sub-orbital area as well as the midface. 
• Deep Plane Lift:  A relatively new procedure which is similar to the SMAS lift but with a little more attention given to the nasolabial area.  As its name suggests, this procedure is performed on a deeper plane than the standard facelift.  The deep plane lift can benefit the neck and jaw. 

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COST:

The average cost of facelift surgery runs around $5000. Being a cosmetic surgery, it is generally not covered by insurance. It is each patient’s responsibility to check with their own insurance carrier concerning the degree or availability of coverage.

Click here to continue with Post Surgery: What to Expect After Facelift Surgery.

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