FACELIFT (RHYTIDECTOMY)
“Devouring time…carve not with thy hours
My love’s fair brow, nor
Draw no lines there with thine antique pen.”
Shakespeare
Accompanying the passage of time is the dynamic process of aging, affecting each individual uniquely and
personally. Aging in the aesthetic sense is revealed by ever-changing facial features and expressions. Every
one of us possesses inherent inner biological clocks which are programmed to age at different rates. Our
biological clocks and thus our youthfulness are not only estimated by age, but influenced by our daily social and
nutritional habits, our mental and physical well being, the effects of gravity and environmental exposure, and by
our given genetic endowment.
It is often quoted that beauty is skin deep, however, with the aging process, beauty is both skin and structurally
deep. With the passage of time, the enveloping skin and soft tissues of the face and neck begin to lose their tone
and volume. Gradually, the skin loses its elasticity, the facial skeleton and underlying fatty soft tissue volume
shrinks, the skin becomes furrowed, wrinkled and loose; succumbing to the influences of gravity. The round,
full, proportionate and balanced youthful appearance with a smooth, flawless complexion descends and
weathers. The pure canvas of youth transforms into furrows, and tissue descent, resulting in irregularity and
jowling of the jawline, loose and redundant skin, and localized fatty deposits.
This process of aging is first noticed in the twenties, around the eyes. The upper eyelid skin and brows begin to
descend, obscuring the upper eyelid crease, projecting an early tired and fatigued look to the eyes. During the
thirties, small creases occur in the forehead and crows foot areas. During the forties, the wrinkles become more
pronounced, folds deepen, and the jawline begins to lose its definition. In the fifties, the sculptured jawline and
chin are obscured by jowls, and the neck loses its sharp angle with the chin due to excess skin, muscle banding
and fatty deposits. The lifted, triangular appearance of the youthful face is replaced by the descended, irregular,
rectangular appearance to the face and neck.
Cosmetic facial surgery addresses these unfavorable changes of aging in an attempt to restore tissues to a
rejuvenated, uplifted state. Rhytidectomy, or the facelift operation, is a surgical procedure used to alter
changes in the areas of the temples, cheeks, face, jawline, and neck. The purpose is to improve aesthetic
appearance and restore balance and harmony to the entire facial area. In some patients, neck contouring via the
removal of fat or by addressing platysmal muscles, can be used to sculpt the neck and jawline for improved
definition. Additionally, combination surgeries to enhance the eyelids, forehead, or facial bony structure can be
performed concurrently with facelift surgery. Common surgical procedures that are combined with facelifts to
correct specific aging problems are eyelid surgery (blepharoplasty), eyebrow and forehead surgery, midfacial
extended lifting, facial implantation, and chemical and laser skin resurfacing or photorejuvenation. The goals of
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facelift surgery are to improve jawline contour, tighten the jowl, elevate the sagging cheeks and provide
elevation of the facial expression lines from their downward position to a more youthful position. Facelifting
techniques soften folds, and reduce redundancy and sagging of loose facial and neck skin and deep tissue layers.
This technique is achieved by elevating the skin of the face and neck, repositioning and tightening the
underlying soft tissue fascial and muscular layers (the SMAS complex), and removing the excess redundant
skin. Fatty tissue sculpturing and muscle tightening (plication procedures) are used to refine the overall result.
These sophisticated techniques of deep lifting attempt to prolong the longevity of the facelift procedure.
“My personal philosophy is to customize each facelift procedure individually with respect to incisions, lifting
technique and hair patterns. The goals are to respect characteristic features and lifestyles, and to preserve
individual identity, ethnicity, masculinity or femininity, and the dignity of the patient. It is also important to
achieve a natural and unoperated look, in order to make each individual look the best they can. The goal of
facelift surgery is improvement; by enhancing and complimenting individual and unique characteristic features,
restoring a harmony and balance. I believe the surgeon serves to function as an artistic visionary and sculptor in
order to achieve aesthetically pleasing results.”
It is important to realize that facelifting procedures have limitations; the procedure cannot eliminate cheek folds,
wrinkles, irregularities and blemishes of the skin. Complimentary procedures such as chemical peels,
dermabrasion, facial implantation, and laser resurfacing and photo rejuvenation can restore the surface of the
skin. It is important to realize that facelifting is not a panacea for facial and neck aging. The aging process may
be modified, but the course unavoidably continues.
Today, an increasing number of men and women reap the benefits of facelift surgery. As the general population
ages, many older individuals who continue to work and enjoy good health wish to look as good as they can by
diminishing the signs of aging. We are born with distinct characteristics and features, and we mold our selfimage and esteem from how society reacts and accepts us. Thus, self-esteem evolves from our outer reflection.
Aesthetic surgery offers the opportunity to improve our outer appearance often resulting in an improved selfimage. With cosmetic surgery becoming more acceptable, available and affordable, it is becoming a standard of
personal care. As cosmetic surgery can offer a psychological, personal, emotional and spiritual uplift, a new
philosophy has developed by which individuals feel comfortable taking the needed steps to cosmetic
improvement.
Although age is not as important as the specific appearance of the patient, various groups of patients can benefit
from a facelift. Younger individuals (usually 35-45 years of age) can maintain their youthful appearance with
facelift surgery. These younger individuals often obtain the best results since the tissues and muscles still
maintain elasticity and have not yet been irreversibly stretched or sagged. Results often are more subtle than
those seen in a more aged individual, but appear to be more lasting due to the favorable characteristics of the
youthful skin. Subtle changes avoid drawing attention to the fact that elective aesthetic surgery has been
performed.
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The other group consists of the older patients who wish to achieve dramatic correction for more severe facial
and neck sagging. The older patient achieves significant and dramatic results, often reversing the aging process
by 10-15 years. While this is a very exciting prospect for patients, they must be emotionally prepared to look
younger than their peers. Older patients who undertake facelifting procedures often experience mild degrees of
skin relaxation postoperatively, due to the deficiency of elasticity in the skin.
Elective facelift surgery requires preparation. It is imperative that one understands his or her motivation for
partaking in facelifting surgery and has realistic expectations for results. Cosmetic surgery is a very private,
personal experience and should be a well thought-out decision. Facelift surgery will not resolve interpersonal
issues or change the individual internally. Regardless of corrective surgery, the body continues to age from the
moment of the “new look”. The goals of cosmetic surgery are improvement. A rational candidate for cosmetic
facelift surgery must prepare physically, mentally and spiritually as well as be psychologically stable with
realistic expectations, understanding human imperfection limits, recoveries, risks and commitment to follow-up
in respect to elective surgery. Rewarding results require a recovery period and downtime.
CONSULTATION
The consultation is your personal time to interface with Dr. Schmid. It is at this time that your cosmetic
inquiries will be thoroughly reviewed and discussed. Your aesthetic characteristics will be evaluated to
determine whether corrective surgery of the face and neck is indicated.
At this meeting Dr. Schmid listens to you in order to understand your personal goals and needs. It is important
that you openly discuss the motivations for seeking the cosmetic consultation and candidly express your honest
perceived expectations from the procedure. Your honesty and openness allows an accurate assessment to be
made as to whether these expectations are acceptable, realistic goals. It is important that you understand that
there are limitations to what any surgical procedure can achieve. The outcome of any surgical procedure is
dependent upon individual anatomical characteristics, physical variations, how live tissue reacts to surgery,
and/or how this tissue heals. The process is not predictable. The patient must realize that the goal of the
surgery is not to achieve perfection, but to improve the appearance.
“My goal is to individualize patient care, so the consultation is paramount. I realize that each patient is unique
and special, and should be treated independently with respect to planning, procedures, operative goals and
incisions. In this consult, my goal is to determine which facelifting approach will compliment your natural
physical characteristics to achieve a natural and unoperated look. As previously mentioned, independent or
combination surgeries may be recommended to achieve optimal results. My priority is to secure a safe
procedure from the onset through recovery. It is also during this consultation that we will discuss long term
preventative and maintenance skin care programs to develop personalized objectives to maintain longevity to
the lifting procedure. Furthermore, the consultation should reflect my attitude and artistic approach towards
elective personal enhancement.”
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Emotional stability is very important for any cosmetic procedure. After surgery, some patients experience
slight depression or melancholy. It is during this recovery period that the patient visibly experiences swelling
and bruising, senses tightness and discomfort, and requires an isolation period and downtime. This loss of
spontaneity in one’s lifestyle and a strong focus on physical recovery requires patience and self-reassurance.
This is a common response because there is always a recovery period prior to achieving your final cosmetic
result. Furthermore, there is an emotional recovery or readjustment period for some patients to their new
aesthetic image, and anxiety as to how society will interact towards this new image.
Once the consultation has been completed, you will be presented with various options for cosmetic
enhancement. Preoperative photographs may be taken to provide documentation for preoperative planning and
postoperative comparison. If requested, instructions for preoperative skin preparation, social habits and dietary
guidelines will be provided to you. It is at this time that you must thoroughly review this information to
determine whether the proposed options are satisfactory and reasonable to meet your needs. It is also at this
time that Dr. Schmid will determine whether you are a candidate for cosmetic surgery and whether your goals
can be met.
FACELIFT PROCEDURE
Prior to the facelift procedure a preoperative history & physical by your family physician and lab work are
required. In addition, you are required to make the appropriate arrangements and lifestyle adjustments to
accommodate for the necessary recovery period. Work and social demands must be postponed in order to allow
for appropriate postoperative recovery time. Cosmetic procedures cannot be “squeezed into” tight social
calendars and lifestyles. All patients must be accompanied by a responsible adult for their transportation,
comfort and care after the procedure. All out of town patients are asked to arrange nearby lodging, as it is
necessary for Dr. Schmid to see you frequently after surgery for dressing changes or personal needs.
Preoperative medications to alleviate anxiety and to reduce infection will be prescribed. The surgical procedure
will be performed at the Office Surgical Suite or a Surgery Center, depending on the preferences of you and Dr.
Schmid. Intravenous (“twilight”) sedation will be utilized during this procedure along with local anesthesia to
ensure comfort throughout the procedure.
The incision for the facelift operation begins in the temple area, behind or around the sideburn hair tuft. The
incision then extends down in front of the ear, and is camouflaged by natural ear contours or skin folds. This
incision will extend around the earlobe, up on the back of the ear, and then backward into or along the hairline.
For male patients, incisional variations are practiced with respect to the beard. All incisions vary and are
tailored to each individual patient. Also, a small incision will be performed under the chin. From these
incisions, the skin is elevated over the face and onto the neck. The lift is then focused on repositioning the deep
soft tissues (i.e., muscle and fascia), which have become lax. These tissues will be elevated and sutured to
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accomplish “deep lifting” to achieve more lasting results. The excessive skin is then removed, along with
sculpturing of the neck and face to remove excessive fat. The skin edges are meticulously closed with suture.
(NOTE: Male patients require repositioning of the beard skin onto the neck and approximating the ear.)
The facelift procedure usually takes between three and four hours. Upon completion, a soft bulky dressing is
applied to support the surgical areas and two drains will be placed to emit fluid accumulations. You will
gradually recover from anesthesia to an alert and active state.
During and after the procedure, the patient should expect a tight, lifted sensation secondary to the facelift pull.
This sensation will subside over several days to weeks. Swelling and bruising are expected, along with
decreased sensation at the surgical areas. Normal sensation should return over the next several months. Rarely
is this condition permanent. The swelling from the surgery usually subsides within the first week and bruising
resolves over a few weeks. There is usually mild discomfort for a short time after surgery, but this is easily
controlled with pain medication. Significant or progressive pain is quite rare and should be reported
immediately to Dr. Schmid.
Postoperative instructions, activities, wound care, and diet are provided for your convenience. All patients must
be seen by Dr. Schmid on various office visits following the procedure. Follow-up visits are individualized and
scheduled within the first several days for suture removal and postoperative surgical evaluation.
Up to the day of suture removal, the patient undertakes an active role in wound care. Wound care must be
strictly adhered to on a daily basis. Once the sutures have been removed, the incision will undergo a
progressive healing process over the next several months. Typically, incisions are red and ropy for the first few
months and then undergo a remodeling or softening stage. After ten days, makeup may be used to disguise
incision lines and bruising. The incisions will gradually fade in color, and can be aesthetically camouflaged
with jewelry, hairstyles, clothing, and topical makeup application. It is important that the incisions are
monitored on a follow-up basis, so that any excess scar formation may be addressed. Furthermore, there are
often surface irregularities, which resolve as the swelling subsides.
As with any surgical procedure certain risks can occur, although these are rare. Surgical results cannot be
guaranteed. Aesthetic surgery is a technical art, not an exact science, and the final results are very dependent
upon the inherent healing characteristics of each individual patient. Since a facelift is a surgical procedure, a
natural healing period follows. Thus, the results become apparent over time. The initial healing period takes
several days. It is important that appropriate downtime is allowed for this initial recovery period. As
previously mentioned, it is not uncommon to experience melancholy, fatigue, or slight depression after surgery,
as any cosmetic surgical procedure may evoke a sense of anxiety, emotion or stress. Postoperatively, there is an
emotional recovery period and readjustment to the new aesthetic appearance.
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The majority of individuals have asymmetrical facial halves due to structural and developmental differences.
These subtleties are reviewed prior to surgery, revealing the imbalances present. The process of repositioning
the skin with a facelift does not address these deep structural differences unless recontouring procedures are
utilized. As with any surgery, risks can occur. Risks common to all procedures include anesthesia and potential
medication reactions. Risks such as bleeding or infection can occur after surgery; requiring drainage procedures
or antibiotics. Any blood clot formation after surgery may prolong the recovery period or promote additional
bruising. Temporary or permanent hair loss, excessive scarring, suture reaction or rejection, skin changes
(prolonged swelling, hyperpigmentation, increased small blood vessel appearance, dimpling, surface
irregularities, skin perforation or loss), and earlobe changes can occur. The patients most at risk for healing
problems are smokers and diabetics, which conditions often promote poor circulation to the skin, thus resulting
in poor wound healing and the potential for skin loss. Smokers have 13 times the increased risk of healing
complications. Strict adherence to smoking restrictions and medical instructions should be followed or else
surgery will be canceled. Postoperative relaxation of the skin or early recurrence of the deformity may result in
and is usually related to prolonged swelling, inherent skin characteristics, or lack of elasticity of individual
patients. A second operation incorporating skin excision may be needed in the future. Additional risks, such as
nerve injury may lead to temporary or permanent numbness, facial weakness or asymmetry, an irregular smile
or facial expression, or speech difficulty. Such occurrences may require a prolonged period of recovery or
could persist. These risks are very rare.
Naturally, individuals contemplating the operation are interested in how much improvement they can expect or
for what duration the improvement will be apparent. The amount of improvement depends upon the degree of
wrinkling and skin laxity present, and the patient’s predetermined genetic predisposition. If the aging changes
are marked, the results may be dramatic. If sagging is early and the operation is being done to attempt to keep
the patient looking young, the improvement may be more subtle; remarks are often made that face looks less
tired and more alive. The duration of improvement cannot be accurately predicted in all cases. If wrinkling or
skin laxity is severe, it will obviously take a longer time after surgery for the condition to become as bad as it
was before surgery. If a degenerative process of the skin is very rapid, the wrinkling and sagging will occur
more rapidly. In a face that is simply rounded and fat, it will be improved for only a short time. In ideal cases,
however, the duration of improvement is often from five to ten years. No operation can permanently prevent
aging, but the individual can expect to appear younger than if the operation had not been performed. A realistic
approach to understanding the results of a facelift surgery may be illustrated by considering identical twins. If
only one twin undergoes facial aesthetic surgery, he or she will, of course, continue to age but will always look
better and younger than the twin who did not choose to undergo facial rejuvenation surgery.
Finally, it should be understood that the facelift operation will not eliminate the small vertical creases around
the lips, the bulging or excess skin around the eyes, the horizontal creases of the forehead and the deep
cheek/lip grooves. These disfigurements may require separate procedures that may be confined with a facelift
operation. Facial creams, cosmetics, muscle exercise, and chin supports all have little or no effect on the aging
process and cannot be a substitute for a needed facelift when facial sagging and poor muscle tone exist.
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If you decide to undertake the facelift procedure, I would like to express that throughout your recovery period
my staff and I will be available to address any questions or needs that you may have, and to offer personal
support to help ensure a expedient and comfortable recovery. Please do not hesitate to ask for any assistance or
advice. My staff and I would also like to thank you personally for entrusting your confidence in allowing us to
manage your surgical aesthetic needs.
Please acknowledge your review and understanding of this information by providing your signature below.
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