It wasn't all that long ago that facelifts seemed reserved for celebs and stars. People used to talk about Zsa Zsa, Joan, or Phyllis. "How many facelifts do you think she's had?" That was the burning question back then.

But nowadays, the facelift (or rhytidectomy) is a highly common and widely accepted procedure -- certainly not just for stars anymore. In 1992, an estimated 40,077 facelifts were performed, according to the American Society of Plastic and Reconstructive Surgeons. Facelift is the fifth most common of all cosmetic plastic surgery procedures after 1. eyelid surgery; 2. nose reshaping; 3. liposuction; and 4. collagen injections.

As the baby boomers in this country continue to age, facelift will become even more popular. In the hands of a well-trained plastic surgeon, the risks of the surgery are few and the benefits can be dramatic.

Who should consider facelift?
As we age, sun exposure, the effects of gravity, and the stresses of living life all take their toll on our once-taut and youthful faces. We can develop deep creases between the nose and mouth, jowly jawlines, and folds and fat deposits around the neck. Our faces and necks seem to sag. Maybe we don't feel as old as we look. It seems unfair. That's where a facelift comes in.

Good candidates for facelift are individuals whose skin still has some elasticity and whose bone structure is strong and well- defined. A facelift can remove the excess fat, tighten underlying muscles, and re-drape the skin on your face and neck.

What does the surgery involve?
Facelift can be done alone, or together with other procedures such as a forehead lift, eyelid surgery, or nose re-shaping. The surgery itself usually takes several hours...or somewhat longer if you're having more than one procedure done at the same time. It can be performed on an outpatient basis, using local anesthetic and sedation or in a hospital, with the patient under general anesthesia.

Preparing for a facelift
Your plastic surgeon will advise you to use or not use certain medications. Drugs that interfere with blood clotting, such as aspirin, may cause more bleeding under the skin during surgery and should not be taken. Patients who smoke are cautioned to stop at least 2 weeks before surgery and not to resume for at least 3 weeks after surgery. Healing time is longer and scarring is much more noticeable with smokers.

Smoking has an adverse effect, because nicotine constricts the blood vessels, decreases blood flow to tissues, and greatly increases the chance of scarring and overall poor healing. In fact, cigarette smoking has been found to be a major cause of complications in people who have facelifts.

How is a facelift done?
Incisions are made on either side of the face from inside the hairline at the temples, in front of the ear, around the earlobe, in the crease behind the ear and to the lower scalp. The design of these incisions may vary from patient to patient and according to the surgeon's personal technique. Loose skin is pulled up and backward, and the excess is removed. A layer of tissue over the facial muscles can be tightened as well, and this can greatly enhance the results of the facelift, especially on the neck.

How long will you be "out of circulation?"
The immediate side effects of facelift are temporary bruising, swelling, numbness and tenderness of skin, a "tight" feeling, and dry skin.

While the first several days after surgery may leave you feeling more tired than usual, you can probably be back at work within ten days to two weeks. Special camouflaging make-up can be used to hide bruises that haven't healed completely. By the third week, you should be looking and feeling much, much better.

Healing is gradual, so expect to wait several weeks to months before optimum results are achieved. Since your skin will remain somewhat sensitive for a few months following the surgery, you would be wise to limit sun exposure and protect your skin with a sunscreen.

Most of the scars will be hidden under your hair or in the normal creases of your skin. The scars can usually be easily concealed by the hair and with the judicious use of makeup.

Interestingly, when men have facelifts, they may have a permanent need to shave behind their ears, since beard-growing skin is pulled up behind their ears during the procedure.

What complications may occur?
Possible complications from the facelift procedure include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin and bad scars are most likely in smokers. Excessive bleeding can be caused by high blood pressure and clotting disorders. If you have these or other health problems, it's important that you inform your surgeon during your pre-surgical consultation or exam.

With the vast majority of facelift patients, there are no serious problems or complications. But you should always be aware of the risks, and weigh them against the benefits, before consenting to any plastic surgery procedure, facelift included.

How much does it cost?
The price for the procedure varies widely, from state to state. It also depends on the surgeon performing it, whether the surgery is done inpatient or outpatient, etc. The national average for surgeons' fees (not including surgical facility/hospital costs and anesthesia) is $4,156 ($5,410 in The Big Apple, $4,448 out California way).

Who gets facelifts?
The vast majority of facelifts are performed in people 35 - 64 years of age (81%). 51% are performed in people 51 - 64 years of age. Although men do have facelifts, most facelift recipients are women (93%).

How long does facelift last?
Your bone structure, skin texture, sun exposure, lifestyle choices, and hereditary factors all play a role in how many "years" a facelift can "remove" and, to some extent, influence how long it will last. In general, the younger the patient, the more enduring the results. A woman in her forties should enjoy the benefits for approximately 10 years; a woman in her sixties, approximately five years.

If you would like more information about facelifts, please call my office and we will send you a brochure describing the procedure in greater detail.

Editor's note: The preceding article has been provided as a public service by Christine M. Rodgers, M.D., Board Certified Plastic Surgeon, 4600 Hale Parkway, Suite 430, Denver, Colorado 80220 USA, Phone: (303) 320-8618. The article originally appeared in the second issue of Dr. Rodger's educational patient newsletter, "Reflections for a better You."

© 1994, Christine M. Rodgers, M.D. All rights reserved

Source: The Medical Reporter, July 1995. Reprinted with permission from The Medical Reporter.