The spectrum of operations which have been devised to decrease the signs of aging in the cheeks and neck is known as rhytidectomy, or facelift.

Many of the obvious signs of aging are in the face. The forehead becomes more elastic and eyebrows droop. Fine wrinkles appear around the eyelids and across the forehead. Fat which is normally in the cheeks falls to the level of the jaw, which results in jowls. The folds from the side of the nose to the corners of the mouth become more prominent. Women, particularly, develop fine wrinkles on the upper and lower lips, which can cause lipstick to "bleed."

There are also signs of aging in the neck. The neck skin becomes loose, and superficial muscles in the neck, the platysma, become prominent as bands running from the underside of the chin to the collarbones.

The first facelifts were carried out in the 1920's and 1930's. Skin incisions, which have not changed appreciably since then, are in the scalp above the ear and behind the ear. On the cheek the incision lies in front of the ear where many people have a naturally occurring fold.

In early facelifts, only the skin was tightened by pulling it backward and upward after making the skin incisions and undermining the skin. Since the 1930's additional surgical techniques have been devised to rejuvenate the face during a facelift. Many plastic surgeons not only elevate the skin off of the cheeks, but also elevate a deeper layer, which is abbreviated the SMAS. Fine wrinkles around the lips can be improved by laser or dermabrasion, and the skin of the neck and the platysma are tightened. Areas of fat can be aspirated by suction lipectomy. The results of all of these procedures are that your face is rejuvenated, and made more youthful. A facelift has truly become a customized operation, in which the plastic surgeon uses different techniques for each patient, dependent on what concerns the patient, and what the surgeon sees during the consultation.

The most common risk of any operation to improve appearance is an "unsatisfactory result," which means that the patient is unhappy with the result for any reason. Usually, in patients who have a realistic attitude as to the likely outcome of a facelift, results are good. Dr. Newkirk's goal in carrying out a facelift is to make you look better but without making it obvious that you have had surgery. There are several other risks with facelift surgery. The most worrisome one is injury to the nerves which go to the facial muscles. Fortunately, this is rare, and Dr. Newkirk has never had this complication. Other complications are bleeding under the flaps, which may involve a short operation to remove the blood. Infection in a possible complication, but Dr. Newkirk has never seen one.

Dr. Newkirk carries out facelifts in the operating room suite at Columbia Plastic Surgery. You can go home after surgery, but the staff sees you a day after your operation to change your dressings. Stitches are removed between 5 and 10 days; patients can sometimes return to work after one week from the time of surgery. The best candidates for a facelift are men or women, who are healthy, do not smoke, and have particular aspects of their faces which concern them which can be corrected by surgery. In these patients, a facelift can make a real improvement in someone's appearance.

Pictures: Before and Afters

1. Before Facelift photo
1. After Facelift photo

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