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JAMA Patient Page
December 11, 2018

Rhytidectomy (Face-Lift Surgery)

JAMA. 2018;320(22):2387. doi:10.1001/jama.2018.17292

Rhytidectomy is a surgical procedure meant to counteract the effects of time on the aging face.

In the rhytidectomy procedure (also known as a “face-lift”), the tissues under the skin are tightened and excess facial and neck skin are excised.

Rhytidectomy literally means wrinkle (rhytid-) removal (-ectomy). The targeted area includes the cheek, midface, jawline, and neck areas. The name is misleading because rhytidectomy does not actually remove wrinkles. Wrinkles are removed by resurfacing procedures like peels or laser therapy. Medications such as botulinum toxin injected into underlying muscle can also soften the appearance of wrinkles.

A rhytidectomy may be performed alone or in combination with a forehead lift and/or eyelid lift (blepharoplasty) or nose surgery (rhinoplasty).

Steps of Rhytidectomy

Incision: The surgery consists of an incision starting in the hairline near the temple, tracing a path in front of the ear, around the earlobe, behind the ear, and ending again in the hairline. If a neck lift will also be performed, a small incision is made under the chin. For men, the incision is made to accommodate natural beard lines. In all cases, the incisions are placed where they will fall into a natural skin crease for camouflage.

Procedure: A skin flap is elevated over the tissues that will be lifted in surgery. A second tissue layer, deep to the skin, is then elevated and sutured. Tensioning of this layer allows for tightening of facial jowls and improvement of jawline contour. This tissue layer is then suspended from the upper face and sutured roughly horizontally, allowing for tightening of the lower face and jawline. If neck tightening is required, an incision is made under the chin. The platysma muscle is exposed. The platysma is continuous with the tissue layer used for “lifting” the face and tightening it allows for rejuvenation of the neck. This muscle also causes “neck bands.” The platysma is secured behind the ear to the mastoid bone for a more horizontal pull, using sutures that ultimately are absorbed. Excess skin left over from these procedures is removed.

Closure: Once the surgeon is satisfied with the “lift” and excess skin has been trimmed, the skin is then closed with sutures. A combination of absorbable and permanent sutures is used. Staples may be used in the skin in the hairline, as this does not cause damage to the hair follicles. A face-lift dressing is applied to put pressure on the incision lines and surgical area to limit swelling and decrease the chance of fluid collection in the surgical wound.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: American Academy of Facial Plastic and Reconstructive Surgery

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