Introduction The causes of age are well documented – the effects of gravity, exposure to the sun, and the stresses of daily life. The effects are apparent – deep creases between the nose and mouth; a slack and a jowly jaw–line; folds and fat deposits around the neck. So what can be done to prevent aging? Well, nothing actually. Although you continue to age with a face lift, or “Rhytidectomy”, it does appear to set back the clock, improving the most visible signs of aging. It achieves this by removing excess fat, tightening underlying muscles, and re–draping facial and neck skin. As facelifts treat the bottom two–thirds of the face, it is not uncommon to combine another procedure, such as a forehead lift, eyelid surgery or nose reshaping. Clearly, a facelift can take you towards looking younger and fresher and increasing your self–confidence. What it can’t do is give you “A totally different look”. The best candidate for a face lift is a man or woman whose face and neck have begun to sag but whose skin still has some elasticity and whose bone structure is strong and well–defined. As for age, most patients are in their 40s–60s, but face lifts can be done successfully on older people as well. Face Lift Surgery With the aging process, there is loss of elasticity in the skin, decreased muscle tone, and loss of fatty tissue immediately beneath the facial skin. Conversely there may be an accumulation of fatty tissue and relaxed muscle under the chin. Heredity and sun exposure definitely influence the progression of facial aging. A face lift surgery (cheek–neck lift surgery) can be performed to improve the aged appearance of the lower two–thirds of the face and the neck. The amount of improvement with surgery depends upon the extent of sagging, the bone structure of the face and wrinkling of the skin. The goal of this surgery is a more rested, vibrant and natural look – not a pulled, mask–like appearance. In the past, face lift surgery involved only the removal of excess facial and neck skin. Today there are several techniques used in a face lift, depending upon the problems that each patient has and what the patient wants to achieve. The most common patient concerns are jowls that occur along the jaw line, lax skin in the neck, bands or “Turkey gobbler” appearance of the neck under the chin, and accumulation of fat immediately beneath the chin. In order to correct these problems, all of the involved tissues must be corrected. That is to say, not only is excess skin excised and fat removed with liposuction, but the platysma muscle is lifted and tightened as well (called the platysma cervical lift). Surgeons can remove excess muscle which causes bands under the chin and elevate the muscle to decrease or eliminate the jowls. By pulling the sagging muscle up, surgeons can tighten those muscles and avoid tension on the skin. A much better, longer lasting result can be achieved with this deeper plane lift. This eliminates the unnatural, mask–like look that can occur when the skin is pulled tightly. With the platysma lift, we are able to re–sculpt the frame of the face and neck, and delay the recurrence of the physical signs of aging. Patients are sometimes interested in “Mini–lifts.” The surgery is less extensive, and consequently the period of convalescence is shorter. Beware, however, that a mini–lift gives a mini–result. The improvements are not as significant, nor do they last as long. Surgeons can improve the deep folds and creases of the face with face lift surgery but the fine lines such as those occurring in the upper lip are untouched. In order to correct these problems, other procedures such as dermabrasion, chemical or laser peel, or collagen injections are necessary. Procedure The incisions start below the tuft of hair in front of the ear. In this way the excess skin can be removed without elevating the tuft, which would cause an obvious bald spot. The incision progresses into a natural crease and then it can be hidden within the ear canal. It is extended around the ear lobe onto the back side of the ear and into the hair immediately behind the ear. When it is necessary to remove excess fat or muscle under the chin, they place a separate incision in a crease under the chin. In this manner they place all the incisions in natural creases or are hidden within the ear and hair–bearing scalp. Discomfort is minimal and treated with analgesics for a very short period of time after surgery. A dressing is kept in place for three to four days. The sutures around the ears and under the chin may be removed about six days after surgery. Those within the hair are removed in ten to twelve days. You should allow approximately two weeks for recovery from the temporary bruising, swelling and discoloration that occurs. Makeup can be worn seven days following surgery. Cosmetologists who specialize in helping patients improve their appearance during the short period of convalescence can be approached. There is some numbness around the face which resolves over several weeks. The patients experience tightness in the face and neck, which prohibits strenuous activities for a few weeks.