A facelift, or rhytidectomy, is a surgical procedure that improves visible signs of aging in the face and neck. A facelift involves the removal of excess facial fat, the tightening of facial muscles, and the trimming or redraping of facial skin to approximate a smoother, firmer facial appearance.

A facelift procedure may include surgery on the face, neck, and/or ears. A facelift does not decrease fine lines and wrinkles or sun damage.

A facelift is considered an elective procedure and there are very few, if any, medical reasons that a facelift is 100% necessary. The most common reason is trauma requiring reconstructive surgery and a facelift.

This article will discuss reasons you may want a facelift, inclusion and exclusion criteria, as well as preoperative testing that must be completed prior to the surgery.

Diagnosis Related to Facial Plastic Surgery

Unlike other surgical procedures, there are very few direct diagnoses that would result in the need for facial plastic surgery. These diagnoses may include:

Facelifts are performed to cosmetically improve the aging in the face and neck. According to the American Society of Plastic Surgery, the purpose of a facelift is for:

• Relaxation of the skin of the face causing sagging
• Deepening of the fold lines between the nose and corner of the mouth
• Fat that has fallen or has disappeared
• Jowls developing in the cheeks and jaw
• Loose skin and excess fat of the neck that can appear as a double chin or “turkey neck”

Criteria

Because a facelift is considered an elective procedure there is no exact specific criteria; plastic surgeon experts do have criteria that makes patients ideal candidates. These include:

• Strong angular bony skeleton with a normal or high positioned hyoid complex
• Ideal weight with minimal facial and submental fat and appropriate facial skin elasticity
• Smooth non-sun-damaged skin and be without deep rhytids
• Without systemic disease
• Psychologically realistic and well-motivated

Despite being an elective procedure, according to experts there are patients that are not eligible or are considered less than ideal candidates. These patients include:

• Active smokers
• Patients in the middle of a life-changing situation or who are emotionally unstable
• Body dysmorphic disorder
• Obese patients, particularly those who are not controlling their weight and have large fluctuations or plan a significant weight loss in the next three to six months following surgery
• Patients unable to tolerate either deep sedation or general anesthesia
• Patients who are medically not cleared for surgery for cardiac or other reasons
• Patients who have active vasculitis or autoimmune diseases specifically related to the facial skin, such as facial scleroderma
• Patients on chemotherapy or a chemotherapeutic type medication controlling their autoimmune disease
• Patients with a history of full course radiation to the preauricular and infra-auricular neck skin
• Patients with a low hyoid, producing a very obtuse cervicomental angle
• Patients with very deep nasolabial grooves and prominent cheek mounds and folds

Tests and Labs

Preparing for facial plastic surgery will often include preoperative labs and other diagnostic tests depending on your health and preexisting conditions.

These preoperative tests are used to evaluate to determine if you are healthy enough to undergo the facelift surgery, and to maximize your safety when you are treated surgically. Furthermore, it is intended to determine any potential risk of complications under anesthesia.

Along with a routine physical, you may be required to complete the following labs:

Other preoperative diagnostic test include:

• Electrocardiogram (ECG or EKG): This study measures the electrical activity of the heart and can detect abnormalities and arrhythmias or dysrhythmias.
• Echocardiogram: This imaging study uses wave technology to create a picture of the heart while it is moving and to assess the blood flow in and out of the heart.
• Chest X-ray: This will look at the chest, lungs, heart, large arteries, ribs, and diaphragm.
• Facial magnetic resonance imaging (MRI): This provides the most detailed picture of the face and neck include blood vessels and bone structure.

The aforementioned tests, if needed, will all be required at least three to four weeks before the surgery so that the results are back prior to the scheduled surgery date. These preoperative tests may alert your surgeon to additional potential risks or complications to the procedure. Furthermore, if anything in the preoperative screening comes back abnormal it may require cancellation of the procedure.

On the day of surgery, a urine pregnancy test will be done for all patients capable of pregnancy who are of child-bearing age. Pregnancy is a contraindication to facial plastic surgery.

Because of the possible emotional and mental stress of having a facelift procedure, some surgeons will also recommend a psychological evaluation to ensure you are ready for the procedure and recovery.

A Word From Verywell

The possible visual and psychological benefits of undergoing facial plastic surgery can be vast; however, it is important to have realistic expectations for the purpose of the procedure.

Undergoing this type of surgery is an incredibly big decision, one that requires deep consideration and thought. This procedure changes your outward appearance and it is often difficult to “re-do” the surgery if unhappy with the results.

Fully understand the purpose of a facelift, surgical risks, and potential complications, as well as all inclusion and exclusion criteria, can help you make an informed decision. This will help you and your loved ones determine if undergoing a facelift is a viable option at this time.