The face is divided arbitrarily into three regions: 1) The brow and forehead, 2) the eyelids and mid face (cheeks), and 3) the lower face including the jowls, jaw, chin, and neck. Contrary to popular thinking, a face lift procedure does not lift all three regions. It is primarily concerned with surgically lifting the lower face and neck. As we age, our tapered, triangular face transforms into a more rectangular shape. The jowls, which drape over the lower jaw contribute to this appearance. In addition, the skin under the lower jaw and the neck may also be quite lax leading to an appearance of having no neck.
The procedure involves making an incision from the front of the ear down around to the back of the ear. A plane between the skin and the underlying fat is created on either side of the face. This plane is carried under the neck. Excess fat under the neck is removed. A muscle layer on both sides of the face is tightened with sutures. The loose skin is pulled up and any excess is removed. The skin is closed with a combination of staples and sutures.
Surgery of the other two regions, the upper face and the eyelids/mid face, may be done with the lower face lift or they may be performed on a separate day.
Swelling, bruising, and mild discomfort are experienced postoperatively. Sutures and staples are removed at one week.
Full healing generally occurs by 6 months, though a "normal" facial appearance is often noted within 3 months.
Surgery of loose neck skin is performed using the same incisions and procedure as in a standard face lift. The difference between the two is that the direction of skin tightening in a neck lift is more horizontal than vertical (direction of a face lift). Liposuction may be performed. Postoperative care is the same as for the face lift.
Occasionally, CO2 laser may be used to tighten the surface wrinkles of the neck, however, it is no substitute for an incisional neck lift.