What are the considerations and recommendations for a healthy adult, likely between 40 and 70 years old, with a history of sun exposure and signs of facial aging, seeking a facial lift (rhytidectomy)?

Facial Lift (Rhytidectomy) Recommendations

For a healthy adult aged 40-70 with sun-damaged skin and visible facial aging, rhytidectomy remains the definitive surgical option for addressing significant tissue descent, jowling, and neck laxity, with deep plane techniques providing superior and longer-lasting results compared to superficial approaches. 1, 2

Understanding the Aging Process Before Surgery

The visible signs you see on the surface—wrinkles, skin laxity, jowls, and folds—reflect deeper pathology that must be addressed surgically for optimal outcomes. 3 Specifically:

• Vascular degeneration is the primary driver of facial aging, causing decreased blood flow, oxygen delivery, and nutrient supply to tissues 3
• Deep fat atrophy occurs from this reduced blood supply, leading to volume loss in the malar fat pads, periorbital regions, and cheeks 3
• Muscle changes include hypertrophy with age, creating permanent wrinkles and contributing to tissue descent 3
• Subcutaneous tissue shrinkage results in loss of the "volumizing cushion" effect, particularly in high-fat compartments like the glabella, cheeks, and nasolabial folds 3

Surgical Technique Selection

The deep plane rhytidectomy technique is superior to superficial approaches because it addresses the underlying anatomic changes of aging rather than simply tightening skin. 1, 2

Why Deep Plane Works Better:

• Mobilizes and repositions the superficial musculoaponeurotic system (SMAS) and deeper tissues in their anatomically correct vectors 1
• Creates stronger flaps for soft tissue redraping with less tension on skin 2
• Provides more consistent and longer-lasting results by reversing actual anatomic changes rather than masking them 4, 2
• Reduces complications by avoiding excessive skin tension and distributing forces across deeper, more robust tissue layers 2
• Better addresses midface aging, melolabial folds, jawline definition, and neck contour in a single procedure 2

Technical Approach:

• Perform as an outpatient procedure under local anesthesia with IV sedation for excellent tolerance and rapid recovery 5
• Combine with adjunctive procedures (brow lift, blepharoplasty, submental liposuction) for complete facial rejuvenation rather than isolated facelift 5
• Use extended SMAS dissection to achieve midface rejuvenation and restore aesthetic harmony 4
• Focus on reconstructive principles—reversing anatomic changes rather than simply lifting or tightening 4

Preoperative Optimization

Before proceeding to surgery, optimize the patient's skin and tissue health:

• Implement strict photoprotection with broad-spectrum SPF ≥15 to prevent further UV-induced collagen degradation 6
• Apply high-lipid content moisturizers immediately after cleansing to restore barrier function and address age-related hydration deficits 6
• Counsel on smoking cessation and alcohol minimization, as these impair blood flow and accelerate the vascular degeneration underlying facial aging 6
• Recommend vigorous exercise (≥4 hours weekly of high-intensity aerobic activity) to reduce stratum corneum thinning and increase mitochondrial biogenesis 6

Adjunctive Non-Surgical Options

For patients not ready for surgery or seeking enhancement of surgical results:

• Autologous platelet concentrates (PRF) offer natural rejuvenation with superior safety profiles compared to synthetic fillers, improving skin texture, tone, elasticity, and collagen synthesis over 2-fold 7
• Hyaluronic acid fillers provide volumizing effects lasting 6-18 months for targeted volume restoration, though they carry vascular occlusion risks requiring proper technique 7
• Fat grafting addresses deep volume loss in subcutaneous tissues, particularly effective for periorbital and perioral regions 3

Critical Pitfalls to Avoid

• Do not perform superficial SMAS techniques when deep plane approaches provide superior, longer-lasting results with fewer complications 2
• Avoid isolated skin tightening without addressing underlying SMAS and fat compartment changes—this creates unnatural results and early recurrence 4, 1
• Never rely on skin tension alone for tissue repositioning; this increases complications and produces surgical stigmata 2
• Do not overlook neck rejuvenation—address the neck, jawline, and midface as integrated units for harmonious results 2

Revision Surgery Considerations

Revision rhytidectomy is significantly more complex due to altered anatomy from previous surgery, scar tissue, and potential facial nerve landmark distortion. 8 If considering revision:

• Expect amplified risks with deep plane revisions and aggressive neck procedures 8
• Address specific deformities like cobra neck or pixie ear that may have resulted from primary surgery 8
• Recognize that natural aging years after primary surgery is a legitimate indication for revision 8

Expected Outcomes and Recovery

• Postoperative recovery is routinely uneventful with outpatient deep plane techniques 5
• Complications are rarely encountered when proper technique is employed 5
• Results provide consistent, lasting, and natural appearance that ages gracefully over time 2
• The procedure restores quality of life by addressing issues that negatively impact body image and physical functioning 9