The main surgical criterion is whether a technically sound rhytidectomy can change the individual’s appearance to a more youthful one. The benefits of a rhytidectomy are limited to tightening and resupporting the tissues of the lower two thirds of the face. These include the jowl, submentum, anterior neck, and, depending on the face-lifting technique, malar tissues. If brow ptosis or excess eyelid skin is contributing to the individual’s aging appearance, a brow lift or blepharoplasty is required to produce the desired result. Is Rhytidectomy for you?
In addition to cervicofacial skin ptosis, aging brings about other changes. Fine lines and deeply etched wrinkles are problems not well addressed by rhytidectomy. They require ancillary procedures, including chemical and laser exfoliation. The nasolabial fold is not affected by a traditional SMAS facelift; the patient must understand this prior to surgery, and options such as endoscopic midface lifting and deep plane facelifting can be discussed with the patient. Discussion of these 2 procedures is beyond the scope of this article. Geniomandibular grooves are similarly not corrected by facelifting. Again, special procedures or implants may be necessary for correction; surgical planning to treat this problem may include pre-jowl chin implants or autologous fat injections. However, a new technique has been studied for filling deep nasolabial folds with SMAS tissue.
The overall improvement possible with rhytidectomy is limited by aging of the upper third of the face and eyelids and the presence of wrinkles. When these problems are not addressed, suboptimal results are obtained, leaving half the face appearing aged. The underlying structure of the face is also critical because the redraping of the skin from the facelift highlights attractive cheekbones, chin, and jaw line. A relatively high and posterior hyoid is ideal, allowing maximal elevation of the submental contour.
Patients with rounder faces, low cheekbones, short mandibles, and ptotic submandibular glands have limited cervicofacial definition with rhytidectomy alone. With these patients, adjunctive cheek and chin implantation may be necessary to provide the desired result. Patients with a small chin or inferiorly placed hyoid cannot achieve the desired cervicomental definition without a chin implant.