A rhytidectomy is the medical term for a facelift, a surgical procedure that repositions the deeper soft tissues of the face to reduce visible signs of aging. It specifically targets sagging skin along the jawline (jowls), deep creases running from the nose to the corners of the mouth, and loose bands in the neck. The procedure goes beyond simply pulling skin tighter; modern techniques lift and reposition the structural layers beneath the skin for results that typically last around 11 years before patients consider a revision.
What a Rhytidectomy Actually Does
Aging causes the structural tissues of the face to gradually slide downward under the force of gravity. Fat pads shift, connective tissue loosens, and skin loses elasticity. A rhytidectomy addresses this by working on a layer called the SMAS, a sheet of fibrous and fatty tissue that sits beneath the skin and connects to the muscles responsible for facial expressions. By lifting and repositioning this deeper layer, a surgeon can restore facial contours in a way that looks natural rather than “pulled.”
There are several variations of the procedure. In a traditional SMAS facelift, the surgeon separates the skin from the SMAS, then tightens and repositions each layer independently. In a deep plane facelift, the surgeon works beneath the SMAS, releasing and lifting the skin and SMAS together as a single unit. A lower rhytidectomy focuses primarily on the neck and jawline. The right approach depends on where the most significant aging has occurred and how much correction is needed.
Where the Incisions Go
A traditional rhytidectomy incision starts at the temples, within the hairline. It continues downward, following the natural crease in front of the ear, wraps around the earlobe, and ends behind the ear in the lower scalp. If the neck needs work, a small additional incision is made under the chin. These scars are permanent but are designed to hide within the hairline and the natural contours around the ear, making them difficult to spot once healed.
Less extensive versions, sometimes called mini-facelifts, use shorter incisions and involve less tissue repositioning. These are better suited for people with mild to moderate sagging who don’t need a full correction.
Anesthesia and Surgical Setting
Rhytidectomy can be performed in a hospital operating room, an outpatient surgery center, or an accredited office-based surgical suite. The choice of anesthesia depends on the complexity of the procedure. A full facelift, which can take several hours, is often done under general anesthesia, meaning you’re completely unconscious. Shorter or less extensive procedures may use monitored sedation, where you receive intravenous medications that keep you in a deeply relaxed, semi-conscious state while the surgical area is numbed with local anesthetic.
What Recovery Looks Like
The first few days after surgery are the most uncomfortable. Bruising and swelling peak around days three and four, then gradually improve. Your face will be bandaged, and small drains may be placed to prevent fluid buildup. Most people look noticeably swollen and bruised for the first week or two.
Sutures come out between the end of the first week and the third week, depending on the specific technique used and how your body heals. By weeks three and four, most people can return to exercise and normal daily activities without obvious outward signs of surgery. Some residual swelling and numbness can linger for a few months, but it’s subtle enough that others generally won’t notice.
How Long Results Last
A facelift doesn’t stop aging, but it does reset the clock. A study spanning 30 years of deep plane facelifts found that patients returned for a revision after an average of 10.9 years. Age at the time of surgery matters: patients who had their first facelift at age 53 or younger waited an average of 12.4 years before seeking a revision, while those older than 53 came back after about 9.3 years. Studies of the SMAS technique have found similar durability, with patients returning for a second procedure after roughly 11 to 12 years on average.
These timelines reflect when patients felt they wanted additional correction, not when results disappeared entirely. The structural improvements from the initial surgery persist even as natural aging continues.
Risks and Complications
Rhytidectomy is considered safe when performed by a qualified surgeon, but it carries the risks inherent to any surgery. A systematic review of facelift complications found that hematoma (a collection of blood under the skin) is the most common issue, accounting for about 27% of all reported complications. Unfavorable scarring made up 24%, and temporary nerve irritation causing numbness or weakness accounted for 22%. Fluid collection at the surgical site represented about 7%.
Hematomas usually develop within the first 24 hours and may require a return to the operating room for drainage. Nerve-related issues are typically temporary, resolving over weeks to months as the nerve heals. Permanent nerve damage is rare. Smoking significantly increases the risk of poor wound healing and skin loss, which is why most surgeons require patients to stop smoking well before and after the procedure.
Cost
The cost of rhytidectomy varies widely based on the surgeon’s experience, the technique used, and geographic location. For a lower facelift (neck lift), the average surgeon’s fee alone is around $7,885, according to the American Society of Plastic Surgeons. That figure does not include anesthesia fees, operating room costs, or other related expenses, which can add several thousand dollars to the total. A full facelift addressing both the mid-face and neck typically costs more. Health insurance does not cover rhytidectomy when it’s performed for cosmetic reasons.