Many people, from the late thirties and up, choose to undergo Face Lift Surgery (also known as Rhytidectomy or Rhytidoplasty) to enhance their features and restore their youthfulness.  In fact, there is a rising trend in minor facelifts in patients as young as 30.  Many young professionals undergo this procedure to gain an edge in their field.  There are minor procedures such as cheek pad lifts (midface lift) and less invasive temporal lifts (lateral brow lifts) which can return a young-looking appearance without the many months of waiting for a full face lift to fall. A Face Lift can improve your appearance and give you a look that can be dramatic or simply refreshed and well rested.  It is about rejuvenation and or change of appearance.  Please go over with your surgeon the amount of change you wish you have and listen to what he or she deems as realistically possible.  Having a face lift won't change who you are but it can return a youthful appearance to an otherwise tired-looking face.  If you believe that you look older than you feel, a facelift may match your outside to your inside.

What Is A Face Lift?
Also known as Rhytidoplasty or Rhytidectomy, the Face lift is an operation is designed to reduce sagging and wrinkling in the lower face and neck.  It does not correct problems around the eyelids, at the corners of the mouth (unless a mid-face lift is also performed) or the wrinkles around the lips.  This operation may be chosen for one of two reasons: to help prevent the advancement of aging, i.e. to help relatively young individuals (40 and younger) to appear to stay young, or it may assist one who is already wrinkled or whose skin sags to appear younger and fresher.  The amount of improvement depends upon the degree of wrinkling and sagging already present.  If minimal, then changes may be subtle but the aging process appears markedly impeded.  If the wrinkling and sagging is great, then the results can be very dramatic.

Are You a Candidate for Face Lift?
First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery.  Communication is crucial in reaching one's goals. You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.  Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure. This is an operation which requires patience and stability in dealing with the healing period.  There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue. Please consider this before committing to a procedure. If the above describes you and you have the desire to rid yourself of loose sagging skin of the face and neck, you may be a good candidate for Face Lift. 

Also, if you are considering losing a considerable amount of weight you should wait until after your desired weight is met.  You may need additional surgery to remove the excess skin after you have lost the desired weight which would mean that the money, time and effort spent on the previous Face Lift would be wasted.  But it is definitely not unheard of for people to have several facelifts in their life.

Types of Face Lifts
There are several available face lift and related lifting techniques.  Some procedures correct or improve most areas of the face and some that were designed to enhance only specific sections.  There are variations to all of these and even some combining forms, therefore it depends upon the surgeon..

• Standard, Conventional or Traditional Lift: Is designed to lift sagging skin and its deeper structures (sometimes).  The incision lines are usually along or behind the hairline.  The skin is excised and the skin of the face is brought tighter and lifted and sutured.  It is possible that one surgeon may consider a skin-only facelift a traditional while another may re-suspend the fat and muscle.

• SMAS (Superficial (or Sub-) Muscular Aponeurotic System) Lift: The SMAS is responsible for your facial movements.  Without it you would not be able to smile, frown, smirk or make other facial expressions.  This area is lifted up and out -- diagonally would be the best way to explain it.  This can be done with the Platysma lift (neck lift) for increased rejuvenation.  Read more below.

• Platysma Lift (neck lift, platysmaplasty): in conjunction with a SMAS lift, this is considered the best treatment for a sagging and loose-skinned neck and jowls by many surgeons usually.  With the Platysma lift, the platysma muscles are tightened and then sutured as well as the hanging skin and excess fat is removed to result in a more youthful neck, post-operatively.  It is possible to have a plastysma lift only if this is all you need.  Many men seek this procedure earlier in their life.

• S-Lift: This procedure was innovated in the late 1960's; although German surgeons further improved the procedure before it's transcontinental migration to the US.  This procedure can be performed on patients in their late 30's to even their 80's on upwards.  The incision is directly in front of the ear and the layers are moved and pulled laterally.  The lift is for the lower third of the face.  The upper areas and eye wrinkles are not affected.  The jaw line, jowls and neck can be smoothed this way.

• Mini Lift: Some surgeons consider the lateral lift with incisions directly in front of the ear only, a mini-lift of sorts.  It can slightly address the nasolabial folds.  Many surgeons offer their patients a Midface, or cheek pad, lift to effectively address the midface in a vertical lifting fashion.

• Mini Lift (with suture suspension): This surgery is where sutures are anchored into the underlying muscle with barbs or anchored by sewing through the muscle and is suspended by anchoring the ends with non-dissolvable thread to the frontalis (front-top) of the head.  Another option is implanting a small screw in the skull from which to suspend the suture material.  

• SOOF (suborbicularis Oculi Fat) Lift: This procedure is designed to reposition the Sub-orbiularis Oculi Fat to help correct a hollow or skeletal looking under eye area.  Some surgeons include a cheek pad lift as well (midface lift).

• Subperiosteal Facelift: This technique was designed to lift the sub-orbital area as well as the midface. The suspension... "is accomplished by anchoring mattress sutures to the cut edges of the temporalis fascia on the flap, and tying them to approximately two cm above the superior incision in the temporalis fascia. As in a coronal brow lift, the appropriate skin excision is accomplished and the skin is closed. Ramirez felt that in his series, the perioral and periorbital tissues were rejuvenated by this pull, areas that the standard lifting techniques could not access.  His complications were limited to a single hematoma that resolved spontaneously, and the above mentioned frontal branch paresis. Although 20% of the subjects were smokers, no flap necrosis was seen, likely a result of the flap thickness." source: Ramirez O. Subperiosteal rhytidectomy: The third-generation facelift. Annals of Plastic Surgery 1992;28(3):220.

• The Deep Plane Lift: This facelift is a relatively new procedure It is performed in a deeper plane than in the standard face lift.  This procedure is like a SMAS lift with a little extra oomph for the nasolabial area (those pesky grooves that run from the side of the nose to the lips.  Unfortunately, lateral tension on the SMAS deepens the SMAS so the deep plane lift was designed with the use of a longer flap elevated with optimal vascularization.  The nasolabial folds will be improved by lifting the sagging fat pad that causes this fold.  At the same time, this pad will be repositioned upward and backward, improving cheekbone definition.  As this procedure is performed in the deeper plane, there is a higher risk of facial weakness after the procedure. The benefits to the neck and jaw are the same as with the standard facelift.  "The risk is higher of facial nerve injury, however.  Other benefits, though, include improved rejuvenation of the nasolabial fold, ptotic malar fat, and sagging orbicularis oculi muscles." source: Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96

• Temporal Lift (Lateral Lift, lateral brow lift): This is a more lateral-diagonal lift.  It can also produce an exotic look to the outer arch of the brow. it can also produce an exotic, cat look.  It can relieve folds and small wrinkles in the forehead, the glabella (between the brows), and to the crow's feet.  The Temporal Lift also lifts the cheek skin and can restore a more chiseled look to the cheekbones where fat and loose skin has fallen south.  This lift is considered a tension lift which may run the risk of stretched or widened scars.  There are variations such as internal suture material, suspension and underlying muscle tightening.  Be sure to ask your surgeon which techniques and additional lifting variations it performs.

• Tissue Glue Face Lift: The face lift is considered to have a faster recovery time and less bruising.  Also it is reported that the scars are lessened in appearance and recovery is easier on the patient due to tension only where there are sutures rather than across the whole incision as a whole.  With sutures, there is often pin pricking and irritation as you heal.  Whereas with tissue glue, reportedly there is none of the above.  It isn't necessarily a different internal technique but rather a different approach to how the incision lines are closed.  The tissue glue, usually Fibrin Sealant, is applied along the incision line.  The sealant actually acts as a vasoconstrictor and closes off the severed or broken capillaries and literally seals the incision within a few minutes as the surgeon holds it.  There is no need to have sutures removed as the Fibrin Sealant eventually is rid by your body and washes off by the time it is no longer needed.

• Mid-Face Lift: This is a good option for younger patients who do not yet need a full face lift.  It provides a refreshed look regarding sagginess around the under eye, nasolabial and upper mouth and outer upper lip area.  The open technique does not affect the brows so if you would like an endoscopic brow lift that is complementary with the mid face lift you may need this separately.  Unless you have the endoscopic mid-face lift which rejuvenates the outer brow as well.  The mid-face lift is carried out two ways.

  1. One technique, sometimes considered an open technique is through and incision under the lower lash line and sometimes with an additional small incision within the nasolabial fold.  Although not all surgeons choose the additional nasolabial incision.  This is a great option for those needed more of a vertical lift rather than a horizontal or diagonal windswept lift.  There is usually a subtle result and rejuvenation is mostly what is desired rather than a major change of appearance.

  2. Another technique, considered to be endoscopic, requires two incisions in the scalp an inch to a few inches above the temples.  This approach can improve the outer eye, temple and brow.  Imagine an extended Temporal Lift. It would be like a temporal Lift in conjunction with a mid-face lift. This is more invasive and does require a few days more recovery and more bruising and swelling. However, this technique is more effective for a face that needs more pulling both vertically and diagonally. There is a risk of a windswept look if not performed correctly. Unless of course a minor windswept look is what you're aiming for. The endoscopic approach also affects the outer brow and lifts the temple as well.

What to Expect at Your Consultation
After checking a few surgeons' backgrounds and credentials, you will make an appointment for a consultation.   You will meet with these surgeons and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take, etc., this is very important.  Visit the Medication & Supplements List for more information. 

You will discuss your complaints and concerns and discuss the various looks one can achieve, the amount that can and should be removed, etc.  Your surgeon will explain the technique and incision placements or methods that may be most appropriate for you and should discuss the risks associated with Face Lift with you, as well. 

You will also discuss the available anesthesia that will be used for your procedure.  Most deep plane face lift procedures are performed under General IV Sedation, although Light Sleep Sedation is a possibility.  Either way, discuss this beforehand as many people are not aware of the risks of Anesthesia.  If you do go under Deep General, ascertain that the anesthesiologist is certified.  Please read the All About Anesthesia Page - the risks regarding anesthesia should be considered for a fully informed choice. 

If you would like more information on consultations or a list of questions to ask your surgeon please visit the Consultation Help Page.  If you should choose to book or reserve a surgery date you will usually give a deposit to hold your surgery date.  Most times if you cancel a few days beforehand, this amount is non-refundable.  After paying your deposit and scheduling a surgery date, you will also schedule a pre-operative appointment...

Your Preoperative Appointment
This appointment addresses more questions you may not have thought to ask at the initial consultation, such as more surgical details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure.  Just as your surgeon will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the months ahead.  You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs.  Remember, always ask your doctor before taking any of these products. 

Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment.  If you remember something when you get home or the next day or even the day of surgery, don't be afraid to ask. 

Preparing For Your Surgery
You should be given a pre-operative information packet that explains everything you should do and know before your surgery date.  The packet should include a list of all the medications you should not take starting usually at 2 weeks before your surgery.  These medications will include, but are not limited to, aspirin containing products, stimulants, seratonin supplements, etc.  Would you like to view a typical Medication & Supplements List?

It is quite possible that you will have preliminary blood work performed.  This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count (called a complete blood count, or CBC) and check for disease or disorders beforehand.  If you are a female they may take an extra vial for a pregnancy test.  Some surgeons ask that you have physical.  This can be yet another out of pocket expense so ask at your consultation what will be needed when you are quoted a price.

It is really important to quit smoking as soon as possible, if you presently do.  When a patient smokes there is decreased vascularization, circulation and healing. This can resulting in tissue necrosis (skin death), delayed healing, complications, intense bruising, etc. Please consider these risks. 

So many things to do... so little time.  Your surgery will be here before you know it so visit the Preparing For Surgery page and relax.  This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day.

How A Rhytidectomy Procedure Is Performed
A Face Lift normally  takes from 3 to 6 hours to perform.  If you are having a Platysma (neck) lift, the surgery may last closer to 6 hours. 

First, you will have monitoring pads attached to you so that the surgical team can properly monitor your vital statistics before, during and after your operation.  When you are brought to the operating room, electrodes will be plugged into these pads which are connected to the monitoring equipment.  

Once you are on the operating room table, you will then be given your choice or your surgeon's preference in anesthesia as discussed prior to your surgery date.  If you had been given an oral sedative or valium prior you will have less anxiety.  They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular doorway for anesthesia, antibiotics, and other medications.  If you haven't been given a sedative, it is more stressful for some patients.  If you feel that you may experience anxiety inquire beforehand regarding an oral sedative.  Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time.  It's the initial placement of the IV that may sting a bit.  Some people get heir IV placed in the crook of the elbow, some the hand, it all depends upon your veins, though.  So if your veins are not very prominent this can be a problem. You are then brought to the O.R. if you aren't on the table yet.  After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein.  This is called a catheter.  The  catheter is taped to your skin so it is not accidentally knocked or pulled out and is ready to be used as a sort of entryway for anything the surgical team deems necessary for your body.  This is usually done before you get into the actual O.R., by a nurse, and you have a saline bag hooked up to you.  The medications will usually be given with a drip system with this saline. As said before, the saline will keep you hydrated both during and post-operatively.  

If you have chosen an IV Liquid Sedative, they will insert a hypodermic into your tube that you are attached to or they attach the bag of it with a drip system to add a few drops every few seconds and when they spring open the stopper and it starts heading towards your body.  The the effects of the anesthesia are felt soon after injection or opening the stopper, a few seconds in fact.  It may feel similar to a sensation of heat entering your arm or hand at the catheter site.  It then feels as though it is creeping up your arm, then it jumps from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized.   The anesthesiologist or surgeon will then determine if you are sedated properly, your stats are stable and if you are ready for the surgery to begin.

You will then be marked with a magic marker type pen for the incision placement areas if your placement is to be performed intradermally.  You will then be scrubbed with Betadine, the surgical marker markings will remain, although not as dark.  You will be injected with a solution of Lidocaine, epinephrine and saline.  The epinephrine is a vasoconstrictor.  This will impede your skin's ability to bleed excessively.

The incisions will follow along the natural lines and creases by the ear, neck, wherever and whatever type of lift you will be having. All efforts possible should be made in order to achieve inconspicuous scars. 

 He will then dissect [: to separate or follow along natural lines of cleavage (as through connective tissue)] the tissues from your underlying structure, depending upon the type of lift and desired results. This is like separating the skin and muscle from your skull. He will then proceed to either excise excess, loose skin and suction or remove excess fat manually, or possibly atrophied muscle. Underlying structures are then suspended by permanent sutures if you are going this route. Some surgeons work on one area at a time, some like to move back and forth checking for possible asymmetries - it is really a matter of preference. The surgeon will then lift your skin to the desired level of lift, usually insert a drain, and either apply a tissue glue or more than likely sutures and staples (the latter, if it involves incisions in the scalp).

The surgical team then performs a sponge and instrument count and your surgeon then closes your incisions with, more than likely, a non-dissolvable type suture.  Your surgeon will then apply a bulky dressing to your face and head to protect your wounds, keep the tissue in the proper place during recovery and possibly as pressure to help with swelling and prohibit displacement.  This involves wrapping a dressing around the top of your head to underneath your chin, sometimes slightly over your ears.  Of course there may be differences in surgical technique depending upon the preference of your surgeon.

You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released.  This is dependent upon the individual but may take up to two hours.  Your face may feel tight and quite tender as the anesthesia wears off. You may even feel emotional or upset - this will depend upon your body's reaction to anesthesia.  You may also experience rigors or shivering.  This may feel uncontrollable and is usually from the medications - more than likely epinephrine that is used as a vasoconstrictor. The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable.  You may even be fortunate to have heating lamps.

Some patients feel nothing different although if you have had General you may feel a little sick, hopefully your surgeon gave you something to lessen this.  Your prescribed medication should alleviate this pain and discomfort.  However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately.  You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

The Road To Recovery 
You may get sick on the ride home from the surgical center or hospital so have a bucket or can with a lid as well as water and some Ritz or Goldfish crackers.  Bring pillows and a blanket if need be.  If you hurt take your pain relievers.  There is simply no reason to suffer.  Besides studies have shown that patients with increased pain heal slower than patients who are not in pain.

You may be groggy from the anesthetic and or oral medications and probably won't remember much of the first day or two.  You will have to take it easy and sleep on two pillows to keep your head elevated for about 14 days, or however long your surgeon suggests.  A recliner is the best for this. PLEASE KEEP YOUR HEAD STILL.  Do NOT turn your head from side to side.  MOVE YOUR WHOLE BODY, if you must move.  When you wake up you will notice that your face will look even more swollen in the first 3 days.  You won't usually be extremely swollen until late that night or the next day and then the third is by far usually the worst.  But, as the days go on the swelling will dissipate.  There may be a lot of bruising, but this will go away, as well.  So make a mental note of this or you may be shocked into a depression.  Bruising and swelling are a normal occurrence in most surgeries.  Don't worry, it is all a part of the natural healing process.  You shouldn't really look at yourself in the mirror, but rather have your partner or nurse care for you instead (even take photos if you wish it). 

Although any discomfort should be alleviated by your prescribed pain medication if you have excessive pain, redness, pus or other symptoms that do not appear normal, contact your surgeon immediately!  Take your temperature regularly.  An elevated temperature could mean an infection.  Take those antibiotics on time.  Also, don't forget if you are a female taking birth control pills that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well.

If you have had intraoral incisions (intra-oral mid-facelift) your diet may be restricted.  You should ascertain all fresh fruits and vegetables have been washed, no raw fish (sushi), very rare meat or other types of foods that may contain high amounts of bacteria.  Eating foods such as this may increase your risk of infection due to the incisions being in the mouth.  You may be instructed to rinse with Listerine several times a day.  DO NOT PICK or tongue your incisions or sutures!

Your back will more than likely cramp up from not being able to lie completely stretched out and flat on your back so some patients prefer heating pads or hot water bottles.  Remember not to sleep while using any of these devices.  This can result in severe burns - especially if you are heavily medicated and don't feel the heat or pain.

You will go in the next day more than likely for your first post-operative visit.  The surgeon MAY change your bandages or may wait until the end of the week - depending upon the seepage or the extent of work. Your sutures won't be removed until day 5-7 and your staples in your scalp (if applicable) not until around day 10.  Your scalp takes longer to heal.

Your skin will be numb - don't be afraid or worried, this is quiet normal, remember your nerves and all have been partially separated from their source.  Give them time to recuperate, just as you, yourself, need time to heal.  Please take it easy and try not to do too much, too soon.  You should be up and about in the first few days but don't feel guilty if you don't.  Listen to your body. 

Even though you may feel better, you must take it easy for the first 3 weeks.  Be careful not to bend over or lift heavy objects.  And be careful not to raise the blood pressure for at least 3 weeks as this could cause internal bleeding at your treatment area.  Your blood vessels dilate to allow increased blood flow when you raise your heart rate.  This may cause problems at internal wound sites.  Do not participate in contact sports for at least 6-8 weeks - although ask your surgeon what he recommends specifically.  NO steam rooms or devices, saunas, face masks or products containing Niacin, Niacinamide or Niacinamate (these products cause flushing and make your face red); NO products of any kind to promote major flushing of the skin.  Face lift surgery is one of the most surgically involved and requires the most strict of post-op care - unless of course you had a very minor lift.  And even then you must take it easy and do as your surgeon tells you.

Please continue to avoid alcohol and aspirin containing products for a few weeks to months (or until your surgeon tells you) as this has anti-platelet properties and could cause bleeding.  Also you are going to be bruised and swollen for quite some time.  If you quit smoking before the procedure you REALLY should not start back up.  Smoking greatly increases lack of vascularity promoting necrosis (death) of skin, improper healing and excessive scarring.  Quit beforehand and stay such.

You may notice a change in your smile, odd sensations of tightness, tingling, the sporadic sharp pain, or pulling, burning, and cold sensations.  These usually subside within the first few weeks.  Your swelling will subside, revealing a more defined, youthful version of your former self.  Although this may take some time so please prepare yourself emotionally.  Some patients experience a lull or down period where they become depressed or feel unattractive.  This is very normal.

Risks & Complications Of Rhytidectomy
There are quite a few risks of Rhytidectomy.  First and foremost there could be an allergic reaction to the anesthetic.  The most common are complications are due to hemostasis [1 : stoppage or sluggishness of blood flow] or "overextensive undermining of flaps".  Although extremely rare, it is possible to bleed post-operatively resulting in another surgery to control and drain the collected blood.  Another possibility is hematoma (a collection of blood, some report 8.5% but usually is in the 5% range), seroma (a collection of the watery portion of the blood) and thrombosis (abnormal clotting).  Loss of sensitivity is common, although temporary.  Permanent sensation loss in the cheek or chin area or  in general, can and may happen. There is also a risk of excessive scarring or inner scar tissue. 

Although greatly feared, nerve injury is rare - 0.4% and 2.6%. Out of the nerves of the face, the frontal branch [: a branch of the ophthalmic nerve supplying the forehead, scalp, and adjoining parts]  is most commonly injured.  The reason it is vulnerable to injury during  dissection is due to its path over the zygomatic arch [: the arch of bone that extends along the front or side of the skull beneath the orbit and that is formed by the union of the temporal process of the zygomatic bone (English translation: cheek bone) in front with the zygomatic process of the temporal bone behind] The mandibular branch [: the one of the three major branches or divisions of the trigeminal nerve that supplies sensory fibers to the lower jaw, the floor of the mouth, the anterior two-thirds of the tongue, and the lower teeth and motor fibers to the muscles of mastication] can be injured during dissection below the platysma (neck muscle) at the mandibular angle (angle of the jaw). There is the possibility of buccal [1 : of, relating to, near, involving, or supplying a cheek <the ~ branch of the facial nerve>] injury which can happen when deep dissection is carried out medially in the mid-face section. The greater auricular nerve is injured more than the facial nerve due to the postauricular [: located or occurring behind the auricle of the ear <a ~ incision>] flap [: a piece of tissue partly severed from its place of origin for use in surgical grafting] being elevated off of the adherent subcutaneous tissues.

As far as hematoma is concerned, "The pathophysiology [: the physiology of abnormal states; specif : the functional changes that accompany a particular syndrome or disease; in English this translates to the "reason" or "cause"] behind this problem is that the flaps are separated from the deep tissues, limiting the blood supply. Additionally, tension is placed on the flap as the skin expands to accommodate the underlying volume. Skin necrosis routinely follows unrecognized hematomas. Expanding hematomas must be addressed by opening the incisions and obtaining hemostasis [1 : stoppage or sluggishness of blood flow]. Smaller ones may disappear with serial evacuations. Meticulous hemostasis, judicious flap dissection, and attention to postoperative pain are the best defense against this common complication." source: Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96

If too much skin is removed or if inadequate incisions are placed, a rhytidectomy patient can suffer greatly. You see, excessive tension can widen scars (as talked about in the Temporal lift) Hypertrophic scarring is possible, especially in individuals who are prone to such (ethnic patients).  If this happens these scars can be treated with repeat injections of triamcinolone [: a glucocorticoid drug used esp. in treating psoriasis and allergic skin and respiratory disorders, such as Kenalog or Kenocort:] every month. These injections help calm down inflamed tissue and break up the excess collagen causing the excessive scarring.  

Another possibility is tissue necrosis (skin death) or skin sloughing [: dead tissue separating from living tissue; esp : a mass of dead tissue separating from an ulcer] . Topical and oral antibiotics will help but the necrotic tissue must be debrided  [: the surgical removal of lacerated, devitalized, or contaminated tissue]. Many forms of debridement exist but the most common is manual with an acidic pack. The least common being maggot therapy debridement [: use of sterile maggots from the blue bottle fly].

A very common after effect is Alopecia [: loss of hair, wool, or feathers : BALDNESS]  along the incision lines and even hair of the head in general or facial hair, such as eyelashes or eyebrows sometimes because of the anesthesia and medications such as antibiotics and pain relievers.  Only about 1% (source:  Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96) report permanent Alopecia. T his may be from individual bodily reactions, circumstances or excessive tension. Sometimes a scar excision is suitable, sometimes this will only create further tension.

Another major risk is facial weakness or paralysis.  This can be from necrotic muscle tissue or surgeon area in detaching the flap of muscle for too long of a period of time and then the flap is traumatized.  Resulting in necrosis at worst, as well as dysfunction.  Another is attached earlobe, also called Pixie Ear Deformity [:drawn down or attached earlobe due to excessive rotation of the flap and auricular regions]. 

* Please note the prices charged for surgeries represented in the documentations of the links above are representative of what an American doctor would normally charge. Of course, our fees are lower but our doctors are more experienced because more patients come to us due to the affordable prices. Thus, the doctors work on more cases (especially oriental patients and many Caucasians).