A rhytidectomy is the medical term for a facelift, a surgical procedure that repositions the soft tissues of the face and neck to reduce visible signs of aging. It targets sagging skin, deep creases along the nose and mouth, jowls along the jawline, and loose skin under the chin. The procedure works on multiple layers beneath the skin, not just the surface, which is what separates a modern facelift from older techniques that simply pulled skin tighter.
What the Surgery Actually Does
A rhytidectomy works on up to four distinct layers of facial tissue: skin, fat, muscle, and a deeper structural layer called the SMAS. The SMAS is a sheet of fibrous and fatty tissue that sits between the skin and the deeper muscles of your face. Think of it as the scaffolding that holds your facial structure in place. As you age, this layer loosens and drops, pulling your skin down with it.
During surgery, the surgeon lifts and repositions this deeper layer rather than just stretching the skin. There are two main ways to do this. In one approach, the SMAS is folded over on itself and stitched into a higher position. In the other, a strip of the SMAS is removed and the remaining edges are overlapped and secured, creating a tighter foundation. Fat pads around the cheeks and under the eyes can also be repositioned to restore volume where the face has gone flat or hollow. For patients with a loose or sagging neck, the surgeon may also tighten the broad, flat muscle that runs from the collarbone to the jaw by stitching its two halves together at the midline.
The result is a structural repair, not just a cosmetic tightening. Because the deeper layers are doing most of the work, the skin doesn’t need to be pulled as aggressively, which helps avoid the “windswept” look that older facelift techniques sometimes produced.
Incisions and Anesthesia
The standard incision starts at the temples, follows the natural crease in front of the ear, curves behind the earlobe, and ends in the lower scalp behind the ear. This path keeps scars hidden in the hairline and the natural folds around the ear. For procedures that include neck work, a small additional incision is sometimes made under the chin.
Most full rhytidectomies are performed under general anesthesia or deep sedation with local numbing. Less invasive versions, sometimes called mini-facelifts, may use local anesthesia with lighter sedation and involve shorter incisions that focus on the lower face and jawline.
Full Facelift vs. Mini-Facelift
A full rhytidectomy addresses the entire face and neck. It involves longer incisions, deeper tissue work, and a longer recovery. A mini-facelift uses shorter incisions and focuses primarily on the lower face, particularly the jowls and jawline, without extensive neck correction. Mini-facelifts have grown steadily in popularity because they offer quicker healing and leave less visible scarring, though they produce less dramatic results and aren’t the right choice for someone with significant neck laxity.
What Recovery Looks Like
Bruising and swelling are most noticeable in the first two to three weeks. For a full rhytidectomy, most people return to work after two to three weeks. A mini-facelift recovery is faster, with many people back to their routine in five to seven days. Strenuous exercise is typically off-limits for at least three weeks.
Even after the visible bruising fades, your face may not feel entirely normal for two to three months. Tightness, numbness in certain areas, and a sensation of stiffness are common during this period and gradually resolve. The final result continues to settle and refine over several months as internal swelling goes down and tissues relax into their new position.
How Long Results Last
A clinical study that tracked patients for over five years found that different areas of the face age at different rates after surgery. The jowl area held up best: it was lifted by about 6 mm during surgery and only lost 21% of that correction at the 5.5-year mark. The angle under the chin and along the neck showed more relapse, losing about 69% of its initial improvement over the same period. The creases around the nose and mouth (nasolabial folds and marionette lines) also remained well-corrected at 5.5 years.
Overall, 76% of patients still looked younger at the 5.5-year follow-up than they had before their facelift. Aging doesn’t stop after surgery, but a rhytidectomy essentially resets the clock. Most patients can expect to look noticeably younger than they would have without the procedure for a decade or more, even as some natural aging resumes.
Risks and Complications
The most common complication is a hematoma, which is a collection of blood beneath the skin. It occurs more frequently in men and in patients with uncontrolled blood pressure. Small hematomas may resolve on their own, while larger ones sometimes require a return to the operating room to drain them.
Nerve injury is the complication patients tend to worry about most. Temporary numbness or weakness in parts of the face is relatively common in the weeks after surgery as nerves recover from swelling and surgical manipulation. Permanent nerve damage that affects facial movement is rare but possible, particularly with techniques that involve deeper dissection. Other risks include infection, visible scarring, skin loss (especially in smokers, whose blood supply to the skin is compromised), and asymmetry.
Who Is a Good Candidate
The best candidates have noticeable facial sagging with skin that still retains some elasticity. Skin that has become very thin, sun-damaged, or lost most of its stretch may not drape as smoothly over the repositioned deeper tissues. Bone structure also plays a role: a well-defined jawline and cheekbones provide a stronger framework for the lifted tissue to rest against.
Smoking is one of the biggest risk factors for poor healing. It constricts blood vessels and reduces blood flow to the skin flaps created during surgery, raising the risk of skin death and delayed wound healing. Most surgeons require patients to stop smoking for several weeks before and after the procedure. Uncontrolled high blood pressure also increases the risk of hematoma. Conditions that impair healing, such as unmanaged diabetes or autoimmune disorders requiring blood-thinning medications, may make someone a poor candidate.
Cost
According to the American Society of Plastic Surgeons, the projected surgeon fee for a rhytidectomy in 2024 ranges from $12,000 to $19,000. That range reflects variation in geographic location and practice setting but covers only the surgeon’s fee. Total out-of-pocket costs, which include anesthesia, operating room fees, and post-operative garments, can push the final number higher. Rhytidectomy is considered a cosmetic procedure, so health insurance does not cover it.