There is no “one procedure fits all,” it’s not like an appendectomy where a set piece of the body is removed. Face lift, a rhytidectomy on a large scale, is a balance between minimising the surgical interference and maximising the alteration: a reconstruction of the facial skin. As such, it is on every occasion an agreement between what the patient would like to have changed and how the surgeon thinks it can best be carried out.
Fundamentally, excess skin is removed, the remaining skin is made more taut, and the underlying supportive tissues may also be tightened.
It is “cutting” surgery – an incision is made – either one long or more than one short incision. Many of the variations, and much of the drive to gain maximal cosmetic (aesthetic) benefit, lie in the minimizing and placement of the incision(s). The positioning of the incision might, at the surgeon’s judgement, be different in men than in women because of the facial hair.
In principle, the incision is made far back in the face, anterior (sometimes only, or also posterior) to the ear, and the facial skin tissues are lifted from the deeper tissues by undermining them. When the skin and subcutaneous tissues have been lifted as a unit, necessary tightening up (plication) of the muscular aponeurosis is performed as the surgeon considers indicated. The freed skin of the face is then drawn back and up to the incision line, and the newly defined excess quantity is trimmed off.
The incision is closed by whichever technique the surgeon believes will cause least visible scar but will effect a firm closure of the skin margins – in general a choice between sutures and staples in their multiplicity of commercially available forms.
The “lift” might be supplemented by other techniques of fat or prosthetic grafting (liposculpture), by an element of liposuction, known also as lipoplasty, or Botox injection, or combined with other surgical operations such as reconstructive procedures on the eyelids.
The decision when to do the operation is one that has to be made by the patient, but if the patient is sure that a face lift is going to be desired, sooner or later, then sooner is advisable, while the tissues are in their best condition for surgery and several small “touch-up” procedures might be possible instead of one large reconstruction.