Rhytidectomy

Definition

The removal of excess skin of the face and neck area, and the tightening of underlying support structures, such as muscle and superficial fascia.

Discussion

• A rhytidectomy is often performed in combination with a blepharoplasty.
• As the natural aging takes place, skin around the face and neck begins to lose its tone and will sag.
• This procedure, commonly called a “facelift” if performed to improve the appearance of the patient, provides both emotional and social benefits.
• The procedure may be performed under general or local anesthesia, depending on the preference of the patient and the surgeon.

Positioning

• Supine with arms tucked in the sides.
• The head may be supported on a headrest.

• A nasal preparation is usually performed prior to begin the skin preparation.

Instrumentation

• Basic plastic tray
• Small Deaver retractors

Supplies/ Equipment

• Head rest
• Restraints
• Suction
• Sitting stools
• Basin set
• Blades
• Needle counter
• Local anesthetic with epinephrine
• Syringes and needles
• Drain
• Solutions
• Sutures

Procedure Overview

1. The incisions are made close to the hairline or in the hair so that the resulting scars are unnoticeable.
2. A small amount of hair may need to be shaved from the hairline; in most cases, this is performed by the surgeon.
3. The skin and subcutaneous tissue are mobilized by undermining (separation of skin and subcutaneous tissue from their attachments underneath).
4. Care is taken to avoid injury to nerves such as facial nerve branches and greater auricular nerve.
5. After hemostasis is secured, placation sutures are placed in the musculofacial tissues.
6. Tension is placed on the flap and traction sutures are used to pull the flap superiorly and posteriorly.
7. The excess skin is trimmed.
8. Wound closure is completed with fine interrupted sutures.
9. A closed-suction drainage unit may be inserted before closure.
10. A light pressure dressing is then applied, padding the ears.

Perioperative Nursing Considerations

1. Do not allow the preparation solution to pool in or around the eyes or ears.
2. A head drape should be used for all facial surgery.
3. The table may be flexed for added patient comfort.
4. A foam mattress should be used for extra support.