Facelift

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As a part of the normal process of aging, the skin of the face and neck progressively starts to lose its elasticity. There is also a loss of volume in the midface and descent of soft tissues. As a result of this, the cheeks become less prominent, nose to mouth lines start to deepen, and the jawline sags. This in turn gives rise to jowls, and the skin of the neck develops loose folds.


All of this alters the appearance of the face which changes from being heart shaped to more square as you get older. Near the eyes, the eyebrows begin to droop and the skin on the eyelids tends to drape, thereby causing a hooded appearance. Such problems can be addressed surgically with the help of a face and neck lift, which can be combined with surgery of the eyelids. A facelift rejuvenates the face and neck, giving one a fresh and youthful appearance.*


What can be done?

There are a number of procedures that can help rejuvenate aging skin problems of the face. These procedures are referred to as a facelift. In a facelift, the scars are placed to remain well hidden. The skin of the temples, cheeks and neck is tightened upwards as well as backwards. In addition to this, the layer of muscle-like tissue that lies under the skin (SMAS layer) is also lifted in a similar manner to give natural and long lasting results. This helps improve the facial shape and returns it to a more youthful outline without a tight or pulled appearance.*

The decision regarding which type of facelift will be performed would depend upon your particular requests, anatomy of your face, and the effect that aging has played on the appearance of your face. The latter might be assessed with the help of photographs that have been taken around 10 years back when you were younger. You will be requested to bring along these photos for the consultation session.

Often, the primary concern is the neck area. In case there is a lot of loose and saggy skin, or separation of the muscles, producing 2 bands, a neck lift procedure may be required.* Usually, this can be performed through facelift incisions, to tighten the neck muscles also. Sometimes, a small scar hidden underneath the chin may also be required for tightening of the neck muscles centrally.

DETAILS

Types of Facelift

Cutaneous (skin) Facelift:
This is a traditional facelift that has been performed for several years. It is a procedure in which the skin is lifted from the underlying tissues and tightened upwards and backwards. While there is an improvement in the overall appearance of the face, there is no improvement in the deeper facial tissues. However, this method does not provide very long lasting results and therefore is not used very frequently.

SMAS Facelift:

Under the skin on the face there lies a deeper layer to which the soft tissue and muscles are attached (SMAS – Superficial Musculo-Aponeurotic System). This can be utilized to elevate the soft tissues of the face, in order to provide long lasting results as compared to conventional facelifts where only the skin is tightened. This can either be achieved by removing a portion of the SMAS and tightening it (SMASectomy Facelift) or folding a portion of the SMAS itself in order to preserve volume (SMAS plication Facelift). Such facelifts prove useful when there is a need to restore fullness to the cheekbone area, remove jowls and redefinine the neck. This type of facelift is performed on most patients, but the direction in which the SMAS layer (muscles) is pulled is different for each patient. Hence, the result is natural and based upon the appearance seen in photographs of you when you were younger, which the doctor will have studied during your consultation.

‘MACS’ Lift (Minimal Access Cranial Suspension):

This facelift is appropriate for patients with mild and moderate jowls, but no loose skin on the neck. In the procedure, permanent sutures are utilized to elevate the soft tissues on the face and suspend them in a better position. This procedure has a shorter scar behind the ears and the recovery is relatively quick. However, the results may not be as long lasting as SMAS facelifts.

Volumetric Facelift:

Facial aging often results in loss of fat on the face, and a hollow or gaunt appearance. This procedure uses a different approach to restore a youthful appearance. Volume can either be added by injecting the patient’s own fat into the face, or moving the cheek tissues from a lower position to a higher position over the cheek bones. Recent advancements have helped make fat transfer a much more reliable and predictable option.

Endoscopic Facelifting (endoface) and Subperiosteal Facelift (mask lift):

As compared to other types of facelifts, mask lift is a completely different concept. It was developed by a French plastic surgeon with ideas that came about from reconstructive techniques, which were then tailored for cosmetic use. The soft tissues on the face are released from their deeper attachments. They are then lifted and repositioned on the site they occupied before gravity caused its downward drift. Patients most suitable for the procedure are people who are in a relatively younger age group (35 – 45), with heaviness of the brows, and sagging of the outer corners of the cheeks and eyes, but without changes in the jowl or neck. An endoscopic facelift is exactly the same procedure. However, it uses small incisions in the hair-line and an incision in each lower eyelid, instead of a long incision in the scalp.

Necklift and Platysmaplasty:

All deep plane facelifts tighten the neck muscles to improve the jaw line and jowl area. The goal of a necklift is to eliminate vertical folds in the neck, tighten the skin and reduce the amount of excess fat underneath the chin. Usually, this can be accomplished through incisions made for a facelift. However, a small incision under the chin might also be needed for fat removal or to tighten the neck muscles centrally (platysmaplasty). This will be discussed with you in detail during your consultation session with the doctor.

Short Scar Facelift:

All the above mentioned facelifts can be performed with a shorter scar. Besides the the normal scar in front of the ear, the rest of the incision behind the ears is limited and doesn’t extend into the scalp. This means that even the ability to tighten the neck could be somewhat limited. Anyone with moderate amounts of loose skin on the neck would be better served with a marginally longer scar in order to accommodate this. Nevertheless, it provides a useful alternative for patients who require tightening predominantly in the face. Usually, these patients belong to a younger age group (early 40’s).

Which of these facelifts is best for you?

Today, there are a number of options available for effective facial rejuvenation surgery. The different types of facelifts will be discussed with you in order to determine which one would be the most appropriate option to produce the desired results. All facelift procedures are designed to offer a natural fresh look and will not produce a tight, mask-like appearance. The main focus of this type of surgery must be on the shape of the face. A youthful face would have full, high cheekbones along with a well defined neck contour and jaw line. As it ages, the face tends to become squarer. This trend is reversed with the help of effective facial rejuvenation surgery. The doctor will give you clear guidance on what would be the most suitable option for you.

How long will a facelift last?

This is amongst the most frequently asked questions that patients ask. The answer to this question is that this type of surgery turns back the aging process by almost 7 to 10 years. However, the procedure cannot stop time from ticking. Ten years after the surgery, you will of course look older; but you will always look 7 to 10 years younger than you would have looked without the surgery.

How will the doctor ensure a natural look?

This is a major concern for anyone who is considering facial surgery. The foundation for a good outcome is a thorough consultation as well as analysis of how your face has aged. This requires a review of your photographs taken about 10 years ago. You will be requested to bring along these photographs with you to the consultation with the doctor (all that is required is family photographs). This would give an accurate impression of the anatomical changes that have occurred, and also act as a “Roadmap”, so that the surgery truly rejuvenates you, instead of recreating an appearance you never wished for. The next step is the surgery, in which the doctor rejuvenates the skin by moving the soft tissues on the face (SMAS layer). This is so that rejuvenation of shape is achieved, which usually is the main change from youth to middle age. The skin will be tightened as well, but it can now can be done without a “wind tunnel” appearance. Your previous appearance from your photographs (“Roadmap”) helps the doctor in deciding the direction of pull of the SMAS, so that your procedure helps achieve a natural appearance and maintains the exact character of your face from youth. This also requires a certain element of artistic appreciation to achieve satisfying results.

Is it possible to hide the scars?

The scars for all the above facelifts are mostly located within the hairline and around the ear. The incision made on the face extends downwards from the scalp to the top of the ear. It travels for a short distance inside the ear canal so that it remains hidden from view in the cheek area. The incision then turns backwards at the bottom of the ear in order to lie deep in the groove between the side of the head and behind the ear. After it reaches the top of the ear, it turns to enter the scalp and remains hidden. These scars are located in a way that allows you to wear your hair in any style you choose after the scars have matured.

Can I have another facelift if I have had one before?

A number of facelift procedures involve treating patients who have already had facelift surgery before. Patients go back for another procedure because they have continued to age after their previous surgery which could be 7 to 10 years back, or perhaps because they are unhappy with their scarring or residual signs of aging that were not properly dealt with. Repeating a facelift that was performed over 7 years ago is generally straightforward, since there would be further laxity of the skin as well as soft tissues as a result of the aging process. Hence, a further lift is technically quite feasible. One can undergo 3 facelifts before the tissues actually become difficult to operate upon. Secondary facelifting for residual signs of aging or unhappiness with scarring is more demanding, as removing the unwanted scars requires a patient to have enough skin laxity for sufficient excision as well as re-positioning of the scars in a favourable line. The doctor will give you an honest opinion on whether this is possible, or whether you should wait for a year or two in order to achieve better results.

Preparing for the Procedure

It is imperative to avoid taking Aspirin or any products that contain Aspirin for two weeks on either side of the operation. This is because Aspirin is known to have an adverse effect on bruising since it thins the blood. The same applies for vitamin E tablets and NSAIDs (non-steroidal anti-inflammatory drugs) such as Nurofen, Voltarol and Brufen. Some patients find homeopathic remedies like arnica to be helpful in reducing bruising, but it is quite difficult to “prove” their effectiveness scientifically. In case you want to use arnica, you must begin 2 to 3 days before the procedure and continue for a week after that. If you smoke, it is very important that you stop for at least 4 weeks prior to the surgery and for 2 weeks after surgery. This is to avoid restricting circulation to the skin. This applies to all forms of nicotine which include inhalers, patches and nicotine gum. Hair tinting can be continued until the time of surgery, but you should avoid strong bleach-containing colorants for 6 weeks after the procedure. Ensure that you thoroughly wash your hair, using a mild shampoo, a day prior to the surgery. Also, come to the hospital without wearing any make-up on the day of the surgery. While making preparations, make sure to arrange for someone to drive you home after the operation, and also to help you out at home for a couple of days after the procedure.

Where is the surgery performed?

The surgery will be performed at the hospital. You will be admitted on the day of the procedure, and will need to stay for at least 1 night. In case you have travelled from out of town for the surgery, the doctor might recommend staying in the hospital for an extra night before going home. You will need a relative or friend to accompany you home after you are discharged from the hospital.

What type of anesthesia will be used?

A facelift surgery is performed under general anaesthesia. As a result, you will sleep through the entire procedure. The doctor will employ the services of a skilled consultant anaesthetist specializing in anaesthesia for facial aesthetic surgery. This without a doubt makes the procedure a lot safer and also improves the results.

How It Works

What does the procedure involve?

After the anaesthetic has been administered, the doctor prepares the face and hair for surgery. He/she will not shave any hair at all during the procedure as it can be parted easily by using hair gel. The doctor infiltrates the face using a salt solution that contains a local anaesthetic. This helps reduce the swelling and bruising caused after surgery and has also been proven to improve scarring after facelifting. Following this, incisions are made around the ear, extending into the scalp. At times, an additional incision is made under the chin in order to allow fat removal as well as specific tightening of the neck muscles centrally. The skin of the neck and face is carefully lifted from the underlying fatty tissue and muscle. At this stage the fat can be trimmed from around the chin and neck area to improve the contour of the jawline. The doctor will then tighten the underlying fatty tissue and muscle (SMAS) before pulling the skin back, and removing excess skin. Following this, stitches are used to secure the skin and close the incisions. Metal clips can be used in the scalp as it proves beneficial for hair growth. For the first night after the procedure, a head bandage is applied around the face and neck area. It will be removed before you are discharged from the hospital the next day. A certain amount of bruising will occur. Hence, it is a good idea to bring along dark glasses and a scarf to the hospital, to wear on your way home. Usually, an overnight stay at the hospital is all that is required, unless you live out of town.

Treatment Details

What happens after Surgery? At the Hospital (1 to 2 days): Generally, a light padded dressing will be applied at the end of the surgery. This dressing will remain in place for 24 hours. Soon after the operation, you would be propped in a semi-sitting position in bed. This will help to reduce the swelling. Usually, there is not much pain or discomfort, but this can be subjective. A day after the operation, the bandages and dressings will be removed and the nurse will wash your hair before going home. At home (2 to 10 days): In order for the swelling to subside quickly, it proves helpful to rest/sleep with 3 or 4 pillows for the first week after surgery. The swelling tends to increase during the initial 3 to 4 days after the surgery. However, this is normal and the swelling will subside over the next 2 weeks. It might be a little slower to subside if the weather is warmer. Try and avoid drinking too much water. This is not the right time to drink 1 to 2 litres of water everyday in the hope of flushing out toxins from the system. After surgery, the brain releases a hormone which tends to retain water. Hence, if you drink too much water, you will retain fluid, and this in turn could cause more swelling. Just drink enough water to quench your thirst and drink tea or fruit juice as they will cause less fluid retention and swelling. It is very important to avoid bending forwards as it could cause more swelling. Also, it is better to avoid washing your hair unless you are sitting with your head tilted back at the hairdresser’s. This will anyways be done before you leave the hospital and can be repeated after 3 to 4 days. You must also avoid very hot drinks for the initial week. Avoid foods that are very chewy as this will help the facial swelling to subside faster. It is very helpful to rest as much as possible for the first 5 days and then gradually return to routine activities over a period of 7 to 10 days After a week the doctor will arrange to see you in order to remove any stitches around the eye. He will see you again after 10 to 14 days to remove the remaining stitches and clips. Any eyelid or facial stitches will run under the skin and are not visible, except at either end. Hence, there is nothing to worry as they will not leave behind any stitch marks. First 2 to 6 Weeks after Surgery Following surgery, the face (and the eyelids, if they have been operated on) might feel slightly tight. However, this is absolutely normal and related to swelling as well as scar maturation. At times the eyes may feel slightly “gritty” after surgery. If this is the case, it will prove helpful to use lubricating ointment at night. The ears and cheeks will feel numb for about 3 months after the surgery, but this is also normal and they will recover soon. In general, its best to continue with the usual facial skincare routine as there is a risk of sensitivity to any new product. You can visit your hairdresser after 10 to 14 days, but you must avoid using colorants for four weeks. You must avoid driving for at least 1 week after the surgery or until the time when your neck movements feel comfortable. The majority of patients can resume work after two weeks. However, you should avoid major social events for at least 3 to 4 weeks, until the swelling has subsided. You can resume your normal sporting activity after 3 to 4 weeks, but prior to that it’s best to avoid exercise as it will prolong the swelling on the face. What are the risks involved? Fortunately, these are rare and even when they do occur; they only represent temporary inconvenience instead of a permanent problem. The doctor will do everything possible to lower the risk. Bleeding under the skin can cause excessive bruising and might sometimes need surgical treatment. Overall, the incidence is only around 2 to 3% in all facelift procedures. The most common possibility for it to occur is within the first 12 hours after surgery, when you will be at the hospital. Usually, this is only a temporary hiccup and does not influence the final outcome of the surgery. Some numbness is expected in the area of surgery for about 3 months, particularly in the cheeks. Until this recovers, you might experience some tingling sensation or pins and needles. An infection is extremely uncommon on the face, the incidence being only around 1 to 2%. Occasionally, temporary hair loss is seen, particularly in the region of the temple (generally only in smokers). However, this will invariably recover over a period of 3 to 6 months. Normally the scars are very fine and remain well hidden, but in some cases a scar might tend to thicken after 6 to 12 weeks. Such “hypertrophic” scars can be improved with appropriate treatment. Generally, wound healing on the face is quite quick and reliable. Only sometimes a slow healing wound might be seen. This is normally behind the ear as the skin in that area is most fragile. Fortunately, such problems are very rare and are known to be most common in smokers. Summary Procedure time: 3 to 4 hours General / Local anesthesia: General Number of nights at the hospital: 1 night Sensitivity period: 10 to 14 days Time off work: 14 days Back to routine activities / sports: 4 weeks The modern day facelift has reached a point where it’s possible to tailor the operation in order to suit individual needs. For a majority of the patients it generates a significant rejuvenation as well as improvement in facial appearance for several years, without appearing overly tight or operated.

FAQ

Am I a good candidate for a facelift?

If you feel that your skin is beginning to sag around the jowls, forehead and anywhere else on your face, and if you look tired when you are not, then you are considered to be a good candidate for a facelift. A facelift can help improve and eliminate deep wrinkles and jowls, but cannot eliminate light wrinkles and fine lines. Other alternatives to consider, to refresh the look of your face, comprise laser treatment and chemical peels. These options can get rid of fine lines and wrinkles, and skin discoloration.

What is a facelift?

A facelift is a cosmetic surgical procedure that helps reduce the signs of ageing by tightening the muscles under the skin, tightening the skin itself, and removing excess fat. All of this provides an overall improvement in one’s appearance. You will end up looking revitalized, and much younger. Even though a face lift cannot make someone in their 50’s look like they are 20, the procedure can surely make you look several years younger.

At what age is a facelift generally performed?

There is no “typical age” for a facelift. Age can range anywhere from 30 to 80. However, a facelift can generate better results in people who are more mature or require extensive lifting, tightening or skin rejuvenation. You must discuss the available options with the surgeon in order to determine what is best for your individual case.

Are there different techniques for performing a facelift?

Yes, there are quite a few techniques. There are “skin-only” facelifts that can be suitable for younger people who have sagging facial skin, and lifts that help rearrange the muscles as well as tissues in deeper areas of the face. Deeper lifts involve lifting the SMAS (submuscular aponeurotic system – facial muscles) that tightens the cheeks, jowls, and face in general.

What does a facelift consultation entail?

During a consultation session, the surgeon will discuss your goals with you and also explain what can be achieved realistically with a facelift. You can bring along photos of yourself at a younger age to show your original facial appearance. This will help the surgeon have a better idea of what you want and expect from the procedure. Most patients expect to achieve a more young and attractive look, without looking very different. Some patients may want a greater amount of change. Speak with your surgeon about your goals and the results you are expecting from the procedure.

How is a facelift procedure performed?

The procedure takes approximately 2 to 6 hours to perform. It may even take longer if a neck lift or other procedures are also being performed. A facelift is mostly performed using general or light sleep anesthesia. Generally, patients sleep during the procedure and wake up with very little memory of the surgery itself. Local anesthesia might also be administered in order to numb the surgical area. The incisions are placed as inconspicuously as possible, above or within the hairline. They generally start behind the hairline at the temples, and then continue in a natural line in front of the ears. Some doctors make incisions just in the front of the ear and then curve around the bottom of the ear. The skin is separated from fat and muscle under it. The underlying tissue and muscle are tightened and the skin is pulled back, trimmed, and sutured in place. Sometimes, the doctor may use surgical staples instead of sutures.

What must I expect after the procedure?

Although there is generally no excessive pain related to a facelift, you might experience some. You could even experience numbness in areas on the face, which normally subsides within a couple of months. Do not be worried if you experience any swelling or bruising, as this is very normal because the skin and underlying tissues have been stretched, pulled and cut. Much of the swelling will start to disappear within the first week and then gradually continue to dissipate thereafter. Most patients can resume work and routine activities in around 10 days after the operation.

When are the sutures removed, and will it hurt?

The stitches and bandages are generally removed around 5 days after the procedure. In case surgical staples were used on the scalp, they will be removed after 7 to 10 days. Your face will be swollen and appear at its worst around the third day.

Does a facelift involve a lot of swelling?

Yes, you should expect swelling, particularly by around the third day after the surgery. The face might look quite normal after you get home, but it will begin to swell the next day and the day after. You might not recognize yourself, but there is nothing to worry as the swelling will gradually subside. You could be advised to sleep with your head and shoulders elevated. This is to help keep the swelling to a minimum.

Will there be any scarring and where will is it located?

After a facelift, you should expect some scarring. However, the scars are usually hidden in the hairline, under the jaw line or behind the ears.

How long is the downtime for this surgery and long should I expect to be away from work?

Following surgery, you can resume work after about a week. However, you may still have some swelling as well as residual bruises. You should expect to resume routine activities in approximately 3 weeks. You should not attend any red carpet events or weddings for at least 6 weeks after the surgery.

When can I see the results?

You will notice the rejuvenation as well as improvement in your facial skin and muscle structure soon as the swelling subsides. The final results would appear over several weeks following that.

What are the risks involved in a facelift?

There is some level of risk involved in all types of surgery. There is a possibility of developing a hematoma (pocket of clotted blood or bad bruise), hyperpigmentation (permanent discoloration) caused by the bruising, and numbness from nerve damage. Your face could appear a little asymmetrical. Scarring and infections are some of the other possible risks. In case your surgeon is not experienced and skilled enough, it is quite possible that your skin may be pulled too tight and you end up with a ‘stretched’ look.

How long does a facelift last?

This is hard to say, but the benefits of a facelift can last for approximately 10 years. This surgery will not stop you from ageing, but it can “reset the clock” and reduce the appearance of lines and sagginess.

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*Disclaimer: Laser, Radio Frequency, Plastic & Cosmetic Surgery Treatment Results Can Vary Significantly Between Patients, Risks, Potential Complications and Permanent Scars are going to be an inevitable part of any Surgical Procedure. BEFORE & AFTER photos are NOT guarantees that your results will be the same or even similar: each individual patient’s results will be different. Patient-care ethics of excellence still cannot guarantee results or a lack of complications. Complications, risks and scarring are inherent with surgical procedures. Our Surgeons & Dermatologist are also devoted to helping patients have REALISTIC expectations about what surgery or procedure can — and cannot — accomplish.