A facelift is an operation designed to rejuvenate the ageing face. It may be combined with other facial cosmetic operations like eyelid surgery and liposuction of the neck, as well as with non surgical procedures like neurotoxins (derived from botulinum toxin), and gel injections. Whereas previously the emphasis of the surgery was placed on skin tightening (which gave an operated, rather than a more youthful appearance), a better understanding of the effects of facial ageing coupled with a more detailed knowledge of the facial anatomy, and how this changes with ageing, has led to the development of modern facelifts designed to re-elevate and reposition the deeper tissues to a more youthful position, without the marked skin tightening stigmata seen in the past.
EFFECTS OF AGING
- General “wear and tear” coupled with sun damage leads to changes in the skin quality (wrinkles, lines, pigmentary changes)
- Loss of facial volume, which effects both the soft tissue padding (fat) and the bone
- Descent (ptosis) of the remaining facial fat – droopiness leading to heavy naso-labial lines, flattened cheek prominences, jowls, and sagging neck skin
- Weakened support structures leading to prominent bulges in the eyelids
A good candidate for the surgery is a patient in her late 40’s or 50’s who wishes to look somewhat younger (Patients often tell me that they feel much younger than they appear, and want to look as good as they feel!) You need to be in good general health, and a non smoker to qualify for this surgery.
The surgery is performed under IV sedation or a light general anaesthetic, most often as a day case – only occasionally is an overnight stay needed. The duration may be 3 – 4 hours, or longer, particularly if combined with other surgeries, like eyes. The usual incision commences in the sideburn area, and then (in a well camouflaged pattern) in front of the ear, and often behind the ear in the groove. The scars are usually well hidden, and generally fade significantly over time.
Through this incision, the skin of the cheek is elevated to expose the deeper (sagging) tissues (often referred to as the SMAS), which are re-elevated to a more youthful position. In addition, liposuction of the neck serves to remove excess fat from under the chin area, and helps to tighten the sagging neck skin.
Once the SMAS has been re-elevated, some (usually minor) skin excess is evident, and this is trimmed and inset to the original incision. Fat may be injected into certain areas of the face (cheeks, naso-labial lines, and lips) to plump these out, or gels may used. Finally a bulky, supportive dressing and face-band are applied to support the re-elevated facial tissues, and drains to remove excess fluid may also be placed.
Complications can occur with any surgery, and facelift is no exception. Although uncommon, bleeding, infection, poor scarring and nerve injury are some of the potential complications of this surgery. Please read my advice to see what medication should be avoided in the weeks prior to the surgery to minimise your risk of complications (this will include herbal and homeopathic medicines and vitamins, which often promote bleeding at the time of surgery). Smoking is a major cause of complications, and I do not offer this surgery to active smokers.
Recovery is generally fairly rapid, and the dressings are “debulked” 1 day after the surgery. Drains, if placed, are also removed. An elastic “face band” is then worn for about a week or 2 post op, to help stabilize the neck contour, and to minimise swelling. Skin stitches are usually removed between 5 days and 1 week post op, and by 2 weeks post op, the swelling should have subsided considerably, although it will be several months before the final result can be appreciated. The objective of the surgery is to give one a more youthful, rested appearance without the tell tale signs of surgery.