Face Lift Surgery
A facelift (or face lift) 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). Skin quality is not really improved with facelift surgery which addresses the deeper layers rather than the envelope itself. Laser or peels or other skin treatments are needed to address skin quality issues.
- 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
IDEAL CANDIDATES
A good candidate for the surgery is a patient in her mid to late 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. I don’t offer facelift surgery to men at all.
Here’s what you need to know and do before your surgery:
What to expect during your facelift surgery
The surgery is performed under a light general anaesthetic, most often as a day case –occasionally an overnight stay is needed. The duration may be 3 – 4 hours, or longer, particularly if combined with other surgeries, like eyelid blepharoplasty.
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, provided there is normal healing.
Through this incision, the skin of the cheek is elevated to expose the deeper tissues (The SMAS – the superficial musculo-aponeurotic system), which is then elevated to a more youthful position.
In addition, liposuction of the neck serves to remove excess fat (if any) from under the chin area, and helps to “raw up” the layers so that they are able to scar together once the formal elevation is performed.
In short, facial anatomy relevant to facelift is as follows – from outside in. Skin, then subcutaneous fat, then the SMAS layer (which has a mobile and fixed component) and then the motor nerves beneath the SMAS, salivary glands and finally deep muscles of the face.
The SMAS is important for 2 main reasons: 1. It hold tension better than the skin itself, so the lifting is done using the SMAS and not the skin. 2. It covers, or overlies, the important motor nerves of the face, so staying above the SMAS is a “safe zone” and going under / below it is therefore more “risky”.
Once the SMAS tissue has been tightened, 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. Finally, a bulky, supportive dressing and face-band are applied to support the repositioned 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.
DEEP PLANE SURGERY - DEEP PLANE FACELIFT & DEEP PLANE NECK LIFTS
Currently there is much written about deep plane surgery. Deep plane surgery of the face relates to the level of dissection (deep to / under the SMAS layer, just above the motor nerves) alongside the division of certain “retaining ligaments” of the face.
This is a highly complex surgery, and whilst there are some outstanding experts of this approach, I am of the view that unless you are a very high volume operator and very familiar with the deep structures of the face, that it should not be undertaken by the “occasional” facelift surgeon – the risk of serious damage to the facial motor nerves and salivary glands cannot be underestimated and can result in devastating, lifelong consequences.
This is also true for deep neck lifts, in which the dissection is under the platysma muscle, and usually includes some trimming of the deep muscle (digastric) bellies, deep neck fat and partial resection of the “droopy” element of the submandibular salivary gland – here again, in the best possible hands, this yields very good results – in the wrong hands, it can be catastrophic. Coupled with this “trend” and because of the perceived superiority of this approach (in the best possible hands) many surgeons are now claiming to offer deep plane surgery, which is often not quite the same procedure as that performed by the leaders in this approach.
(One such expert is Dr Mike Nayak in the USA, who consistently produces outstanding results, but really is at the apex of a very broad based pyramid of facelift surgeons).
Let me be very clear – in my practice – I offer NO deep plane facelifts or neck lifts. I do a fairly standard SMAS plication surgery, usually neck liposuction with occasional platysma plication, and fat grafts to the midface or wherever else I feel it is needed.
POST-OP AND RECOVERY
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 7 and 9 days post op, and by 3 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 obvious stigmata of surgery.
Here’s a general overview of what to expect during your recovery:
Pre-operative preparation
- Comprehensive Medical Assessment:
We will conduct a thorough review of your medical history, including any current health conditions and medications. You may require specific pre-operative tests or medical clearances from your doctor to ensure you are in optimal health for surgery. - Medication & Supplement Guidelines:
You will be given specific instructions as to which medications (especially blood thinners such as aspirin, ibuprofen and certain herbal supplements) you will need to stop taking in the weeks leading up to your surgery. This is important to reduce bruising and make sure the procedure is safe. All GLP1s are to be stopped at least 2 weeks pre op (all surgery) - Strict Smoking Cessation:
If you are a smoker, it is imperative that you stop smoking several weeks before your surgery. Smoking greatly impairs circulation and healing, greatly increases the risk of complications and affects your results. I do not operate in active smokers at all. - Arrange Post-Operative Support:
Have a trusted family member or friend available to take you home after your surgery and to assist you with daily activities during the initial recovery period (at least the first 24 to 48 hours). - Prepare Your Home Environment:
Set up a comfortable, quiet recovery area in your home. Get pillows to prop your head up, lots of soft, easy-to-prepare foods, and whatever else you might need within easy reach so you don’t strain. - Fasting Instructions:
We will tell you exactly when to stop eating and drinking before your procedure. It is important to follow these instructions to ensure your safety during anaesthesia. - Final Pre-Op Consultation:
We’ll meet one last time a few days before your surgery to discuss any last-minute questions, go over your surgical plan, and make sure you are fully comfortable.
Following these pre-operative instructions will greatly help in the safety of the procedure and the ease of recovery, and help pave the way for beautiful, natural looking results.
Pre-operative preparation
- Immediate Post-Surgery:
You will wake up with bandages on your face and possibly small drains to collect any excess fluid. Swelling, bruising and some discomfort are all normal and will be managed with prescribed pain medication. - The First Week:
This is when most of the swelling and bruising will occur. Detailed instructions for incision care and when drains or sutures will be removed will be given. The most important thing is rest. Do not engage in vigorous activity or move your head too much. - Managing Discomfort:
Usually any discomfort can be managed with oral pain relievers. We’ll advise you on how to best manage pain and swelling with medicine and cold compresses. - Activity Restrictions:
You will be asked to refrain from strenuous exercise, heavy lifting, bending over, or anything else that will significantly increase your blood pressure for a minimum of 4 to 6 weeks. Light walking is usually encouraged to promote circulation. - Visibility of Swelling/Bruising:
Major bruising usually fades in 2-3 weeks but subtle swelling can last for several weeks to a few months. Most patients feel comfortable getting back to light social activities once the worst of the bruising has faded. - Incision Care:
You will be given specific instructions on how to care for your incisions in an effort to promote optimal healing and to minimise scarring. Progress will be checked at regular follow-up appointments. - Emotional Well-being:
It is normal to feel a bit depressed during early recovery. Treat yourself and your body kindly. You’ll get the final results once the swelling is completely gone. - Long-Term Care:
We will advise you on long-term skincare and lifestyle choices to help you maintain your beautiful, refreshed results for years to come.
Embrace a Refreshed You With Face Lift Surgery
Schedule your confidential consultation to explore your transformative possibilities.
A few commonly asked questions
Am I a suitable candidate for facelift surgery?
If you have moderate to severe facial skin drooping, visible jowls, deep creases running from the nose to the corners of the mouth (nasolabial folds), or loose skin and bands in the neck region, you could be a good candidate for facelift surgery.
Candidates are usually in good general health, non-smokers and have realistic expectations about the outcome. I will assess your skin elasticity, facial structure and aesthetic goals to determine if a facelift is the right procedure for you.
What specific signs of aging can a facelift address?
Facelift is an effective treatment for many of the common signs of ageing. These include sagging in the mid-face, deep creases below the lower eyelids, loss of jawline definition due to sagging skin and fat ( jowls ), and loose skin, fatty deposits, and vertical banding around the neck, although neck bands are often fairly resistant long term!
What is the difference between a full facelift and a mini-facelift?
A mini-facelift is better described as a “short scar” facelift – it is still, in my hands, a significant surgery and is generally indicated for younger patients with early facial ageing, good skin quality, and early signs of neck fatty deposits or sagging.
It requires smaller incisions and a shorter recovery period. It works best for people with less severe signs of ageing. The scar is shorter than a full lift and ends just behind the earlobe
A full facelift is a more extensive version of the above for those with a more significant neck “issue” and here, in addition to the above, the scar extends behind the ear and in to the hairline behind the ear. In my hands a full scar and short scar are both big procedures – there is no “mini” version!
During your consultation, we will determine the best approach to meet your specific needs.
How long do facelift results last?
While a facelift cannot stop the ageing process, it does “reset the clock” very well and provide a significant and long lasting improvement. Results typically last 10 years, and many patients enjoy their refreshed look even longer.
Depending on your genetics, lifestyle and skincare routine, your results may last longer or shorter. Future maintenance procedures are always at hand.
What can I expect during the confidential consultation process for a facelift?
Your first appointment is a full and confidential discussion. I will listen carefully to your concerns and aesthetic goals, review your complete medical history, and perform a detailed examination of your facial anatomy.
Then we will go over the different facelift techniques, what results you can expect, the risks involved and answer all of your questions so that you are fully educated and comfortable with your surgical plan.
What kind of anaesthesia is used for facelift surgery?
Facelift surgery is typically performed under general anaesthesia, meaning you will be completely asleep and comfortable throughout the entire procedure. A highly qualified anaesthetist will administer and continuously monitor your anaesthesia, ensuring your safety and comfort from start to finish.
Will there be visible scarring after facelift surgery?
Facelift incisions are carefully planned and placed in the most inconspicuous places possible.
They are usually concealed in the hairline, around the ears and occasionally under the chin. Scars are permanent, but they do fade with time and become very well camouflaged in natural contours and hair.
We want the least and least visible scarring.
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