A facelift is a surgical procedure which aims to address lax or drooping facial and neck tissue by standard discrete access incisions (in the temple hair-bearing scalp, in front of and behind the ear and backwards into the hairline) to allow firstly the underlying muscle layer to be lifted then the skin to be smoothly draped and tightened. The primary aim is to achieve an improved and more youthful appearance. There are varying techniques which address different aspects of facial rejuvenation – and this is discussed below. Typically a full facelift will also address the neck – see below for more information.
How face lifts have evolved
As part of the aging process, which happens to all of us sooner or late, our skin progressively loses its elasticity and our muscles tend to slacken. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces. The folds and smile lines become deeper, the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrows droop and the skin of the eyelids gathers in loose folds. In the skin the first sign is fine wrinkles developing around the lips, at the outer corners of the eye and lines of expression. The rate at which this happens varies from one person to another and is probably determined by multiple factors including our genes. Ageing of the skin of the face does not necessarily reflect the rate at which the rest of the body and mind is ageing and many people feel frustrated that the face they see in the mirror does not match the age they feel. Substantial weight loss can produce similar changes in facial appearance to those of the ageing process.
Will I benefit?
The best candidate is one whose face and neck has begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well defined. Most patients are in their 40’s to 60’s, but facelifts can be done successfully on people in their 70’s or 80’s.
Ideally, it should not be too obvious that a patient has had a facelift, but instead they look younger, more vital and refreshed. The vast majority of patient not only look better but feel better. It is a procedure that aims to improve the patients appearance increase morale and be well-appreciated by the patient.
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Common reasons for a facelift?
A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles of the forehead then you should perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles, freckles and rough areas will benefit more by chemical peel or laser resurfacing.
What should you do before the operation?
If you are overweight and intend to lose it you should do so before the operation. This allows the surgeon to remove more skin and therefore achieve a more pleasing result. You should avoid taking ‘ blood thinners’ including tablets containing aspirin and non-steroidal anti-inflammatory drugs such as Voltarol or Difene ( diclofenac) or Nurofen (ibuprofen) for at least two weeks before surgery as they increase the risk of bleeding. You can, of course, discuss this with the doctor who usually prescribes them – this may be your general medical practitioner or a cardiologist.
You should stop smoking at least three weeks before surgery as this is the main cause of reduced healing. It decreases circulation of the skin flaps, particularly behind the ears.
Have your hair permed and tinted, if you wish, before your operation as fresh scars are sensitive to these chemicals for a few weeks.
The surgery - procedure and techniques
Incisions are made above the hair line at the temples and extend in a discrete line down the front of the ear, or just along the edge of the cartilage at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear and backwards into the lower hair-bearing scalp. Occasionally, it may be necessary to make a small incision under the chin.
Most techniques require a general anaesthetic. It is possible to carry out modifications of the procedure – e.g. the mini-facelift – under local anaesthetic and intravenous sedation but the patient would still be advised to spend ~1 night in the hospital unless rigorous local supervision arrangements are in place with a competent 24 hour chaperone and pre-approved with both the surgeon and hospital. The procedure, although long (2.5-3.5 hours), can be combined with other operations of all sorts. The neck can be further refined / tightened by a small incision under the chin, then some fat removal followed by joining together the platsyma muscles in the midline of the neck (technically known as a submental lipectomy and platysmal plication) and this can add a further ~ 1 hour to the procedure. Other common procedures sometimes performed together would be a brow lift and an eyelid reduction with or without a chemical peel. According to the individual case, other possible procedures performed with a facelift are malar (cheek bone) and chin augmentation and lip enhancement. This is obviously to maximise the benefit of one general anaesthetic and condense the period of ‘down-time’ or recovery time outside of your social and professional network.
A skin-only facelift is where only the skin is lifted following separation from the underlying platysma muscle – while this may work occasionally in the right patient, this technique has been largely abandoned, as it probably does not last as long and the scars may stretch and become more visible.
What happens after the procedure
After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend towards the neck / chest over time and changes colour as it resolves. Discomfort is usually mild and can be controlled with Paracetamol. It is normal for there to be some numbness of the skin of the cheeks and ears. This will usually disappear in a few weeks or months. Anyone undergoing facelift surgery must appreciate that it carries the small risk of weakness of muscles in the face which, if it occurs, is usually temporary but may be permanent. Part of the reason for the growing popularity of the procedure is that such complications are thankfully uncommon and the modern techniques are more predictable. It is better to keep the head elevated for a couple of days to reduce swelling. Avoid strenuous activity, saunas and massage for at least two weeks.
At the beginning your face will look a little puffy and may feel rather strange and stiff. Scar formation at the line of incision is a normal outcome of facelift surgery. The scars can be very well hidden by women with their hair and disc shaped earrings so that they should be able to resume work and social activities within a couple of weeks. Camouflage make-up can be helpful in masking bruising and the skin will be stable enough for make-up 7-10 days after surgery. Only make-up which is non-perfumed should be used – and which you have used/tested before without any adverse skin reaction. To conceal pink scars in the initial healing phase, a green pigment base powdered make-up can be used with skin tone foundation as the next layer.
What are the potential complications of a facelift procedure
Face-lifts have only achieved popularity because they are generally safe and largely predictable. As with any surgery, face-lifting is subject to complications which, although uncommon, do occur and your surgeon should have informed you about:
- Bleeding / haematoma (collection of blood): this complication applies to almost any surgery. It generally occurs within the first 12 hours after surgery and usually needs a return visit to the operating theatre to drain any collection of blood and attain control of any bleeding points under general anaesthesia. The risk of this is approximately in the order of 1 in 100.
- Wound infection: it is rare to have infection following a facelift, largely because antibiotics are used before surgery and the anatomical area has a great natural blood supply. If it occurs it is treated with further antibiotics and appropriate wound care.
- Poor scarring: some individuals may develop thick and red scars, so-called hypertrophic scarring. Occasionally this may proceed to keloid scars. These unfavourable scars can be treated with steroids and sometimes may have to have surgical or laser revision. It is advisable to avoid vigorous massage to new scars for 8 weeks, as it takes time for skin to develop adequate strength to withstand pressure without stretching.
- Hair loss: this is rare and may occur as a result of tension swelling in the scalp or as a general reaction to the trauma of surgery – more so with repeated facelifts. Wound infection can also cause temporary hair loss in the vicinity of the wound. Fortunately, in most cases, hair loss is reversible but may take many months.
- Numbness: follows most surgical procedures and gradually decreases with time. Sometimes, small areas of the face / ear lobes may develop permanent numbness – in the latter case, there is no remedy.
- Bruising: this is a normal sequel to surgery and, therefore, is not a complication. The duration of bruising can vary from two to twelve weeks and depends on the extent and thickness of skin, among other factors.
- Injury to the facial nerve: facial nerve controls the movement of muscles of facial expression. Injury to one or more of the nerve branches will result in paralysis the muscles of facial expression. Most injuries are caused by swelling or bruising around the nerve and are therefore temporary. Permanent injuries are very rare.
- Poor healing: some areas of facelift scars, especially behind ears are subjected to more tension and may receive poorer blood supply to its edges. This is particularly so in smokers, ex-smokers or those with an impaired immune system. It is very important to cease smoking prior to surgery for this reason alone. If healing is delayed, it may take up to eight weeks for the wound to close. Later, the scar may need revision.
- Skin tethering: in some areas, e.g. in the neck, skin is attached to the underlying immature scar and this has a tethering effect. In most cases this problem corrects itself with time and it may take a year.
- Asymmetry: most patients have some facial asymmetry and most of these cannot be corrected by face-lifting – a perfectly symmetrical result can never be guaranteed in any operation performed on both sides of the body. Any concerns about asymmetry should be discussed with your surgeon.
How long does a facelift last?
A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to always be there, in that you should not look as old as you would have done if it had not been carried out. You continue to age every year and some patients go on to choose to have another facelift about 10 years later. Thus, allowing subtle shifts in rejuvenation such that continue to look more youthful than your true age.
Get in touch
To arrange a consultation please contact Serryth Colbert on 01225 838869