Facelift

face Lift

Facelift

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If you are bothered by the signs of aging in your face, a facelift may be right for you. Technically known as rhytidectomy, a facelift is a surgical procedure to improve visible signs of aging in the face and neck, such as:

•   Sagging in the midface
•   Deep creases below the lower eyelids
•   Deep creases along the nose extending to the corner of the mouth
•   Fat that has fallen or is displaced
•   Loss of muscle tone in the lower face may create jowls
•   Loose skin and excess fatty deposits under the chin and jaw can make even a person of normal weight appear to have a double chin

Rejuvenation procedures typically performed in conjunction with a facelift are brow lift, to correct a sagging or deeply furrowed brow, and eyelid surgery to rejuvenate aging eyes.
What it won’t do: As a restorative surgery, a facelift does not change your fundamental appearance and cannot stop the aging process.

A facelift can only be performed surgically; non-surgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery.

What are the alternatives?

Other treatments may be used either as alternatives, or in combination with a facelift. Some of the options available include those listed below.

Resurfacing techniques reduce surface wrinkles, Laser facial resurfacing. A chemical peel can also improve and smooth the texture of the facial skin by removing its damaged outer layers.

Tissue augmentation plumps out deep wrinkles with fillers to make up for the loss of fullness to the skin that tends to occur with aging.

Anti-wrinkle injections, where botulinum toxin (e.g. Botox) is injected into the facial muscles, can flatten out skin wrinkles. This is particularly suitable for forehead wrinkles and "crows' feet".

Many creams, gels and beauty treatments claim to be able to tighten the skin. However, there is no scientific proof that they work permanently.

A facelift is a highly individualized procedure and you should do it for yourself, not to fulfil someone else’s desires or to try to fit any sort of ideal image.

Facelift surgery is a good option for you if:

•   You are physically healthy
•   You don’t smoke
•   You have a positive outlook and specific, but realistic goals in mind for the improvement of your appearance

Pre operatively/consultation

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your face will be examined and you will usually have a photograph taken before the operation so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

Be prepared to discuss:

•   Why you want the surgery, your expectations and desired outcome
•   Medical conditions, drug allergies and medical treatments
•   Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
•   Previous surgeries

Your surgeon may also:

•   Evaluate your general health status and any pre-existing health conditions or risk factors
•   Discuss the options available to you for facelift and facial rejuvenation
•   Examine and measure your face
•   Take photographs for your medical record
•   Discuss your options and recommend a course of treatment
•   Discuss likely outcomes of a facelift and any risks or potential complications
•   Discuss the type of anaesthesia that will be used

Prior to surgery, you may be asked to:

•   Get lab testing or a medical evaluation
•   Take certain medications or adjust your current medications
•   Stop smoking well in advance of surgery
•   Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

•   What to do on the night before and morning of surgery
•   The use of anaesthesia during your face lift
•   Post-operative care and follow-up

The operation

A facelift generally requires a one or two night stay in hospital. The operation lasts around three to four hours and is usually done under a general anaesthetic.

There are a number of different facelift techniques. Your surgeon will explain the options available to you.

1 – Anaesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anaesthesia. Your doctor will recommend the best choice for you.

A variety of other procedures can further enhance the outcome of a facelift. They include:

•   Facial implants
•   Soft tissue augmentation to recontour the facial structure
•   Resurfacing techniques to improve the tone and texture of facial skin
•   Wrinkle reduction by injection

2 – The incision

Depending on the degree of change you’d like to see, your facelift choices include a traditional facelift, limited incision facelift or a neck lift.

A traditional facelift incision often begins in the hairline at the temples, continues around the ear and ends in the lower scalp. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is repositioned, commonly the deeper layers of the face and the muscles are also lifted.

Skin is redraped over the uplifted contours and excess skin is trimmed away. A second incision under the chin may be necessary to further improve an aging neck. Sutures or skin adhesives close the incisions.

Traditional Facelift

                
An alternative to a traditional facelift uses shorter incisions at the temples, continuing around the ear and possibly within the lower eyelids or under the upper lip.

Limited Incision

              
Sagging jowls, loose neck skin and fat accumulation under the chin may be corrected with a neck lift. The neck lift incision often begins in front of the ear lobe and wraps around behind the ear ending in the lower scalp.

Neck Lift

                          
3 – Closing the incisions

Once healed, the incision lines from a facelift are well concealed within the hairline and in the natural contours of the face and ear.

4 – See the results

The visible improvements of a facelift appear as swelling and bruising subside. Your final result should not only restore a more youthful and rested appearance, but also help you feel more confident about yourself.

Traditional facelift

For a typical facelift, once the anaesthetic has taken effect, your surgeon will make a surgical cut right around your hairline, past the front of your ears. Cuts may also be made under your chin, if you want to lift a sagging jaw line.

Your skin will then be carefully separated from the underlying muscles of your face. Excess fat will be removed and the muscles will be tightened. The skin will then be lifted up, pulled back and any excess will be trimmed off. It will then be stitched back to the line where the cut was initially made.

Other techniques

Sometimes your surgeon will perform a facelift using keyhole (endoscopic) surgery, particularly for a brow lift (where your forehead is lifted). Several tiny cuts are made that allow an endoscope (a small, flexible tube with a light and a camera lens at the end) to be placed under the skin. The operating instruments are inserted through other tiny holes. The surgeon watches a TV monitor to see what he is doing under the skin.

Another type of facelift surgery is minimal access cranial suspension (MACS). Shorter cuts, compared to a traditional facelift, are made in the temple and in front of the ears. Fibrous tissues under the skin are tightened with permanent stitches that are fixed to tissue close to the cheek bone or the fibrous connective tissue under the skin. Both endoscopic facelift and MACS have the advantages of smaller scars and usually a shorter recovery time.

At the end of a facelift operation, your face is tightly wrapped in bandages. Depending on the exact procedure carried out, these may run under your chin, around your ears and/or over your head. They are usually taken off after about one or two days. Stitches are removed after 5 to 10 days.

Post operatively

When you wake up after the operation you may have tubes running from the operation site to drain fluid into a bag beside your bed. These are usually removed a day or two after surgery.
You will be given painkillers to help relieve any discomfort as the anaesthetic wears off.
Before discharge, your nurse will give you advice about caring for your face, hygiene and bathing.

If you have had a general anaesthetic you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.
It may take several months for swelling to fully dissipate and up to 6 months for incision lines to mature.

Life-long sun protection will help to maintain your rejuvenated appearance by minimizing photo-aging or sun damage. In addition, a healthy lifestyle will also help extend the results of your rejuvenated, more youthful appearance.

Generally the pain after a facelift is mild but once home, further painkillers may be taken if needed, as advised by your hospital.

Applying a cold compress, such as ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. You should not apply ice directly to your skin as it can give you an 'ice burn'.

There are some important things to remember while recovering from a facelift:

•   keep your head elevated for a couple of days to reduce swelling
•   avoid bending or straining
•   avoid saunas and massage for at least two weeks
•   avoid the sun for a few weeks

Vigorous activity should be avoided for four or five weeks. Most people feel like returning to work after about three weeks, once the bruising and swelling have gone down.

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Another surgery may be necessary.

Risks

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Specific side-effects of a facelift include:

•   Unfavourable scarring
•   Bleeding (hematoma)
•   Infection
•   Poor wound healing
•   Anaesthesia risks
•   Correctable hair loss at the incisions
•   Facial nerve injury with weakness
•   Facial asymmetry
•   Skin loss
•   Numbness or other changes in skin sensation
•   Fatty tissue found deep in the skin might die (fat necrosis)
•   Fluid accumulation
•   Pain, which may persist
•   Skin contour irregularities
•   Skin discoloration, sensitivity or swelling
•   Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
•   Unsatisfactory results may include asymmetry, unsatisfactory surgical scar location, unacceptable visible deformities at the ends of the incisions (It may be necessary to perform additional surgery to improve your results)
•   Deep vein thrombosis, cardiac and pulmonary complications
•   Possibility of revisional surgery