Facelift

Overview

The effect of ageing on the face leads to loss of skin elasticity and support for the deeper facial structures. In the upper face, this can cause the brow to droop, the upper eyelid skin to become hooded and the lower eyelids to form bags. In the mid and lower face, the facial skin, cheek fat, and superficial muscles of the face and neck tend to slacken and droop. This causes wrinkling in the neck, deepening of facial folds, smile lines, jowls (sagging skin hanging below the jawline), and deep nasolabial folds (furrow between the upper lips and cheeks). All these effects are worse in people who have suffered chronic sun exposure and in those who smoke and the appearances can make people look older than they really are.

A facelift is an operation to try and reverse the effects of ageing on the mid and lower face and so rejuvenate the face to make it look younger. It is often combined with a brow lift and blepharoplasty surgery (eyelid reduction surgery) to address the upper part of the ageing face. There are many different types of facelift operation, which vary in complexity depending on which physical feature of the face needs to be addressed. For example, a standard face lift is primarily aimed at addressing the jowls and the neck area, but does not lift the drooping cheek fat, nor correct the deep nasolabial folds, whereas a composite/deep plane facelift, or a subperiosteal facelift can address the sagging mid portion of the face. A platysmaplasty is a procedure to tighten the platysma muscles in the neck at the front and at the same time remove any excess fat in this region and so can aid a standard facelift in providing a youthful definition to the neck. Sometimes a combination of all these techniques is required.

All of the facelift operations are performed under general anaesthesia and last between 2-4 hours. Some of the more complex procedures, when combined with brow surgery and eyelid surgery can take longer than this. Usually a 1-2 day stay in hospital is all that is required.

During a standard facelift, an incision (cut) is made on each side in the hairline above the ear extending just in front of the ear and then passing behind the ear back into the hairline. The skin is lifted off the face and the neck, and the underlying platysma muscle together with its fibrous attachment is pulled and tightened with stitches. The excess skin is pulled and excised and the wounds are closed with a combination of dissolving stitches and stitches that need to be removed after 7 days. In the composite/deep plane type of facelift, the incisions are the same but the skin and underlying layer are lifted together rather than separately. In the subperiosteal facelift, there are incisions in the hairline above each ear, as well as a small incision on the inside of the mouth in the upper gum line, and an additional cut just underneath the eyelashes of the lower eyelid. Using these incisions, the full thickness of the facial structures are elevated off the facial bones and lifted to a more youthful position, and held in place with deep stitches that dissolve. The wounds are then closed with a combination of stitches that dissolve and those that need to be removed after 7 days. The wounds are then covered with a bandage.

This is one of the most commonly performed cosmetic procedures and has high patient satisfaction and low complication rate.

Frequently asked questions

Am I suitable for a facelift?

What are the benefits of a facelift?

Where are the scars?

Is the procedure painful?

How long does it take to recover from the surgery?

When will I notice the results and how long will they last?

Will I be told the risks and complications?

What follow-up appointments will there be?

Am I suitable for a facelift?

Not everyone is suitable for a facelift. Suitability is a matter for you and Mr Johnson to discuss in clinic, following a thorough analysis of your medical history and a thorough clinical consultation. If you are suitable, during your consultation Mr Johnson will discuss with you the particular type of facelift that best addresses your facial concerns.

What are the benefits of facelift?

The results of the surgery will make your face look younger. The operation is very successful at increasing patient confidence and improving self-esteem.

Where are the scars?

The location of the scars is dependant on the type of facelift being performed and what combination of techniques are used. The standard scars are hidden in the hairline above each ear and then pass just in front of the ear and then pass behind the ear back into the hairline. If this is combined with a subperiosteal facelift there is an additional scar in the inside of the mouth in the upper gum line, and an additional cut just underneath the eyelashes of the lower eyelid. The scar for a platysmaplasty is 3-4 cm long located horizontally in the skin crease under the chin. All the external scars tend to be either hidden within the hair, or else concealed in natural skin creases making them as inconspicuous as possible.

Is the procedure painful?

A facelift is not a particularly painful procedure. During the operation strong painkillers are administered so that when patients wake up from the surgery they will be comfortable. It is normal for patients to experience some discomfort in the face and for the first day or postoperatively, strong painkillers can be administered if required. On discharge from hospital, any discomfort can usually be managed with simple tablet type painkillers such as paracetamol, etc.

How long does it take to recover from surgery?

It is normal to feel lethargic and tired for the first 2 weeks following surgery. Bruising and swelling can last for several weeks following surgery. Most people feel able to return to completely normal activities after 6 weeks.

When will I notice the results and how long will they last?

The improvement in facial appearance will be immediately apparent following a facelift. However, there will be some bruising and swelling which may last several weeks. The scars will undergo a natural maturation process involving a series of colour and texture changes over a period usually varying from 6 months to 2 years. The final result can usually be judged at around 6 months following surgery. It is important to note that the normal age-related effects on skin laxity continue to take place and over time will lead to a recurrence of the facial features affected by ageing.

Will I be told the risks and complications?

Any operation carries with it the risk of complication. Major complications, however, are uncommon following a facelift. During your initial consultation Mr Johnson will have a full discussion with you about the risks and complications of surgery. If you decide to go ahead with surgery, these risks will again be discussed as part of the consenting process. Fortunately, with correct patient selection and appropriate procedure selection, the risks are kept to an absolute minimum. It is important that you should be reassured that Mr Johnson will not agree to perform any cosmetic procedure on you unless he feels the benefits significantly outweigh the risks.

What follow-up appointments will there be?

Mr Johnson will come and see you on the ward after your surgery and will review you everyday throughout your hospital stay. After you have been discharged Mr Johnson will arrange to see you in clinic after 7-10 days to review the wound. He will then make arrangements to see you in clinic for longer-term follow-up appointments. You will be given contact details for the hospital and Mr Johnson's secretary should you wish at any time to discuss further aspects of your care or make additional arrangements for review.


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