As part of the ageing process which happens to all of us sooner or later, 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 deepen, 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 our genes. Smoking and sunexposure undoubtedly play a significant role in the premature development of wrinkles. Ageing of the skin of the face does not necessarily reflect the rate that the rest of our body and mind is ageing and many people feel frustrated that the face they see in the mirror is not the one they feel should be there. Substantial weight loss can produce similar changes in facial appearance to those of the ageing process.
Who will benefit from a facelift?
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.
It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful. It is a procedure that technically works well but also increases morale and is well appreciated by the patient.
What does a facelift not do?
A facelift works better for the lower half of the face and particularly the jaw line and neck. Loose skin with fine wrinkles, freckles and rough areas will benefit more by laser resurfacing or injectable fillers.
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 tablets containing aspirin and non steroidal anti-inflammatory drugs such as Voltarol and Indocid for at least two weeks before surgery as they increase the risk of bleeding. Also avoid any homeopathic medication such as gingko biloba or Vitamin E which has a blood thinning effect.
You should stop smoking at least two weeks before surgery as this is the main cause of reduced healing. It decreases circulation of the skinflaps, 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.
There are essentially two commonly performed facelifts.
1. SMAS (full Facelift
(superficial submusculaponeurotic system)
A SMAS facelift tightens the soft tissue of the cheeks and is ideal for addressing significant loose skin of the neck, and midface. This operation has in most cases been superceded by the MACS facelift , but is still used where there is significant skin looseness esepecially of the neck. The incision is made starting in the hair line at the temples and extends in a natural line down the front of the ear, and continues around behind the earlobe and up in the crease behind the ear and off into the lower scalp.
2. MACS Facelift
(minimal access craniosuspension)
A MACS Facelift is used more commonly in younger patients with less loose neck skin, and results in a shorter scar running in front of the ear into the forehead hairline. As a result tightening of the mid and lower face, jowls and neck area is achieved.
A facelift is carried out in a hospital and most surgeons and patients prefer a general anaesthetic. The procedure, although long, can be combined with other operations of all sorts. The most common however would be an eyelid reduction.
It tightens the skin of the midface and freshens the eyes, opening and lifting the outer angle and reducing the wrinkles of the crows feet. The neck is tightened. There will be swelling around and below the eyes which gradually resolves in about a month. There may also be scars beneath the eyelashes of the lower eyelid . There is a slight risk of damage to the nerve which supplies the muscles of the forehead or the corner of the mouth. This weakness is usually partial and temporary, on rare occasions it may be permanent.
Occasionally it may be necessary to make a small incision under the chin. Sometimes only the skin is lifted following separation from the underlying platysma muscle. More usually however the platysma muscle and its fibrous attachments (SMAS) is dissected free and sutured tightly to the solid structures in front and behind the ear. At other times the skin and the SMAS layer are lifted together as a single layer, but will still be sutured separately. Fat along the jaw line and under the chin may be removed by liposuction or on occasion through an incision under the chin. The skin is sutured so that it is lifted upwards and backwards, just as when one lifts the skin when looking in the mirror. Sometimes drains are inserted. Most surgeons will bandage the face to minimise bruising and swelling. These bandages will stay for one or two days and the sutures are removed in 7 to 8 days. After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend into the neck. 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. It is better to keep the head elevated for a couple of days to reduce swelling. Drainage tubes will be removed a day or two after surgery. 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. 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.
Men find it more difficult to disguise the scars and will need to shave their beard closer to the ear in front and also behind the ear where the skin has been lifted.
The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound. There may be some slight reduction in hair growth in the temples, but this is not usually a problem unless the hair is very thin and repeated facelifts are being carried out.
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 will not look as old as you would have done had it had not been carried out. You should see benefit for as long as 5-7 years