Facelift Surgery

The best candidates for facelift are generally considered to be those individuals whose skin quality is still relatively good. Most patients are between forty and seventy years of age, although older patients may also benefit.

Some of the common reasons to consider facelift surgery include:

• • Significant wrinkles, often the result of a loss of tone in the facial muscles due to ageing,
  • Sagging skin around the face, caused by a loss of tone and elasticity in the muscles,
  • Reduced definition in and around the jowl, chin and neck, caused by an excess of loose skin and droopy facial tissue
  • Droopy cheeks around the mouth, often caused by excess loose skin

Over-exposure to sun can make these symptoms even worse and further contributes to an aged appearance by diminishing the overall quality of the skin. Substantial weight loss in later life can create a more aged appearance, because aged skin has less elasticity than young skin and, without the fat, it will become saggy and wrinkled.

Aside from cosmetic reasons, people might consider getting a facelift:

• • To reduce the appearance of a facial deformity,
  • To restore your facial appearance following a disease or illness that has caused disfigurement.

Whatever the reasons for considering a facelift, it is important to have a realistic expectation and be aware of what can and cannot be achieved through surgery.

A variety of different types of facelifts and facelift techniques are performed today. Some of the more common types are described here. Mr Rezai will discuss with you which type of facelift is right for you, or which combination of techniques will give you optimal result.

Traditional (SMAS) Facelift

Traditional facelift addresses the lower face and neck. During the procedure, incisions are made in the hairline, starting above the ear, continuing behind the ear, curving around the ear and ending in the hairline behind the ear onto the lower scalp. Once the incision has been made the surgeon will carefully separate the skin from the underlying tissue, reposition excess fat and use sutures to lift and reposition the muscle layer (“SMAS” – superficial musculo-aponeurotic system) toward the ears. This allows the structures in the lower face and neck, to be sutured to bone higher on the face, hence tightening the sling running around the lower face and chin/neck. This muscle tightening is thought to provide longevity to the surgical result. The skin will then be lifted and sutured into place along the original incision, the excess skin is removed and the incisions are closed.

The Mini-Lift or Skin Only Facelift

A mini-lift addresses the lower face and neck. This is the most basic of facelifts, and involves little more than a skin tuck. The surgeon first makes the traditional facelift incision, as explained above. He then dissects the skin from the underlying fat and muscle, stretches it back, trims excess skin, and closes the incisions. Due to the skin’s ability to stretch out over time, this facelift is considered to be less long-lasting than facelifts employing muscle tightening. Occasionally, drains may be used. The Mini-Lift has little, if any, effect on folds running between the nose and mouth (naso-labial folds).

The Deep Plane facelift

The deep-plane facelift is modification of the traditional facelift. During this type of facelift, the surgeon will dissect to a deeper plane of the patient’s face before lifting and repositioning the muscle. Additionally, the surgeon will separate certain muscle layers off of deeper muscles and or other facial structures. Some surgeons believe it offers certain advantages to a traditional facelift including a more natural result and improved rejuvenation of droopy skin. However, this technique has a higher risk of facial nerve injury and many surgeons dispute that it offers a significant advantage to the traditional facelift.

Endoscopic (Scarless) Facelift

In addition to “traditional” facelift, in certain circumstances there is also the possibility of opting for an “Endoscopic Facelift”, a very modern technique in facial plastic surgery. This is also known as the “scarless facelift”.

The endoscopic, or “scarless” facelift, is the latest trend in facial plastic surgery, and can be a highly effective treatment for both facial enhancement and rejuvenation.  Endoscopic, or ‘minimally invasive’ surgery, uses an endoscope – a long, flexible tube with a camera and light attached to it designed to permit internal inspection of the body.   Inserted through small incisions or natural body openings, the endoscope transmits magnified images to a screen the surgeon is then able to watch throughout the operation.

Endoscopic facelift is a major advancement in the field as it prevents the need for long incisions, facilitating faster healing and generally resulting in fewer side effects than a traditional facelift. It also allows the surgeon to treat harder-to-access areas – such as the central third of the face, including frown lines between the brows, the folds next to the nose and the lines around the mouth – that traditional techniques cannot reach. This technique is generally considered to benefit those whose skin quality is still relatively good and do not have too much excess skin. Typically, these patients tend to fall within the late-30’s to late-50’s age range.

Neck lift

Neck lift surgery targets a drooping or sagging neck area and involves the removal of excess skin and fatty tissue, leaving the skin around the area of the neck and jaw smoother and more defined. Incisions are typically shorter than those made during a traditional facelift and will normally be placed only at the earlobe and behind the ear. Vertical bands and lines can be eliminated using platysmaplasty; a procedure which involves making small incisions under the chin or behind the ears to tighten the muscles of the neck. Excess fat from the neck area is removed by using liposuction or similar techniques. In patients with excellent skin elasticity, a neck lift may be performed alone. More commonly, when skin elasticity is fair or poor, a facelift is performed as well, to remove excess skin that would otherwise remain.

Alternatively, neck lift surgery, rather than a full facelift, may be sufficient to achieve the results you desire. As with any other cosmetic procedure, your expectations should be realistic. The results of neck lift surgery will depend on the elasticity of your skin and to what degree it has been affected by sun damage.

It is important that before you see Mr Rezai, you consider what you are trying to achieve from your surgery. Lifestyle choices also need to be considered and certain steps must be taken to reduce the likelihood of later complications. If you intend losing weight, it is best to do so before your facelift. Smokers are advised to stop smoking for at least six weeks prior to surgery in order to help healing and reduce the risk of infection (smoking, amongst other things, reduces the blood supply to the thin skin flaps created by Mr Rezai).

The importance of the initial consultation cannot be overemphasised. At your consultation, Mr Rezai will fully discuss every aspect of your aesthetic goals and address any concerns you may have; he places the utmost importance on providing his patients with all the information they need to make fully informed decisions, ensuring each one arrives at the outcome that’s best for them.

Your medical history will be discussed with you. It is important that you answer all questions as honestly and accurately as possible as failure to do so can have significant clinical repercussions. Please feel free to bring along any medical records that may be pertinent to the discussion. Also, it is important to alert Mr Rezai to any allergies or health issues you may have, along with a record of what medicines or vitamins you are taking and whether or not you smoke.

Routine blood tests are required for all patients, about 2 weeks prior to the surgery. An ECG is also required for patients over 50 years of age.

The majority of patients who request facial surgery will have been thinking about this path for a considerable amount of time. They will have had long-term concerns about their appearance and understand better than anybody else just how important the results of the surgery will be. For this reason Mr Rezai spends considerable time with his patients in order to obtain answers to critical questions such as exactly what they desire as a result of surgery; what actually concerns them is indeed the real problem; and whether or not other possible treatments might be more appropriate or beneficial. If all such factors point to facelift surgery as being the best solution, then a bespoke surgical plan will be developed for you. Mr Rezai will explain in detail the treatment options available, the techniques that would be used, and any potential risks and complications you need to be made aware of.

• The operation may be performed under local anaesthetic with sedation. However, the majority of patients and surgeons prefer the use of general anaesthetic.
• Surgical drains are usually deployed and removed the following day.
• The face may also be dressed with a bandage, which is normally removed the following day.
• The operation may take two or more hours, especially if additional procedures are performed.
• Most patients stay in hospital for one or two nights.
• If your work is not physically demanding, expect to return to work within two weeks.
• Expect to be back to normal physical exercise within four to six weeks.

As with all surgery, you must expect to feel sore and bruised after the operation. A bandage is applied to the face for a couple of days to reduce swelling. Sutures are normally removed after one week to ten days. You may also be asked to keep your head elevated for a few days to help the swelling go down. Initially your face will feel puffy and somewhat stiff. This is entirely normal and a natural part of the healing process.

Mr Rezai and his team will provide you with detailed pre- and post-surgery instructions to expedite your recovery. Should you develop any doubts or concerns following your treatment, however, they would encourage you to contact them straight away.

A further benefit of facelift surgery is that, provided a patient has the appropriate indications, several other related procedures can be performed at the same time.

These include neck lift, blepharoplasty (eyelid surgery), chin augmentation and brow lift procedures, including the endoscopic brow lift.

Liposuction is often performed during facelift or necklift to remove excess fat from the neck. When performing liposuction, the surgeon will make a tiny incision, usually under the chin. He will then use a small cannula attached to a suction device to carefully remove the fat to allow optimal definition of the chin and neck regions.

PRP Therapy is used to improve the skin elasticity and promote faster healing. Fat transfer is used to address hollowed areas of the face, commonly, under the eyes, around the mouth and under the cheek bones. It is thus an additional aid in restoring the face to its natural, youthful appearance. It can also be used in correcting asymmetrical areas of the face, sunken cheeks and eyelids, and thinning lips.

Cosmetic surgery is amongst the safest of surgical procedures. However, all patients must understand and accept that no surgical procedure is absolutely free from risk. Mr Rezai will discuss these risks with you at your consultation. For further information, please refer to Risks and Complications of Facelift.

The results of facelift surgery should appear natural with no obvious signs of surgery. A facelift will turn back the clock, but it will not make time stand still. Our patients usually report that friends and family say they look “well”. Often, they will be asked if they have lost weight, had their hair done or even simply changed their make-up. It should not be obvious that they have had “work done”. A facelift will turn back the clock, but it is unable to make time stand still. You will always look younger than you otherwise would without having had the surgery, but your face will continue to age over the years.

There are many non-surgical procedures which, when used in conjunction, can help to prolong and maintain the results. For further information please visit the Non-Surgical section of our website.