As people age, the effects of gravity, stresses of daily life and exposure to the sun can be seen in their faces. With increasing age, the brow drops, jowls form and the skin of the neck becomes loose. Deep lines may form between the nose and corners of the mouth. The rate at which a person’s face ages, varies considerably. Much of this is determined genetically, although the ageing process may be accelerated by excessive sun exposure or smoking.
There are many different types of facelift and the choice of procedure depends very much on how individual faces have aged. Most facelifts involve making an incision that extends along the front part of the ear and extends along or into the hairline for variable distances.
Facelifts are designed to reverse the signs of ageing as much as possible. In general, they involve tightening the underlying facial muscles and re-draping the skin of the face and neck so that it no longer hangs in folds or creases. Facelifts may be performed alone, but are often performed in conjunction with procedures such as brow lift or blepharoplasty.
Frequently Asked Questions
Cutaneous Facelift – This is a very traditional facelift, which has been performed for many years. The technique involves lifting the skin from the underlying tissues, tightening the skin and removing the excess skin produced. The technique has a tendency to produce a rather stretched look and the effects are generally short lived. This type of facelift has largely been replaced by more modern facelifts.
SMAS Facelift – This facelift often uses the same incision as a traditional facelift, but relies on lifting the deep system of muscles and soft tissues called the SMAS to produce its rejuvenating effect. There are many different ways of performing a SMAS facelift and for most people a small amount of the SMAS is removed and tightened (SMASectomy). For people with severe ageing, an extended SMAS facelift may be performed, which produces a very dramatic rejuvenating effect, but has the disadvantage that recovery times are prolonged.
MACS Lift (Minimal Access Cranial Suspension) – The advantage of this facelift is that it can be performed through a relatively short scar. Permanent sutures are used to elevate the soft tissues of the face to a more youthful position. The MACS lift works well for people with mild to moderate jowl formation, but it is less effective at rejuvenating the neck.
Volumetric Facelift – As the face ages, there is often a loss of fat producing a gaunt or hollow appearance. Volumetric facelifting techniques rely on injecting a patient’s own fat into the thinned areas of the face and by moving the cheek tissues to a higher position to produce a more youthful shape to the face. These volumetric techniques are often combined with facelifts that lift and tighten the SMAS.
Facelifts are very individualised procedures. In your consultation, your concerns will be discussed. A detailed evaluation of your face will be undertaken to look at quality of the skin, the underlying bone and position of the soft tissues. The most suitable type of operation will also depend on your general health, whether or not you are a smoker and how quickly you need to recover from your surgery.
You should not take Aspirin or non-steroidal anti-inflammatory drugs such as Brufen or Nurofen for two weeks before your surgery. These drugs increase the risk of post-operative bleeding and have an adverse effect on bruising.
If you smoke you will need to stop smoking for two weeks before your surgery and a week afterwards. Smoking reduces the blood flow to the skin and can prevent healing. You will need someone to drive you home after your surgery and to help you out for a few days at home. If you hair is very short you may want to let it grow before your surgery so it is long enough to hide the scars while they heal. Hair tinting may be continued up to the time of surgery. It is desirable to avoid strong hair colourants for six weeks after surgery.
All surgery carries some risks. A facelift is usually a very straightforward procedure. There is a small risk of haematoma formation (a collection of blood under the skin that must be removed). Injury to nerves that control the facial muscles can rarely occur and if it does happen, the effects are usually temporary. There is a small risk of infection and poor healing of the scars. These complications are much more common in smokers.
Most facelifts are performed under general anaesthesia and require a one- night stay in hospital after the operation. Before your surgery, it may be necessary to draw some lines on the face in order to help produce a symmetrical and pleasing result whilst you are asleep. Whilst you are asleep, the hair is parted and held in position with hair gel. It is not necessary to shave any hair. The incisions are made around the ear and generally extend into the scalp. The facelift is performed through this incision. Stitches are used to close the incisions in front of the ear and occasionally metal clips are used in the scalp, because unlike normal sutures they tend not to interfere with hair growth. A special face and neck dressing is placed to apply gentle pressure to the lifted areas.
Most people stay in hospital for one night after a facelift. You will be nursed in a semi-sitting position following the operation, which helps to reduce swelling.
Facelifts are generally not painful. Most people complain of a feeling of numbness over the cheeks, a sensation of tightness in the face and neck skin. The day after your surgery, the dressings are removed and your hair will be washed by the nurses before going home. At home, it is helpful to rest and sleep with 3 to 4 pillows for the first week after surgery in order to encourage the swelling to subside as quickly as possible. Swelling tends to increase for approximately 48 hours after surgery and then gradually subsides. In the first week you may notice an increasing amount of bruising in the lower part of the face and neck. The stitches in front of the ear are removed one week after surgery. Metal clips are placed in the hairline and it is often two weeks before these are removed. There is often a feeling of tightness in the cheek and neck, which may last for 6-8 weeks. The cheeks often feel numb, particularly in front of the ears and this feeling of numbness may last for approximately 3 months.