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Facelift surgery:
A facelift is also known as Rhytidectomy a word of Greek origin meaning wrinkle excision. The procedure has passed through an evolution process over the last century.
The effect of gravity, exposure to the sun and stress also show on our face. As folds and lines deepen, drooping occurs at the sides of the mouth. Skin on the neck also becomes looser, and the jaw line becomes saggy causing jowls. One of the first signs of skin ageing is fine wrinkles around the outer eyes area and lips. However the rate at which this occurs differs from person to person. A facelift helps in you looking younger and as a result feeling younger.
A facelift procedure objective is to lift the facial skin and the layer above the muscles to give the face a smoother and younger appearance, effectively brining a more youthful rested look. As we age the layer above our facial muscles (SMAS layer), slackens and loose elasticity giving and aged appearance. The management of the SMAS is the secrete to the more youthful look a longer lasting cosmetic outcomes.
The history of facelifts evolution:
The subcutaneous era of facelift surgery originally described by Hollander in 1909 and performed into the seventies. This involves moving skin only and can give the wind swept look especially if the skin is over tightened. It also increases the risks to the skin blood supply and can cause poorer scars as a result of the undue tension on the skin.
Following the cutaneous facelift came the SMAS lift, which relies on the internal muscsulo-aponeurotic system to lift the face, however, the skin is adjusted without undue tension giving a more natural and longer lasting effect with less risks and potential complications. Skoog initially described this procedure in 1968 and with time it became more popular.
A French craniofacial surgeon, Paul Tessier, introduced the sub-periosteal deep plane dissection facelift in 1979 allowing for mobilising the soft tissue through deeper dissection mobilising the layer covering the bone (periosteum), to obtain a longer lasting outcome at the expense of more swelling and a longer recovery period. This did not gain much popularity in the UK.
A composite facelift mobilises skin and SMAS as one layer. Sam Hamra in Texas described this surgery and published a book on it in 1993. One of its advantages is to preserve the blood supply to the skin.
It is important to note that the lateral aspect of the neck is lifted as part of the facelifts described above In addition in some necks the front aspect may need tightening of the muscle known as platysma. In some fuller necks liposuction under the chin is performed and this adds further improvement to the cosmetic outcome of the surgery. The surgery on the front of the neck also known as platysmaplasty can be preformed at the same time or at a later date. This will be discussed during your pre-surgery outpatients visits.
A mini facelift is one of the least invasive of facelifts and omits the lifting of the neck in this procedure. It a more limited procedure with lesser dissection and lesser down time. The patient does not achieve as much longevity; however, it is only for the less aged faces without neck aging or neck skin excess.
The MACS lift, minimal access cranial suspension lift allows for the correction of the sagging face using a short incision. This is a shorter procedure with less skin undermining and lesser down time. It relies on lifting the SMAS using vertical suspension sutures. However, as in all plastic surgery patient selection plays a big role in obtaining the best results.
Now in the 21st Century volume replacement of the face can in the appropriately selected patients give a youthful look. In my opinion combing this with other surgeries can be a powerful tool in giving excellent results. Hence, we must take into consideration these techniques as significant outcomes can be achieved with minimal down time and no scarring. However, we must also respect that there are limitation and surgery can achieve different results for more longevity at the expense of scarring and more down time. In my opinion and experience combining the two together is the best way forward in the majority of patients.
It is important to stress that the face ages as a whole rather just one isolated component. Hence, in my opinion, as is the opinion of many other colleagues; to obtain the best outcomes in face rejuvenation surgery multiple procedures should be combined. These can be performed at the same time or at different times. In addition it is important that non-surgical treatments including wrinkle relaxing injections (Botox), and facial fillers are used as tools to maintain outcomes and bring cosmetic outcomes to even a new high. Further it is of profound importance that the sun-damaged skin is managed with the relevant skin products and/or peels, laser or plasma regeneration. All this can be discussed in clinic and a plan is made.
WHAT TO EXPECT:
A facelift is normally performed under general anaesthetic; however, local anaesthetic with sedation is another option. A 1-night stay is required in hospital with postoperative recuperation time of 2-3 weeks is needed.
Most patients do not have extensive dressing or drains following the surgery. Over the last 7 years I use tissue glue to help reduce swelling and bruising. Pain control is good and would be in the form of tablets. I would advise my patients to take Arnica tablets few days before the surgery and for few days after as there is scientific evidence that Arnica tablets are of benefit in reducing bruising after facelift surgery.
The face feels stiff to begin; it will appear puffy, and bruised in some patients for approximately 2-3 weeks. In some patients they also experience tightness in the neck or behind the ears when turning their head from side to side. Social activities and work are curtailed for the first 2-3 weeks. There is scarring as a result of a facelift; however, this scarring is mostly hidden within skin creases, or covered by hair and in the majority of patients settles well.
