Face lifting is a general term referring to the tightening of facial skin through standard incisions running through the temple hair-bearing area, in front of the ear, behind and back into the hairline. Full facelift refers to total facial rejuvenation and it may involve eyelid surgery, brow lifting and some sort of skin "resurfacing". With increasing demand for this type of surgery, and surgeons' quest for better results, especially in the area of cheeks and mouth-to-nose lines, new developments have introduced new techniques such as deep face lifting. Improvements in neck surgery are also the result of more advanced techniques. However, all these improvements are due to more invasive surgery with its underlying risks, and demand more surgical skill and experience.

The standard or skin only facelift is an old technique, which relies entirely on lifting the facial skin and tightening it above and behind the ears. In the right patient it may give a good result but probably not as long lasting as facelifts involving some kind of muscle tightening at the same time. Also scars tend to stretch and may become visible. This type of face lifting is becoming obsolete.

The muscle-tightening or SMAS facelift was introduced some 20 years ago and remains the mainstay of face lifting at the present time. In this case, the muscle over the jaw and upper neck is tightened, and the skin draped over it. It has the advantage of producing a less stretched face, with less tension on the skin and better scars. Unfortunately, it has little or no effect on the cheeks and the nose-to-mouth lines. Because SMAS facelift is not very effective in treating sagging cheeks and deep nose-to-mouth lines, deep or extended SMAS facelift was introduced several years ago. There are variations to this technique, but they all attempt to correct the same problem. This technique is much more demanding on the surgeon's skill and experience, and the risk of nerve injury is slightly higher. However, in the right patient this technique affords the best result in face lifting at present.

Approximately 7 years ago a new technique called subperiosteal facelift was introduced which attempted to lift the forehead and mid-face through an incision in the scalp. This is an extremely demanding technique, with higher risk of nerve injury and not very spectacular results, except in a few selected patients. One of the problems with this technique was the scar, hair loss and extensive numbness. More recently, this technique has been performed using key-hole surgery, yet more technically demanding. It is more appropriate for the younger patient with saggy eyebrows and cheeks. It has very little effect on jowls and saggy neck. The result of face-lifting depends on many factors, such as surgeon's skill and experience, patient's age, condition of skin, severity of skin laxity, and of course, patient's expectations.

The stay in hospital is usually not more than two nights, and sutures are removed 7 to 10 days later. Bruising may be present up to three weeks post-operatively, depending on the extent, type of surgery, and patient's tendency to bruise. The settling down process is a long one and may take six weeks or so. However, with proper make-up the patient should be presentable two weeks after surgery. Scars are generally difficult to see, and they improve for many months. On the whole, scars are not "mature" for at least one year after surgery. Sometimes scars may have to be revised if they are thick or obtrusive. In patients with poorly elastic skin it may be necessary to tighten the face after six months or so.

When making a decision about having cosmetic surgery, it is important to weigh up the pros and cons. It is particularly important, because cosmetic surgery is not medically necessary and the benefit can be measured in purely psychological terms only.

As with any surgery, face-lifting is subject to complications which although uncommon do occur.

1. Bleeding / haematoma

2. Wound infection

3. Poor scarring

4. Hair loss

5. Numbness

6. Bruising

7. Injury to the facial nerve

8. Unfavourable result

As in all surgery it is essential to see a surgeon who will be able to tell you whether your problem can be remedied by surgery, and what the risks are. Thereafter you will be in a position to decide whether you should go ahead or not.

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