Face The Facts
" If you opt for a face-lift, you'll need expert advice from a plastic surgeon, like Jan Stanek FRCS, to help you decide the most appropriate procedure "
Face-lifting is the general term for the surgical reversal of ageing. Facial ageing affects not only facial skin, but also the fat layer, tissue under the skin and , to a lesser extent, bone. Causes of ageing are many, but the most important are heredity, degree of muscle activity and sun damage. A combination of these can make a person look prematurely old.
'Face-lift' can refer to many types of procedure, but, generally refers to lifting of the mid-face, jaw line, and neck. Endoscopic face-lifts the forehead only. When combined with procedures such as brow-lift and eye surgery, face-lift is often referred to as full face-lift.
Who is suitable?
Anyone who, through ageing excessive exposure to sun or extreme weight loss, has developed excessive slackness of the facial skin and tissues may be suitable for face-lift. Most people are suitable by their early or mid-forties, with some exceptions earlier or later in life. Biological age is what matters, not chronological. A person who has inherited good skin and avoided sun exposure may not need a face-lift, even in their early to late fifties. Equally, a person in their mid-thirties who has lost a lot of weight and has poor skin laxity may be a good canditate for face-lifting.
The surgeon has to assess whether face-lifting will achieve the desired changes by testing for skin and tissue laxity and observe signs of ageing, such as mid-facial tissue descent, deepening of naso-labial grooves, jowling and slackness of neck skin and platysma muscle. Face-lifting can be useful only when some or all of these signs of ageing are present.
There are many types of face-lift, but none of the procedures are perfect, however, some will be more appropriate to specific patients than others. Every surgeon has his own favourite technique and may try to persuade prospective clients that his is the best.
The more complex techniques, such as endoscopic face-lifts or extended SMAS, are practised by a few experienced surgeons, who feel that under most circumstances these will give the best result. Some simpler techniques, such as skin-only face-lifts will also give good results in carefully chosen subjects, and should not be dismissed as completely outdated.
This procedure has been recurrently in vogue because of its simplicity and short recovery. It should not be carried out, because it aims at those who are too young to a have a proper face-lift and its effect is short-lasting and barely visible.
The aim is to elevate the mid-facial tissues, such as cheeks, and improve the naso-labial grooves with temple skin tightening. In its simplest form, an incision is made behind the temple hairline and skin is undermined and any excess removed. Often this results in an ugly, stretched scar and tighteing will last six months or so.
A more recent variant of this technique, the SOOF lift, lifts cheek tissues either through a lower eyelid incision or a temple incision, utilising keyhole surgery.
The cheek tissue can be mobilised through an incision inside the mouth, just above the gum. Having mobilised cheek tissues, these are then suspended by a series of sutures deep to the temple. In the right person results can be good and lasting.
This is the most commonly performed procedure. It utiliises standard face-lift incisiions, starting in the temple, skirting the top of the ear, curving just in front of the ear, underneath the earlobe, behind the ear and then curving back into the hairline. Skin is then undermined and lifted for a variable distance towards the cheeks, jawline and neck. Tightening is carried out at two main points, just above the ear and behind. The excess skin is removed and wounds closed to form a neat suture line.
The main problem with this technique is that it does not address the muscle (SMAS)/soft tissue looseness beneath the skin and therefore places an undue tension on the skin. This results in a very taught-looking face and scars tend to become stretched because of the undue tension on them. Moreover, the vectors, or lines of pull, are un-natural, giving the face a peculiar face-lift appearance. Because of tension on the skin, risk of necrosis, or diminished blood supply to the skin edges is high, especially in smokers.
Elderly patients with thin faces and marked, slack, skin, where complex procedures are to be avoided, can be good candidates for this procedure.
Essentially, this is very much like a skin-only face-lift, except that the muscle layer overlying the parotid gland is tightened, either by pleating or lifting the muscle and tightening it. This has a beneficial effect on some of the mid-facial tissues and jaw line. However, it can have a detrimental effect on the nose-to-mouth grooves by making them deeper. When tightened too much, it can lead to obvious signs of tighteing during animation. It has no effect on the neck. Because it relieves some of the tension on the skin, scars tend to be better than in skin-only face-lifting.
Extended SMAS Face-Lift
This is currently the best all-round face-lifting technique, practised by a minority of surgeons who have extensive experience in facial rejuvenation. It is technically very demanding and time consuming. Although the risk of nerve injury is theoretically higher, in practice it occurs very rarely.
Most face-lift patients are expected to stay in hospital for one or two nights. They can stay longer, but hospital stays are inevitably very expensive. How long the surgery will take depends on the procedure, whether other procedures will be carried out concurrently, and how slowly or quickly the surgeon chooses to proceed. The length of surgery for a face-lift only may vary from 1.5 to 3.5 hours. In cases of combined surgery, such as full face-lift, it may take up to six hours to complete all the procedures.
After surgery, the patient spends some time in the recovery area until he is completely awake, before returning to the ward.
The face is bandaged and often ice-packs are applied to reduce swelling. There should be very little pain, if any. The face will feel numb and tight, but this will gradually decrease and, eventually, disappear.
Before discharge from the hospital all dressing are removed and the hair is washed. At that time there is very little swelling and minimal bruising. These will get worse over the next five days or so, but by the end of the first week will diminish considerably. At home, it is important to rest, and to sleep with the head elevated at 45 degrees and to avoid strenuous activity. Swelling can be controlled with ice packs. Hair should be washed every day to keep the wound clean and crust-free.
Sutures are usually removed seven to 10 days after the operation. Any wound infection will then be detected. Good practice will offer a camouflage for residual bruising.
It will take much longer than most patients imagine for the face to return to normal. It can take up to six months for the swelling to disappear completely and even longer for numbness. Scars usually take 12-18 months to fade. However, the patient should be able to face the world 2-3 weeks after surgery.