Face Lift Surgery by Jan Stanek at Surgical Aesthetics
Face lifting is a general term referring to the tightening of facial skin and underlying soft tissues 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, browlifting 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 pioneered almost 100 years ago, 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, except in selected cases.
The SMAS facelift
The muscle-tightening or SMAS facelift was introduced some 30 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 many 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.
Neck surgery is necessary if the SMAS lifting will not correct neck muscle and skin laxity, especially the skin and muscle sagging under the chin. Those patients with “heavy” necks will also require this procedure because facial correction alone will not produce pleasing results and may make the neck laxity look more prominent. It is important to discuss this with your surgeon prior to making a decision whether you should undergo this procedure combined with facelifting.
Face Lift Results - What To Expect?
The result of facelifting 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 introduction of fibrin glue in facelifting has reduced the duration of recovery in terms of bruising and swelling making it possible to face the world in 10-14 days without detectable signs of surgery. It has also significantly reduced the risk of some of the complications, such as haematoma, seroma and skin necrosis.
The stay in hospital is usually not more than one night, 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 many months. However, with proper make-up the patient should be presentable two weeks after surgery. Scars are generally difficult to see, and they continue to improve for up to a year. 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 and tissues it may be necessary to tighten the face after six to twelve months.
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 and aesthetic terms only.
As with any surgery, face lifting is subject to complications, which although uncommon do occur.
1. Bleeding / haematoma: - It occurs in less than 0.5%of patients. Most prone to this complication are males and those with high blood pressure. Those who have taken Aspirin or vitamin E are also at risk. It occurs usually shortly after surgery and is treated immediately with no long-term effects, except perhaps marked bruising.
2. Wound infection: - It is rare for major infection to occur; it is more usual to have localised infection, especially behind the ears. It is treated with antibiotics and local wound care with no long-term effects. Risk of infection is less than 1%.
3. Poor scarring: - Most surgeons aim to produce the best possible scar but some patients may have a tendency to form thickened scars, called hypertrophic. In very rare cases, in particularly in dark-skinned patients, the scar may grow (keloid scar). These scars require treatment with steroid injections and sometimes they may have to be revised. These scars may continue to be problematic in spite of treatment.
4. Hair loss: - It is uncommon and usually happens in the vicinity of the temple scar. In most cases the hair re-grows after several months.
5. Numbness: - It is normal to experience numbness in the cheek, jaw and neck areas. In time this subsides completely. Sometimes a patch of numbness may persist permanently.
6. Bruising: - It is common and some people, such as redheads, bruise more than others. Aspirin and Vitamin E make you bruise more easily and it is important to stop taking these preparations at least one week prior to surgery. Most bruising subsides after three weeks or so.
7. Injury to the facial nerve: - This is a complication due to injury to a small branch of the facial nerve which may make one of the small muscles of the face paralysed temporarily or permanently. It is extremely rare. You should discuss this complication with your surgeon.
8. Unfavourable result: - Dissatisfaction with the outcome of surgery can be the result of many factors, such as unattainable expectations. Face-lifting generally achieves good results but it cannot make you young again.
9. Skin Necrosis: - In some cases skin may heal poorly because of poor blood supply. This is particularly the case in smokers, who are advised to stop smoking at least four weeks prior to surgery. Even if they stop smoking, smokers will always have higher incidence of this complication because of permanent damage to blood vessels and circulation caused by smoking.
It is important to discuss these points, as well as the various types of face lifting with your surgeon at the initial consultation. He/she should be able to answer all your questions as well as alternative forms of treatment, so that you can decide whether you want to go ahead with surgery.