Facelift

Purpose:

A facelift is an operation, which tightens the skin of the lower half of the face and neck resulting in a more youthful appearing face.

Who will the operation help?

A facelift is very good at reversing the following signs of aging:

What causes these signs of aging?

The skin and soft tissues of the face are held in place by ligaments (see picture). With age, as a result of:

The skin of the face starts to sag between the fixed ligaments, resulting in the classic signs of aging (see picture).

Who will the operation NOT help?

A facelift does not rejuvenate the eyes and does not have any significant effect on the skin around the mouth area.

What are the limitations of the facelift operation?

When planning a facelift operation it is important to consider the whole of the face. The aim is to maintain, or achieve, facial harmony. As a facelift only tightens the skin of the lower half of the face, the upper half of the face (the forehead and eyes) may then appear to look "older" in contrast to the rejuvenated lower face. For this reason, people undergoing a facelift often combine this procedure with an endoscopic browlift and eyelid surgery (blepharoplasty). Sun damage to the skin of the face is one of the main factors which can lead to accelerated aging. A facelift only tightens the skin of the face, it does not reverse the effects of sun exposure. However, it is possible, in many cases, to improve the signs of sundamaged skin by a daily skin care protocol using Retinova.

Are facelifts available on the NHS?

Generally speaking, facelifts are not available on the NHS.

What types of facelift are available?

There are several types of facelift available, each has distinct advantages and disadvantages and the most appropriate method to achieve your desired outcomes will be discussed with you at consultation.

Subcutaneous facelift: this was the earliest type of facelift, in which the skin of the cheeks and neck is undermined and pulled up. Any excess skin is trimmed off and the wounds closed. This is fairly quick and safe, but unfortunately the results are not very long lasting, as the skin and scar stretch after about 1 year.
SMAS lift: this is the most popular type of facelift and is described below. It involves the most surgical dissection of tissues and takes the longest to recover from, but offers the best and longest lasting results.
Mini-facelift: the facelift operation can be tailored to an individuals requirements and some patients request a mini-facelift, which involves far less surgical dissection, fewer complications and a faster recovery time, the disadvantage is that the "lift" is not as dramatic.
MACS lift: is a newer type of facelift which involves less dissection of the cheek skin and then a simple lift of the SMAS layer. Because of the limited dissection it is safer, faster and the recovery period is shorter. It is very effective for the cheek and jowel area, but the main limitation of the MACS lift is that it does nothing to improve the neck area.

How is the operation done?

The operation is done under a general anaesthetic (with you asleep). A 3cm long incision is made just underneath and behind the chin, to keep the scar hidden:
and through this incision any excess fat under the chin is removed and the muscles beneath the chin are tightened. Then an incision is made in front of and behind the ear and the skin is carefully lifted off the cheeks. A second deeper layer (the SMAS layer) is then raised and it is this layer which is used to lift the face.

This layer is stitched up into its new position and finally the skin is redraped and trimmed as necessary. Tissue glue is sprayed under the skin to allow the skin to stick down, this avoids bleeding and the need for any drains. Metal staples are used to close the skin of the scalp and removable stitches are used to close the facial skin. The wounds are then dressed with a bulky cotton wool and crepe dressing.

How long is the operation?

A SMAS facelift usually takes about 3 - 3.5 hours.

How many days in hospital?

Most women undergoing facelift surgery stay in hospital 2 nights and are discharged home the following day.

Postoperative period in hospital

You should rest as much as possible for the first 24 hours after surgery. It is wise not to talk or laugh in the first few days to allow the cheek skin to stick back down and avoid collections of blood or fluid beneath the skin flaps. The bulky dressing will be removed on the first day after surgery and you will be given a pressure "mask" to wear, which will support the tissues until they have properly bedded down. You should wear this constantly for the first 2 weeks (removing it for one hour a day for hygiene purposes).You will be able to wash your hair before being discharged, but must ensure you dry it carefully with a hairdryer on a low heat setting (your nerves will have been disturbed and it is easy to burn yourself without being aware of it).

Postoperative Follow Up

After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see your surgeon six days after your operation. Your surgeon will remove any dressings and inspect your wounds, which may or may not have healed at this time. The removable stitches will be removed and you will be given a further appointment to see the nurse about 5 days later. On this visit, the metal staples in your scalp will be removed. If the wounds have healed you will be given an appointment to see your surgeon four weeks after your operation. At this appointment, your surgeon will check on the early outcome of surgery; if all is settling satisfactorily your surgeon shall arrange to see you in a further month and then arrange a final appointment for about six months.

What are the possible risks?

Any surgery has the potential for complications. Although a facelift is generally a very safe procedure, it does carry some risks: Refer to Considering Cosmetic Surgery

Procedure information is copyright Department of Health (http://www.dh.gov.uk. Reproduced under the terms of the Click-Use Licence.