What is a facelift?
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:
- Sagging cheeks
- Sagging jowels
- Sagging neck
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 continual effects of gravity,
- reduced amount of fat beneath the skin and the
- tissues becoming more lax,
- 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 sun damaged 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.
- Sub-Cutaneous 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: 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: This 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 – 3½ hours
How many days in hospital?
Most women undergoing facelift surgery stay in hospital overnight 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 my Cosmetic Nurse six days after your operation. She 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 me four weeks after your operation. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I 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 the following risks:
- Infection: This is uncommon and results in swelling, redness and tenderness along the wound at any time up to 3 weeks after surgery. This usually responds well to a course of antibiotics.
- Bleeding: Bleeding is uncommon but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. Should a bleed occur under the skin, the face may swell quite dramatically, it can be quite painful and you may develop visible bruising and tenderness. If this happens you usually need to return to theatre to have the blood removed and the bleeding stopped.
- Delayed Wound Healing: This is not a disaster, but can leave a somewhat wider scar. Delayed wound healing is more common in smokers and you are strongly advised to stop smoking before your operation, and not to start again (if you must!) until the wounds have finally healed.
- Ugly Scarring: Most wounds will initially be red and a little thickened for the first six months or so, but will eventually settle very nicely to leave a thin, pale, flat scar. Occasionally however, scars may become red, raised, wide, itchy or ugly. This is very uncommon, but any wound breakdown which occurs in the early postoperative period may result in a slightly stretched, flat scar.
- Flap Necrosis: This is fortunately very uncommon, and is usually seen only in smokers. Part of the skin in front of, or behind, the ear dies (usually due to a combination of poor blood supply, infection and haematoma) and a black crust develops. This complication is usually treated conservatively, waiting until the crust comes off spontaneously over the following weeks/months. This may leave an ugly scar, which may be improved by further surgery after a year.
- Alopecia: Again this is rare, but if part of the skin which is damaged due to poor blood supply is hair bearing scalp, the hair follicles can die resulting in a bald patch. Altered sensation; when the skin of the cheeks are lifted the nerves to the skin are often stretched or even cut. Almost inevitably, the skin in front of the ears will be numb after the operation. Initially the patch of numbness will be very extensive, extending up to the chin and cheeks and even ears on occasions, but gradually the size of this area of numbness will shrink to leave a small area of altered sensation just in front of the ears. It can take up to 2 years for this to recover. During this time, it is possible to injure or burn this skin without realising it. For this reason you should carefully inspect the skin of this area regularly, and in particular be careful with hot hairdryers and don’t sleep with earrings in.
- Facial Weakness: This is the worst complication of a facelift. The facial nerve lies just beneath the SMAS layer, and if it is stretched or cut during the facelift, one or more of the facial muscles may be weakened. This nerve is injured in about 0.5% (one in 200) facelifts. Fortunately, most nerve injuries recover on their own after 2 or 3 months, but weakness can occasionally be permanent.
- Irregularities Beneath The Skin: high tension stitches are used beneath the skin to hold the face up and sometimes firm areas or lumps can be felt beneath the skin of the cheeks. This can be softened after 6 weeks or so by regular massage, and these areas usually settle completely.
- Asymmetry: The two sides of a persons face are almost never the same, and some degree of facial asymmetry is common both before and after this procedure. This is part of what makes our own face unique. Great care is taken to ensure that the two sides are as symmetrical as possible by the end of the procedure, but occasionally different degrees of scarring will occur after the operation and result in facial asymmetry. You may be acutely aware of this immediately after the operation, but given time for the scarring and swelling to settle it usually settles to an acceptable result.