The term "facelift" or "rhytidectomy" is not a single type of operation but rather a variety of options that should be tailored to the individual patient's needs. There are many factors to take into account, the most important of which have to do with the patient's own anatomy (ie. bone and soft tissue structure). In general terms there have been a number of very significant advances in facial aesthetic surgery in recent years. These have mainly come about through a better understanding of the face with the development of craniofacial surgical techniques for the correction of congenital birth defects that involve the face.
During our consultation we may discuss one or more of the following facelift techniques:
- Cutaneous facelift.
This is the traditional facelift technique that lifts the skin from the underlying tissues and re-drapes it upward and backward. Excess skin is then removed. This is the easiest of the surgical techniques and involves the shortest convalescence period. However because the underlying SMAS (see below) is not addressed, the results are not as long lasting or impressive as the deeper plane techniques that do more to address the structural "drooping" of the facial tissues.
- SMAS lifts / deep plane lifts
The SMAS or Subcutaneous Musculo-Aponeuritic System is a thin but strong layer underneath the skin to which the muscles and soft tissues are attached. The discovery of this layer in the late 1970's was really the key step forward in being able to effectively and durably lift and replace the tissues of the face that have moved downward with age.
These deeper plane lifts do require a detailed knowledge of facial anatomy and meticulous surgical technique, but the gains are well worth the extra time taken to perform the surgery. In most patients, this is the technique that reliably gives the best and most impressive results that stand the test of time.
I have found another modern variation on this theme to be particularly effective in restoring the characteristic youthful appearance of the cheek areas. This is known as the volumetric facelift and is a powerful rejuvenation technique in the right patient.
- Short scar techniques / MACS lift
In some patients it is possible to avoid extending the facelift scar behind the ear. There are a number of names given to this approach but the important issue again is correct patient selection. Patients that benefit from this sort of approach are the younger patients who do not have significant age-related changes in the neck.
- Subperiosteal facelift
This approach is a direct extension of reconstructive craniofacial surgery to aesthetic facial surgery and works to lifts the soft tissues at the deepest possible level, the facial bones. It is appropriate in a small number of patients who are in the younger age group and wish to have a long-lasting and distinct transformation. The major advantage of this technique is the avoidance of external facial scars which is a big plus! However the recovery time is longer than with other techniques and its application is limited really only to younger patients without significant superficial skin changes.
Neck lift and platysmaplasty
All deeper plane facelifts tighten the muscles of the neck to improve the jowl area and the definition of the jaw line in both the frontal and side views. To eliminate vertical folds in the neck and improve the neck and chin definition as much as possible, I would almost always perform a platysmaplasty routinely usually in combination with a lower or full facelift to achieve the same effective rejuvenation in the neck as in the rest of the face. This is usually in the form of a lateral platysmaplasty and liposuction under the chin. Occasionally a small incision is also made below the chin to perform an anterior platysmaplasty if needed. This will always be discussed with you if it is planned.
The scars for all types of facelift fall within the hairline and around the ear. They are designed in such a way that you will be able to wear your hair in any style that you wish once they have had a chance to mature.
There are a number of additional procedures that complement the results of a facelift and may be carried out when required. These include endoscopic browlift, upper or lower blepharoplasty (eyelid surgery), rhinoplasty, bony adjustment of cheeks or chin, liposculpture or fat injection around the face or lips, and skin resurfacing with chemical peels or laser. Bony adjustment of the chin (genioplasty) can produce a subtle yet dramatic improvement in the facial proportions. Additionally fat injection to the lips can re-produce the youthful fullness of the lips (without producing the ‘pout' that is preferred by some celebrities). Any or some of these procedures may be discussed with you in more detail at the time of consultation.
What to expect on the day of and after surgery?
We will provide you with specific information about what to do before and after surgery but you may find the following guidelines useful in planning your operation and knowing what to expect.
Most patients stay one night in hospital after such surgery, although two nights would not be unusual if extensive surgery has been carried out.
You will have a light padded dressing which will be removed the day after surgery and prior to you going home. You may have some tape on your face and also cool pads on your eyes, particularly if you have had eyelid surgery. It is advisable to rest as much as you can in the first 48 hours and then gently resume normal activities in 7 to 10 days. The sutures will be removed at 3-7 days. Usually you will be able to resume most activities such as swimming or golf at 4 weeks, perhaps slightly longer for more vigorous exercise.
We will see you regularly in the postoperative phase to make sure you are looked after and longer term followup will also be arranged. All postoperative dressings, visits, and appointments are part of the surgical care and you will not incur any additional cost.
The modern face and neck lift will, for most patients, produce a significant rejuvenation and improvement in facial appearance for many years to come. Perhaps the best results are obtained when the harmony of the face is addressed in its entirety in combination with other procedures such as brow lift and eyelid surgery. It is important to remember however that aesthetic surgery is entirely "optional surgery" and it is essential for us to plan and discuss the surgery together carefully preoperatively to achieve a realistic and ideal goal.