Facelift

Overview

Face lift is a cosmetic surgery procedure performed under general or local anaesthetic and lifts the jowls, tightens the jawline and rejuvenates the lower face. It is often combined with eyelid surgery and a brow lift, a so-called full face lift for a more harmonious result.

The term facelift is a general term and encompasses a number of procedures. Other terms used include: Full facelift, Mini facelift, Short scar facelift, S-lift, Simoni lift, MACS lift, midface lift, SMAS facelift, the Concept face lift. Many of these terms are used interchangeably or for marketing purposes. The key point is safety and a natural-looking result. It should be noted that Mr Nduka performs no two facelifts in exactly the same way, because no two individuals are exactly the same (except identical twins!)

Our faces age for many reasons. Heredity, gravity, sun exposure – these all play a role. Face lifts (a procedure that is over 60 years old) are intended to reverse the aging process by smoothing and redefining the contour of the neck and jaw line to create a younger, fresher appearance. No other kind of surgery allows the surgeon more creativity; and no other kind of surgery is more deeply personal for the patient. Because the results are always on show, it is vital that you do careful research and ideally see more than one surgeon for a consultation. Performing a facelift well takes years of experience and your surgeon should be able to show you results from many years ago.

One of the most difficult things about deciding to undergo surgery, is the understandable desire for a quick fix. Unfortunately, Mr Nduka sees many patients for second opinions who have undergone so-called “lunchtime facelifts”, thread lifts which have left patients with either irregular contours, or resulted in a lift that lasted a matter of months.

Gravity pulls at soft facial tissues, and trying to support them with threads is frequently ineffective in less than a year. In time our cheeks begin to sag, the crease running from the nostrils to the sides of the mouth (nasolabial fold) is accentuated, and our jaw line and chin lose their smooth, refined appearance. As we age we also lose some of our facial fat and our skin becomes less elastic, leading to wrinkling and sagging of our skin, which affects our features.

Sun exposure can be a major contributor to accelerated aging. People who live in climates where the sun is strongest often suffer from prematurely aged skin, irrespective of their ethnic characteristics. Other factors, such as smoking and drinking alcohol, especially if done to excess from a young age can prematurely age the skin.

Years of research, and the cumulative experience of surgeons, have led to an increasingly sophisticated understanding of the ageing process and the more subtle elements in the anatomy of the face. From this, techniques have developed to restore a more naturally youthful appearance.

A face lift can help refresh your appearance, but it will not erase permanent creases, particularly those around your mouth. There are additional procedures like chemical peels which can diminish those lines and can be performed at the same time as your face lift.

Your consultation

When you meet with Mr Nduka, you have an opportunity to receive information and ask any questions about the results you would like to achieve. Mr Nduka will tell you what will happen during your surgery and help design a procedure that meets your individual needs. It is often helpful to bring photographs of yourself when you considered you looked your best (10-15 years previously). Ideally these pictures should show you from the front and from the side, and if possible without a smile as this masks the jowls.

Mr Nduka will take a detailed medical history and ask about any previous facial surgery or non-surgical treatments you may have had. If you are a smoker, please discuss this with Mr Nduka as it may delay healing and affect your recovery. He may also speak about normal differences in your facial symmetry, some of which you may have never noticed previously. Mr Nduka surgeon will, in all likelihood, gently manipulate your facial skin. This performs a dual purpose; assessment of your skin and to show you the type of result you may expect after surgery.

You should receive a comprehensive explanation of the other effects of your facial surgery, particularly in relation to your hairstyle. For men the beard area may move so that it is slightly under and behind the ear, necessitating shaving in that area. Mr Nduka will also discuss with you the risks, which may include scarring, bleeding and infection. He may also explain about procedures that can be used to improve the overall results of face lift surgery. These can all be tailored to meet your individual needs and include; deep (SMAS) lifts; chin fat removal and; remodeling of the neck muscles.

Facelift definitions

FULL FACELIFT – whilst a facelift commonly means rejuvenating the lower face and jawline, a full face lift is usually used to describe rejuvenation of the whole face, typically by means of a brow lift and eyelid surgery.

MINI FACELIFT – a mini face lift is a cosmetic surgery procedure performed under general or local anaesthetic for younger patients without sagging of the neck, and often involves a shorter scar. It is often combined with eyelid surgery or a brow lift.

SHORT SCAR FACELIFT – This cosmetic surgery procedure performed under general or local anaesthetic is suitable for those with earlier signs of ageing.

S LIFT – also known as the Simoni lift or S-lift, this type of face lift involves less dissection but has been largely replaced by the MACS lift

MACS LIFT – a face lift technique popularised by Patrick Tonnard and is a modification of the S-lift. This cosmetic surgery procedure performed under general or local anaesthetic is suitable for those with earlier signs of ageing.

MIDFACE LIFT – a technique for enhancing the cheeks and performed with incisions hidden in the hair and inside the mouth. A mid facelift is particularly suitable for those with flat cheeks but minimal loose skin.

SMAS FACELIFT – this is the traditional facelift technique. SMAS stands for Superficial Musculo Aponeurotic System which is the layer under the skin that contains the facial muscles. SMAS facelift techniques involve either lifting a flap of SMAS, removing a strip, and stitching it into place (SMASectomy), or folding it on itself (SMAS plication)

CONCEPT FACELIFT – This is a marketing term for an operation that is very similar to the MACS lift. The advantage is that it is quick and can be performed under a local anaesthetic. The results have not been shown to last as long as more established techniques.

In addition, there are additional procedures that can be done at the time of your face lift, such as:- • blepharoplasty (eyelid surgery) – this is reduction of loose skin around the eye • forehead or brow lift • the use of fat from other parts of your body to plump up particular areas in your face (Coleman fat transfer) • midface endoscopic lifts for more definition of the cheekbone area.

What to expect from your operation

In most cases your face lift will be typically done under light general anaesthetic and you will spend the following night in the hospital. Once you are comfortably asleep, Mr Nduka will make an incision that starts high in the temple area that is, at this point, hidden by the hair, following the curves in front of the top and bottom of the ear and behind the middle part (tragus). The incision then continues round the earlobe and up behind the ear before curving gently back into the hair.

In some cases a second incision in made under the chin where it will also be well hidden. Its purpose is to assist with definition of the chin and neck.

Using these incisions on both sides of the face, the skin, fat and muscle is remodelled. The incisions are closed with stitches in front of the ear and clips in the hair. Fine, soft drainage tubes are inserted under the skin during the operation and are removed a day after your surgery. These help to minimise bruising and swelling around the face and neck so that you may return to work and resume your normal social activities without too much delay.

The day after your surgery

Your compression garment will usually be removed the morning after surgery and Mr Nduka will check that everything is all right. After that, your hair may be washed and you will be able to go home. You should receive a complete list of postoperative care instructions before you leave the hospital and advice such as:

  • the importance of not engaging in over vigorous activity for a few days after surgery, as this will help to prevent post-operative bleeding;
  • aspirin should be avoided. If you do experience any pain or discomfort a mild analgesic such as Paracetamol can be taken;
  • washing of your hair is fine with a mild shampoo (such as baby shampoo), making sure that you do not to disturb the suture area.

In the week after surgery

As you continue to convalesce, you can expect that:

  • your sutures will usually be removed around five to seven days after surgery. It is advisable not to apply any hair colour for four weeks following surgery due to the strong chemicals like bleach or ammonia in the product;
  • your scars will usually be very faint at first, but usually these thicken and redden for a few months after your surgery before they return to a more natural skin colour and texture;
  • it is normal to experience some bruising, swelling and numbness after a face lift. These symptoms are temporary and should mostly disappear after about two weeks. Numbness sometimes takes longer to go. It may be present for up to a month in the cheek area and three to four months for the underside of the chin.

To help lessen post-operative bruising, arnica may be taken for one week prior to surgery and two weeks after. Products such as arnica cream may also be useful to reduce and clear the bruises more quickly.

Possible complications

Mr Nduka would like to stress that complications are rare, but you should be fully informed about potential side effects.

  • If a haematoma (a collection of blood under the skin) should occur you may need to go back to the operating theatre. If this is dealt with promptly it should not affect the long-term results of the surgery.
  • Occasionally, delayed wound healing may occur. This is particularly true in diabetic patients or patients who smoke.
  • Damage to the facial nerves which control the muscles is extremely rare with face lift surgery. In the majority of cases where this does occur there is a full recovery. As Mr Nduka is very experienced in the management of facial paralysis as part of his reconstructive practice, he is very comfortable operating safely in the vicinity of the facial nerve.
  • With any surgery that takes more than about an hour there is an increased risk of clots in the leg veins (deep vein thrombosis). Because of this, it is important that, apart from the measures taken during the hospital stay, you continue gentle mobilisation, exercising your feet lightly but regularly in the week following her operation. This will help restore your circulation and reduce the chance of clots forming.
  • Anti-biotic are given as a precaution, at the time of surgery and infections are very rare.

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