As part of the ageing process which happens to all of us sooner or later, our skin progressively loses its elasticity and our muscles slacken. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces. The folds and smile lines deepen, the corners of the mouth drop, the jaw line sags and the skin of the eyelids becomes loose.
In the skin, the first sign is fine wrinkles developing around the lips, at the outer corners of the eyes and lines of expression. The rate at which this happens varies from one person to another and is probably determined by our genes.
Ageing of the skin of the face does not necessarily reflect the rate that the rest of our body and mind is ageing and many people feel frustrated that the face they see in the mirror is not the one they feel should be there. Substantial weight loss can produce similar changes in facial appearance to those of the ageing process.
Who will benefit from a facelift?
The best candidate is one whose face and neck has begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well defined. Most patients are in their 40’s to 60’s, but facelifts can be done successfully on people in their 70’s or 80’s. It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful. It is a procedure that technically works well but also increases morale and is well appreciated by the patient.
What a facelift does not do?
A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles of the forehead then you should perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles, freckles and rough areas will benefit more through chemical peel or laser resurfacing.
How long does a facelift last?
A facelift does not stop the clock but it does put the clock back. The effect of a facelift is likely to always be there in that you will not look as old as you would have done had it not been carried out.
A facelift is carried out under general anaesthetic. The procedure, although long, can be combined with other operations of all sorts. The most common, however, would be an endoscopic brow lift and an eyelid operation. Other extra procedures which can be used to enhance the face at the same time are malar (cheek bone) and chin augmentation and lip enhancement.
Incisions are made above the hair line at the temples and extend in a natural line down the front of the ear, just inside the cartilage at the front of the ear, or just inside the cartilage at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear and off into the lower scalp. Occasionally, it may be necessary to make a small incision under the chin. Sometimes only the skin is lifted following a separation from the underlying platysma muscle. More usually, however, the platysma muscle and its fibrous attachments (S.M.A.S.) is dissected free and sutured tightly to the solid structures in front of and behind the ear. At other times the skin and the S.M.A.S. layer are lifted together as a single layer, but will be sutured separately. Fat along the jaw line and under the chin may be removed by liposuction or on occasion through an incision under the chin. The skin is sutured so that it is lifted upwards and backwards, just as when one lifts the skin when looking in a mirror. Sometimes drains are inserted. Most surgeons will bandage the face to minimise bruising and swelling. These bandages will stay for one or two days and sutures are removed between 7 to 14 days
After your surgery there is usually some bruising of the cheeks with gravity this tends to descend into the neck. Discomfort is usually mild and can be controlled with Paracetamol. It is normal for there to be some numbness of the skin of the cheeks and ears, and this will usually disappear in a few weeks or months.It is advisable to keep your head elevated whilst sleeping, for two to three weeks with two or three pillows, to reduce swelling. Drainage tubes will be removed a day or two after surgery. Avoid strenuous activity, saunas and massage for at least four weeks. At the beginning your face will look a little puffy and may feel rather strange and stiff. The scars can be very well hidden by women with their hair and disc shaped earrings so that they should be able to return to work and social activities within a couple of weeks.
Scars in the hairline can be hidden by the hair. There may be some slight reduction in hair growth in the temples, but this is generally only problematic if the hair is thin or repeated facelifts have been carried out previously.
Choosing your surgeon
A facelift is a skilled procedure and we would recommend that you choose a surgeon who has undergone full training for cosmetic surgery. These surgeons will be on the Specialist Register in Plastic Surgery at the General Medical Council. All members of the British Association of Aesthetic Plastic Surgeons (BAAPS) are on the Specialist Register.
What should you do before the operation?
If you are overweight and intend to lose weight, you should do so prior to booking any surgery and you should be at a weight that you can reasonably maintain. This allows the surgeon to remove more skin and therefore achieve a more pleasing result.
You should avoid taking tablets containing aspirin and non-steroidal anti-inflammatory drugs such as Voltarol and Indocid for at least two weeks before surgery, as they increase the risk of bleeding.
You should stop smoking if possible, or stop at least four weeks before surgery and six weeks after surgery. It decreases circulation of the skin flaps, particularly behind the ears.
Do not tint or dye your hair for two weeks before surgery and six weeks after surgery, as scars can be sensitive to these chemicals.
ARNICA tablets will reduce swelling. This can be purchased from a CHEMIST. These should be started a few days before surgery and continued for several days afterwards.
Swelling and bruising may be severe.
You should sleep on two or more pillows. This will reduce the swelling in your face.
The face bra should be worn night and day for two weeks and then only at night for a further four weeks.
Some of the sutures will be removed at 7 to 10 days. Others are dissolving and do not need removing. Occasionally a small piece of stitch may remain and need removing at a later date.
You must wash your face as normal except that you should use a gentle soap such asunperfumed, mild soap such as Johnstons Baby Soap.
Ice packs can be applied if desired. They should ideally be GEL PADS may be applied. Do not apply ICE PACKS directly to your skin, apply once you have wrapped a towel around it and gently rest this on your face.
Scarring can also be an issue. Advice will be given on scar management in your follow up consultation with your surgeon