MINIMALLY INVASIVE FACIAL PROCEEDURES VERSUS FACELIFT SURGERY
In more recent times, there has been an explosion in minimally invasive facial procedures and non-surgical facelift ideas promoted by various companies and nonsurgical qualified practitioners. Although there is an obvious attraction to avoiding surgery, it still holds true that such techniques produce short-term results. Patients need to realise that no minimally invasive facial procedure will match the results of a surgical facelift.
Often the main hesitation in proceeding with surgery is the anaesthetic itself and the post-operative recovery time. However, with modern techniques which use an intravenous form of sedation (TIVA) combined with carefully planned and performed surgery, patients are discovering they are surprisingly pain free and have quick recovery times.
Above all it is important to remember that to make a fully informed choice on the benefits of a non-surgical approach versus a surgical one, you must seek the advice of a fully qualified plastic or cosmetic surgeon. Asking a practitioner unqualified to perform facelift surgery will not provide you with the information you require.
WHAT ARE THE OVERALL BENEFITS OF A FACELIFT AND HOW LONG WILL THE RESULTS LAST?
In experienced hands, facelift surgery will create a youthful looking face that avoids visible scars and an ‘operated on’ appearance. Modern procedures encompass a number of state-of-the-art techniques that can be individualised to a patient to give a very natural facial appearance. Importantly the results tend to last between eight to ten years which if you picture your life a decade on, will mean you should look much younger for your age compared to a situation if no surgery had been carried out.
INDIVIDUALISING FACELIFT SURGERY TO THE PATIENT
A number of important factors are taken into consideration in selecting the correct facelift technique. The most important factor is understanding the patient’s desires and dislikes. A careful analysis is required to assess the patient’s expectation in order to select the correct technique.
At the same time, ageing features, as well as underlying anatomical features, vary from person to person. For example, a younger patient may only have early signs of loose skin on the cheek and jowls for which a mini-facelift is appropriate, whereas an older patient may have considerable skin laxity on the cheeks, jawline and neck which would require both a face and neck lift procedure.
THE TECHNIQUES OF FACELIFT SURGERY
Standard facelift In this procedure, the scar is carefully hidden in the creases in front of the ear and runs in the groove behind the ear and back into the scalp hair. One of the most frequently performed procedures is the SMAS facelift. Just beneath the skin, there is a muscle layer called the Superficial Musculo Aponeurotic System which provides some support to the deeper tissues of the face. This can be tightened in various ways to elevate the tissues and correct the jowls, provide fullness high in the cheekbone area and to correct loose muscle in the neck. Correct elevation and tightening of this layer is critical to avoid tension on the skin and to avoid a ‘wind-swept appearance’. The way in which this layer is tightened and repositioned gives rise to some of the different types of techniques. The SMAS layer can be tightened by removing a strip of this tissue and stitching the edges together which is called a SMASectomy facelift.
The alternative is to avoid removing a strip of SMAS, but instead use tightening stitches to fold this layer inwards thereby preserving volume in the face, a technique called the SMAS Plication facelift. If however the SMAS layer is widely elevated, a long flap of this tissue is available and the tension can then be adjusted in various directions according to where the ageing features are most prominent, a technique called the extended SMAS facelift.
Rather than elevating the SMAS layer, many newer techniques involve placing stitches in loops to elevate and suspend the SMAS layer. Each stitch can be placed precisely in a different vector to produce a slightly different lifting effect in various parts of the face.
Mini-facelift This usually benefits the younger (early 40s) age group who mainly have mild loose skin on the cheek and jowls but a normal neck. The scar is limited to a position just in front of the ear. Since the scar behind the ear and scalp is avoided, the neck tissues cannot be tightened very effectively. However, the limited scar does allow a quicker recovery period and the technique can have definite advantages in the younger patient. A modern variation of this procedure is the MACS lift (Minimal Access Cranial Suspension) which uses the limited scar of a mini-facelift but combines it with sutures placed in loops in various directions to elevate the soft tissues.
Volume enhancing or ‘volumetric’ facelift One of the most notable features in the ageing face is a loss of soft tissue volume, something which can be clearly seen when a patient suddenly looses a lot of weight giving rise to a hollow appearance with the sudden onset of loose skin and wrinkles. In simplistic terms, it is the fat which is plumping out the skin to keep it smooth without laxity and wrinkles. In the majority of patients however, this effect occurs slowly over many years.
By recognising this effect, facelift techniques have been created to restore this volume loss. This is often achieved using a technique called fat transfer where the patient’s own fat is re-injected into the face to produce a fuller and more youthful appearance. Other techniques involve using stitches in the deeper parts of the face to elevate and suspend the tissues so that they are repositioned higher over the cheek bones.
Mid-facelift Over time some patients loose volume in the cheek area just below the lower eyelid (the midface) which can be quite an ageing feature. A mid-facelift will rectify this by elevating the soft tissue of the cheek in this area. It can also employ the fat transfer technique which aside from being very versatile in restoring volume to this area will avoid extensive surgery.
Neck lift A major concern that many patients have is the development of loose skin and laxity of the neck muscle over time which causes vertical bands below the chin. Tightening the SMAS layer can correct these ageing features via a facelift incision. Sometimes however, an additional small scar is required under the chin to stitch together the vertical bands of muscle and remove fat. This is called a Platysmaplasty.
In contrast to the ageing face where volume loss is seen in the neck, there can be a considerable amount of fat excess under the chin and neck area which can obscure the jawline. In such cases, liposuction is required to remove this fat. Mr Chana uses the latest VASER Liposelection technique to remove fat and re-sculpt the neck area, which has a significant benefit over standard liposuction as it is less traumatic especially when dealing with the very delicate and important structures of the face and neck. Furthermore, it emulsifies the fat (which is a lot more effective in removing it) with little or no bruising. In some younger patients, facelift surgery can be avoided altogether using this technique, providing the main problem is excess fat alone with the absence of loose skin.