facing up to surgery

One of the UK’s leading Consultant Plastic Surgeon, Mr Jag Chana, talks us through the ins and outs of facelift surgery.

The main reason for patients requesting facelift surgery is loose skin in the cheeks, jawline and the neck.  As the face ages, skin loses its elasticity and there is a loss of fullness and volume of the soft tissues. A combination of these factors results in visible creases, jowls and sagging skin of the neck.  Around the eyes, the level of the eyebrows can drop, and excess skin can cause hooding of the upper eyelids and ‘bags’ around the lower eyelids.

Minimally invasive procedures or surgery
There has been a recent explosion in minimally invasive and non-surgical facelift ideas.  However, although there is an attraction to avoiding surgery it still holds true that these are shortcut techniques that produce short-term results.

The main hesitation in proceeding with surgery is the anaesthetic and recovery times of surgery.  However, with modern anaesthetic techniques, which use an intravenous form of sedation (TIVA) and carefully performed surgery, recovery times are quick and surgery is painless.

Patients also have to realise that only a fully qualified plastic surgeon will be able to give an opinion on the benefits of non-surgical and surgical approaches.  Seeking advice from a practitioner unqualified to perform surgery does not provide sufficient information for you to make a fully informed choice.

What are the benefits of facial rejuvenation surgery?
According to the latest Mintel Report on cosmetic surgery (May 2011), facial rejuvenation surgery is currently expanding at its fastest pace to date. The reasons why are that facelift surgery will provide a youthful looking face and avoid an ‘operated on’ appearance and visible scars.  Modern facelift surgery encompasses several techniques, so the procedure can be individualised to the patient. Results from facelift surgery tend to last approximately eight to ten years but one has to remember that ten years down the line patients will look more youthful and better for their age than they would have done had no surgery been carried out.

Individualising the procedure to the patient
A number of important factors are taken into consideration in selecting the correct facelift technique.  The most important factor is the patient’s expectations from surgery and careful analysis is required to access these. At the same time, ageing features vary from person to person, as they do underlying anatomical features.  For example, a younger patient may only have early signs of loose skin, for which a mini-facelift is appropriate, whereas an older patient may have considerable skin laxity which would require a procedure encompassing both a face and neck lift technique.

Standard Facelifts
In standard Facelifts 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 layer can be tightened in various ways.  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.  An alternative is to avoid removing a strip of SMAS but to use tightening stitches to preserve volume in the face – the SMAS application facelift. If the SMAS layer is widely elevated, a long flap of tissue is available and the tension can be adjusted in various directions according to where the ageing features are most prominent, the extended SMAS facelift.

The Mini-Facelift
This facelift is usually of benefit in the younger age group who mainly have mild loose skin in the cheek and jowls but with a normal neck.  The scar is limited to 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 be definite advantages.

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 this with sutures placed in loops in various directions to elevate the soft tissues.

The Volumetric Facelift
One of the important features in the ageing face is a loss of soft tissue volume. A clear example of this is when patients suddenly lose a lot of weight in their middle age which can give rise to a hollow appearance. Recently, facelift techniques have been designed to restore this volume loss. This is often achieved using 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 cheekbones.

The Mid-Facelift
Some patients develop descent combined with a loss of volume of the cheek area just below the lower eyelid. Mid facelifts involve elevating the soft tissue of the cheek in this area. Fat transfer is also very versatile in restoring volume to this area.

What are the latest advances in facelift surgery?
The use of fat transfer is an important advance and the use of smaller cannulae to inject the fat with different methods of preparation of the fat is making the fat transfer a more reliable technique. Another big step forward is the MACS facelift which utilizes the advantage of a short scar combined with stitches placed as loops to elevate the SMAS layer.  The minimal dissection required with this technique also leads to a quicker recovery time although patients with an ageing neck are not always suitable.  Fat removal in the neck is an important consideration in any face and neck lift procedure.  With the advent of the latest VASER liposelection techniques, fat removal in this area has become effective and less traumatic.

Choose Your Surgeon Wisely
You can see that facelift surgery is a hugely specialist area encompassing a large variety of techniques.  The safety and success of this procedure is dependent on your surgeon is experienced in a broad range of techniques.  Only a high level and breadth of experience will ensure an excellent natural looking facelift result.

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