Reasons for patients requesting facelift surgery?
The main reasons for patients requesting facelift surgery are for loose skin in the cheeks, jawline and the neck. As the face ages the skin of the face loses its elasticity and there is loss of fullness and volume of the soft tissues. A combination of these factors results in visible creases, lines, 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.
Mr Chana is well known for his expertise in facelift surgery. Read about the experience of one of Mr Chana’s facelift patients in the Daily Mail.
Watch the video of Mr Chana being interviewed on Sky news about facelifts.
Minimally invasive procedures or facelift surgery?
There has been an explosion in mimimally invasive procedures and nonsurgical facelift ideas promoted by various companies and nonsurgically qualified practitioners. Although there is an attraction to avoiding surgery it still holds true that these are short cut techniques that produce short term results. Patients have to realise that no mimimally invasive procedure will match the results of a surgical facelift. 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 patients are surprised with pain free and very quick recovery times.
Patients also have to realise that only a fully qualified plastic surgeon will be able to give an opinion on the benefits of nonsurgical and surgical approaches in each individual. Seeking the advice from a practitioner unqualified to perform surgery does not provide the patient sufficient information to make a fully informed choice in the current climate of high pressure selling of cosmetic procedures.
The benefits of facelift surgery and how long do they last?
In the right hands facelift surgery will provide a youthful looking face and at the same time avoiding an ‘operated on’ appearance and avoiding visible scars. Modern facelift surgery encompasses a large number of techniques and therefore the procedure can be individualised to the patient to result in a very natural appearance. Facelift surgery tends 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 compared to a situation if no surgery had been carried out.
Individualising the 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 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 vary from person to person as well as the underlying anatomical features. For example a younger patient may only have early signs of loose skin in the cheek and jowls for which a minifacelift is appropriate whereas an older patient may have considerable skin laxity both in the cheek, jawline and neck which would require a procedure encompassing both a face and neck lift technique.
What are the different types of facelift?
In a standard facelift 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 MusculoAponeurotic System which provides some support to the deeper tissues of the face. This layer can be tightened in various ways to elevate the tissues and thereby correct the jowls, provide fullness high in the cheekbone area and also 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. An alternative is to avoid removing a strip of SMAS but to use tightening stitches to fold this layer inwards thereby preserving volume in the face, the SMAS plication facelift. If 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, 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 very
precisely placed in a different vector to produce a slightly different lifting effect in various parts of the face.
The mini facelift
This facelift is usually of benefit in the younger (early 40s) 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 have definite advantages in the younger patient. A modern variation of this procedure is the MACS lift (Mimimal Access Cranial Suspension ) which uses the limited scar of a minifacelift but combines this with sutures placed in loops in various directions to elevate the soft tissues.
Read about Mr Chana’s patient who underwent a minifacelift in the Daily Mail ( link)
The volume enhancing or ‘volumetric’ facelift
One of the important features in the ageing face is 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 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. Recognition of this effect has resulted in facelift techniques designed to restore this volume loss. This is often achieved using a technique called fat transfer where the patient’s own fat is reinjected 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.
The mid facelift
Some patients develop descent combined with loss of volume of the cheek area just below the lower eyelid (the midface). This can be quite an ageing feature. Mid facelifts involve elevating the soft tissue of the cheek in this area. The technique of fat transfer is also very versatile in restoring volume to this area and can avoid some of extensive surgery involved to produce a volume enhancing and lift in this area.
What about the neck?
Loose skin and laxity of the neck muscle causing vertical bands below the chin are often of major concern to patients. 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 in this area. 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. Excess fat in this region obscures a well-defined jaw line. Quite often liposuction is required in this area to remove this fat. Mr Chana is now using the very latest VASER liposelection technique to remove fat and resculpt this area. This technique has tremendous benefit since it is less traumatic than conventional liposuction where one is dealing with very delicate and important structures of the face and neck. Also this technique emulsifies the fat and therefore can be more effective in removing the fat from this very delicate area with very little or no bruising. In some younger patients facelift surgery can be avoided altogether providing the main problem is fat excess alone with the absence of loose skin.
What are the latest advances in facelift surgery?
The latest advances in facelift surgery have involved a recognition of the fact that the ageing face results not only from loose skin and descent of the soft tissues but that a significant component of ageing is due to volume loss in the face. Volumetric facelift procedures are therefore a significant development in this field. 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 are making fat transfer a more reliable technique.
Another important advance is the MACS facelift which utilises 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 more effective and less traumatic. Mr Chana was one of the first fully accredited plastic surgeons to offer VASER liposelection in this country and he is using VASER as an adjunct to many of his facelift procedures with very impressive results.
Many patients will combine blepharoplasty (eyelid) surgery and browlift surgery to enhance the overall rejuvenating effect of a facelift. However, other procedures can also make an equally enhancing anti-ageing effect in combination with a facelift. Often a chin implant can improve the contour of the jawline and enhance the angle between the chin and the neck. In many older patients the nose tip can lose support with age and give a drooping appearance. Carrying out surgery to improve and lift the nose can dramatically make an improvement. In appropriately selected patients Mr Chana often uses these little known adjustments to enhance the overall antiageing effect of a facelift.
What to expect after the surgery?
What are the risks associated with facelift surgery?
Complications after facelift are rare. Should infection occur, it is usually readily treated with antibiotics.
If a haematoma (a collection of blood under the skin) should occur in the hours after surgery, a revisit to the theatre may be necessary. However this would not affect the longterm result.
Occasionally, poor skin circulation together with tension behind the ear may lead to areas of skin which become leathery scabs and die. Healing would be delayed and scarring would be wider. In these situations measures can be instituted to improve the scars. Smokers are especially prone to these risks.
Some numbness in the skin of the cheek is normal and will take a few months to return to normal.
Damage to the nerves which control the facial muscles is an extremely rare event which may be associated with a facelift. Even if this should occur, in the majority of cases there is a full recovery. It must be reiterated, this is a very very rare complication which has to be mentioned by your surgeon.
Mr Chana will discuss with you very carefully the risks associated with the surgery and you will be given a detailed information leaflet prior to surgery.