What is a facelift ?
A facelift is a surgical procedure which improves the jawline along with the loose skin in the cheek and neck area. The surgical technique involves elevation of the skin together with lifting of the deeper tissues of the face which have sagged over time. Compared to all techniques including non-surgical methods the surgical facelift is the most effective procedure at rejuvenating the face and provides the best longevity. Although the facelift is a standard procedure there are various minor modifications of the way in which the deeper tissues are lifted which allows the procedure to be appropriately tailored to suit the requirements of the patient. These modifications are described below.
What does a facelift achieve ?
A facelift is a facial rejuvenation procedure which addresses the jowl area, loose skin in the cheek, and to some degree the laxity of the tissues in the neck. If the muscles of the neck are very loose and cause vertical bands then a neck lift is required and this is very conveniently performed at the same time with the two procedures complementing each other. A facelift does not address the ageing of the surface and texture of the skin which gives rise to minor ageing pigmentation and fine lines which are often sun induced and occasionally as a result of smoking. Chemical peels and fractional carbon dioxide laser resurfacing is most effective for this aspect of facial rejuvenation.
What age is suitable for a facelift ?
A facelift is suitable for middle aged and older individuals who have begun to notice that the jawline has become less defined with the onset of jowls. There may also be loose skin in the cheek and the laxity of tissues in the neck can also cause loose neck skin, loose muscle bands and quite commonly there may also be excess fat in the region under the chin.
It is not possible to provide an absolute guide to the best age for a facelift. The reason for this is that the circumstances can vary from person to person. For example, someone who has lost a huge amount of weight in their late 30s can have more severe facial ageing than someone in their 50s. Therefore, each case is assessed on an individual basis.
The following examples illustrate this:
A facelift in a 40 year old:
Kerry was 40 years old when she came to see me complaining that she looked much older than 40 .. She underwent a minifacelift and liposuction under the chin. The before and after pictures below illustrate that even in a 40 year old the results can make a significant difference while maintaining a very natural appearance. Kerry was featured in a Daily Mail feature on
Mr Chana’s facelift technique. You can read the link here.
A facelift in a 50 year old:
50 is a very common age group to undergo facelift surgery. This patient underwent a high SMAS technique for her facelift and this was combined with fractional carbon dioxide laser resurfacing to the upper and lower lips and lower eyelids. Not only has she a much improved jawline and neck contour but her skin complexion has been significantly rejuvenated.
Are there characteristics which determine good results following surgery ?
Individuals who achieve the best results from facelift surgery are generally those who are not too overweight with slim faces and good underlying bone structure. Individuals who are overweight may have ‘chubby’ faces and t the results from facelifts are more limited in these cases although some degree of improvements can be achieved.
Individuals who are in the older age group who have perhaps had an excessive amount of sun exposure often have extremely weathered skin with lots of deep set folds and lines. In this group it is also challenging to provide very good results since the deep lines are so ingrained in the skin that these features tend to dominate the face even though the laxity of the tissues is addressed following a facelift. In this situation often a combination of treatments is required such as the addition of fractional carbon dioxide laser treatments to freshen the skin or fat transfer or dermal fillers to reduce the deep lines in the skin.
What happens during the operation ?
During a facelift the skin is elevated using an incision which is hidden in the natural curves in front of the ear and in the groove behind the ear which then extends into the hairline. No hair is shaved during the operation but is simply parted. The skin is elevated in the cheek, along the jawline and into the neck. The deeper tissues are then elevated using stitches to reposition the facial tissues into a higher and more youthful position. This deeper tissue which is elevated is called the SMAS which gives rise to the term the ‘SMAS’ facelift. The exact manner in which this is achieved will vary. You should not allow yourself to get too bogged down with technical details since the crucial determinant is to tailor the surgery individually in each patient in order to produce the desired results. In actual fact there are no scientific studies demonstrating that one technique is better than another. The use of a particular technique usually comes down to a combination of surgeon preference, careful analysis and an artistic eye to achieve the best result in each patient.
What is the importance of the SMAS layer ?
This is the deeper layer of tissue which supports the muscles and fat compartments of the face. This layer also extends into the neck and is continuous with the superficial muscle of the neck called the platysma. It is well known that one of the effects of ageing is that the tissue of the face which includes the skin, muscles and fat compartments in the cheek and jawline sag downwards from a reduction in tissue elasticity combined with the effects of gravity. Since this layer supports the structure of the face, lifting and tightening the SMAS is one of the most important determinants of correcting the tissues that have dropped and sagged as a result of the ageing process. Tightening the SMAS therefore helps lift all of these structures back into their normal more youthful position. It is a misconception that the skin alone is pulled upwards. In fact there should be very little pull on the skin otherwise this will give rise to an unnatural swept appearance which is commonly seen and is a tell-tale sign of bad appearances after surgery. Pulling the skin alone can also give rise to some complications of surgery such as adverse scars or a pulled down and misshapen earlobe. In fact, after tightening the SMAS layer, the skin should always be simply redraped back onto the face in its new position without tension. Tightening the SMAS layer is therefore one of the critical steps in achieving good results from facelift surgery. Since SMAS procedures require a detailed knowledge of facial anatomy many surgeons who have limited experience and less confidence in facial surgery take short cuts in this part of the surgery by limiting the degree of work on the SMAS and concentrating on the skin alone . This is one of the many reasons why results from facelift surgery may be sub-optimal in inexperienced hands.
What are the different types of SMAS facelift ?
As a very brief summary the following are a number of terms used to describe the exact type of SMAS procedure. The SMAS may be elevated and pulled tight which is the standard SMAS technique. The high SMAS technique involves elevating the SMAS quite high near the cheek bone which provides a very effective vertical elevation and tightening of the tissue combined with restoration of fullness in the cheek bone area. Another technique removes a small vertical strip of SMAS tissue and the edges are then stitched together which is called a lateral SMASectomy.
At the same time as tightening the SMAS layer the neck tissues can be addressed if necessary. This involves tightening the muscles of the neck and often some degree of liposuction or fat removal to redefine a more youthful curve below the chin and jawline . You can read more about a necklift below.
There is a space under the skin which can sometimes accumulate some fluid and hence a drain is sometimes needed. This is a tube which lies under the skin and comes out from under the skin to be connected to a small plastic bottle. This is removed the next day after surgery.
After the deeper tissues have been tightened the excess loose skin is trimmed away and the skin is sutured very carefully around the ear with delicate stitches. A dressing will be applied to produce some gentle compression in the few hours after surgery.
What is a necklift ?
If required, a necklift is carried simultaneously with the facelift since this addresses the adjacent area below the jawline where the skin and muscles often become lax and cause sagging tissues. Since the two procedures are complementary they should be considered together as a ‘face and necklift’.
A tightening of the deeper tissues is performed by pulling the neck muscles ( the platysma muscle) from the side via the opening which is made around the ear. This is known as the lateral approach to correcting the neck and is very conveniently performed simultaneously with the facelift. If the neck muscles are very loose and cause vertical bands then an anterior approach is needed which involves a further small incision under the chin to sew the platysma muscle bands together. This is called a platysmaplasty . If necessary some liposuction can be carried out at the same time to improve the contour of the neck and occasionally a deeper layer of fat beneath the platysma muscle is also removed before the platysmaplasty is performed since this sharpens the angle between the neck and the chin. Mr Chana usually uses VASER liposuction to achieve this contouring in view of its benefits in smoother and more gentle fat extraction.
This 60 year old patient below underwent a lower facelift and platysmaplasty. You can see that the neck bands have improved and jawline is re-contoured.
What additional procedures can be carried out at the same time as a facelift ?
It is quite normal to undergo additional facial rejuvenation procedures at the same time as the facelift. These can include upper and lower blepharoplasty and a brow lift. Mr Chana very commonly carries out fat transfer in order to restore the volume loss which occurs with ageing and this is called a volumetric facelift technique. This helps to enhance the overall result and keep the face looking very natural. Fractional carbon dioxide laser treatment can be also be used avoiding the area where the facelift is carried out and this typically includes the upper and lower lips to be treated. If suitable, the addition of any of these procedures to the facial rejuvenation plan will enhance the overall effect of the surgery and all of this will be carefully discussed with you at the consultation. .
What anaesthetic is required ?
A facelift is usually performed under general anaesthetic. Although a facelift on its own without any additional procedures in the neck can be carried out under local anaesthetic with sedation the sedation tends to be quite heavy and in reality this is not too different from a general anaesthetic. In fact many anaesthetic consultants will insist that a general anaesthetic is in fact safer since there is more control and you will be far more comfortable asleep. There will be some clinics heavily promoting local anaesthetic procedures but this is usually due to the fact that they have no facility for general anaesthetic, no access to larger fully equipped hospitals and the surgery is routinely being carried out in a very limited manner which will of course limit the results of the facial rejuvenation.
What is the recovery ?
It is advisable to stay the night in hospital. Some patients experience a tight feeling but usually there is very little discomfort from this operation. If there is any discomfort it is easily controlled with mild pain killers but in general this is an operation with surprisingly little pain.
A dressing which is applied around the face and neck is removed the next morning. Your hair will then be carefully washed by the nurses. When you return home you will be provided with a detailed information leaflet explaining the dos and don’ts following surgery. it is important to sleep upright for the first few days and to be careful not to lift heavy objects and to avoid stooping. You will feel surprisingly well after surgery and there can be a tendency to overdo it in the first few days as a result. Taking it gently will reduce the swelling and bruising. The degree of bruising is variable but tends to be minimal with a facelift alone. If liposuction has been required under the chin the bruising tends to be more noticeable. Any visible bruising subsides by the end of two weeks. You can cover with makeup provided you keep away from the stitches around the ear. You may shower daily.
The stitches are removed at 5 – 7 days after which you should feel generally quite comfortable. The stitches around the ear itself are removed but those stitches in the hairline are dissolvable and although the protruding ends of the stitches may be trimmed by the nurses they will spontaneously disappear.
After 2 weeks it is acceptable to return to work but there will still be some very minor swelling which takes another 3 to 4 weeks to completely settle. However, during this stage it should not be overtly visible that you have had surgery. It is best to refrain from heavy exercise for approximately six weeks post-surgery.
There may be some minor thickening that you can feel under the skin and this may be on one side and not the other. This is simply some localised swelling or scar tissue which spontaneously improves as the skin and deeper tissues gradually heal over the first few months.
The best results are seen at approximately 3 months by which time the tissues have settled. However, the cheek area can feel somewhat numb and it can take a few months for the full sensation to return.
What do the scars look like ?
The scars from a facelift are quite inconspicuous and very well hidden in the curves in front of the ear and behind the ear. The rest of the scar is hidden in the hairline. Mr Chana pays particular attention to detail in ensuring that the skin is sewn meticulously into the natural curves around the ear. There should be a very careful positioning of the earlobe with no skin tension in this area and any part of the scar which extends into the hairline is stitched with very fine absorbable stitches rather than staples which are commonly used to speed up the process. The hairline should not be disturbed by the position of the scar .
There may be an early phase where the scars are a little pink in discolouration which is normal but they will then continue to mature. After a few months they will fade but it can take up to one year before they have matured completely.
Insert photo of facelift scar
How do I ensure the results look natural ?
Although a facelift hasn’t always enjoyed the best reputation, the modern-day facelift is an advanced procedure that uses carefully finessed techniques for subtle, natural results – making the patient look rejuvenated and refreshed, rather than as though they have ‘had work done.’ Mr Chana will ensure that you have a very natural result and will demonstrate to you during a consultation examples of before and after photographs from his own patients. He has a reputation of producing very natural results and as a result has been asked by the media on numerous occasions to comment on facelift surgery. You can read about his work and stories of his patients on the following links. Place link to daily mail article , daily express article, and you tube video of my patient.
Who should avoid facelift surgery ?
If you have other major medical conditions such as major heart disease or lung disease then the risks of surgery may be too high to undergo surgery.
There are certain conditions which cause particular problems with skin healing such as diabetes or if you are on steroids. Facelift surgery involves elevating the skin and since the blood supply or healing capacity is impaired for such individuals there is a higher risk of delayed healing or skin necrosis.
The risks of this operation are also higher in smokers and if you smoke it is important to completely stop at least two weeks prior to surgery. If you are a heavy smoker and you cannot stop smoking you will be unsuitable for surgery.
These risks will be carefully assessed during a consultation prior to surgery.
What are the risks ?
There is generally a low incidence of risks following a facelift procedure especially if you follow all the advice provided to you.
Infection is a risk but you will be given a prophylactic antibiotics during the procedure and for a few days afterwards which means that this situation is very rare.
Bleeding is a risk which can result in a situation called a haematoma. This is a swelling under the skin which will mean a return to the operating room to remove the swelling and stop any bleeding point. It is not life threatening and will not compromise the result of the surgery. However, there can be a little more bruising during the recovery phase. This situation occurs in about 2 – 3% of patients and if it occurs it will be identified during the first night in hospital.
The skin of the cheek will lose its sensation but this gradually returns over a period of a few months. During this recovery phase there may be some minor symptoms like pins and needles or some itching. This is nothing to be worried about and is part of the normal recovery.
Delayed healing of the skin can rarely occur adjacent to the scars. This results in a thick leathery scab which will take some time to separate and heal. It can mean the scar may be thicker than usual and may need further minor intervention to improve the quality of scar. This is more common in smokers and therefore it is imperative you do not smoke prior to surgery.
Damage to the facial nerve is rare during facelift surgery but in particular this is exceedingly rare during a mini-facelift.
How do I maintain the results of a facelift ?
Although the results of surgery are long lasting, general measures such as sun avoidance and the daily use of sun block will slow the effects of ageing. It is also important to stop smoking since this depletes the collagen in the skin resulting in more rapid development of lines and wrinkles.
In order to freshen the skin and maintain a youthful complexion a TCA chemical peel can be carried out a few months after the facelift. Fractional carbon dioxide laser resurfacing is also an option resulting in a more effective skin rejuvenation. Mr Chana is one of the few plastic surgeons offering these additional procedures in conjunction with facelift surgery. A combination of surgery and skin resurfacing provides a very effective way of total rejuvenation and in fact these additional procedures enhance the rejuvenating effects of the facelift and help to maintain skin condition. You can read more on this website about chemical peels ( link here to blog on chemical peels and facelift surgery) and fractional laser resurfacing ( link to laser page )
There are also certain areas of the face where surgery does not make significant improvements such as the frown lines, forehead lines and crow’s feet since these are areas of muscle movement causing lines. Regular botox after the facelift can keep the whole face looking fresh and rejuvenated. Botox need not be administered in a way which freezes the whole face. In fact selective injection points can keep some muscles working so that a natural facial expression is maintained.