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Facelift

A facelift – one of the most common and well-known forms of facial rejuvenation – is an umbrella term for a number of different techniques. These surgical procedures differ in technique and the areas of the face they target, but they all commonly aim to tighten the soft tissues of the face and neck in order to restore laxity and youthfulness. Most forms of facelift will address both skin laxity and the laxity of the underlying muscles, tissues and ligaments (also known as the SMAS layer).

Some of the most common forms of facelift include:

  • A skin only facelift
  • Superficial Musculoaponeurotic System facelift – also known as a SMAS facelift
  • A Minifacelift or MACS facelift ( MACS – Minimal Access Cranial Suspension facelift)
  • Subperiosteal facelift – a.k.a. a MASK facelift

Each different type of facelift has different relative merits and drawbacks, and each patient will be best suited to one specific type of facelift. You should discuss which one is right for you thoroughly during your pre-surgical consultation. The most commonly performed type of facelift is a SMAS facelift, in which the skin and the underlying SMAS layer of tissues are adjusted and tightened.

What does the surgery involve?

With facelift surgery basically you get what you pay for both in time and money. A good SMAS facelift will last longer but will also take longer to recover from in terms of general recovery and swelling and bruising.

A facelift is usually performed under a general anaesthetic a.though occasionally limited procedures can be performed under local anaesthetic either with or without sedation.

During facelift surgery, an incision is created which started in the hairline and extends down in front of the ear; in the case of a MACS or mini facelift, the incision will stop just behind the earlobe, but if the patient has elected to undergo a SMAS facelift, the incision will go further back into the hairline just behind the ear.

After the incision has been created, the skin and most superlative layer of tissues are lifted from the face. In the case of a skin only facelift, these layers are tightened with sutures (stitches), and any excess skin is removed from the area.

 

If a SMAS facelift is being performed, the ligament and muscle layers are lifted separately, before each is tightened with sutures.

After the desired layers have been tightened and the overall lifted look has been achieved, the incision is closed – usually with a combination of sutures and small clips that are concealed within the hairline.

Drains are placed in either side of the incision to reduce the risk of developing haematomas, and a compression garment is applied around the side of the head. The drains and bandage will remain in place overnight – during which time you will be required to stay in hospital.

Occasionally, a facelift will be performed in conjunction with a neck lift, if the appearance of the chin, neck and jowls are sagging and drooping. In this occurrence, an additional incision will be made under the chin and the muscles and tissues in the area will be tightened, too.

What can I expect following surgery?

The compression garment and drains will be removed the day after surgery, after which point you can return home if you wish to do so. However, you should wait at least a week before you return to work, and maybe more – speak to your surgeon for a more specific gauge on time frames.

You should not experience much pain postoperatively, and will be prescribed painkillers and antibiotics to take home where necessary. Swelling and bruising varies from patient to patient, but it usually gets worse for the first 3-4 days after surgery, before it begins to subside. The majority of swelling will have gone down a fortnight after surgery, but you will continue to see progress and slight nuances in your facial shape for several months after surgery.

Patients can take Arnica for one week prior to their procedure and for two weeks after in order to reduce swelling and bruising. However, aspirin or ibuprofen should be avoided (for three weeks pre-surgically and a few days post) because it can thin the blood and interfere with the rate of wound healing.

Suture and clips will be removed around 7-10 days after surgery. You should avoid exercise for 2-3 weeks postoperatively, and strenuous exercise or contact sport should be completely avoided for around 4-6 weeks.

It will take a few months – usually between 6 and 9 – for the scars to settle – and in this time, they may appear red and raised.

What are the possible risks of surgery?

  • Bleeding /HaematomaExcess bleeding – or haematoma – is when blood develops and pools under wounds. It is the most common side-effect of facelift surgery, affecting 1-4% of female patients and 4-7% of male patients. It usually occurs within the first few hours of surgery. Minor haematomas can usually be managed with minimal drainage required, but the development of a large haematoma may require an additional surgical procedure in order to drain it and minimse additional bleeding. If haematomas are not drained when they first develop, they can cause problems with long-term wound healing an dinfection.
  • Skin NecrosisSkin necrosis affects around 2% of patients. It usually occurs behind the ear, where the skin is thin and the blood supply is poorer. Careful wound care can usually negate the need for further surgery. However, if the area extends to the earlobe, the resulting scar can sometimes become thicker and therefore may require a scar revision in the long-term. Skin necrosis is much more likely to occur in smokers – one of the reasons you are advised not to smoke for a month before your procedure, or until your wounds have fully healed.
  • InfectionThanks to the rich blood supply to the face and neck, infection after a facelift or neck lift is rare (less than 0.1%) and treatable with antibiotics.

  • Sensory Nerve InjuryIt is possible for the sensory (feeling) nerve around the earlobe and the surrounding skin to be damaged during facelift surgery. If this occurs, it can cause temporary or permanent numbness.
  • Motor Nerve InjuryMotor nerves allow movement to the face, and during facelift surgery, there is a slight risk of damage to these nerves. The chances of this are slim – permanent damage occurs in 0.1% of cases, and temporary in 0.3% – but this risk increases if repeat facelift procedures are performed. Temporary nerve weakness of this nature usually lasts between 3-6 months.
  • Hair LossUsually temporary – can occur at the site of incision. It occurs in less than 0.1% of cases, and usually regrows completely within 3-6 months.
  • ScarsScarring after a facelift usually heal well, but can sometimes widen. If this occurs, they can be treated non-surgically with steroid injections, or surgically with scar revision.
  • Contour IrregularityIt is uncommon, but possible, for small asymmetries and irregularities to occur following facelift surgery. These usually improve over time, and regularly massaging the wounds will assist in effective healing. Skin bunching behind the ear is also an occasional side-effect of facelift surgery, but again, should settle with time.
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