Facelift

Many people make the mistake of pulling the skin back tightly on the face so every wrinkle is removed in order to get an idea of what a facelift will do. The result is a mask- like appearance with the mouth and nose distorted. This is not what a face lift will do. A more accurate demonstration is to hold a mirror above the head and then look up into it. A tightening of the skin in the lower third of the face will be noted.

What signs of aging will a facelift correct?

A popular misconception about facelifts (rhytidectomy) is that it completely removes the signs of aging over the entire face. However it is not true.

A facelift is designed to correct three problems in the lower half of the face: poor muscle tone (which causes laxity in the neck and cheek regions); excess amounts of fat in the jowl, chin , and neck regions and too much skin in the lower half of the face resulting in excessive wrinkling.

These problems are due to a combination of degenerative changes and the constant pull of gravity on the skin and muscles of the lower face. The occurrence and severity of the problems will vary from individual to individual depending on a person’s inherited aging pattern and the amount of exposure they have had to sun, wind, and pollutants.

A facelift will not correct the vertical wrinkles that occur around the mouth due to muscle pull nor the crow’s feet around the eyes. It is for this reason that many surgeon often combine a facelift with resurfacing. The facelift deals with the quantity of skin and the resurfacing with the quality of the skin.

Who is the candidate for facelift surgery?

If the lower half of the face has too much fat, poor muscle tone and the lax skin , then facelift surgery could correct these problems .

What is the ideal age for face lift?

There is no " best" age for facelift surgery , although the average age tends to be approximately 50 to 55 years. As with other forms of cosmetic surgery, communication between the patients and the physician is essential to ensure that expectations are reasonable. A person would not expect to look the same way as they did when they were young, nor would they expect facelift surgery to solve marital problems. It is important that the surgeon fully understands the problem the patient wishes to have corrected. Misunderstandings may result if the physician interprets the problem differently.

The Procedure

Facelift surgery is tailored to specific needs, but basic steps are as follows:

• A general anesthetic is usually used for this procedure. In selected few cases intravenous sedation along with the anesthetic is used.
• Some of the hair above and behind the ear may have to be shaved if the incision is to be made in the hair- bearing skin of the scalp.
• The incision, although always around the ear, will vary according to the problems to be corrected, the quality of the skin and the technique used. To minimize trauma during the procedure and to shorten the healing time endoscope facelifts are becoming more and more popular. They also offer advantage of concomitant procedures especially laser resurfacing, which can cause a lot of swelling and with this tight incision line may be compromised.

• Once the incision is made, the skin over the cheek and neck areas is lifted away from the underlying fibrous tissue.

• If the neck muscle requires tightening or if fat beneath the skin is to be removed, another incision is made under the chin in a natural crease.

• The supporting fibrous layer under the skin is then tightened.

• The excess fat is removed from the jowl, cheek and chin regions by either cutting or liposuction techniques.

• The skin is pulled smoothly across the lower half of the face and the excess skin is removed.

• The incisions are closed.

Post Operative Care

After the surgery, a bulky dressing is put on. The patient is kept in the recovery room area for 1 to 2 hours until the intravenous medication wears off. They are then sent to ward. An overnight hospital stay is required in most instances. Sometimes the procedure is performed on an outpatient basis. Bed rest, with the head elevated on pillows, is recommended for the rest of the day. After 24 to 48 hours, the surgeon will remove the dressing and check the incisions. Following this, the patient should gently wash the face, have a shower, and shampoo the hair. The sutures in front of the ear are removed 4 to 5 days later and at 10 days the remaining sutures are removed.

FAQs

Will there be a scar?

After the skin is cut, an initially red scar will gradually fade to pink and finally become white. Aesthetic surgeons cannot perform facelift surgery without scars. They are, however, trained to place the scars in inconspicuous places so they will be barely noticeable when healing is complete.

Does facelift surgery hurt?

One of the greatest fears when considering a facelift is the pain. No pain will be felt during the surgery but, once the freezing wears off; there will be some discomfort along the incision line accompanied by a feeling of tightness in the neck region. Painkillers will usually be prescribed for the first 2 or 3 days of discomfort. Acetylsalicylic acid (aspirin) or similar product is not recommended because they tend to encourage bruising. A pulling, tender sensation behind the ear may be noticed, particularly when turning the head while sleeping. Once the sutures are removed or absorbed, this problem tends to subside.

Any severe pain in the area of the facelift may indicate a serious complication and the patient should contact their physician immediately.

Will there be any swelling and bruising?

An inevitable consequence of any surgical procedure is swelling and bruising although it tends to be less of a problem when lasers and endoscopic techniques are used. Swelling tends to be more prolonged in men. Swelling usually subsides in 10 to 14 days, although it may take as long as 6 weeks before the swelling completely disappears. Compresses may be helpful, but elevation of the head while lying down and time are the best healers.

When can the normal activities be resumed?

We recommended that patients take at least 2 weeks off work, largely because of the bruising and swelling any kind of normal activity that does not precipitate discomfort is allowed after 7 to 10 days. Strenuous physical activity and exercise should be avoided for approximately 4 to 6 weeks. It is best to use common sense: if it hurts, don’t do it.

When can the hair be colored?

When can makeup be worn?

When can the depilatory or electrolysis be used to remove hair?

How soon can a hair dryer be used?

How soon can a facial be done?

Not until six weeks after surgery.

How long do the effects of the surgery last?

Can facelift be combined with other procedures?

Facelifts are frequently combined with laser resurfacing, chemical peels, brow lifts, and/ or eyelid surgery. Each procedures improves an isolated area of the face. A combinaltion of procedures to correct multiple areas of facial aging results in a better overall appearance than does a single procedure to correct an isolated problem.

What should men beware of when considering facelifts?

Men undergo facelifts less often than do woman and are generally less demanding in their expectations. Men have different hair patterns and a larger number of blood vessels because of facial hair. As a result of these differences, post- operative swelling tends to last longer in men, and the incidence of small blood clots is higher in men than in women. After surgery men will notice that their side burns are narrower because some of it will have been removed with the redundant skin.

What are the possible complications?

• Scarring: unless there is a tendency to develop thick scars this will not be a serious complication. Scarring is an inevitable consequence of a surgical procedure where an incision has been made. Cosmetic surgeon try to hide scars but cannot prevent them.

• Seroma: clear fluid may collect under the skin resulting in a seroma. These usually occur in the cheek area and feel like small firm lumps. In most cases they reabsorb spontaneously in 4 to 6 weeks.

• Hematomas: if blood collects under the skin, it is called hematomas. The incidence of this is only 2% and tends to be more common in men than in women. Rapid swelling develops progressively on one side of the face with an increasing amount of pain and a feeling of tightness. If recognized early, it can be treated satisfactorily by removing the clot and stopping the bleeding. If the hematomas remain unrecognized, pressure under the skin might lead to skin loss and result in facial scarring. The increased bruising, swelling and firmness that accompanies hematomas will prolong recovery from surgery.

• Nerve injury: it is normal to have some loss of sensation in the face following the surgery. Sensation begins to return within 1 week and complete sensation is usually restored within 6 to 12 weeks. There is, however, a risk of injury to the nerve that supplies feeling to the ear. If this nerve is damaged, the sensation over the ear will be permanently decreased and there will be a small painful lump in the upper neck where the nerve was injured. Rarely will the nerve to the muscles that move the forehead and elevate the eyebrows be damaged. Injury to the muscle in the corners of the mouth is an uncommon occurrence, but if it does happen , the result will be a lopsided smile. The incidence of this is about 1 or 2 per thousand cases, and the majority of these recover spontaneously after 3 to 4 months.

• Infection and skin slough: infection is a rare complication in facelift surgery. As a precaution some aesthetic surgeons will prescribe an antibiotic. If infection does occur and is extensive, some skin along the incision may die because the blood supply is interrupted. This can also occur because of excessive tension at the skin closure, a hematomas, or smoking after the operation. Eventually, the wound heals, but a thicker, wider scar develops.

• Contour irregularities: if a small lumps or irregularities occur in the cheek area, they are commonly caused by a small hematomas or seroma. They invariably subside with time (4 to 6 weeks) and do not require any specific treatment. Occasionally, irregularity in the neck region may occur if more fat has been removed from one side than from the other. This can be corrected by removing remaining fat with liposuction but only after a waiting period of 6 to 12 months. The waiting period is to ensure that the irregularity is not just asymmetrical swelling that resolves without surgery. Sometimes, the salivary gland beneath the jaw bone is quite prominent. If the gland was prominent before surgery but camouflaged by excess skin and fat, it will become more prominent after the surgery because the excess fat is removed and the skin is tightened.

What can be done if the surgery is unsatisfactory?

If the patient is dissatisfied with the facelift, and has not experienced any untoward complication he or she may have had unrealistic expectation in the first place. This may have occurred because the preliminary communication process between the patient and physician did not clear up all the misconception about what facelift surgery could accomplish.

It can also happen that a complication following facelift surgery causes a less satisfactory result. In these circumstances, revisional surgery could be performed to improve the disappointing results.

Who performs facelifts and how much they cost?

A plastic surgeon trained in cosmetic facial surgery performs this surgery. It is up to the patient to check the credentials of the surgeon to ensure that he or she is properly trained to do the procedure. The cost of a facelift ranges from Rs 40,000/- to Rs 80,000/-. Other facial procedure done in combination with facelifts will affect these cost.

What are soft laser facelifts?

The use of soft of cool beam lasers has received some publicity. There is, however, no evidence to show that soft beam lasers permanently reduce wrinkles, as do surgical facelifts.

Medical lasers, such as carbon dioxide laser, are surgical tools used to alter the skin by cutting or vaporizing. Soft lasers, which include gallium- arsenide and helium- neon, are not surgical lasers. They are light beams that enter the superficial layers of the skin causing some mild changes. Inflammation and subsequent edema (accumulation of fluid in the tissue) may actually make wrinkles temporarily less obvious because the fluid puffs them up. It is debatable whether the soft laser light enters the second layer of the skin to alter tissue it would be considered a medical instrument and cosmetic salons could no longer use them.

The soft laser light is often accompanied by an electrical impulse that contributes to further inflammation and a accumulation of fluid in the tissue. It may also cause a temporary spasm of the muscles giving the appearance and sensation of tightness to the face, but this is only temporary.

Some soft lasers give the sensation of a single, brief, mildly uncomfortable pulse or wave of pulse that starts gently, reaches a peak, and then dies out. Others are completely painless. If the soft laser beam is accompanied by an electrical pulse, it is usually mildly uncomfortable. The treatments are uncomfortable. The treatments are generally given in 5 to 10 minute intervals for at least 20 sessions.

Are electric therapy facelifts beneficial?

As with soft facelifts, which are distinct from surgical facelifts that can be performed with a medical laser, electric therapy facelifts are controversial. Electric therapy is often used with soft lasers but may be used alone. A machine that delivers a very mild electric current is applied to the face causing some irritation and inflammation of the upper skin layers with subsequent edema. It may be applied on top of or into the skin using small needles. Insertion of needles is potentially dangerous and might lead to local infections, scarring, or transmission of such diseases as hepatitis or AIDS. The current may cause temporary muscle spasms giving a sensation of tightness to the skin. It may also cause fluid shifts due to inflammation which puffs up fine wrinkles. This effect, however, is only temporary and lasts minutes, hours, or days, but certainly not longer. Anything causing excessive irritation or inflammation of the skin can cause damage. Most treatments involve 10 to 60 minute sessions every few days for several weeks and once a week thereafter.

There is considerable controversy over whether or not electric therapy is of any value whatsoever. Estheticians usually administer this therapy, but their training is variable and the types of equipments used differ widely. Risk is potentially small but certainly does exist, as it does with any device causing inflammation, irritation, and possible infection.

Is acupuncture of any value in lessening wrinkles?

The insertion of small needles into the skin of the face will cause swelling and puffing up folds, creases, and wrinkles. This has the temporary effect of making the wrinkles appear less obvious. There is no long term benefit to acupuncture for the treatment of sagging, redundant skin and wrinkles.

What is APTOS Face Lift?

APTOS is a special type of surgical thread which is inserted under the skin under local anesthesia. This is a recent development and offers the benefits of a face lift with a procedure of lesser magnitude. The results are instant. This is going to be the procedure of choice in future as an alternative to face lift in selected patients. For details of the procedure please visit section APTOS Face lift