Facelift Surgery
For more information and questions, please use the Contact Us page.
Frequently Asked Questions:
The common reasons that people seek facelift surgery can be
Jowling/fullness of the jaw line
drooping of the angle of the mouth
fullness or sagging of the neck and
undesirable folds of skin, either in the face and/or the neck.
The above features are addressed through facelift surgery but in addition to the above, people may also have concerns about other features of facial aging e.g. excess eyelid skin or bagginess of the eyes. Thus 'facial rejuvenation' surgery may employ not just facelift surgery but if desired by the patient a number of other adjunctive techniques to make the face look younger / fresher e.g. blepharoplasties, fat grafting etc.
Top
What does a facelift aim to achieve?
As we age the effects of gravity are to pull, not only the facial skin, but also the facial fat downwards, and hence, we loose the fullness of our cheeks and the fat descends to cause deeper lines around the nose (naso-labial folds) and further down, the sagging fat at the jaw level is called jowling. With regard to the neck, the sagging of the skin and neck muscles result in either a double chin appearance or a less defined jaw/neck line. The different types of facelift will aim to address each of these facial features, thus the goal is to elevate the facial fat and skin to the position of youth and elevate and redrape the neck skin to redefine the jaw line. Facelift surgery should not, contrary to public opinion, make the face look tight instead return the facial soft tissues to where they were in youth.
Top
What different types of facelift procedure are there?
Facelift surgery developed by purely elevating the skin in an upward fashion to smooth out the skin and eliminate the wrinkles of aging. This however, fails to address the deeper problems associated with aging, namely the jowling and slackness of the jaw and neck and hence, deeper plane techniques were developed. The deep plane techniques such as the SMAS techniques aim to address this deeper layer of tissue and reposition this is a more youthful level. There are a variety of forms of manipulation of the SMAS such as the SMASectomy, the extended SMASectomy, SMAS plication but they all aim to achieve the same goal. Further types of facelifts that act on a different plane beneath the SMAS level really aim at shifting the entire structures of the face and to do so this involves operating at bony level and these are known as subperiosteal facelifts. Subperiosteal facelifts however are only occasionally indicated for patients, as most patients have some laxity of their skin and subcutaneous fat that is best addressed through a deep plane technique such as a SMAS facelift. Subperiosteal facelifts however are beneficial to the younger patient who do not have problems with their soft tissue but wish to have a better shape to their face.
Top
What does the procedure for a facelift entail?
Most facelift surgery is carried out under a general anaesthesia and this would be administered by a health service Consultant Anaesthetist. Most patients prefer this form of treatment as they do not wish to be aware during the procedure, but if patients prefer to have sedation this can be discussed with the consultant anaesthetist before surgery. After general anaesthesia is induced local anaesthetic is injected underneath the skin and this provides very good pain relief after the surgery and generally there is very minimal pain, if at all, after facelift surgery. Carefully placed incisions are made and these are hidden in the hairline and around the ear so that they are camouflaged from the public. The skin is then elevated and allows access to the underlying fat/SMAS layer. This deep layer may then be appropriately manipulated/elevated prior to addressing the redundant facial skin. The excess skin can be excised so that there is a neat fit, but that no tension whatsoever is placed on the skin and this maintains a natural appearance following facelift surgery. Drains are usually placed under the skin, as this helps reduce bruising after surgery, and speed recovery. Usually an overnight stay in the hospital is required where patients can feel secure that they are looked after by nursing staff to ensure that no problems arise after surgery. The next morning the drains can be removed with only a very minor discomfort and patients can be discharged at that stage after being seen by Mr Fogarty.
Top
What other techniques may be used in conjunction with facelift surgery?
While many of the facial features age, this may not be apparent to the patient but a number of procedures are available if desired to address those features that patients feel are undesirable. The eyebrows, if the eyebrows have lowered with aging then a brow lift can address this, if the eye lids have excessive amount of skin or bulging, puffiness then blepharoplasty can be used to correct these. Facial liposculpture and liposuction may be used to reshape the facial contours by reducing the prominence of the creases along the cheeks (nasolabial folds) and fat grafting can be used to improve the lip contours that become somewhat deflated as time passes. Fat grafting may also be used to improve the lines around the face and also improve the overall facial shape by improving the cheek contours. Liposuction can be also used to refine the jaw line and thin a double chin and platysmaplasty is used to address the neck muscle (platysma) to reshape this and improve the neck contours in conjunction with the facelift. Very occasionally the nasal skin and shape deteriorates with age and this can be improved through rhinoplasty. While facelift procedures address the deeper folds in the skin, facial resurfacing can smooth the very fine textural lines. Facial resurfacing involves tightening the surface of the skin to smooth the fine lines and this is achieved with either chemical peels, laser resurfacing or dermabrasion depending the location and depth of the lines and patient skin type.
Top
Will people notice that I have had a facelift?
Most patients are concerned at how they will appear after surgery both in the short and longer term. Thus the aim is a very natural subtle improvement such that nobody should appreciate that the patient has had surgery, just that the patient looks 'well or fresher.' Often others who do not know that one has had surgery may just pass comment that one looks like they have lost weight or just how well one looks. However in the absence of seeing before and after photographs they would not usually be able to tell that one has had a facelift.
Top
What is the recovery like after facelift surgery?
On the night of the surgery most patients are in fact either pain free or have mild pain that is controlled with pain killing tablets. A small minority of patients may have some nausea and nursing staff can administer an injection to suppress any sickness that may occur on the night of the surgery. The next morning drains are removed and when Mr Fogarty has ensured that everything is satisfactory one may go home the day after surgery. Swelling will be maximal in the first 24 hours after surgery and if one has had blepharoplasties then there will be swelling and bruising around the eyes. Cold compresses will help comfort the eyes and reduce any swelling but one is able to open the eyes and vision is not impaired. Stitches (sutures) are removed when one returns to the clinic at day 5 post op. Any bruising will dissipate within the first 10 days fading to a light yellow colour that can be covered up with some foundation at that stage. In order to speed up the healing process facial and eye massage can be employed after the sutures are removed and one should be 'presentable' in public between days 10 - 14. There are no additional constraints after the wounds are healed but if there is any scalp numbness one should be careful with the heat from a hairdryer. One should avoid the use of a bleach-based colorant for 6 weeks after surgery. At six weeks post op one can resume vigorous exercise and while there will be a very gradual 'settling' underneath the skin essentially one is completely recovered by this stage.
Top
Facelift recovery summary points:
hospital stay overnight
resume hairwashing day 1
removal of sutures 5 -7 days
return to hairdresser 10 days
return to public 1-2 weeks
resolution of bruising and swelling 2 weeks
resume gentle exercise 4 weeks
resume full exercise 6 weeks
Top
What potential problems can arise after facelift surgery?
All surgical procedures have got 'potential' complications and all measures are taken to minimise the potential risk of these complications. The complications that may occur include the following:
Bleeding and haematoma: the facial tissues are very well supplied with blood which greatly benefit wound healing but on the down side
there is always a risk that there is excessive bleeding after surgery and hence great pains are taken to ensure that all bleeding is
controlled during surgery. Thus, there is a small risk of developing a collection of blood underneath the facial skin flaps on the night of the
surgery. If this were to occur it is usually within the first 6-8 hours after surgery and if so then one can go back to theatre that night to
have the blood clot removed. When recognised early in this fashion, there would be no significant blood loss with any need for blood
transfusion. Once the haematoma is removed there should be no major problems arising thereof. Haematoma can be associated with
ingestion of blood thinning medication such as aspirin or Non Steroidal Anti-Inflammatory Drugs (NSAIDs) eg. Brufen, Voltarol and also
some herbal remedies, including Chinese herbal remedies that may contain ingredients that thin the blood. This is why it is important to
ensure that the pre-operative advice is followed to minimise potential complications such as this (see pre-op notes for facelift).
Infection: infection in the face is rare, because of the abundant blood supply but if infection were to occur it is readily treatment with
antibiotics.
Wound breakdown: if infection was to occur and there was a problem with wound healing, the wound may break down and dressings
over wound would be required to promote healing. This is an uncommon complication and often arises secondary to a poor skin blood
supply. The most common reason for this is often patients who smoke. While smoking is not an absolute contraindication to facelift
surgery, the technique can be modified to minimise the potential for damage to the skin blood supply and this can be discussed with
Mr Fogarty. If a problem of wound breakdown occurs, the scarring that results, maybe unsatisfactory to the patient and this would need
to be revised at a later date to improve the appearance.
Skin numbness: after surgery facial the skin will temporarily feel numb and this is usually confined to the area in front of the ears and near the cheekbones. Most patients do not find this a major problem and it resolves over a number of months.
Nerve injury: there are a number of nerves in the facial area that are potentially at risk in facelift surgery. The most commonly injured
nerve is the nerve that supplies sensation to the earlobe and this is called the great auricular nerve. If this is injured a permanent
numbness can result in the earlobe area and/or tenderness in the neck where the nerve is injured. This occurs in less than
5% of patients and usually no further treatment is required. The major nerve that supplies the muscles of the face is known as the facial
nerve and, while this itself is not at risk in facelift surgery, there are a number of branches of the facial nerve that are potentially
at risk. The branch that elevates the eyebrow is known as the frontal branch and the branch that lowers the angle of the mouth is
known as the mandibular branch. Both of these branches are potentially at risk in facelift surgery but overall the risks are low, less
than 1%. Injury to one of these branches could result in either a lowering of the eyebrow or asymmetry of the mouth when smiling in
particular.
Revision: surgical procedures are not like carving a sculpture in that mother nature is involved in the healing process and this to a degree
is unpredictable between individual patients. Thus minor irregularities in the scars may occasionally arise and if these do not settle
over time they may be revised (touched up) often under local anaesthetic as an outpatient. Palpable irregularities may occur under the
skin i.e. one feels lumpiness and this very often settles itself with the post-operative massage of the skin and as long as it is not
visible then no further action is required.
Facelift surgery essentially resets the clock but it does not stop the clock i.e. the aging process. Thus aging continues at the same speed but one is starting again at a 'younger start point'. The results of facelift surgery are said to last up to seven years but in truth the aging process is a continuous one and not something that suddenly occurs at the seven-year period. Hence the patient may desire revision facelift to restore the original benefits of surgery at some stage further down the line.
Top
For more information and questions, please use the Contact Us page.
Frequently Asked Questions:
- Who will benefit from facelift surgery?
- What does a facelift aim to achieve?
- What different types of facelift procedure are there?
- What does the procedure for a facelift entail?
- What other techniques may be used in conjunction with facelift surgery?
- Will people notice that I have had a facelift?
- What is the recovery like after facelift surgery?
- Facelift recovery summary points:
- What potential problems can arise after facelift surgery?
The common reasons that people seek facelift surgery can be
The above features are addressed through facelift surgery but in addition to the above, people may also have concerns about other features of facial aging e.g. excess eyelid skin or bagginess of the eyes. Thus 'facial rejuvenation' surgery may employ not just facelift surgery but if desired by the patient a number of other adjunctive techniques to make the face look younger / fresher e.g. blepharoplasties, fat grafting etc.
Top
What does a facelift aim to achieve?
As we age the effects of gravity are to pull, not only the facial skin, but also the facial fat downwards, and hence, we loose the fullness of our cheeks and the fat descends to cause deeper lines around the nose (naso-labial folds) and further down, the sagging fat at the jaw level is called jowling. With regard to the neck, the sagging of the skin and neck muscles result in either a double chin appearance or a less defined jaw/neck line. The different types of facelift will aim to address each of these facial features, thus the goal is to elevate the facial fat and skin to the position of youth and elevate and redrape the neck skin to redefine the jaw line. Facelift surgery should not, contrary to public opinion, make the face look tight instead return the facial soft tissues to where they were in youth.
Top
What different types of facelift procedure are there?
Facelift surgery developed by purely elevating the skin in an upward fashion to smooth out the skin and eliminate the wrinkles of aging. This however, fails to address the deeper problems associated with aging, namely the jowling and slackness of the jaw and neck and hence, deeper plane techniques were developed. The deep plane techniques such as the SMAS techniques aim to address this deeper layer of tissue and reposition this is a more youthful level. There are a variety of forms of manipulation of the SMAS such as the SMASectomy, the extended SMASectomy, SMAS plication but they all aim to achieve the same goal. Further types of facelifts that act on a different plane beneath the SMAS level really aim at shifting the entire structures of the face and to do so this involves operating at bony level and these are known as subperiosteal facelifts. Subperiosteal facelifts however are only occasionally indicated for patients, as most patients have some laxity of their skin and subcutaneous fat that is best addressed through a deep plane technique such as a SMAS facelift. Subperiosteal facelifts however are beneficial to the younger patient who do not have problems with their soft tissue but wish to have a better shape to their face.
Top
What does the procedure for a facelift entail?
Most facelift surgery is carried out under a general anaesthesia and this would be administered by a health service Consultant Anaesthetist. Most patients prefer this form of treatment as they do not wish to be aware during the procedure, but if patients prefer to have sedation this can be discussed with the consultant anaesthetist before surgery. After general anaesthesia is induced local anaesthetic is injected underneath the skin and this provides very good pain relief after the surgery and generally there is very minimal pain, if at all, after facelift surgery. Carefully placed incisions are made and these are hidden in the hairline and around the ear so that they are camouflaged from the public. The skin is then elevated and allows access to the underlying fat/SMAS layer. This deep layer may then be appropriately manipulated/elevated prior to addressing the redundant facial skin. The excess skin can be excised so that there is a neat fit, but that no tension whatsoever is placed on the skin and this maintains a natural appearance following facelift surgery. Drains are usually placed under the skin, as this helps reduce bruising after surgery, and speed recovery. Usually an overnight stay in the hospital is required where patients can feel secure that they are looked after by nursing staff to ensure that no problems arise after surgery. The next morning the drains can be removed with only a very minor discomfort and patients can be discharged at that stage after being seen by Mr Fogarty.
Top
What other techniques may be used in conjunction with facelift surgery?
While many of the facial features age, this may not be apparent to the patient but a number of procedures are available if desired to address those features that patients feel are undesirable. The eyebrows, if the eyebrows have lowered with aging then a brow lift can address this, if the eye lids have excessive amount of skin or bulging, puffiness then blepharoplasty can be used to correct these. Facial liposculpture and liposuction may be used to reshape the facial contours by reducing the prominence of the creases along the cheeks (nasolabial folds) and fat grafting can be used to improve the lip contours that become somewhat deflated as time passes. Fat grafting may also be used to improve the lines around the face and also improve the overall facial shape by improving the cheek contours. Liposuction can be also used to refine the jaw line and thin a double chin and platysmaplasty is used to address the neck muscle (platysma) to reshape this and improve the neck contours in conjunction with the facelift. Very occasionally the nasal skin and shape deteriorates with age and this can be improved through rhinoplasty. While facelift procedures address the deeper folds in the skin, facial resurfacing can smooth the very fine textural lines. Facial resurfacing involves tightening the surface of the skin to smooth the fine lines and this is achieved with either chemical peels, laser resurfacing or dermabrasion depending the location and depth of the lines and patient skin type.
Top
Will people notice that I have had a facelift?
Most patients are concerned at how they will appear after surgery both in the short and longer term. Thus the aim is a very natural subtle improvement such that nobody should appreciate that the patient has had surgery, just that the patient looks 'well or fresher.' Often others who do not know that one has had surgery may just pass comment that one looks like they have lost weight or just how well one looks. However in the absence of seeing before and after photographs they would not usually be able to tell that one has had a facelift.
Top
What is the recovery like after facelift surgery?
On the night of the surgery most patients are in fact either pain free or have mild pain that is controlled with pain killing tablets. A small minority of patients may have some nausea and nursing staff can administer an injection to suppress any sickness that may occur on the night of the surgery. The next morning drains are removed and when Mr Fogarty has ensured that everything is satisfactory one may go home the day after surgery. Swelling will be maximal in the first 24 hours after surgery and if one has had blepharoplasties then there will be swelling and bruising around the eyes. Cold compresses will help comfort the eyes and reduce any swelling but one is able to open the eyes and vision is not impaired. Stitches (sutures) are removed when one returns to the clinic at day 5 post op. Any bruising will dissipate within the first 10 days fading to a light yellow colour that can be covered up with some foundation at that stage. In order to speed up the healing process facial and eye massage can be employed after the sutures are removed and one should be 'presentable' in public between days 10 - 14. There are no additional constraints after the wounds are healed but if there is any scalp numbness one should be careful with the heat from a hairdryer. One should avoid the use of a bleach-based colorant for 6 weeks after surgery. At six weeks post op one can resume vigorous exercise and while there will be a very gradual 'settling' underneath the skin essentially one is completely recovered by this stage.
Top
Facelift recovery summary points:
hospital stay overnight
resume hairwashing day 1
removal of sutures 5 -7 days
return to hairdresser 10 days
return to public 1-2 weeks
resolution of bruising and swelling 2 weeks
resume gentle exercise 4 weeks
resume full exercise 6 weeks
Top
What potential problems can arise after facelift surgery?
All surgical procedures have got 'potential' complications and all measures are taken to minimise the potential risk of these complications. The complications that may occur include the following:
there is always a risk that there is excessive bleeding after surgery and hence great pains are taken to ensure that all bleeding is
controlled during surgery. Thus, there is a small risk of developing a collection of blood underneath the facial skin flaps on the night of the
surgery. If this were to occur it is usually within the first 6-8 hours after surgery and if so then one can go back to theatre that night to
have the blood clot removed. When recognised early in this fashion, there would be no significant blood loss with any need for blood
transfusion. Once the haematoma is removed there should be no major problems arising thereof. Haematoma can be associated with
ingestion of blood thinning medication such as aspirin or Non Steroidal Anti-Inflammatory Drugs (NSAIDs) eg. Brufen, Voltarol and also
some herbal remedies, including Chinese herbal remedies that may contain ingredients that thin the blood. This is why it is important to
ensure that the pre-operative advice is followed to minimise potential complications such as this (see pre-op notes for facelift).
antibiotics.
over wound would be required to promote healing. This is an uncommon complication and often arises secondary to a poor skin blood
supply. The most common reason for this is often patients who smoke. While smoking is not an absolute contraindication to facelift
surgery, the technique can be modified to minimise the potential for damage to the skin blood supply and this can be discussed with
Mr Fogarty. If a problem of wound breakdown occurs, the scarring that results, maybe unsatisfactory to the patient and this would need
to be revised at a later date to improve the appearance.
nerve is the nerve that supplies sensation to the earlobe and this is called the great auricular nerve. If this is injured a permanent
numbness can result in the earlobe area and/or tenderness in the neck where the nerve is injured. This occurs in less than
5% of patients and usually no further treatment is required. The major nerve that supplies the muscles of the face is known as the facial
nerve and, while this itself is not at risk in facelift surgery, there are a number of branches of the facial nerve that are potentially
at risk. The branch that elevates the eyebrow is known as the frontal branch and the branch that lowers the angle of the mouth is
known as the mandibular branch. Both of these branches are potentially at risk in facelift surgery but overall the risks are low, less
than 1%. Injury to one of these branches could result in either a lowering of the eyebrow or asymmetry of the mouth when smiling in
particular.
is unpredictable between individual patients. Thus minor irregularities in the scars may occasionally arise and if these do not settle
over time they may be revised (touched up) often under local anaesthetic as an outpatient. Palpable irregularities may occur under the
skin i.e. one feels lumpiness and this very often settles itself with the post-operative massage of the skin and as long as it is not
visible then no further action is required.
Facelift surgery essentially resets the clock but it does not stop the clock i.e. the aging process. Thus aging continues at the same speed but one is starting again at a 'younger start point'. The results of facelift surgery are said to last up to seven years but in truth the aging process is a continuous one and not something that suddenly occurs at the seven-year period. Hence the patient may desire revision facelift to restore the original benefits of surgery at some stage further down the line.
Top
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