A Facelift is an operation designed to refresh and rejuvenate the ageing face. A Necklift is often part of a Facelift procedure and often directed at treating unsightly neck folds. Care must be taken to tailor the operation to the patients aims and towards individual facial structure and skin type.
Typical concerns that the patient may have include:
- Heavy nasolabial folds
- Heavy jowls
- Excess skin and fat
- Platysmal folds
- Turkey neck
- Jawline contouring
Some patients may have health concerns that mean a facelift may not be able to be performed due to a high-risk medical profile. Please see the section on preparation for surgery to understand better what those potential health concerns can be.
The surgery on the face and neck can be considered in a couple of steps; the skin incisions, the management of the deeper layers of the face known as the SMAS layer and volumetric enhancement.
Usual post-operative course and management
Facelift surgery can take anywhere between three and seven hours depending on the elements of surgery that have been incorporated. For longer surgeries patients do require a night in hospital afterwards. There will be a bandage placed over the ears and sometimes under the neck following the surgery. Small silicon drains may be used in order to reduce the amount of fluid collecting at the front of the neck after the surgery. The drains and the head bandages are removed at day two following the operation. Dissolving stitches are used behind the ear. The stitches that need to be removed after the surgery are usually in front of the ear and these come out at day seven following the surgery. Patients will notice some bruising on the face and neck which can last up to two weeks and occasionally longer. There will be swelling of the face which is partly due to the operation and partly natural swelling that occurs after surgery. I reinforce to patients that when they wake up the face will feel tight. This can be a sensation that can be distressing (as it feels like an anxious sensation) but it does get better over three or four weeks and that tight feeling is good, as it reflects the type of surgery you’ve had. Please see the section on after-care for more information
Incision lines for short scar facelift
Incision lines closed for full facelift
The short scar facelift involves an incision that starts from in front of the hairline near the temple and extends over the tragus, underneath the lobule of the ear and around behind the ear. This type of incision is useful in patients who don’t have a lot of excess skin.
The extended incision facelift involves the same incision as a short scar facelift except it is extended up and behind the ear and into the hairline of the neck. This is for patients with lots of excess skin where we are removing all that skin and preventing excess folds from forming after the surgery.
The next question with a facelift is how to manage the deeper layers to the face known as the SMAS layer. This is the structural layer of the face and in most patients for whom it is their first facelift, I normally recommend a High-Extended SMAS procedure which is also known as a Deep Plane Face Lift (DPFL). In these operations the SMAS is dissected forward into the face and releases the anchor points of the face. The SMAS is pulled up and back in order to create a smooth and rejuvenated appearance. An alternative to this is a SMAS plication whereby the layer is doubled over in the cheek area. To create the rejuvenated appearance following both procedures the skin is re-laid down without tension and trimmed according to how much needs to be removed.
For many patients it is important to tighten the platysma muscle in the middle of the neck. This is known as a corset platysmaplasty. This involves making an incision underneath the chin, dissecting down, removing any extra fat and then joining in the muscle together in a corset fashion. By doing this and then by pulling out the back the procedure creates a very smooth and firm jawline.
The scar in front of the ear and underneath the chin normally heals extremely well and is almost imperceptible. The scar that most individuals are aware of, is the one that runs up behind the ear as it crosses the hairless area and can often be noted by hairdressers when cutting hair.
Benefits of the surgery
The aim of the surgery is to create a rejuvenated and natural appearance. The goal of surgery is not necessarily to remove every wrinkle (as this may look unnatural) but rather to create an appearance of someone who is rested and youthful.
Potential problems that may arise and how they managed
Sometimes there can be a little bit of bleeding from the incision lines which usually stops with gentle pressure for up to three minutes. If the bleeding hasn’t stopped after three minutes please give us a call at the office for further advice.
This is a problem when a small amount of fluid has collected underneath the skin. This is much less common in facelifts than in other surgeries and it simply needs a small needle drainage to fix the problem
Occasionally there can be small areas where the incision takes a little longer to heal. This can be normal especially behind the ear.
This occurs rarely. This is where a nerve that supplies the motor function of the face can be affected by the surgery. The most commonly affected nerve is the Marginal Mandibular Nerve which runs underneath the jawline to supply the corner of the mouth. If this has been affected by the surgery it can look like the person has had a stroke. Often this is temporary but occasionally could be permanent. I personally haven’t had this problem in my practice for any facial surgery but I do hear from others that if it does occur it can be very distressing.
Everyone has different aspects to their face and are different on each side. There will always be some subtle differences between each side and that is to be expected.
Up to one in ten patients can have some relapse of the platysmal bands of the neck wrinkles following the surgery. This often becomes evident after three months following the surgery. In some patients a year after the surgery, they require another operation in order to re-address the neck bands.
Occasionally following the surgery, you can get blood clots in your legs. This is a risk of any General Anaesthesia but it’s fortunately rare in facelift surgery. In order to minimise the chance of this we are careful to ensure patients have calf compression devices on during the operation which massage the lower legs and keep the blood flowing. Following the surgery we also encourage patients to mobilise early by walking around.
There is a sensory nerve that runs up to the ear lobe known as the Greater Auricular Nerve. Occasionally this can be affected by the surgery meaning that the sensation to the earlobe changes. More commonly for patients is that they notice the outer aspect of the cheeks is numb following the surgery. This is due to elevating the skin of the underlying tissue.
Sometimes people make the scars that can stretch. I do my best to ensure there is no tension on the skin at the end of the procedure which means that getting a poor scar is less likely.
I hope you find these guides helpful in preparation for surgery and for your recovery. It will cover general details of surgery and the normal way that individual’s recover after facial surgery.