As part of the ageing process,
which happens to all of us sooner or later, our skin progressively
loses its elasticity and our muscles tend to slacken. The
stresses of daily life, effects of gravity and exposure to
the sun can be seen on our faces. The folds and smile lines
deepen, the corners of the mouth droop, the jawline sags and
the skin of the neck becomes slack. Around the eyes, the eyebrows
droop and the skin of the eyelids gathers in loose folds.
In the skin the first sign is fine wrinkles developing around
the lips, at the outer corners of the eyes and lines of expression.
The rate at which this happens
varies from one person to another and is probably determined
by our genes. Ageing of the skin of the face does not necessarily
reflect the rate that the rest of our body and mind is ageing
and many people feel frustrated that the face they see in
the mirror is not the one they feel should be there. Substantial
weight loss can produce similar changes in facial appearance
to those of the ageing process
Who will benefit from a
The best candidate is one
whose face and neck has begun to sag but whose skin still
has some elasticity and whose bone structure is strong and
well defined. Most patients are in their 40s to 60s, but facelifts
can be done successfully on people in their 70s or 80s. It
should not be obvious that you have had a facelift, but instead
you should look younger, more vital and cheerful. It is a
procedure that technically works well but also increases morale
and is well appreciated by the patient.
What can a facelift not
A facelift works better
for the lower half of the face and particularly the jawline
neck. If you have sagging eyebrows and wrinkles of the forehead
then you should perhaps consider an endoscopic brow lift.
Loose skin with fine wrinkles, freckles and rougher areas
may benefit more by chemical peel or laser resurfacing
What should you do before
If you are overweight and
intend to lose it, you should do so before the operation.
This allows the surgeon to remove more skin and therefore
achieve a more pleasing result. You should avoid taking tablets
containing aspirin and non-steroidal anti-inflammatory drugs
such as voltarol and neurofen, for at least two weeks before
surgery as they increase the risk of bleeding. You should
stop smoking at least two weeks before surgery as this is
the main cause of reduced healing. It decreases circulation
of the skin flaps, particularly behind your ears. Before the
operation if your hair is very short, you might want to let
it grow longer, so that it is long enough to hide the scars
while they heal. It is better to have your hair permed and
tinted before surgery, if you so wish, as your fresh scars
are more sensitive to these chemicals for a few weeks afterwards.
A facelift is carried out
in hospital and most surgeons and patients prefer a general
anaesthetic. It is possible to carry out the procedure under
local anaesthetic and intravenous sedation but you would still
be advised to spend a night in hospital. The procedure, although
long, can be combined with a number of other operations. The
most common however would be an endoscopic brow lift and and
eyelid reduction. Other extra procedures which can be used
to enhance the face at the same time are malar (cheekbone)
implants, chin augmentation and lip enhancement.
Incisions are made
above the hairline at the temples and extend in a natural
line down in the front of the ear, or just inside the cartilage
at the front of the ear, and continue around behind the ear
and up in the crease behind the ear and off into the lower
scalp. Occasionally it may be necessary to make a small incision
under the chin.
area of surgery, skin and muscle lift and closure
Sometimes only the skin
is lifted following separation from the underlying platysma
muscle. More usually, the muscle and its fibrous attachments
(S.M.A.S) are dissected free and sutured to the solid structures
in front and behind the ear. At other times the skin and this
S.M.A.S layer are lifted together as a single layer, but will
still be sutured separately. Fat along the jawline and under
the chin may be removed by liposuction or occasionally through
an incision under the chin. The skin is sutured so that it
is lifted upwards and backwards, just as when you lift your
skin when looking in the mirror. Sometimes it is necessary
to insert small drains.
wake up with a bandage on your face to minimise bruising
and swelling after the operation. This bandage should
stay for one or two days and the stitches will be removed
in seven to eight days. The stitches or staples in your
scalp may be left for a few days longer.
After your surgery
there is usually some bruising of the cheeks and with
gravity this tends to go into the neck. Any discomfort
is usually mild and can be controlled with Paracetamol.
It is not unusual for there to be some numbness of the
skin of the cheeks and ears. This will usually disappear
in a few weeks or months. It is better to keep your
head elevated for a couple of days to reduce swelling.
If drainage tubes have been inserted they will be removed
a day or two after surgery.
You should avoid
strenuous activity, including sex and heavy housework, for
at least two weeks. Walking and mild activity such as stretching
is fine. You should avoid alcohol, steam baths, massages and
saunas for several months. You should be aware that you will
need plenty of rest to allow your body to spend its energy
At the beginning, your face
will be a little puffy and may feel rather strange and stiff.
Women can conceal their scars very well with their hair and
disc shaped earrings, so that you should be able to resume
work and social activities within a couple of weeks. Camouflage
make-up can be helpful in masking bruising.
Men find it more difficult
to disguise their scars and may need to shave their beard
closer to their ear, both in front and also behind the ear
where the skin has been lifted. The scars on the scalp do
not usually show except where the hair has been cut shorter
immediately around the incision. There may be some slight
reduction in hair growth around the temples, but this is not
usually a problem unless the hair is very thin and repeated
face lifts are being carried out.
All surgery carries some
uncertainty and risk
Complications are infrequent
and usually minor. However, individuals vary greatly in their
anatomy, their physical reactions, and their healing ability,
and the outcome is never completely predictable. Complications
that can occur include haematoma, (a collection of blood under
the skin that must be removed by the surgeon), injury to the
nerves that control the facial muscles (usually temporary),
infection, and reactions to the anaesthetic. Poor healing
of the skin is most likely to affect smokers.
Getting back to normal
You should be up and about
in a day or two, but you should plan on taking it quite easy
for the first week after surgery. You should be very gentle
with your face and hair, as your skin will be both tender
and numb, and may not respond normally at first. Because of
the swelling , your features may appear distorted, your facial
movements may be slightly stiff and you will probably feel
self-concious about your scars. You may find that you tire
easily and it is not surprising therefore that you may feel
disappointed and depressed at first.
How long does a facelift
A facelift does not
stop the clock, but it does put the clock back. Your face
will continue to age with time and you may feel it necessary
to repeat the procedure perhaps 5 or 10 years later. The effect
of the facelift is likely always to be there, in that you
will not look as old as you would have done if it had not
been carried out.
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