 Before
and After Photos
Instructions
 Brochure
(PDF)
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The
demand for facelifts has increased over the last few
years. As a result of this, various types pf new facelift
have been introduced which can often lead to confusion.
The
original facelift was a dissection purely under the
skin to pull it tight in the hope of removing creases.
The subcutaneous facelift is still undertaken for older
patients, especially when they are having a repeat operation
or for mini-lift procedures done as a day case under
local anesthetic. In general however creases are best
removed by using the carbon dioxide laser to peel the
skin.
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Newer techniques
include repositioning fat and muscles in the face back
onto the cheek bones by using a SMAS list, and also
pulling on the platysma muscle in the neck, which has
been further refined to produce the extended SMAS, and
combined with a brow lift is often called a composite
facelift.
These types of lifts are known as the first generation
of facelifts. Further generations of facelift involving
the subperiosteal dissection of the face with hitching
up of the mid-face and muscle around the eyes and
cheek fat have led to second, third and forth generations
of facelifts.
We have extensively studied the various forms of
facelift and we can undertake extended SMAS dissections,
subperiosteal endoscopic facelifts and carbon dioxide
laser resurfacing techniques. We constantly evaluate
(audit) our result and we will discuss with you the
best way of approaching the operation to the individual
patient given what you wish to try and correct.
It is important to remember that the more dissection
that is undertaken the more prolonged will be the
post-operative swelling and bruising. Like all things
is cosmetic surgery, what one wants to get is the
balance of the maximum gain for the minimum pain.
Facelifting is a major undertaking and therefore
requires careful preparation, planning, surgical performance
and post-operative care. We have available a team
of plastic surgeons, specialist anesthetists, nurses
and aesthetician as well as a high-tech ultrasound
healing machines, all of whom will help to speed up
and smooth your recovery period.
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I like to have two consultations
with patients undergoing facial rejuvenation surgery.
At the first consultation following examination, photographs
will be taken and the broad principles of surgery
will be explained to you and the type of operation
that I recommend will be described. There are several
different procedures that may be used with a facelift
in particular chemical peel,
CO2 Lasering, dermal fat grafts to the lips and fat
injections, augmentation of the chin and of course
eyelid surgery and brow lifting.
The full operation is a long
and detailed procedure, which will produce an excellent
long-term result and improvement for a considerable
number of years. At the second consultation a more
detailed discussion will be undertaken with the aid
of the photographs and this will allow you to ask
me any questions that undoubtedly will arise following
our first consultation and the reading of our information
sheets.
The best candidate for a facelift
is a man or a woman whose face and neck have begun
to sag but whose skin has still some elasticity and
whose bone structure is strong and well defined. Most
patients are in their forties and sixties, but facelifts
can be successful on people in their seventies or
eighties and increasingly is undertaken on younger
patients, particularly those whose face has aged with
smoking or excess sun. A facelift can make you look
younger and fresher and it may enhance your self confidence
in the process, but it should not give you a totally
different look nor can it restore the health and vitality
of your youth. Before you decide to have surgery think
carefully about your expectations and discuss them
with me.
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MACS
lift
The original subcutaneous face lift involved just
lifting up the skin on the face, stretching and then
re-draping it. This has now been modified by the use
of internal suspension sutures. This type of facelift
is undertaken as a day case usually under local anesthesia
with sedation. This procedure with limited incisions
done as a day case allows the maximum effect for the
minimum amount of surgery and is suitable for the
younger patient or the older patient who does not
want a major procedure.
The
original classical subcutaneous facelift
I involved just lifting up the skin on the face and
re-draping it. This is the sort of lift is undertaken
as a day case and called a mini-lift. The long-term
benefit to the patient, once the post-operative swelling
has settled, are not consistent. It is also used in
the older patients.
SMAS
Face Lift
It became apparent to produce a better correction
of the face, a deeper lift was required and the pull
was therefore on the underlying muscle in the neck
and on the fascia in the face. This was the SMAS facelift.
More recently as the anatomy has became better understood,
this SMAS plane is dissected much further across the
face towards the nose allowing a much greater correction
of the mid-face and is known as the extended SMAS
face lift and is most popular in the US.
The
Mask
The mask, or deep place facelift, has developed from
craniofacial surgery and involves an incision in the
scalp as part of the brow lift with an extension of
this to dissect the structures deeply in the face
via a lower eyelid incision and with incisions also
placed inside the mouth to help with the dissection.
The drawback however is that the post-operative swelling
does take a lot of time to settle and the full effect
of the lift will is not apparent for three to six
months. Some patients find an altered look to the
eyes a problem.
Endoscopic
Face LIft
With the introduction of endoscopic (keyhole) surgery
it has been possible to undertake the dissection of
the above mask lift through very small incisions just
above the ear and through the lower eyelid. This is
at present being developed as a 3rd and 4th generation
facelift and, whilst good results are obtained some,
there is no long-term follow up on this type of surgery.
Composite
Facelift
The composite facelift is a combination of the brow
lift and extended SMAS facelift and is advocated the
older patient to produce a harmonious elevation of
all structures in the neck, face and in particular
around the eyes.
Other types of face
lift include:
Short Scar
Face Lift (S-Lift)
APTOS Lift
Chemical Peels
Laser Peels
Lifting creams
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It is important you realize
that the results may not be immediately apparent until
after the swelling and bruising are gone and the scars
soften. It is not surprising that some patients are
disappointed and depressed at first. This is normal
and should not alarm you. It is not easy to be bruised
and swollen when your expectations are toward improving
your appearance. Fortunately this period passes quickly.
All surgery carries some uncertainty
and risk. But fortunately when a facelift is performed
complications are infrequent but must be treated promptly.
Individuals vary greatly in their anatomy, their physical
reactions and their healing abilities and the outcome
is never completely predictable. Complication that
can occur include:
Haematoma: (a collection of
blood under the skin) which must be removed and this
usually occurs immediately after surgery during your
stay in the hospital.
Nerve Injury: Numbness of the
skin in front of the ears and cheeks is routine, but
some patients will be aware of this in a wider area
over the ears and neck. Recovery takes place over
a course of three to six months. Injury to the nerves
that control the facial muscles are usually temporary.
This is usually a concussion caused by stretching
and will recover within a period of six to eight weeks.
Very occasionally this facial weakness can be permanent,
producing either an asymmetric smile or an inability
to raise the eyebrow. This major complication is in
our experience extremely rare.
Infection and poor healing:
Infection is again a very rare complication and always
responds to antibiotics. Poor healing of the skin
is most likely to affect smokers. Occasionally, small
persistent lumps may appear in the cheeks two to three
weeks after surgery as the swelling goes down, this
is scarring under the skin and no specific treatment
is required as they always resolve and flatten spontaneously
over a period of weeks.
Scars: Scars are usually fine
and well hidden. But in some individuals the scars
may tend to thicken, itch and become red six to twelve
weeks. Such hypertrophic scars can be helped by incisions.
The most obvious scars are behind the ear where tension
is maximal. You would be advised not to wear your
hair tied up or back for at least six months, in order
that your hair can flow forwards and cover these scars.
Men may find they have to shave behind the ears because
of the repositioned beard.
Having a facelift does not
stop the clock, your face will age with time and you
may wish to repeat the procedure five or ten years
down the line. However the effects of even one facelift
are lasting and you will continue to look better that
if you had never had a facelift at all.
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