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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 facelift?

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 do?

A facelift works better for the lower half of the face and particularly the jawline and
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 the operation?

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.

The surgery

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.

The incision, 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.

The final result
You will 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 on healing.

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 last?

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.

© Cosmetic Surgeon Directory, 2014