Face Lift

Signs of ageing appear gradually. As you grow older you will see skin becoming looser on your face and neck and the youthful facial curves you once had become flatter. Crow’s feetappear at the corners of the eyes. Fine lines develop across the forehead and may grow over time into deeper folds. Some people develop frown lines between their brows. Eyebrows and eyelids begin to droop. Deep folds appear on both sides of the nose. A once firm jaw line begins to soften and falls away from the neck to form jowls under the chin. You may end up with a double chin or horizontal folds across the neck.

How your body and face ages is partly a matter of heredity. Then gravity works to your disadvantage. Environmental factors like sun, wind, dust and other elements speed up the ageing process. Research has shown that in Australia, some people see signs of ageing as early as their late twenties.

Lifestyle choices matter too. Cigarettes and alcohol can speed up the ageing process. Recreational drug use can make things worse. Nutritional choices and how well you keep your body and skin hydrated can affect how quickly your skin and face will show signs of age.

A facelift or rhytidectomy is a surgical procedure to reverse the signs of aging. There are a number of different types of facelifts such as the skin-only facelift, the SMAS facelift and the deep-plane facelift, as well as a variety of techniques that surgeons employ when performing a facelift.

This article provides you with the basic information you need before making a decision to undergo facelift surgery. It covers how a facelift is performed and what you can realistically expect from one. This article is not intended to be a comprehensive guide to facelift surgery; nor should it be considered an alternative to a thorough and detailed discussion with your chosen facial plastic surgeon.

Successful outcomes in rhytidectomy, as with all surgery, are a result of teamwork and rapport between you and your facial plastic surgeon. Only your surgeon can answer questions about what specific procedures are best suited for your needs and what changes to your face may help improve your appearance.

Is Facelift Surgery for You?

It is essential to have realistic expectations when choosing a facelift procedure.

A facelift cannot put a stop to ageing or completely turn back the clock. But it can help you achieve a more youthful appearance, ridding you of most facial wrinkles and restoring firmness to the muscles of the face and neck. It can help you regain a more refreshed, rejuvenated look that reflects your youthful spirit and energy levels.

You may benefit from a facelift if you have any of the following:

  • Loose skin and loss of firmness on the lower part of your face.
  • A loss of elasticity in the skin of your neck.
  • More and more facial wrinkles, which do not appear to respond to non-surgical treatments.
  • Jowls gradually appearing underneath your chin.
  • Skin around the cheeks sagging.
  • Deep creases under the lower eyelids.
  • Deep creases on both sides of the nose, extending to the corners of the mouth.

Although most facelifts are performed on people over 50, certain types of facelifts that last longer and produce subtle changes that keep signs of ageing at bay are becoming increasingly popular among those in the 40 to 50 age group.

As with all elective surgery you must be in good health at the time of surgery.

Before You Have Surgery

Choosing a facial plastic surgeon you can trust is one of the most important decisions you can make before your facelift surgery. Your trust should be based on the verifiable qualifications and expertise of the surgeon, his or her reputation and past experience with this type of surgery. The rapport you develop with your surgeon during the initial consultation process is also very important.

Your surgeon will begin with a physical examination in which he or she will look at your facial bone structure, your skin’s texture, elasticity and thickness and the extent of wrinkles on your face. Besides skin type, your surgeon will also consider your ethnic background and how you respond to healing.

The goal of a facelift is to improve your overall facial appearance rather than aim for an abstract ideal. The exact changes desired should be discussed with your surgeon, who can guide you as to what type of facelift procedure is best suited for your needs.

Sometimes, after inspecting your face and skin, the surgeon will recommend additional surgical procedures to help improve overall results.

Whether you opt for a facelift alone or wish to combine it with other procedures, your surgeon will discuss all the surgical options with you during this initial consultation and address the risks involved. This discussion should be an open and honest exchange of ideas between you and your surgeon, which will help establish reasonable expectations for the outcome of surgery.

Once you make the choice to proceed with facelift surgery, and you and your surgeon are in agreement about the best course of treatment, your surgeon will explain the type of anaesthesia that may be employed and provide you details of the surgical facility where your procedure will take place.

You will be asked to provide a thorough medical history, so your surgeon can take into account any medical conditions that could increase your level of risk during surgery.

When you decide to undergo cosmetic surgery, it is necessary to make a commitment to follow closely the pre- and post-operative instructions issued by your surgeon.

As part of the informed consent process, your facial plastic surgeon will also explain to you alternatives means, if any, that are available for you to achieve the same outcome and inform you of the costs involved for the proposed procedure or combination.

Understanding the Surgery

Exactly what happens during your facelift procedure depends on the type of facelift and the techniques involved.

Facelift surgery usually involves incisions around the ears, both in front near the temple hairline and behind, often extending to the scalp. When facelifts are performed on men, incisions are usually made within the beard line. Surgeons try to place all incisions in such a way that they are hidden in the natural creases of the skin.

After making the incisions, your surgeon will raise the skin away from the face to give access to the soft tissue layers underneath. A facelift typically involves repositioning and tightening the underlying muscle and connective tissue. In some cases skin and fat tissue will be removed during this process.

Once the lift procedure is complete, any excess skin will be trimmed and the incision closed with the help of fine sutures and metal clips. These techniques enable surgeons to carry out the surgery without shaving the hairline.

When the surgery is complete, your surgeon will apply a dressing to the entire area to protect it during the initial healing process.

Depending on the extent of the work, your facelift may take between two and four hours to complete.

What to Expect After Facelift Surgery

It is normal to experience some degree of swelling and bruising on the face after surgery. How much pain you experience after a facelift varies from person to person and cannot be pre-judged. Your surgeon will prescribe pain medications to deal with any discomfort.

Your surgeon will provide instructions about caring for yourself during the recovery period. It is important to follow these instructions closely in order to get the best results from your surgery.

For instance, your surgeon will ask you to use cold compresses to keep swelling under control. You will also be asked to keep your head elevated when you sleep or lie down to minimise discomfort and control swelling. Sleeping on your back is the safest during your initial recovery from facelift surgery. You can encourage the healing process by avoiding vigorous activity.

Any dressing applied after surgery will be removed in a day or two. Sometimes it becomes necessary to attach drainage tubes during surgery. They will be removed within a couple of days. Sutures and staples closing the incision are typically removed 5 to 10 days after surgery.

Expect the recovery to take two to three weeks, even though many patients go back to work within a couple of weeks. Your scars will have become mature by then and will not be very noticeable. They will also be hidden by hair or disguised in the natural creases of skin. You should be able to use makeup after the initial healing period to conceal the scars if they still show. Regardless of your surgery, the ageing process will roll on. As a result some relaxation will occur in the tissues in the coming weeks.

You should take extra care to protect your face from risk of injury during your recovery.

Follow-up care is essential as it allows your surgeon to monitor the progress of healing. Make sure to attend follow-up appointments on dates specified. In between report anything unusual to your surgeon without delay.

Additional information

Facial plastic surgery helps to correct facial flaws and temporarily removes signs of aging.

In general, insurance does not reimburse costs of elective cosmetic surgery. But if your facelift is performed as part of a procedure to correct deformities or as part of treatment for traumatic injury, some parts of the cost may be covered by insurance.

Just to be sure, always check with your insurance plan on the specifics of coverage.

You can find accredited facial plastic surgeons who perform facelift surgery among members of the Australasian Academy of Facial Plastic Surgery.

Dr. David Hall

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David is currently a Fellow at Royal Perth Hospital.

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Dr. Arthur G Bilski

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Dr. Bilski is a surgeon based in New South Wales.

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