It is helpful to understand the basic construction of facial skin in order to appreciate the various facial cosmetic treatments, including facelift. The skin is made up of two principle layers; the visible surface layer called the epidermis, and the inner layer called the dermis. This inner layer, the dermis, supports the surface skin and gives it its shape and tone. An important part of this layer is a network of collagen and elastin fibers, which i n the young skin are firm and elastic, with the necessary resilience to recover from the lines and wrinkles created by facial expressions such as smiling and frowning. However, w ith the ageing process we find that the collagen network starts to weaken, the supporting bones gradually shrink a little, facial fatty tissues decrease, muscles slacken and the skin looses its elasticity. This ageing process is genetically controlled, but over the years these biological influences are accelerated by excess exposure to sunlight, by the effect of gravity, and general stress and strain. Thus the skin sags, resulting in the looseness, folds and wrinkles that we associate with age. This happens to different people at different chronological ages, which can mean that a person may look older than they might be, or wish to look, or in fact feel. Indeed, age is more an attitude of mind - one is as young as one feels.
There is no substitute for the facelift operation if facial sagging is predominant, muscle tone is poor, and lines and wrinkles that once disappeared naturally have become a permanent feature - only a surgical facelift will provide a significant improvement. The surgical name for a facelift is Rhytidectomy. It is the general term applying to the various techniques used to tighten, uplift and remove excess skin, while supporting the underlying muscle tissue, and to reduce certain lines and wrinkles thus creating a more youthful appearance. A brow lift or upper facelift corrects the forehead or eye area. It does not remove actual eye bags - this is an additional procedure and often done along with the facelift. A lower facelift tightens sagging skin in the lower half of the face and neck, improves jaw line jowls, and flabby cheeks. One may have either a full facelift or a half facelift, according to what is needed. The experienced surgeon can advise on these points, so you may want to discuss this option with him. Face-lifting is most appropriate and effective in the forty years and over age group. The effects do last between five and ten years approximately for the \standard\facelift. Nowadays results have improved due to additional tightening of muscles (SMAS) and liposuction under the neck which is sometimes necessary to complete the end result. An important point to note here, is that it should not be thought that the skin will age more rapidly after surgery. The ageing process of the skin appears slowed down, or at the very least remains unaltered for a time.
The operation is carried out either under general anesthesia or twilight anesthesia. Many different techniques and variations of basic procedures are used in Rhytidectomy, but for the purposes of these notes for guidance, we will explain the operation in simple terms. In the standard facelift procedure for the lower face, an incision is made in front of and behind each ear, and the skin is then stretched backwards and upwards, the excess is removed and the skin sutured into position at the incision points. For a brow lift, the excess skin is trimmed via incisions just inside the natural hairline before lifting the remaining forehead skin upwards and suturing in place to remove the frown lines. A double-layered lift (supra-facial musculoaponearotic system - SMAS) works along the same lines. The SMAS procedure involves working on the facial muscle and fatty tissue below the skin. It should be noted that in any facelift operation the skin is not drastically stretched, it is only put under a similar tension comparable to that previous to ageing and sagging. This is a rejuvenating process.
The operation time is two to three hours, or more, for a standard facelift procedure. The time varies depending on the complexity of the case. An overnight stay in the hospital is required. Sometimes two nights are required but the surgeon will decide on these points in discussion with you. After the operation, the face is bandaged in compression dressings and facial movements must be restricted for the first few days. Stitches are removed between five to twelve days after surgery, and normally after about two weeks you will be able to return to work and to socialise as normal. Patience is required however, as the time it takes for the facelift to settle down properly and for the full effect to be achieved is three to six months. Post-operatively it is helpful to massage the face with moisturising cream. It is very important to carefully follow the surgeons directions on aftercare to ensure the best results. As with any surgery there are risks, but fortunately complications are rare and can be treated by routine procedures, and are not hazardous to the patient' s health. At first there may be swelling, bruising and tenderness as one would expect, but pain relievers and sedatives will be prescribed. As soon as the stitches are removed you may wear full makeup. There will be scars when there is an incision although they will be inconspicuous in position and with time will fade to become virtually undetectable. A temporary feeling of tension may be felt. Occasionally numbness to the ear may be permanent. A numbness across the cheeks may be noticed, which might last six to twelve months, but is not permanent. Injury to the facial nerve has been reported in medical literature but this is very rare indeed. In men there might be a very slight alteration in the hairline and beard pattern which can be discussed with the surgeon. There may always be permanent hair loss at the actual incision sites. Bleeding under the skin occasionally presents itself but this can be treated and will not affect the ultimate result of the operation. To reduce the risk of bleeding and to allow the underlying tissues time to heal it is important, as mentioned above, to restrict motion of the face after surgery, and exertion of any kind must be kept to a minimum for the first few days. In certain cases, albeit very rare, a secondary operation may be required - where there is a marked degree of skin laxity the initial facelift may need to be re-enhanced by a second operation six to twelve months later. It should be noted that the facelift alone cannot remove all wrinkles and fine lines, so two other methods are often used together with the facelift operation - Chemobrasion and dermabrasion and laser resurfacing . Any secondary or additional procedures would incur all the associated hospital and surgical fees. Finally, bearing the risks in mind, the operation is not as dramatic as it sounds and is not life-threatening or hazardous to the patient's health in any way. Rhytidectomy is a well-established, very effective and successful operative procedure which has benefited many thousands of patients, both male and female. It is therefore not surprising that the facelift is one of the most sought after and satisfying of cosmetic procedures in m practice.