A facelift is a surgical technique which aims to reduce visible signs of aging in the face and neck. It maintains its reputation as the ‘gold standard’ procedure for facial rejuvenation.Time and effects of gravity, facial grimacing, sun exposure etc. all leave mark on our facial skin over long period of time. Skin progressively looses elasticity and the underlying muscles slacken so that lines and folds deepen and tissues start to sag.

Facelift should not change your fundamental appearance, neither it can stop the aging process. Patients should understand that facelift surgery is a highly individualized procedure which should be considered if you want your face to look more youthful, not try to be somebody else or fit any sort of ideal image.

The best candidate is usually a patient whose face (and neck) has begun to sag, but whose skin still has some elasticity and whose facial bones are strong and well defined. Most patients are in their 40’s to 60’s, but facelift can be done successfully on people in their 80’s too. Facelift can work well in combination with non-surgical modalities of rejuvenation (peels, injectables, skin farmaceuticals etc). Neck lift is often frequently done with rejuvenation of the lower face, as their tissues function as the same unit.

In general, facelift leads to significant improvement in appearance and psycho-logical wellbeing and predictably highly satisfied patients. Essential to that, however are realistic expectations, thorough and honest consultation, surgical expertise and above all, mutual trust.

It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:

• All of my patients are strongly advised to stop smoking prior to surgery as smoking significantly increases the complication rates and can create devastating problems, especially after this type of surgery
• Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand.
• Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery
• Plan your time off school / work / sports
• Allow at least few weeks after surgery before considering a travel

A facelift addresses signs of aging by removing excess skin, tightening the underlying fascia and muscles and redraping skin on the face and neck leaving more youthful look. It is possible to re-tension the skin of the cheeks, provide a softer contour to the nasolabial fold, reduce fullness over the jawline and tighten the skin on the anterior neck. It can correct sagging of the middle face, marionette lines, jowls and a double chin. Although it is feasible to carry out the procedure under local anaesthetic and sedation, my personal preference is to perform facelift under general anaesthetic, except in very minimal corrections. Operation can take anything up to 4 hours depending on the complexity and severity of the problem, but operation ius rarely executed in less then 2.5 hours.

A full facelift operation involves an incision in front of the ear, back up behind the ear and transversely across the hairline. Redundant underlying connective tissue (so called ‘SMAS’ layer) is tightened and redundant skin is excised. Although facelift incisions are relatively extensive, subsequent scars are largely hidden within the hairline and on the back of the ear so hardly recognizable to the vast majority of people during normal social interaction. Men may find it more difficult to disguise the scars and will need to shave their beard closer to the ear. Occasionally, usually in a younger patients, it is possible to achieve above goals by using a shorter scar and this is known as a MACS lift (minimal access cranial suspension), but this method has it’s specific indications.

Drains are usually inserted on each side, and these will normally stay in for 1-2 days. Wounds are closed by absorbable and non-absorbable sutures in different parts of the face and covered with simple, discrete surgical tape. I rarely use special facelift dressings as those can be cumbersome. At the beginning your face will look a little puffy, you may feel that cheek and ears skin is numb and the whole face stiff, but this is all normal, expectant and improves quickly. Patients should try to sleep in relatively upright position for the first 2-3 days to help reduce swelling and pain.

You should expect to be will in the hospital for 2-3 nights. The wounds will be taped and any sutures in front of the ear removed at one week. Stitche within the hairline are left in place for up to 10-12 days.

In most circumstances, I apply a thick layer of cotton wool and elasticated net to hold it around the face, to provide comforting padding and compression in the first few days after surgery. When necklift is performed too, specialised compression garment is applied and I will advise you on this well ahead of surgery.

You will be able to shower the day after you leave hospital and then use a hairdryer on a warm setting to dry the tape off. It is important to minimize your activities in the first few weeks. Bending or lifting should be avoided as well as strenuous exercise for 6 weeks. You will usually need to take 3 weeks off work and will return to normal within 6-8 weeks.

Unfortunately, complications can occur following any surgery and patients need to be fully aware of this. I always tend to carry out surgery in a safe manner and take all sensible measures to minimise risks and complication rate.

As with any surgical procedure, there are general and procedure (facelift/necklift) specific risks which patients must be aware of:

General Risks (especially if operation is carried out under general anaesthetic):

• Adverse reaction to general anaesthetic
• Clots in the legs/lungs
• Vein trombosis (DVT) / inflammation (trombophlebitis)
• Bruising and swelling in the operated area (especially in patients on aspirin or anti-inflammatory drugs)
• Bleeding and haematoma (including need to return to theatre to evacuate large blood clot in approximately 3-4% of patients)
• Scarring
• Infection (3% of patients)
• Skin/scar irregularities
• Hypertrophic (lumpy and itchy) scars
• Delayed healing
• Numbness, alteration in sensation around operated area

Procedure Specific Risks:

• Skin numbness and necrosis of facial and neck flaps
• Asymmetry between two sides of the neck
• Earlobe numbness and altered positioning of earlobes
• Damage to the facial nerve and its branches (weakness of the corner of the mouth and/or lower lip)
• Alopecia (bold patches of skin)
• Mild facial asymmetry
• Need for a revisional surgery several years later (in response to ongoing ageing and gravity)

It can take few weeks for swelling to disappear, scars fade and soften. The scars are initially pink, can be a bit lumpy and/or itchy, but over the course of 3-6 months, they mature nicely and become hardly noticeable white lines. Although scars are permanent and quite extensive, in my experience, they rarely pose problems in the long term. Postoperative infections can delay healing process and prolong remodelling of the scar tissue.