A face lift surgery is a cosmetic procedure to improve the appearance of the face by repositioning some of the skin and muscle tissue of the face and neck to counter sagging and looseness caused by gravity as the patient ages. Wrinkles around the mouth and eyes may benefit little from face lift surgery.
For complete face correction, other procedures such as blepharoplasty, chemical peeling, or dermabrasion also may be necessary.
Most of the time, general anaesthesia is preferred but the procedure can be done under local anaesthesia with sedation.
In a typical facelift surgery, the surgeon begins by making an incision within the hairline just above the ear. The incision continues down along the front edge of the ear, around the earlobe, and then up and behind the ear extending back into the hairline. The location of this incision is designed to hide any sign of the procedure later. This is repeated on the other side of the face.
The surgeon raises the skin in the subcutaneous plane up to the cheek (nasolabial area), below the chin and neck. The SMAS muscle is also tightened and fixed in a new position.
Medications that can alter the way the blood clots, including female hormones, aspirin, and some non-aspirin pain relievers are to be avoided, for they increase the risk of haematoma. Smoking is to be avoided at least 4 days pre-op and 7 days post-op.
The pressure bandage is given immediately post op, and antibiotics are given both intra-op and in post op period to avoid any infection. The patient is kept in the recovery room for a few hours to check for any bleeding. It is preferable to discharge patients after 24 hours but if the surgery is conducted under local anaesthesia, they can be discharged on the same day.
Ice packs for the first few days can help to reduce swelling and lower the risk of hematoma. Patients continue to take an antibiotic until the first stitches are removed about 5 days after the procedure. The remaining are removed 7-10 days later. Many patients return to work and begin limited activities within two weeks of the procedure.
A major complication following face lift surgery is a hematoma, which might require the patient to return to get the stitches reopened to find the source of the bleeding. Most hematomas form within 48 hours of the surgery. The typical sign is pain or swelling, affecting one side of the face but not the other. Another risk of face lift surgery is nerve damage which can affect the patient's ability to raise an eyebrow, distort their smile, or leave them with limited feeling in the earlobe. Most nerve injuries repair themselves within 2-6 months. Some swelling and bruising is normal following face a lift surgery. Other complications include infection, scarring, and hair loss near incision lines.
The patients are back to work after about 10-14 days. Swelling may persist by that time as it takes 6-8 weeks for it to reduce completely.
Most of the time general anaesthesia is preferred but the surgery can be done under local anaesthesia with sedation. There are a number of very different surgical approaches: The midface may be lifted from incisions subciliary, which means they are placed on the front of the lower eyelid, on the back of the lower eyelid (trans-conjunctival), above the brow, inside of the mouth (buccal), on the temple behind the hairline, or at the canthus.
The plane a can be through the orbicularis or pre-periosteal or sub-periosteal i.e. below the periosteum. The operation may be accomplished under direct exposure utilizing large incisions or through the endoscope using smaller incisions. After exposure, the suture is passed through the fat and fixed to the periosteum or to the fascia at the temple area.
Midface lift may produce a more natural appearance (less pulled) around the cheek and mouth than with a "classical" face lift, which pulls tissue more towards the ear. Lifting the cheek upward restores a more youthful contour that is lost as the cheek descends under the influence of gravity. It can only correct the midface and no effect is there on the jowls.
Swelling and bruising may be pronounced; sub-periosteal dissections may result in swelling lasting up to three months.
Distortion or puckering in the region just beyond the lateral corner of the eye is not uncommon. There is a risk of infection, poor perfusion, bleeding, and scarring. A well-performed midface lift is, comparatively, not an easy operation for the surgeon; proper suture placement is difficult and requires immense skill.
A related but less aggressive procedure, directed primarily at repositioning a single smaller fat pad of the upper cheek rather than the entire midface. It is a helpful addition to blepharoplasty.
There are threads available to suspend the midface with an open surgical procedure.
A neck lift or a platysmaplasty is often preferred over a face lift although it can be performed at the same time. The neck is one of those places on the body which clearly shows the effects of the ageing process. One way of dealing with this is to undergo a neck lift. This tightens and firms the loose skin around the neck which gives a clearly defined jaw line and a youthful appearance.
A neck lift can take about two hours to complete under a general anaesthetic. If it is performed along with a face lift, then this time will increase and an overnight stay is usually required.
Small incisions are made underneath your chin or behind your ears to begin the procedure. The surgeon will move and tighten loose folds of skin around the patient's jaw and neck and then secure this newly tightened skin with stitches or tissue glue.
There are two techniques for this surgery – platysmaplasty, which corrects the neck muscles and cervicoplasty, which firms and tightens loose skin. Liposuction can be used in combination with this to help remove any excess fat. In order to reduce any scarring, your surgeon may use endoscopic or keyhole techniques. The ageing process and gravity cause the skin of the neck and jaw line to lose elasticity and tone. This manifests itself as 'age bands' around the neck and loose folds of skin and fat around the jaw bone. This is ideal procedure for removal of this age bands. Also, for the patients who have lost a lot of weight, it should be combined with a face lift.
Bruising, soreness and swelling might occur and you may have to wear a special pressure garment afterwards. This will have to be worn for a week after the surgery. Scarring at the incision site is also common but it decreases remarkably over the time and becomes nearly invisible. You will require a week (or two) off from work and avoid any strenuous activities during this time. It will take a month before you can return to the gym or undertake any exercise.
Good candidates may be, for example, baby boomers who want to take five years off their face with a mini-facelift. These patients may benefit from smaller incisions and the use of tiny barb sutures, instead of a large incision that requires heavier stitching. However, many of these techniques are new and long-term results have not been proven. Furthermore, mini-facelift patients may not be fully satisfied with the slight skin tightening offered by smaller incisions and barb sutures.
The treatment plan for a mini-facelift patient often includes regular facial-filler treatments to add volume to hollowed facial areas or fill in deep wrinkles. Alternatively, a candidate who consults with a qualified doctor might be surprised to learn that they don't need a mini-facelift after all. Facial fillers may be enough in some cases.
For more extensive cases, patients with deeper wrinkles may not be satisfied with a mini-facelift. They may need a full facelift or neck-lift (or both) to achieve the desired results.
A thread lift uses sutures that lift sagging eyes, deep nasio-folds, or an aging neck. Using a thin needle, a surgeon inserts tiny threads under the tissues of the face. The barbs on one end of the thread grab and lift the sagging skin, and the teeth on the other end anchor the skin to the rest of the facial tissues. No incisions or stitches are required, and no scars are produced.
Two types of threads are used for thread lifts: Contour Thread and the Aptos Thread. It's estimated that as many as 9,000 thread lifts have been performed nationwide with contour threads, which were approved by the Food and Drug Administration in September 2004 with current indications for elevation and fixation of mid-face, brow, and neck. The Aptos thread, which was developed overseas, received its premarket approval from the FDA in March 2005.
The main difference between the two is design. Contour threads are bi-directional, fixed in the area of initial incision, while Aptos threads are one-directional within the skin after the needle is removed.
The contour thread material, clear polypropylene, has been used in other medical applications for many years. It has barbs along the thread that act as cogs that allow the surgeon to grasp, lift, and suspend a relaxed facial area. The barbs open in an umbrella-like fashion to form a support structure that lifts the sagging tissue. The Aptos thread has barbs on the entire length that are inserted under the skin to fill out and lift the cheeks and sagging skin.
Ideal candidates for thread lifts include people who have minimal signs of aging and need just a little lift. If major signs of aging are already apparent, more traditional surgical options may be the best way to achieve a more youthful appearance.
Many people who undergo thread lifts are women between 35 and 45. They choose a thread lift because they have begun to see more prominence of the jaw, a relaxed (or minimally sagging) mid facial appearance, or slight bags under the eyes or on the neck. Older patients may undergo a thread lift during the more aggressive facelift procedure to provide additional support for the soft tissue area that was elevated in the face lift. Other thread lift candidates include those who have had a relapse from a previous plastic surgery procedure such as a facelift or neck lift.
Thread lifts are often performed in an outpatient medical surgery center or hospital. Because the procedure is minimally invasive, general anaesthesia is not required, so you can remain awake, but sedated with local anaesthesia. One benefit is that the plastic surgeon can give you a mirror as the thread is pulled back, allowing you to give feedback.
You may be instructed not to eat or drink after midnight before the thread lift. You may be prescribed an antibiotic to take beforehand, and instructed to cease taking certain other medications.
During the procedure your doctor will make small incisions in key locations and insert a threaded needle to lift the subcutaneous tissue and suspend the lift with the thread. The barbs on these threads will lock in place upon insertion to lift very specific areas.
Variations of the technique exist as well. In general, the "closed" technique involves moulding the soft tissue over the suture in multiple location points until it catches in the appropriate location to provide the best results. During an "open" technique, the surgeon will use instruments under the skin to create a raw surface so that when the thread sutures are pulled up, the lift is more likely to remain in the appropriate position. Other surgeons may employ a combination technique that uses sutures at multiple tissue levels to catch all the barbs and create a suspension that cannot be accomplished with a non-barb suture.
Depending on your needs, the number of threads used in the procedure can range from two to twenty.
Your doctor will provide a complete post-operative instruction list that you must follow in order to reduce the risk of complications during recovery. These instructions may include an escort to drive you home and assist you with daily activities for at least 24 hours, as well as diet restrictions (soft foods) for one week. Pain can be managed with oral medications. Your doctor may recommend elevating your head to reduce swelling. Normal activities can usually be resumed within seven days.
While the use of sutures is not new to medicine, the concept of thread lifts is new (FDA Approval 2004-5). Thread lift results are being substantiated and vary greatly among patients. The problems with sutures rising to the surface and offering only short-term smoothening still exist today. Some plastic surgeons estimate that the thread lift results can last from three to ten years.
As with all surgery, thread lifts can have complications. Some patients may develop an infection in the treatment area (this is rare). If so, your doctor will treat infections with antibiotics. Rarely, an infection may require surgical drainage. Scar tissue formation is also possible. Some doctors have noted that migration can occur, which may cause an imbalanced facial appearance.
In other cases, the thread may break and require reinsertion. You may experience a lack of sensitivity or numbness in the treated area, which usually subsides within weeks of the procedure.
A significant risk of the thread lift procedure is that you may not notice any improvement. In this case, you would want to proceed with a formal brow lift, facelift, or neck lift for a noticeable improvement.
