facelift and neck

Principles of facelift surgery

Reconstructive facial surgery for birth defects, trauma and cancer is a significant part of my public and private practice. I believe this is a significant advantage when performing facial cosmetic surgery which uses similar principles and techniques.

There is no universal “facelift”. Each patient has unique pattern of facial aging which requires precise anatomic diagnosis and individually appropriate surgery.

EXAMPLES OF FACELIFTS AND NECKLIFTS IN MY PATIENTS

BEFORE AFTER   Facelift and submental liposuction • SMASectomy and platysma suspension facelift. • Submental liposuction. The after image was taken 4 months after the operation Vertical platysma face and necklift • Vertical Platysma and SMAS plication necklift • Malar pad imbrication • Upper and lower eyelid blepharoplasties • Rhinoplasty The after image was taken 2 years after the operation SMAS resection facelift • Vertical Platysma andSMAS plication necklift • Malar pad imbrication • Upper and lower eyelid blepharoplasties • Rhinoplasty 2 years after the operation SMAS plication facelift • SMAS flap suspension to mastoid • Genioplasty(chin advancement) • Lateral SMASectomy facelift • Rhinoplasty and blepharoplasties 9 months after the operation Facelift and chin advancement • SMAS resection facelift and platysma plication • Transpalpebral corrugator resection (removal of vertical frown muscles through the upper eyelid) MACS facelift • MACS face and neck lift (minimal access cranial suspension) • Cervical liposuction 8 months after the operation

A face and neck lift addresses decent of the cheek fat fats, nasolabial folds, jowls, neck skin laxity and fatty accumulations beneath the chin. ”Facelift” is not a good description of the procedure I do which involves sculpting, repositioning tissues and volume filling. It is not just a tightening procedure. A natural appearance (rather than a “wind swept” face lifted look) necessitates elevation and resuspension of the deep supporting structures of the face. It is critical that the tension is not transferred to the skin as the effect will be short lived.

The SMAS (superficial musculo aponeurotic system), the fascia over the salivary glands, the malar pads and the platysma muscle are deep structures that are dissected free and sutured to various of parts of the facial skeleton

Global facial aging means that many facelift patients also benefit from concurrent surgery for the forehead and eyelids. Surgery to the nose and chin may also be performed concurrently.

To read more about the current trends in faclifting click here for an article from the Beautiful You magazine >>

Anaesthesia
Most facelifts are performed under General anaesthesia. Some short scar facelifts may be performed under local anaesthetic with sedation if desired.

Common incisions
I often modify the incision around the hairline according to individual patterns

BEFORE AFTER MACS facelift incision Extended SMAS facelift incision Healed facelift incision

Surgical technique
A calf compression device and low molecular weight heparin is used to decrease the risks of leg clots. Areas to be dissected are infiltrated with a solution to decrease bleeding and discomfort. Steroids are given to minimize swelling. After surgery the hair is shampooed and conditioned and dressings applied.

The individualized treatment plan which may include

• Liposuction of the neck and jowls
• Open removal of fat from the neck (lipectomy)
• Microstructural fat injections from abdomen to perioral and periorbital regions
• Suspension of the neck platysma muscle according to the required vector
• Suspension and manipulation of the SMAS layer of the face to restore volume
• Temporal lift (elevates lateral brow only)
• Limited incision brow lift (I anchor the deep layers to the bone)
• Corrugator resection (brow frown muscle)
• Upper and or lower eyelid reduction (blepharoplasty)
• Lateral canthopexy (suspension of the muscles round the outer orbit)
• Perioral skin resurfacing
• Hyaluronic acid filler to fine rytides
• Botox (especially glabella and lip depressors)
• Genioplasty- repositioning the chin bone
• Myomectomy of depressor anguli oris muscle (elevates corner of mouth)
• Ear lobe reduction
• Submandibular gland repositioning or excision

MACS facelift
A MACS facelift elevates facial tissues along a purely vertical vector and is most suitable for first time facelifts in which there is minimal mid neck laxity.

Advantages include a shorter scar, less swelling and bruising, potentially daystay surgery under local anaesthetic and much lower complication rate than a traditional facelift.

Disadvantages include uncomfortable chewing for the first four to five days (sutures are placed into the fibrous envelope of one of the chewing muscle).

Recovery
Recovery depends on the extent of a facelift. After a minimally invasive lift, it may be possible to return to office jobs after one week. If a full SMAS facelift and eyelid surgery is also done two weeks is more sensible minimum as the swelling is still noticeable. Strenuous exercise, gym work and heavy lifting should be avoided for at least three to four weeks.

The first 24 hours are the most uncomfortable. The face is firmly bandaged beneath the chin, cold packs are placed over the eyes, there may be ointment in the eyes and sleeping is in a semi upright position.

A dull ache is normal and is well controlled by oral analgesics. A sleeping tablet is offered.

Sutures and possibly staples are sequentially removed over the following three to ten days. Smoking is strictly prohibited during healing.

Risks and complications
These risks and others will be discussed with you at your consultation with Mr Davis.

Long term maintenance
A facelift will turn back the clock significantly but does not stop ongoing aging. Some people may request a further facelift perhaps a decade later. Avoid smoking and excessive sun exposure which accelerates skin aging. Mr Davis may suggest a postoperative skin care regime depending on your skin type which may include retinoids, hydroxyacids, hydroquinone and a good sunblock.

TOPICS
Click on the links below for more information about face and neck lifts.
Principles >
Anaesthesia >
Common incisions >
Surgical technique >
MACS facelift >
Recovery >
Risks >
Maintenance >