Face and neck lift

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What is a face and neck lift?

Facelift, medical term rhytidectomy, is an operation in which excess or loose skin is removed to smooth out wrinkles. Tissues under the skin are lifted and tightened. The aim is to give a more youthful appearance. There are now many different types of facelift.

Who may consider having a facelift?

Those who have loose and wrinkled skin of the face, particularly the neck and jaw line.

What are the different techniques for face and neck lifting?

There are now many different approaches to facelifting. The following is a brief outline of some of the main techniques.

The classical facelift

The classical facelift is one of the original facelifting techniques. The skin of the face and neck is lifted up and the excess is removed leaving a scar running from the scalp down in front of the ear, up behind the ear and into the scalp behind the ear. The results from this technique are generally considered to be rather short lived and it is not widely used any more.

The standard SMAS facelift

SMAS stands for the superficial musculo aponeurotic system. It is the layer of tissue under the skin. SMAS facelifts aim to tighten or reposition the SMAS layer to create a better foundation for the overlying skin. Plication of the SMAS layer is frequently used although there are many differing approachs to the SMAS. The excess skin is also removed with a similar scar to the classical facelift.

The MACS lift

MACS stands or minimal access cranial suspension. The incision and therefore the scar, is short usually passing in front of the sideburn and down in front of the ear to the ear lobe but not behind the ear. (If the neck is quite lose then there may need to be a scar behind the ear). The SMAS layer is then tightened and lifted with stitches which remain under the skin. This has become popular technique in recent years.

Subpereosteal facelifts

The subpereosteal facelifts require deeper dissection under the covering of the bone. The soft tissue of the face can then be lifted or repositioned. These are powerful techniques but may require longer recovery periods. Sometimes they may cause you to have a slightly different appearance.

Thread lifts and the Silhouette lift

Thread lifts, of which the Silhouette lift is an example, are minimally invasive techniques in which stitches are used to lift the face through very small incisions. As they are minimally invasive these are quite attractive but the results may not be long lasting.

How should I prepare for surgery?

Firstly you must be sure that you understand what is involved with the surgery. You must understand what the surgery can achieve for you and be sure that this is right for you. You must know how long it will take for you to recover and know about possible complications. If you have doubts or further questions you should ask your surgeon well before your operation. This may be possible over the telephone but usually it is better to return to the clinic. Smoking. Smoking increases the risk of complications from surgery. If you stop smoking 4 to 6 weeks before your surgery the risks are reduced. You should avoid aspirin type drugs, vitamin E and fish oil preparations (eg omega 3) for 10 days before your surgery. These types of drugs can increase the risk of bleeding.

When will I come into hospital?

You will come into hospital on the day of surgery. The operation is usually carried out under a general anaesthetic (asleep). You will normally stay in hospital for 1-2 nights after the operation. You will be prescribed regular painkillers and be given extra painkillers if you need them. Modern anaesthetic techniques help to reduce or even prevent sickness following surgery.

How long will I need to recover?

Immediately following surgery there is some swelling and bruising. The bruising and swelling improves over 14 days after the surgery. There may be some residual bruising and swelling for 3 or even 4 weeks. People vary in the time they need to recover following surgery. Most people will want to take at least 2 weeks off work and 4 weeks would be preferable for office type work. You should avoid bending with your head down for a week following the surgery. Generally you can start driving when you feel able but this is likely to be 7 to 10 days after the operation. It is illegal to drive with in 48 hours of a general anaesthetic. Obviously you must be able to drive comfortably and safely. Light exercise can start from 4 weeks building up to normal exercise after 6 to 8 weeks. Swimming should be avoided until the wounds are well healed which is usually about 4 weeks. A full recovery will usually take 6 to 8 weeks.

What results can I expect from a facelift?

The majority of women who undergo a facelift are pleased with the results. Wrinkles and some of the contours of the face will be improved. As the elasticity of the skin is reduced with age this limits the improvement that can be made. It is important to understand that you may look quite bruised and swollen for 2 weeks after the surgery. Facelift scars usually settle down well and can be covered with cosmetics in the early stages if they are pink. Swelling contributes to smoothing out the skin so as the final swelling settles at 6-8 weeks there may some loosening of the skin. Depending on the technique that is used for a facelift it is important to understand where the scars will be placed and what effect they may have on your hairline. Incisions in front of the hairline may be visible although usually these scars are good. If you make poor scars this may affect how you choose to wear your hair. Incisions brought up into the temporal scalp will tend to raise the temporal hairline and scars in the scalp behind the ear may cause a notch on the hairline. How long does a facelift last? A facelift aims to turn the clock back but it does not stop the aging process. Although a facelift may make you look more youthful the face continues to age following surgery.

What are the complications of face and necklifts?

The following describes the principal complications of face and neck-lift-type operations; it does not cover all possible complications. Serious complications are rare in healthy individuals, however very rarely it is possible to have serious complications which can even be life threatening. Patients who smoke, are overweight or have medical problems such as diabetes are more likely to suffer complications and may not be suitable for this type of surgery.

Complications from the anaesthetic

Modern anaesthetics are very safe and serious complications are very rare in healthy people. You should discuss concerns about your anaesthetic with your anaesthetist. Your anaesthetist will give you drugs to control pain and sickness during your recovery.

Bleeding and haematoma (build up of blood under the skin)

Occasionally bleeding does occur after the operation and a second operation may be necessary to remove the build up of called a haematoma. If this does occur a normal recovery usually takes place after the blood has been removed.

Infection and wound break down

Infection may complicate any operation. It is unusual in facial operations as the facial skin has an excellent blood supply.

Asymmetry of the face

Asymmetry of the face is common and so may exist before the operation. Surgery is not an exact science and asymmetry may exist after surgery even where it was not present before hand.

Skin necrosis

Skin necrosis is where part of the skin dies usually because its blood supply has been damaged. This more likely in smokers or people with pre-existing conditions such as diabetes. It will normally heal on its own although may sometimes take some time and leave scarring.

Injury to the facial nerve or one of its branches

Injury to one of the branches of the facial nerve is a rare but important complication of facelifts. The temporal branch of the facial nerve supplies the muscle that lifts the eyebrow and if this is damaged the eyebrow will droop down on that side. The second branch that can be injured affects the muscles which move the corner of the mouth. If damaged the corner of the mouth may droop and not move properly and symmetrically with the other side. Usually injury to these nerve branches is temporary but recovery may take several weeks or months. Nerve damage can be permanent.

Injury to the greater auricular nerve

The greater auricular nerve passes from the neck up to the skin of the scalp behind the ear. This nerve can be cut during a facelift which results in an area of numbness behind the ear. As the nerve grows back a tender lump called a neuroma may form which some people find troublesome.

Poor scarring

Scars vary from one person to another. Scars can stretch, be lumpy (hypertrophic or keloid), stay pink or become brown (pigmented). Poor scars may be visible and affect how you can wear your hair. Usually facelift scars are good.

Deep vein thrombosis (DVT) and pulmonary embolus (PE)

Deep vein thrombosis is a blood clot forming in the veins and a pulmonary embolus is where one of these clots breaks off and travels to the lungs, which can be fatal. This is a rare complication of surgery. Risk factors include, obesity, oral contraceptive pill, hormone replacement therapy (HRT). You can help to protect yourself by getting up and walking around as soon as you can following your operation.

What are the alternatives to a face or neck lift?

You should consider if any of the alternatives to surgery may be able to achieve the desired result for you.

No surgery

Not having surgery is an option for most people as it is unusual for excess skin to cause a functional problem.

Topical creams

Minor wrinkling of the lower eyelid may respond to certain creams (eg topical retinoids).

Skin peels

Skin peels may improve the appearance of fine wrinkles on the lower eyelid.

Laser resurfacing

Laser resurfacing improves fine lines around the lower eyelid and may cause some tightening of the skin.

Where can I get further information?

Speak to your General Practitioner

Your General Practitioner has a broad knowledge of medicine. Your GP will be able to examine you to decide if you should have any investigations. Your GP may recommend a surgeon or a hospital where they feel you will get good advice about surgery.

Outpatient consultation with a Consultant Plastic Surgeon

An outpatient consultation with a Consultant Plastic Surgeon will enable you to discuss what result you would like to achieve. They will also be able to make recommendations as to how best to treat you and whether there are any special considerations for you.

Department of Health (England and Wales):

www.dh.gov.uk search under – Cosmetic surgery and non-surgical cosmetic treatments. Independent and objective advice on cosmetic surgery from the department of health.