The problem
You might have noticed deepening of the crease between your nose and mouth, jowling, loss of jaw definition and baggier skin.
This is a natural consequence of aging and affects us all to a varying extent.
Your degree of ageing is related to many factors including your genetic makeup and lifestyle including factors such as smoking and stress.
An aged face can lead to loss of self esteem as well cause prejudice socially and even at work.
It is a much more powerful way to address several areas of the face and can lead to dramatic improvements in your confidence, looks, esteem and general joie de vivre.
The solution
A facelift (rhytidectomy) is a cosmetic procedure that can help correct signs of facial ageing in the lower face, jawline and neck.
It is a much more targeted and longer lasting approach than “non-invasive” approaches such as PDO thread lifts, as it directly addresses the foundation of your face.
However, a facelift is a surgical procedure and you should be very careful in who you allow to operate on your face.
How is a facelift performed
There are many ways to perform a facelift and can be done under both local and general anaesthetic depending on the degree of changes that need to be made.
I favour a problem based approach such that a personalised plan will be discussed with you to agree on a surgical plan to address your needs.
In general, facelift requires a type of anaesthetic, an incision to access the ligaments of the face, manipulation of face ligaments with carefully placed internal stitches and stitching of skin using precise and accurate stitching that does not distort your face unnaturally.
Patients with minimal ageing might qualify for shallower facelift techniques which limit the degree of skin undermining, involve manipulation of facial ligaments and therefore have a quicker recovery, less cost and risks.
More pronounced ageing might need deeper plane techniques which give a more dramatic enhancement but are more technically demanding therefore have more risks, cost and downtime.
What does a facelift correct.
Facelift largely deals with the lower part of the face.
It aims to tighten face skin and ligaments such that it reduces sagging and returns the face to a more youthful look.
The jawline is better defined, jowls are reduced, the skin looks firmer and less wrinkly and the upper neck is also tightened.
Overall, in the right patient the result can be dramatic and patients often find that they regain positive attention.
The goal is subtle youthfulness such that others cannot tell you’ve had a facelift but can see that you look vital, youthful and well preserved.
What is not corrected with a facelift.
Facelift does not correct the upper face including the forehead and eyelids. Upper face rejuvenation including browlifting, upper eyelid lift and eyebag correction will correct this area and can be combined with facelift.
The skin may also be aged showing sun damage signs, deep static wrinkling and irregularities that a facelift alone cannot fix. Chemicals peels and/or laser can also be combined with facelift to deal with the problem on many fronts.
The nasolabial crease that runs between the nostrils and corners of the mouth will be less pronounced but will not be fully obliterated with facelift alone. Microfat grafting in this area can also be combined with facelift for further gains.
Facial fat is a hallmark of youth. Fat in youth allows a seamless transition between different facial compartments resulting in the look we all recognise as youthful. Ageing reduces facial fat, such that new creases are created between facial compartments. This creates new shadows on the face that we all recognise as ageing. A lift and fill facelift adds microfat grafting to the face to plump up the face, reduces creases and shadows thereby increasing youthfulness.
Facelift helps tighten the neck just below the jawline but pronounced lower neck bands are not fully corrected with standard facelift. These require a formal neck lift involving tightening of the neck platysma muscle. In most cases, the operation required is therefore face and neck lift. Facelift alone without neck lift might cause a situation in which the face looks youthful and the neck looks older causing dissatisfaction. It is also more cost effective to have both than one.
Anaesthetic options
An awake local anaesthetic facelift can be performed as a day case.
I prefer to add sedation so that you are as relaxed as possible.
However, very few people will qualify for this option, such as those needing minor lifts i.e. early ageing changes.
This option will have less downtime, shorter hospital stay but might have more chance of occasional discomfort during surgery (although sedation reduces this) and the results might be less dramatic.
If you feel you might qualify for awake facelift, please use the “contact us” form or call the practice to book a consultation.
Most people will need or prefer a general anaesthetic to be asleep during facelift.
A consultant anaesthetist will discuss your particular risk factors with you.
If you have serious long term health problems such as heart, lung and hormone disorders you might be advised against undergoing any cosmetic general anaesthetic surgery at all or if appropriate, offered awake surgery.
The risks of general anaesthetic include chest infections, severe allergic reactions, clots to legs and lungs.
Most cosmetic patients are generally fit and have minimal risks with anaesthetic and my team takes great care to minimise these risks for you.
Potential complications
The hallmark of a good surgeon is in honestly discussing complications with patients.
My philosophy is to run a boutique practice with few, well informed and selected patients than a production line approach.
All surgeons suffer complications even if the operation is performed to the highest standard.
The complications can be minor including wound infections, temporary bruising and swelling which everyone gets to a varying degree, pain, temporary nerve numbness (around the scar and the ear lobe) and facial muscle weakening (especially corner of mouth droop).
All scars are red and thick to begin with and then mature over a period of 6-18 months. In some people, pathological scarring can be genetic causing hypertrophic and/or keloid scars. If you have had one of these scar types, any cosmetic surgery risks these happening again.
Injury to the facial nerve can lead to marked and permanent facial asymmetry.
Bleeds under the skin can cause blood collections called haematoma which must be drained quickly as they can cause skin necrosis.
An overdone facelift can cause cosmetic telltale signs such as a windswept look as well as distorting structures such as the ear button or tragus. I err on the side of subtlety.
There may be mild asymmetry between right and left but most people do not have a perfectly symmetrical face.
A pixie ear can result either from malposition or scar contracture and is correctable.
Most complications can be correctable and although they are rare, they can happen, and you must be aware of them before committing.
Downtime and recovery
A facelift takes around 4 hours to perform.
An overnight stay in hospital is usually preferred so we can monitor you and give you strong pain relief.
You might also have surgical drains to reduce buildup of blood or wound fluid collections.
Swelling of the face and eyes, bruising and some discomfort is to be expected but measures to reduce these will be started such as advice to sleep propped up with pillows.
Initial swelling and bruising will subside within the first week but overall it might be 3-6 months before the full result becomes apparent.
Week 1 is all about healing and therefore being at home, stress free to reduce blood pressure, with good nutrition and support from loved ones is encouraged.
Stitches will usually be removed at the hospital after 1 week.
In week 2 you can begin light tasks around the home and you’ll be able to drive again at the end of week 2.
You’re advised to stay off work until after week 3 unless your job can be done at home relatively stress free.
Lifting, such as a small child after 4 weeks is usually appropriate.
Heavy lifting and gym is usually allowed after 6 weeks.
These guidelines are meant to reduce risks of complications so it is crucial to follow them.
They are also general and your particular regimen will be discussed with you.
You will also have access to my team to guide you through.
Do I qualify for facelift?
The consultation is the crucial point at which I will gather your medical history perform a comprehensive facial analysis and discuss your suitability for facelifting.
We will also have a detailed discussion of the points discussed above to ensure that you are fully informed and that I am the appropriate surgeon for your particular needs.
I am a head and neck plastic surgeon with specialist training in all facial surgeries. I am well trained in facelifting techniques, and also regularly perform complex facelifts for people with facial paralysis.
I am also an expert in managing the facial nerve, the most feared structure during a facelift.
I will still be honest with you if I feel your needs are not ones I can meet and help suggesting other surgeons who may be able to offer you a better result.
What to do next
If considering facelift surgery, get in touch using the contact forms below and I’d be delighted to help you.