As the years go by, the skin of the face and neck begins to loosen. The jaw line softens into jowls(fig 1 a) and beneath the chin, another chin or vertical folds appear at the front of the neck. The angle formed by the lower jaw and neck gradually flattens losing its youthful sharp angle (fig 1 b). Heredity, personal habits, and the pull of gravity, as well as sun exposure contribute to the ageing of the face.
A facelift is one of the most popular facial plastic surgery procedures for rejuvenating the overall appearance of the face. The purpose of a facelift is to restore the youthful cheeks, lower face and neckline you had years ago. It is designed to remove excess skin and accumulated fat, and to repair stretched out muscles, but cannot eliminate fine wrinkles or pigmentation of the skin associated with long term sun exposure. Facelifts reduces many of the signs of facial ageing such as skin laxity, jowls, and deep wrinkles (fig 1 c) and creases around the face. Properly performed, a facelift makes you look younger and fresher, certainly not different.
The best candidate is a man or woman whose face and neck soft tissues have begun to sag, but whose skin still has some elasticity and whose bone structure is well defined, around 45 to 55 years old.
The modern French-style facelift cannot stop ageing. It turns back the clock, but does not stop it! In most cases, you will look ten to fifteen years younger following surgery… and you will maintain this age difference forever.
During the preliminary consultation, the surgeon will examine the structure of your face, skin texture, colour, and elasticity. Photographs will be taken so the surgeon can study your face. Individual risks will also be examined, especially those related to medical situations such as high blood pressure, a tendency to scar, smoking, and any deficiency in blood clotting. The surgeon will take a thorough medical history.
After the decision to proceed with a lifting is made jointly by you and your surgeon, the surgeon will describe the technique indicated, the type of anaesthesia, the surgical facility, any additional surgery, the pros and cons to include possible complications of the procedure.
Dr Nouwen uses France’s new technique of facelifting: the Mini-Dissection. Thanks to this special approach, a maximum result is obtained using minimum surgical dissection, therefore causing less swelling, less surgical risks and a long lasting natural look.
The surgeon begins the incision (fig 2 a) in the area of the temple hair, just above and in front of the ear, and then continues around the lobe, circling the ear before returning to the point of origin in the scalp. An incision in the skin where hair growth is made in an oblique fashion to leave the hair follicle in place (fig 3 a). Within two weeks, hair grows through the scar (fig 3 b). In all cases, the incision is placed where it will fall in a natural crease of the skin for camouflage. Small modifications are made with men in order to avoid distorting the sideburns and other hair-bearing skin
The skin is dissected (fig 2 b) and deeper tissues are carefully lifted and pulled up (fig 4 a) for the face and up and
back (fig 4b) for the neck, to the natural position they had 10 to 15 years before surgery, in order to tighten the lower face and upper neck regions.
Great care is taken to smooth out the jowls without creating an unnatural or “operated on” appearance.
Occasionally, a small incision is made under the chin in order to gain access to sagging skin or muscles in this area. Sometimes, excess fat (liposuction) can be removed or some of the neck muscle tightened in this region.
The skin is then simply draped. Excess skin is tailored meticulously to avoid any tension in the scar. The incisions are closed in multiple levels. Pre-auricular incision is closed by a very fine suture removed the 6th day after surgery while the incisions within the hair are closed with very fine self-dissolving suture.
Drainage tubes are inserted during surgery. You will have a bandage all around your head.
Depending on the extent of the surgery, the process can take from one and an half to two hours. The procedure is usually performed with a combination of mild sedatives, local anaesthesia, and a mild intravenous anaesthesia and is carried out on an outpatient basis.
Once the operation is over, the medical team will take you back to your room, where you will start recovering your senses. Partial palsy is not uncommon for the first hours after surgery, due to local anaesthesia.
Most patients experience very little pain after surgery. Some degree of swelling and bruising is unavoidable, and your surgeon may instruct you to use cold compresses to keep swelling to a minimum. The surgeon will also instruct you to keep your head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort. There will be a sensation of tightness and possible numbness around the ears for a few weeks
The drainage tubes are removed a few hours after the surgery (fig 5) and your surgeon will remove the bandage in order to inspect the areas. A clean dressing is done before you are then taken to your hotel room. Once you return to your hotel, it is best to relax with your head elevated, such as in a reclining chair or in bed with multiple pillows. Keeping your head elevated will minimize swelling. The incisions are all protected under the bandage so no specific wound care is needed.
The first post operative day, your surgeon will remove the dressing. The wounds will be thoroughly clean and a smaller dressing reapplied (fig 6). This remains in place for 24 hours. The second post operative day is essential as all the dressings are completely removed during the day. From this point on, the incisions are exposed and it is imperative that they are kept clean and covered with a layer of ointment. They can be washed with warm water and regular soap. You may shower and shampoo within 48 hours of surgery. Avoiding sun exposure is essential during this recovery period. You may wear a dressing at night in order to feel more comfortable, as long as needed.
Pre-auricular suture are removed 6 days after surgery, while the very fine suture within the hair will dissolve on its own within two weeks.
Camouflage make-up can be applied over the bruised areas to better conceal them. At times the bruising will migrate down onto your chest. This is perfectly normal and only reflects the effects of gravity. Like all bruises, they will pass through different colours and intensities. Once the bandages are removed, you will be instructed on specific wound care, such as cleaning the incisions and liberal use of a moisturising ointment.
Recovery usually takes one to two weeks, though many patients go back to work in one week (fig 7 television presenter at work 6 days after lifting) .
Scars are usually not noticeable after enough time has passed for them to mature. In any case, they are easily disguised in natural skin creases (fig 8 a), by the hair (fig 8 b), or, in persistent cases, by make up until total healing has occurred. Final healing may take up to 3 months and your appearance will continue to improve
What are the possible complications?
All surgical procedures have risk. Although most procedures are successful, medicine is not an exact science and no one can guarantee that you will have the desired outcome. Your surgeon will openly discuss the risks and complications of any procedure with you.
The potential for complication include: bruising, swelling, sensitivity to anaesthesia, asymmetry, infection, nerve injury and poor healing.