Face the facts: The truth about facelifts

Ageing is more than skin deep

It is absolutely true that the skin on the face sags and wrinkles as time goes on. However, it is not just the skin that ages and causes the face to look older. Muscle and fat also change, leading to sagging and loss of volume. The muscles of the face actually connect to the skin, and the overlying fat pads also change with time. When fat decreases and moves from its natural position, the skin is less supported and we see lines and jowls. In addition, we lose bone with time, which can lead to changes in the bone structure of the face.  The skin probably wrinkles mainly due to sun damage and cell changes such as loss of elastin, thinning of the skin and repetitive muscle movement. It is likely a combination of these factors that cause wrinkles in any particular person and the skin will vary in different parts of the face, which is why experts adopt different strategies for treating different areas of the face. So, we need to address muscle, fat and skin when we perform a facelift- and that is why we call this operation ‘facial rejuvenation surgery’. Also, we do not want to change the person’s looks completely, because everyone has different bone structure and muscle shape which makes their face unique. We want to wind back the years, not make the person look like someone else. So, modern understanding suggests that a combination of a lifetime of muscle movement and the effect of gravity on tissues as we age result in loss of the youthful curves of the face. There are a few points to note here; the effect of gravity and the loss of volume tend to lead to tissue sagging and loss of the typical heart shape of a young face. Prompted by the development of less invasive techniques-such as Botox and fillers to lessen the need for frequent small ‘top-up’ operations- a more detailed understanding of the effect of ageing on the face has developed. A good analogy for the muscle and skin relationship is to think of the skin as a dress and the muscles as the mannequin- when the dress is loose it is because the mannequin has got smaller! The skin drapes over the muscles and so if the muscles are tightened, the skin drapes more tightly over them. This is the principle of surgical ‘corset’ facelifts which are used to treat the mid face. It also demonstrates why the particular muscles of one area of the face- the lower face and neck, often referred to as the ‘jowls’- are key to understanding how facelifts work. The muscles of the neck and face and the sequence of movements they allow when we talk and eat has been so well studied that it forms the basis for developing the modern understanding of face ageing. This modern theory is based on particular sets of muscles consistently showing the effects of ageing, which can also be seen to relate to the changing bony anatomy and the skin changes. It is fascinating how academic research and patient observation together help surgeons to refine operations and get closer to the ideals of achieving a long lasting, reliable and effective operation to help patients look younger prolongedly with minimal risk. And it is this meticulous academic approach with the embracing of newer, more targeted operations that provides the specialist surgeon in facelifting with an ever improving range of techniques. Every person is different so the big challenge is to understand what a particular patient’s needs are and to subtly shape the operation to achieve the best outcome for that person.

Where are the scars?

Often, patients are worried about scarring after a facelift. The modern surgical techniques used have led to scars becoming less and less of an issue for patients. Incisions are made along the hairline in the temples, continuing around the ear and ending in the lower scalp. This means that the scars can be well-hidden. In some cases, an incision may be made within the lower eyelid or under the upper lip, in order to improve the appearance of the skin. However, it should be noted that this is not common and it may not be suitable for all patients. The type of facelift you have will impact both the length and the location of the scars. For example, a mini facelift is less invasive and so the scars will be smaller and easier to hide. Mini facelift scars are usually no longer than about one inch and are placed near the temporal hairline. On the other hand, a deep plane facelift has a longer recovery time and more swelling after surgery, but you will ultimately have a more natural looking result. The technique does have a higher risk of nerve or muscle damage so it is important to discuss the options with a surgeon. The deep plane facelift scar usually goes inside the ear, starting in the front and extending around the earlobe and back into the hair behind the ear. The other common type of facelift is a standard facelift which involves longer incisions which extend from the temple, continue around the ear and end in the lower scalp. The scars from a standard facelift can generally be well concealed by the hair. On the whole, the scars will be quite noticeable in the immediate aftermath of the surgery and can take up to a year to fully mature. However, they generally become less and less noticeable as time goes on. As scars in a visible area of the face may be more worrying for patients, it is important to discuss the options with a surgeon and make sure any concerns are addressed before making a decision to have a facelift. Another thing to note is that smoking, for example, can slow down the healing process and affect scarring. So, it is important to follow all surgeon’s advice to ensure the best results.

What are the options?

Face lift surgery options include standard, liquid, and other types of lifts. A standard face lift is focused on eliminating excess fat in the lower region of the face. After the procedure, the skin is moved upwards creating a tighter and youthful appearance. In the standard face lift procedure, the surgeon makes an incision above the hairline which continues around the ear and stops in the lower scalp region. The skin is then separated from the fat and muscles. The surgeon will then tighten the muscles in the lower face before removing any excess skin. The skin is then pulled upwards and the surgeon will naturally find the correct level to secure it. This is the most common procedure used and is suitable for both male and female clients. However, other procedures include liquid and short scar lifts. A liquid face lift is a non-invasive procedure that focuses on injecting substances in the skin to produce a firmed and fuller appearance. Often, people will opt for a liquid face lift as a preliminary minor surgery before moving onto a more major face lift operation. A liquid face lift procedure avoids any incisions in the skin and operates by injecting dermal fillers administered through a small, fine needle. These will be focused on the lower two thirds of the face, identifying key injection points around the cheeks, lines from nose to mouth, and lines from mouth to jowl. However, as the impact of a liquid face lift is less dramatic than standard face lift surgery, results will last for between 12 and 18 months. Also, the skin will gradually return to its prior condition and the procedure will need to be repeated with longer intervals between successive liquid face lift operations. Compared to standard and liquid face lift operations, short scar lifts are a relatively new method involving a smaller incision and less skin tension. As a result, recovery times and the risk of visible scarring is reduced and people are able to return to their normal daily activities more quickly. A short scar lift focuses on the area around the ear and is commonly used by younger clients in comparison to a standard lift procedure. Whether a liquid, short scar, or standard face lift, all of these options should be discussed with a qualified surgeon in a pre-operation consultation. By exploring the range of face lift surgery options available, you can decide which type of procedure is right for you in line with your preferences and long-term aims.

What you need to know?

Recent increase in the uptake of non-surgical facial rejuvenation procedures such as botox and dermal fillers are observed nationally.  It is seen as the significant breakthrough in the field as these procedures are described as safer, quicker and offer virtually no recovery time compared to traditional facelifts. Another advancement is the use of surgical navigation technology. This technique has emerged as a state-of-the-art facility for achieving high accuracy in plastic surgery.Individuals are advised to seek appointments with their GP after six weeks. By this time, the healing process started and the bruising and swelling should have already started to go down. The purpose of this consultation is to examine the healing process or detect any abnormal signs so that earlier precautions can be made if required. However, with the Private Healthcare Act in place, one can only claim for compensation based on the provisions.

Facelift surgery is major surgery, performed under general anaesthetic, and can take up to two years to completely heal. The success of the operation is not only dependent on the surgery and the skills of the surgeon, but also on how well the individual follows the after-care instructions. Most people are happy with the results, but it’s a personal thing – no one else can tell you how you will feel after having the surgery. Having a facelift will not stop you from getting older, but the aim is to set back the clock at the end of the operation. It’s also important to remember that the ageing process continues after the operation and this can be influenced by lifestyle, as well as things such as exposure to the sun, smoking, changes in weight and stress. Facelift surgery is not a procedure to be taken lightly. It is important that you have a clear understanding of what is involved. This includes the nature of the operation, the benefits and risks of the procedure and the after-care required. You will need to have at least two weeks off work, particularly if your job is customer-facing or involves lifting or carrying. Some people take up to three weeks, depending on the level of bruising and swelling. It is also advisable to have someone with you for the first few days after you leave hospital, to help out around the home. Also, have someone to drive you home and be prepared to stay over in the hospital for at least one night, possibly two. And it is also important to note that the physical side effects of a facelift will be bruising and swelling, although these will start to subside after a few weeks. However, it can take six months to see the benefits of the facelift and up to two years to see the complete healing of the scars. It is worth arranging your post-operation care ahead of time, such as any visits to your surgeon or dressing changes that may be needed. Your nurse or doctor will give you advice about caring for your wound and the stitches used, to ensure a smooth recovery.

Facelift information

The modern trend in facial cosmetic surgery involves procedures such as facial fillers, laser treatments, and skin treatments such as estheticians. However, none of these noninvasive treatment modalities can achieve the changes possible with a surgical facelift. The operation, which helps to correct the sagging of the facial soft tissues, is a complex and highly individualized procedure. Variations in how the face ages, as well as in patient anatomy, in the size and shape of their facial bones, and in the thickness and elasticity of their skin, structure the available choices in surgical treatment. While many surgical choices exist, the comprehensive nature of the soft tissue lifting from a well-performed facelift is associated with the most durable and predictable degree of change possible through surgical intervention.

How to look good for your age?

Make sure to stay safe when trying things like skin peels or micro needling. It might be best to have beauty procedures like Botox or dermal fillers in a professional clinic, which will have proper safety measures in place. Always talk to a qualified doctor before having any sort of non-surgical cosmetic treatment – if you decide to have Botox or dermal fillers in a beauty salon rather than at a clinic, you should also discuss with a healthcare professional what the best treatment is for you. Support is also very important: remember that some beauty treatments that you might undertake over weeks or months, such as chemical skin peels for acne, will require a regular self-care regime at home to make sure that you get the best result. Be sure to seek advice from a professional about what the most important steps are in your everyday routine. And also – mutual support with friends and family really can make the world of difference to how someone might feel about improving themselves and going forward with a treatment. Always make sure that the beauty clinic and the beautician are fully registered. The law requires that any clinic offering ‘special’ beauty treatments of any kind are licensed by the local council. If a beautician comes to your house or if you have treatments in a place that isn’t a clinic or a licensed beauty salon, you should check very carefully. The General Medical Council is a good place to start if you’re concerned that a particular beautician or surgeon might not be fully certified or might be practising in a place that isn’t registered – you can search a list of every doctor registered to practise in the UK on their website.  Any reputable beauty clinic will take patient safety very seriously and will be more than happy to talk to you about their safety measures and regulations. In fact, by law they have to display their most recent CQC report somewhere public in the clinic, so don’t be afraid to ask where it is. It’s also good to remember that sometimes the beautiful city or town you visit might actually be more of a problem than the place you’re having the treatment in. For example, in areas like London and Manchester where there are many beauty salons and surgeries effectively on top of one another, there’s a lot of competition for customers. This can sometimes mean that places can be less thorough in their safety checks and patient care just to make their costs cheaper. Well-established, rated beauty clinics and companies are a much safer bet than a short-term place that’s offering a bargain. And don’t forget that beauty clinics can still show lots of new and innovative ways of enjoying a bit of luxury and relaxation. Just make sure that you find out where the treatment comes from and speak to professionals in registered places wherever possible. Always remember to put your safety and the safety of others first – if you ever notice that someone wasn’t following proper safety guidelines or seemed to be practising without the right licences, you should contact the local council so that action can be taken. After all, not only could you be keeping yourself and your loved ones safe, you could also be helping someone else who might not have the confidence to speak out on their own.

Further facelift information

When a surgeon performs a facelift, he or she will lift up the skin in the face and neck and tighten the muscles underneath. This creates a rejuvenated and youthful appearance. The term « SMAS » stands for Superficial Musculo-Aponeurotic System, which is the group of muscles that is tightened in a SMAS facelift. When a SMAS facelift is performed, the SMAS tissues are repositioned, which lifts up the jowls, cheeks, and neck. The overlying skin is also lifted to be re-draped over the newly rejuvenated facial contours. SMAS facelifts are said to be the most effective type of facelift, which is why a SMAS facelift is commonly performed. This type of facelift surgery is often used to target the mid-face and lower face. This is the area between the corners of the mouth, the jawline, and the ears. On the other hand, « MACS » is an abbreviation for Minimal Access Cranial Suspension. This is a far less invasive type of facelift than the traditional facelift or SMAS facelift, and it mainly targets the lower two-thirds of the face, such as the jowl, cheeks, and neck. In this type of facelift, a short scar is used so that the incision will not be extended into or towards the hairline. Next, « SMAS lifting » is a term used to describe the surgical technique associated with a SMAS facelift. When the SMAS is identified and surgery is performed on this layer, it is referred to as a SMAS lifting procedure. The other method is to perform a « cheek lift » in a facelift surgery, which can also be known as facelift cheeks or mid-face lift. In this approach, the doctor will lift the soft tissues and skin in the cheek and mid-face areas, so as to rejuvenate the contours of the cheeks and the upper lip. The cost of SMAS facelift may differ in different regions. In the UK, it is found that the cost of SMAS facelift ranges from £4700 to £6500 . However, it is noted that the actual cost may vary depending on a number of factors, such as the clinic location and the expertise and qualifications of the surgeon. For example, a clinic in London or a well-renowned surgeon may charge at a higher price. Some other important factors to be taken into consideration include the operating facility and the post-surgery follow-up. Some clinics may cover these costs as part of the total charge, while others may require patients to pay separately. Also, patients who undergo SMAS facelift can also consider additional or combined procedures. For instance, alongside the facelift, they can have ‘blepharoplasty’ to remove the excess fat in the upper eyelids and reduce the bagginess or an ‘endoscopic’ brow lift. On the other hand, some non-surgical alternatives to facelifts include Botox and dermal fillers, which are easier to be performed than a surgical operation and have shorter recovery time. However, it is noted that the results of these treatments may not last as long as from a surgical facelift. Botox works by relaxing facial muscles so that the overlying skin will not wrinkle, while dermal fillers use naturally occurring substance in the body to add volume to the skin and ‘plump up’ the wrinkles. Also, these non-surgical treatments need to be repeated regularly, which may add up to be more expensive than a facelift surgery.