Face Lift

You can hide the signs of an ageing body in smart clothing but hiding the signs of the ageing face is not that simple. Stress, sun damage, smoking and gravity all show their effects in the face. The neck tissues become loose and hang, and the number of chins may multiply! Jowls form at the corners of the mouth and the jaw-line becomes less distinct.

Eyes look heavy and tired. A face lift will not make you a teenager again but it can take away the tired look away from the face and turn the clock back. This is done by tightening the muscles and deep tissues of the face, re-draping the loose skin of the face and neck into a taut position, and removing any excess fat beneath the chin.

A face lift can be performed on its own or as part of a total facial rejuvenation. In specific terms a face lift usually means a face and neck lift. It is designed to tighten the jowls and the loose neck skin. It does not lift the eyebrow (see brow lift) or smooth the lines around the eyes or mouth. All these procedures can however, be performed at the same time which naturally gives a more total and uniform facial rejuvenation.

Skin conditioning, laser resurfacing and the use of injectable materials such as Juvederm, Restylane or Botox, can further enhance the rejuvenation of your face. At your consultation with Dr Scamp, possible remedies for any specific problem you see in your face will be discussed in detail. Some patients wish for surgery to reshape their nose or other parts of their bodies at the same time as their face-lift. This is usually possible in most cases.

Would I benefit from a face-lift?

If you are 40 or over and have laxity of your jowls and neck tissues, then a face-lift can usually improve these features for you. There is no upper age-limit for a face lift as long as you are medically well. It is unusual to perform a face lift before age 40 unless there has been an exceptional amount of tissue ageing that has occurred.

This is sometimes seen in heavy smokers, severe sun damage, major weight fluctuations or after substantial stress or severe acne. A face-lift will not change your appearance. It is designed to turn the clock back. How many years it takes away is hard to quantitate and varies very much from person to person. Similarly, how long a face lift lasts also varies from person to person. Some people think that once you have had a face lift you need to go on having them as the tissues age faster.

This is untrue. Some people have a face lift once and then undergo no further surgery. On the other hand, some people enjoy the benefits of the face lift to the point where after 5 or 10 more years they may wish for a further touch-up procedure. Much of the duration of the face lift depends upon the individual’s lifestyle and their tendency to undergo further ageing. Remember a face lift will never remove all the lines or signs of ageing from your face.

It will freshen your appearance and turn the clock back but it will not make you young again.

What are the risks of surgery?

All surgery carries with it some risks. The risks common to all forms of surgery are: bleeding (haematoma) and infections. Infections in the face are uncommon as the face has a very good blood supply. They tend to occur more frequently in those who smoke as their circulation is poorer and the tissues are therefore not as resistant. Antibiotics are given at the time of surgery to reduce this risk. Bleeding after surgery may lead to formation of a large blood clot (haematoma) beneath the skin.

This may require returning to the operating theatre for removal. If it is too small to require removal, it will still result in excessive bruising and it will take you longer to get back to looking your best. The risk of haematoma is reduced by avoiding things that make you bleed (eg. Aspirin, vitamin E pills, arthritis pills, red wine, and smoking). Drains are usually placed at surgery to remove any blood that forms, but they will not cope with a large amount such as is seen with a haematoma.

A large haematoma may interfere with breathing or the circulation of the skin and require urgent removal The skin on the face and neck will feel numb after surgery and this can last for 6 months or more. This is because the skin is lifted as it is tightened and re-draped. Ears may also feel numb after surgery and this can be permanent on the rare occasion (one in a hundred). Sometimes a little hair is shaved where the incisions are placed but this skin is usually removed at the end of the operation so your hairline is intact again.

It will however, shift your hairline a little at your temples and behind your ears. This is usually not enough to be remarkable. A small patch of hair loss can occur in the first three to four months after surgery, but this is usually no bigger than your finger-nail and resolves as the hair re-grows at about four months. It is unusual for this to be visible.

The major risks of face lift are to the circulation to the skin. If the circulation is compromised too much a piece of skin can die and leave a scar. This is 10 – 20 times more common in those who smoke, and you will be asked to cease smoking six weeks prior to surgery to reduce this risk.

Retin-A and SkinCeuticals products may also help to reduce this risk. Smokers have compromised skin elasticity and get more relapses (return of the skin looseness) after surgery. The most worrisome risk of face lift surgery is damage to the facial nerve. This is the nerve that controls your facial expression, eg. raises your eyebrows, smiles, closes your eyes etc. Injury to a branch of the nerve can result in uneven movement of your eyebrows or eyelids or a crooked smile. Fortunately this is rare (approximately 1 in 1000 face-lifts).

Most of these nerve problems are temporary and resolve in the first four months. They can however, take six months or even as long as two years to settle. This risk is small but it is a significant risk and must be kept in mind. The advice you will be given before and after surgery is designed to reduce your risks as much as possible. Remember if you look good, we look good, and we want your operation to go as smoothly as it can.

Planning your surgery

If you wish you may contact Dr Scamp’s office in advance, (telephone number 07 5539 1000) and information on the surgery will be sent to you in advance. In general two consultations are preferred prior to surgery, but allowances can be made for people who live at a distance. At your initial consultation photographs will be taken and a range of surgical procedures will be explained to you in detail. The risks of these procedures will also be discussed and you will be given information to read on all of these things.

Other procedures that may assist you such as skin conditioning or injectable material such as Botox, Restylane or Juvederm will also be outlined to you. Dr Scamp’s staff will also provide you with an idea of the costs for these procedures. At the second consultation, Dr Scamp will answer any questions you have and discuss the surgery with your photographs. By this stage you will know what is involved in the surgery, the risks involved in the surgery and the costs.

You will therefore be able to explain to Doctor Scamp what you would like to achieve. He will then formulate a plan specific to your needs and wishes.

Preparing for surgery

Remember to: Cease smoking six weeks prior to surgery (this includes nicotine patches as well).  Avoid aspirin for two weeks prior to surgery. Avoid vitamin E pills (high dose) for two weeks prior to surgery. Let your hair grow a little prior to surgery. After surgery you can trim it to suit the new you. While it is a little longer it will make your scars a little easier to hide when they are in the more visible stage.

Where will my surgery be performed?

A face and neck lift can be performed as a day patient under general anaesthesia but often a peaceful night in hospital, helps a smoother recovery. If your brow, eyelids, nose, lips etc. are also to be corrected, then you are best to spend at least one night in hospital. You can stay in hospital for longer than a night if you so desire. In fact, the best time to decide when to go home is after the operation when you can judge how you feel and how quickly you are recovering. Individuals vary with the speed of their recovery.

What sort of anaesthetic will I have?

In general face lift surgery is best performed under general anaesthesia. Face lift surgery takes several hours and it is difficult for you to keep still for this long if you are undergoing a twilight anaesthetic. General anaesthesia is more comfortable for you and makes the surgery safer. Once you are asleep a long-acting local anaesthetic is injected beneath the skin to make it numb for 12 hours to minimise your discomfort.

What is done at surgery?

As mentioned above, the operation is specifically tailored to suit your needs and your preferences. Incisions are placed carefully around the ear to hide them and then up into the hairline where they are also hidden. Some fat is often removed from below the chin to smooth the contour of the neck. This is done by a fine incision and liposuction with small (2mm) canula. Initially, skin of the face and neck is elevated to expose the deeper muscle layer (SMAS-platysma).

This deeper layer is then also lifted and most of the tension of the lift is placed upon this layer. This means skin can lie in a relaxed and natural fashion and there is little strain upon the skin scar. If the anterior folds in the neck are severe, a one-inch incision below the chin may be used to expose these and repair them at the front as well as pulling from behind.

When the deeper layer has been tightened the skin is then carefully re-draped and sewn into position around the ears and into the hairline. Efforts are made to make this look as natural as possible and to disturb the hairline as minimally as possible. If required, surgery to the brow, eyelids, nose and lips is then performed. All incisions are closed with fine sutures or except in the scalp where metal clips are used to secure the wound without disturbing the hair. A soft padded dressing is applied to the face and neck and secured with the bandage.

After surgery

On the morning after surgery, the bandage is removed, the hair is washed and drains are removed. A velcro support is placed to help flatten the swelling beneath the chin and support the face. Ice packs may also be used to further reduce the swelling. You will be encouraged to rest sitting or lying head up to reduce the swelling to the face. You will find at first that the face and neck feels quite numb, as though it did not belong to you.

It will take approximately six months for the sensation to return completely, but you will see some improvement there within the first few months. Expect bruising and swelling for at least two weeks and some less severe swelling to persist for a few weeks thereafter. Your sutures and staples will mostly be removed by five or six days after the surgery.

This is to prevent them from causing any crease in the scar line. In the first four months after surgery you may get the odd patch (about 1cm) of hair loss. This will usually be hidden by the surrounding hair. As your tissues recover, this will disappear and is usually not a problem after four months. Expect your neck to feel quite tight. It may feel a little uncomfortable when you chew or talk or swallow. Your tissues will give and soften as the weeks go by. People tend to look worse than they feel after a face-lift.

Despite substantial swelling to the face on some occasions, there is usually little pain but just a generalised discomfort.

Getting back to normal

Usually by the time 10 – 14 days have passed, you can get around your normal duties albeit with the help of some make up as required. The swelling will not yet be completely resolved at this stage. Gradually resume your normal physical activities. Avoid vigorous exercise for a further two weeks, as this may be uncomfortable or promote further swelling. You will be attending the surgery for massage after the operation. This is designed to reduce the swelling of your face and help you recover faster. Advice on camouflage make-up will also be given if required.

The new you!

By three weeks people are generally very pleased with their new appearance. There will still be some swelling along the suture line, which may feel bumpy. This will pass with additional time.

The neck and face may still be tight at this stage but they should be becoming more comfortable. Write down any questions you may have and ask Doctor Scamp or his staff at your consultation.