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Face

Face-Lifting Surgery

The effects of time, gravity, stress and other lifestyle factors gradually accrue in all men and women to produce typical ageing changes in the face. These changes include descent of the eyebrow accompanied by deepening forehead creases as our muscles act to try and lift the brow back up to its original position. Downward movement of the brow is accompanied by skin excess on the upper eyelids, producing hooding of skin over the eyelid itself. In the lower lid fine wrinkles develop and a bulge in the eyelid, which is accentuated by a deepening groove between the lid and the cheek as the latter moves downwards. To the side of the mouth, it is typical to develop a deepening crease and fuller fold (nasolabial fold), which in its lower part, as it crosses the jawline, produces the typical squaring of facial appearance due to increasingly prominent jowls. The skin of the anterior neck progressively loosens and is accentuated by the effect of the underlying superficial neck muscle, which produces very often two distinct lines in the area between the chin and the voice box. In some patients, fat accumulation under the chin accentuates the changes on the anterior neck.

The Surgery

Face-lifting surgery is relatively complicated but has evolved over the years to provide improved cosmetic outcomes whilst reducing risks of unfavourable results and complications. Face-lifting incisions, although relatively extensive, are largely hidden within the hairline and on the back of the ear. For most patients, the scars after face-lifting are of sufficiently good quality and concealment, so as to be unrecognisable to the vast majority of people during normal social interaction.

Face-lifting surgery involves tightening the skin and deeper tissues of the face and may be extended to the anterior neck to produce a tightening in the area below the chin if this is necessary to achieve the desired outcome. The main aims of face-lifting surgery are to re-tension the skin of the cheeks to provide a softer contour to the nasolabial fold, to reduce fullness over the jawline from the jowl and to tighten the skin on the anterior neck, in some cases restoring the more youthful angle between chin and neck that is lost with age. The aims are to restore a fresher, younger look.

Complications

Bleeding into the face-lifting wounds typically occurs within the first 24 hours and is managed by returning to the operating theatre in many cases for a brief anaesthetic to remove any collection and to arrest bleeding. When treated promptly, there are no long-term sequelae to this complication, which affects about 1 in 20 patients.

Infection produces redness, swelling, pain, fever, a feeling of unwellness and occasionally discharge from the wounds. Treatments is typically with antibiotics alone and in some cases may require re-admission to hospital and very occasionally, even additional surgery.

Because of the way in which the surgery is carried out the skin of the lateral cheek is inevitably numb in all patients. There is a small risk (2-3%) of damage to the nerves that provide sensation to the skin of the outer ear. There is also a small risk of damage to the nerves that provide facial movement. Many patients who experience a loss of nerve function will later enjoy a spontaneous recovery of function.

Delayed wound healing can affect some patients following face-lifting; this typically affects the area at the top of the ear, front and back. Such areas of delayed wound healing are typically managed by dressings alone and usually will heal without any significant, long-term sequelae.

Aftercare

Patients are expected to sleep in a relatively upright position for the first 2-3 days to help reduce swelling and bruising. Patients are routinely offered the opportunity to wash their hair the day after surgery with the assistance of the nurses who are looking after them. For the first 24 hours, the main goal is to remain comfortable and to limit activities. Thereafter, the emphasis is on recovering confidence with mobilisation so that the vast majority of patients will be fit to be discharged to their own homes after 48 hours.

Patients are typically seen a week after surgery for an early review to check wound healing and to remove some of the sutures and then again after 2 weeks for further wound check and removal of any residual stitches and clips. Late follow up is always organised (3-4 months) to assess the long term outcome and interim visits can be organised according to individual patient needs. Specific advice on wound care is provided for patients post-operatively.

Key Points - Facelift

• Face-lifting surgery aims to rejuvenate the face, giving a fresher and younger appearance
• Surgery is performed under a general anaesthetic with a 2 night stay in hospital post-operatively
• Appearances improve over the first 6-8 weeks, as swelling and bruising resolve.
• Office workers are usually fit to return to work after a fortnight

Neck

Along with typical ageing changes that affect the face, many patients ultimately become unhappy with the increasingly slack skin on the front of the neck, and the loss of the normal youthful angle between the jawline and the neck itself. Instead of a pleasing acute angle, this is progressively lost as the skin falls forward, and for some patients too, fat may accumulate under the chin.

Although it is occasionally appropriate to operate only on the neck, if this is the single aesthetic concern, in most instances the neck is tackled as part of a full facelift or in combination with a lower facelift. The reason for this is that the most pleasing results are achieved when the procedure is combined with face lifting, because of the opportunity to deal with the jowls and jawline, and the fact that neck lifting, combined with face lifting, provides the most dramatic aesthetic improvements.

Neck lifting surgery is conventionally performed through the same incisions as facelifting surgery, but entails a more extensive dissection across the anterior neck, often in combination with an incision made under the chin, which provides an opportuntity to remove unwanted fat and to tighten the muscle layers on the front of the neck at the same time.

Treatment of the neck alone, without face lifting, is possible, but represents a compromise in terms of the overall aesthetic benefits, although, for some patients, this may be the right approach.

Key Points:

• Neck lifting is designed to restore the youthful angle between the jawline and anterior neck.
• Neck lifting is typically combined with face lifting surgery