Facelift

What is a Facelift?

A facelift is a cosmetic surgical procedure that lifts and tightens the soft tissues of your face and neck. It also addresses wrinkles, fat deposits, sagging and loose skin and other visible signs of ageing on your face.

Facelift surgery can restore your face to its firmer, more youthful contours leaving you with a fresher, more vibrant yet natural looking appearance. Studies show that facelift surgery can reduce the perceived age of your face by an average of nearly 8 years.

Why you may need a Facelift?

The way your face ages is largely genetic. It’s also influenced by your health and fitness, weight, sun exposure, smoking, and chronic over-expression (such as squinting in outdoor workers). 

People consider getting a facelift when they notice changes in their face including loss of shape, wrinkling skin, tired looking eyes, droopy cheeks and sagging mouth.

Ageing in your face happens in the following areas:

• Structure: When your underlying bone and facial soft tissue lose shape, it can prematurely age you. For example, a small chin may lead to an early loss of jaw line definition.
• Gravity: Over time the effects of gravity pull your brow, jaw line, neck tissue and cheeks downwards. There may also be laxity or loosening of tissues around the folds of your mouth or eyes.
• Volume: When you were younger, your face had full and plump facial tissue. Over time, the loss of volume in parts of your face like the cheeks or lower eyelids can result in a drawn or tired appearance.
• Texture: During the ageing process your skin texture changes. This results in wrinkling, loss of elasticity, pigment changes, broken veins and dry patches due to sun damage. Textural skin changes are usually more prominent in fair skin.

Who is it for?

Facelift is an option for people who feel that their face is ageing, where non-surgical treatments are not sufficient, and where they are in good health and of a healthy weight. It’s important to note that most surgeons will not perform facelift on active smokers.

People who are most likely to benefit from a facelift have one or more of these signs of ageing:

• You have deep folds in your skin on the sides of your nose and mouth,
• Your cheeks have begun to sag, or
• You have developed a double chin or folds in the skin of your neck.

If you’ve got signs of ageing in other parts of your face, your surgeon may suggest that you consider treating these first or at the same time as a facelift. Treating droopy eyelids or eyebrows can often be the most effective treatment to make you look younger.

Before deciding if facelift surgery is suitable for you, your surgeon will carry out a detailed assessment. This may include taking photos for your medical records and asking you questions about your medical history. For the operation to be successful it’s important that you have good bone structure and that your skin has elasticity. If you’re planning on losing a lot of weight, your surgeon may delay the surgery.

How is Facelift surgery performed?

There are a range of procedures used in facelift surgery that include:

• A brow lift, facelift, temple lift, cheek lift and neck lift.
• Volume correction procedures including facial implants, bone substitutes, fat cell grafting and other filler injections. These improve specific areas of atrophy, loss or flattening of volume.
• Skin improvement procedures that are either surgical or non-surgical. A skin maintenance plan can be established where it's needed, including laser, peels, dermal fillers and Botox.

During the facelift procedure, your surgeon makes incisions around your ears and in the folds of skin joining your ear to the head. These incisions may extend up into your temple, and down along the hairline behind the ear. In some cases, a short incision under the chin is made.

Through these incisions, the skin and deeper layers of the face are carefully lifted, tightened, trimmed and repositioned. Every facelift operation is individually designed to meet the needs of the patient. Some facelifts will be rapid recovery or minimal scar procedures, while some may be a major operation (like the SMAS procedure).

The type of facelift procedure you have will depend upon the pattern of ageing, your preferences, the facial assessment by your surgeon and the degree of training, skill and experience of the surgeon.

A facelift operation is performed under a general anaesthetic and usually takes two to three hours. You may also have injections of local anaesthetic to help with the pain after the operation. To reduce the risk of infection, you may be given antibiotics during the operation.

The most common type of facelift is called the SMAS facelift, which goes deeper than traditional facelift surgery to lift and reduce sagging jowls, loose necks and cheeks. The SMAS facelift also tightens the deeper layer of tough tissue under your skin.

Are there different types of Facelift surgery available?

SMAS facelift

Your surgeon will make an incision on both sides of your face. Each cut starts in your hairline above and to the front of your ear, along the natural creases of the skin in front of your ear, around your ear lobe and along the hairline behind your ear. They then separate your skin from the SMAS layer in the area of your cheeks and neck. They cut under the SMAS layer, and lift it upwards to tighten it.

Your surgeon will tighten your skin upwards towards your ears and remove any excess skin. Sometimes your surgeon may make a small cut under your chin to remove any excess fat and tighten the muscles. Tightening the SMAS layer can give you a better facelift that lasts longer.

MACS facelift

The MACS facelift is a variation of the SMAS facelift, where your surgeon tightens the SMAS layer with suspension stitches to avoid cutting underneath it. This involves less surgery but the results may not last as long.

Other types of facelift

These include the composite facelift and mid-facelift and involve lifting up the deeper layers of the face. If you have sagging cheeks and upper face, these facelifts may be a better option.

What’s the recovery time after Facelift surgery?

After facelift surgery, your face will look bruised and feel swollen. It may take up to two weeks for this swelling to settle. You should be able to go home the same day or the day after. However, your doctor may recommend that you stay a little longer.
If you do go home the same day, a responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. If you are worried about anything, in hospital or at home, contact your healthcare team. They should be able to reassure you or identify and treat any complications.

Facelifts and brow lifts require bandaging. Most other procedures have minimal or no dressing. Drain tubes are not generally required. With most procedures we place protective ointment in the eyes, so vision may be blurry on waking up.

Most facial procedures result in discomfort, rather than pain, however medication will be given to limit any pain and nausea. The operated area may remain numb because we use local anaesthetic to minimise discomfort.

We encourage fluids by mouth as soon as possible after operation. We may place ice packs on the face to minimise bruising. Dressings at home are usually only a face form Lycra compression device, and a soft neck collar. These can be put on and taken off by the patient.

At home you should set yourself up in a comfortable chair, couch or bed, with your head elevated. It’s important not to overstretch your mouth or neck for about two to four weeks. The food you eat should be in small, bite-sized pieces, which require minimal chewing. This lets the tissues, which have been tightened heal without stretching. During your recovery from facelift surgery, it’s vital to maintain an adequate fluid intake.

Driving can be resumed once you are comfortable, can react quickly if necessary, are not taking strong painkillers and can see normally. After facelift or eyelid surgery, you can usually resume driving after seven to 14 days. It’ recommended that you avoid heavy exercise for at least three to six weeks following surgery.

Obvious bruising and swelling will be visible for around two weeks, however it takes around two months to fully subside. If you have social events, you may be self-conscious about your bruising for at least two months.

What results can I expect from Facelift surgery?

It usually takes a few weeks for your face to look and feel more natural. The results of a facelift last for a long time. Your face will still continue to age but should always appear younger than if you had not had surgery.
Some patients feel uncomfortably tight around the neck area at first. This is normal. Lumpiness under the skin is common in the first few weeks, but is usually more felt than seen.

Facelifts change the hairline around the temple area. In some patients, there is temporary hair loss in the temple area due to the ‘stress’ of surgery on the hair follicles.

Males having facelifts need to be completely aware of the potential visibility of the incisions, the changes in sideburn position, and the scar position in relation to their ears.

A period of psychological adjustment is common after facelifts. Patients often go through a variety of moods postoperatively. As they recover, and the postoperative period of swelling, fresh wounds and bruising passes, patients feel more positive. After a month or so, most feel extremely positive.

Are there risks or complications with Facelift surgery?

Any surgical operation brings complications of anaesthesia. Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.

General complications of every surgery include:

• Pain. Your healthcare team will give you medication to control the pain. To reduce discomfort and prevent headaches, it’s important that you take the medication.
• Blood clot in your leg (deep-vein thrombosis – DVT). This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. Your healthcare team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medication, or special stockings to wear. Let the healthcare team know straightaway if you think you might have a DVT.
• Blood clot in your lung (pulmonary embolus). If a blood clot moves through your bloodstream to your lungs. If you become short of breath, feel pain in your chest or upper back, or if you cough up blood, let the healthcare team know straightaway. If you are at home, call an ambulance or go immediately to your nearest Emergency department.

What are the specific risks and complications of Facelift surgery?

Scarring: All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different colour than the surrounding skin tone. Scar appearance may also vary within the same scar and may be asymmetrical). It’s possible to get visible marks in the skin from sutures. In some cases scars may require surgical revision or treatment.

Previous Surgical Scars: The presence of surgical scars from previous facial surgery may limit the amount of skin tightening that can be produced.

Nerve Injury: Motor nerves may be injured during a facelift operation. This is rare, but if it occurs it can cause weakness or loss of facial movements. Nerve injuries may cause temporary or permanent loss of facial movements. These injuries may improve over time.

As skin is elevated in facelift surgery, it’s normal for the patient to have some loss of sensation to the skin of the lateral or outer cheek. Sometimes, loss of sensation around the ear or the neck can occur. This is not usually a problem, nor is it visible. Most loss of skin sensation, if it occurs, improves over time. Often some patchy permanent sensation loss to lateral face areas of the skin occurs.

Healing Issues: Certain medical conditions, dietary supplements and medications may delay and interfere with healing. Patients with diabetes or those taking medications such as steroids on an extended basis may have prolonged healing issues.

Smoking will cause a delay in the healing process, often resulting in the need for additional surgery.

There are general risks associated with healing such as swelling, bleeding, possibility of additional surgery, prolonged recovery, colour changes, shape changes, and infection.

Patients with significant skin laxity or after major weight loss will continue to have the same lax skin after surgery. The quality or elasticity of skin will not change and recurrence of some skin looseness will occur at some time in the future, quicker for some than others.

There are nerve endings that may become involved with healing scars from surgery. While there may not be a major nerve injury, the small nerve endings during the healing period may become too active producing a painful or oversensitive area due to the small sensory nerve involved with scar tissue. Often, massage and early non-surgical intervention resolves this. It is important to discuss post-surgical pain with your surgeon.

Bleeding: It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require treatment to drain accumulated blood; this isn’t dangerous. Bleeding under the skin can cause lumpiness, which takes time, even months, to resolve.

Increased activity too soon after surgery can lead to increased chance of bleeding and additional surgery. It is important to follow postoperative instructions and limit exercise and strenuous activity for the instructed time. Do not take any aspirin for at least ten days before or after surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding.

Infection: Infection is unusual after facelift surgery. Should an infection occur, additional treatment including antibiotics, hospitalization, or additional surgery may be necessary.

Firmness: Excessive firmness can occur after surgery due to internal scarring. The occurrence of this is not predictable. Additional treatment including surgery may be necessary.

Change in Skin Sensation: It’s common to experience loss of skin sensation in the areas that have had surgery. This may not totally resolve.

Skin Contour Irregularities: Contour, shape irregularities and visible wrinkling of the skin may occur. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility when there is excessive redundant skin. This may improve with time, or it can be surgically corrected.

Major Wound Separation: Wounds may separate after surgery. Should this occur, additional treatment including surgery may be necessary. Major wound separation after having a facelift is extremely uncommon and is correctable.

Delayed Healing: Wound disruption or delayed wound healing is possible. Some areas of the skin may not heal normally and may take a long time to heal while some areas of skin may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Patients who have decreased blood supply to tissues from past surgery or radiation therapy may be at increased risk for wound healing and poor surgical outcomes. Smokers have a greater risk of skin loss and wound healing complications.

Sutures: In facelift surgery, there are a number of deep sutures. Some skin sutures are removed a week after surgery. In hair bearing areas, skin staples are often used. You may notice these sutures after your surgery. Buried dissolving or permanent sutures may occasionally cause a small lump or even spontaneously poke through the skin, become visible or produce irritation that requires suture removal. This is rare.

Damage to Deeper Structures: There is the potential for injury to deeper structures including nerves or blood vessels, during any facelift surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.

Pain: You’ll experience some tightness and discomfort after your surgery. Pain after a facelift is not severe in general.

What are the alternatives to having a Facelift?

A facelift is the most effective way to reduce sagging in your face and neck but will not help to reduce the fine wrinkling around your mouth, eyes and forehead as this is caused by the action of your muscles.

Your surgeon may be able to assess you for resurfacing or injecting Botox to smooth out fine wrinkles. Deeper wrinkles can sometimes be filled out using implants.

A thread facelift uses stitches to lift sagging tissue and does not involve any cuts. However this is suitable only for some people and the effects may last less than a year.

Droopy eyelids or eyebrows can be treated using other surgical techniques and you may want to consider these first or at the same time as a facelift.

Fat grafting involves injecting fat from other areas of your body into your face to make your face look more full. It can be performed instead of, or after, a facelift.

How do I choose a Facelift Surgeon?

A facelift is a cosmetic operation to make your face appear younger. You should consider the options carefully and have realistic expectations about the results.

Surgery is usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.

Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. The face is not symmetric and almost everyone has some degree of unevenness, which may not be recognized in advance. One side of the face may be slightly larger, while the other side of the face may be droopier. Some issues with your face may not be fully corrected with surgery. The more realistic your expectations as to results, the better your results will be,

You can find the best Facelift Surgeons in Australia here.

Key facts

• Choosing to have facelift surgery is a big decision. It usually involves up to a month of recovery time.

  After facelift surgery your face should look younger. Most people who have a successful facelift are more comfortable and confident with their appearance.

• All patients having facelift procedures where the skin is undermined become numb in the cheek and temple area, in front of the ears, and sometimes in the upper neck. This may last for weeks or months and feels odd but will generally improve over time.

  Facelifts can change the hairline around the temple area. Not all hairstyles are compatible with a facelift.

• Males having facelifts need to be completely aware of the potential visibility of the incisions, the changes in sideburn position, and the scar position in relation to their ears.

• Driving can be resumed once you are comfortable, can react quickly if necessary, are not taking strong painkillers and can see normally. After facelift or eyelid surgery, you can usually resume driving after seven to 14 days. Heavy exercise is to be avoided for at least three to six weeks following surgery.

• The complications related to facial rejuvenation surgery include bleeding, requiring return to the operating theatre (haematoma), infection, skin or wound breakdown, small lumpy blood clots or scar tissue under the skin, nerve injury resulting in temporary or permanent loss of movement of part of the face, poor or obvious scarring, development of new wrinkles or creases in the skin on expression, and asymmetry.

• A period of psychological adjustment is common after facelifts. Patients often go through a variety of moods postoperatively. As they recover, and the postoperative period of swelling, fresh wounds and bruising passes, most people feel positive.

Important to know

So you can make an informed decision, your elected surgeon will discuss the possible risks associated with a facelift. Although the majority of patients do not experience these complications, it's important to understand how they can be managed in the event that they occur.