Face-lift is a surgical intervention that has been practiced since 1970 and it’s the best solution to diminish age cosmetic damage. As a result of the aging process, the gravitational effects, every day stress and sun exposure effects can be seen on our faces and can determinate severe wrinkles. The aging process affects the skin and the tissues bellow: face and neck muscles and even bone structure can be subject to involving modifications. Face-lift cannot stop the aging process but it “turns back time” by smoothing the most visible aging signs.
The main signs of the facial aging are:
- Sag and laxity of the skin of the cheek and neck
- Proeminence of the nasolabial fold
- Deepening of the nasolabial and perioral commissural creases
- Formation of the jowls with laxity and sag of the facial skin over the border of mandible, causing the jaw line to become less distinct
- Formation of the rhytids in various areas of the face
The comprehensive anatomic analysis should be combined with aesthetic judgment to create a problem list and a surgical plan.
Proper preoperative consultation is important to assure a happy patient and meet patient’s preexisting expectation. The objective of consultation for the patient is to leave with an understanding of what can be realistically achieved with their underlying anatomy. The limitations of face lift procedure should be addressed to patient. The surgeon should choose the proper procedure with the least morbidity, the best improvement and the long lasting result.
WHO CAN BENEFIT FROM A FACE LIFT PROCEDURE?
Usually, face-lift is performed on individuals aged between 40 and 60 years but it can also be performed on healthy people of 80 years old. We must underline that the face-lift rejuvenates but does not embellish meaning it only corrects the aging effect.
RISKS OF THE SURGERY
As any other surgical intervention face-lift implies certain risks. If the surgery is performed by an experienced plastic surgeon the complications are rare and usually minor. There are considerable differences between patients as regards the healing process thus the result is never predictable. Several complications might appear: hematoma, infections, injuring of the facial nerve. Moreover, scars might become larger and hair fall might appear on the created scar.
- Do not eat or drink after midnight before the surgical intervention
- Taking aspirin and drugs containing aspirin with two weeks before the surgical intervention is forbidden;
- Usually, for women, the surgical intervention must be performed besides menses;
- The surgeon and anesthesiologist must be notified if any medical problems exist (blood pressure, vascular problems, heart attack, diabetes, lung problems, bleeding problems, epilepsy, neurological problems, allergies for different drugs);
- The physician must be notified if you have a set of plates or eye lenses;
- If you smoke, plan to quit 3 weeks before surgery and do not start to smoke again for at least 2 weeks after the surgery;
- Avoid sunbathing in excess before surgery, particularly in the abdominal area;
- Do not follow a strict diet before surgery because it might delay the healing process;
- If you catch a cold or have any infection the surgery must be rescheduled
THE SURGICAL PROCEDURE
A properly selected and individually adapted face lift technique should ensure an effective correction of the aged face, producing a natural rejuvenation and not a mask-like appearance. Today trend in facelift is volumetric redistribution of the face tissues instead of tightening the skin and flattening the face.
THE MAIN FACE LIFT TECHNIQUES
Skin only face lift
For a patient to be a candidate for a skin-only facelift, the anatomic problem should be limited mainly to skin excess. A patient who previously has undergone a facelift with SMAS ( superficial musculoaponeurotic system) tightening and now desires a touch-up may fit into this category. To obtain a natural-appearing result with a skin-only lift is more difficult because of the greater amount of pull that usually needs to be placed on the skin flaps. The long-term benefit to the patient, once the post-operative swelling has settled, is not consistent.
SMAS ( superficial musculoaponeurotic system) face lift
SMAS lift involves surgery to both the SMAS and the skin. This can be achieved by either reconstituting the SMAS after removing a strip or by SMAS plication alone. The degree of the SMAS flap elevation is variable from none, to a small amount to extended sub SMAS elevation to the lateral edge of the zygomaticus major muscle in the face. In the mini-lift the skin incision is limited and the SMAS is plicated with a series of sutures at the lower face and neck area. In the deep plane facelift, the dissection is in a plane below the malar fat pad. Composite facelift adds the dissection of SMAS flap of the inferior portion of the orbicularis oculis to the dissection of the deep plane. The deep-plane rhytidectomy was designed to reposition the malar fat pad, thereby addressing the mid face and nasolabial or melolabial folds. However, the deep plane or composite face lifts increase the incidence of facial nerve injury and prolong postoperative recovery.
The subperiosteal facelift
The subperiosteal facelift is addressed to the problem of midface ptosis and nasolabial fold. This technique elevates the periosteum off the zygomatic arch and the anterior face of the maxilla in order to reposition the whole unit superiorly. While improving the midface it alone does not address skin and soft tissue laxity of the lower face and neck.
The face-lift surgical intervention is performed under general anesthesia combined with local infiltration. Some surgeons prefer local anesthesia with intravenous sedation. The procedure takes for about 3-4 hours. The performed incision extends from the hairy area of the scalp, passing by the ear, the ear lob and its posterior side. The skin is separated from the muscles and the fat below it. The muscles become tighter the skin is pulled back and upwards and the excess is removed. After the surgery a small drainage tube can be maintained in order to avoid hematoma. At the same time, dark rings from the lower eyelids can be surgically removed along with skin surplus on the upper eyelid. After the surgery a compressive circular bandage is applied on the face.
After face-lift surgery a hospitalization of 1 to 2 days is mandatory in order to be kept under medical care. During this period antibiotics will be administrated preventively. Drainage tubes are removed after 1-2 days.
In the first days after surgery, a slight discomfort might exist along with local pain that can be controlled with pain control pills. Moreover, for several weeks slight skin insensibility might persist. Bandages must be kept until 7-10 days. In the first week skin skin is pale, slightly swelled presenting small ecchymosys that will disappear after the first week. Stitches are removed after 8-12 days after surgery, being easily removed even by the family doctor. After healing, it is highly important to avoid sun and cold exposure as well as weight oscillation that may compromise the results of the intervention. As far as for scars, up to a period of six months they blemish and swell and after 9 months –1 year they even and have a light color. Practically, after 9 months the scar upfront the ear, the only area not hidden by hair, becomes nearly invisible.
Careful patient selection, proper timing of surgery and thorough preoperative preparation are paramount if rhytidectomy is to be rewarding for surgeon and patient. Surgeons should choose a procedure that is suited to the anatomic findings and aesthetic needs of the individual patient, consistent with their training and skill, and with which they can expect to obtain the most reliable, safe, and effective results. The range of operations for facelift surgery is now varied from minimal to more extensive deeper lifts. The surgeon needs to understand the benefits and limitations of each procedure in order to provide the best result for the particular patient. This variety in options provides challenges in training and experience. Future directions seem to be trending towards developing more advanced results from smaller procedures. Despite the development of deeper procedures, the consumer is demanding smaller procedures with less risk, less swelling, less hospital stay, less time off normal activities and better results. This may be achieved with the development of suture suspension and endoscopic surgical techniques. Moreover, a more complicated procedure does not necessarily bring better aesthetic results and more satisfaction to the patient.
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