Local (LA) or General (GA)
Length of Stay
Daycase or overnight
A face lift, or Rhytidectomy, is an operation where the soft tissues of the face and/or neck are re-suspended and tightened, thereby creating a more youthful appearance. A small amount of skin is usually removed as well.
- Have sagging cheeks and/or jowels
- Have a sagging neck
- want to improve self-image and esteem through trying to achieve a more youthful appearance
A facelift does NOT rejuvenate around the mouth or the eyes or forehead. Chemical peels can be applied at the time of surgery to help with the fine lines and wrinkles around the mouth and forehead, and eyelid surgery to help rejuvenate the eyes can also be performed. Face lifting is often performed in conjunction with fat grafting/lipofilling the face at the same time to help correct volume deficiencies.
A Facelift can be performed both under a General Anaesthetic (you are asleep) or local anaesthetic with/without sedation. The duration of surgery is around four hours. Incisions are made from the hairline in your temple region, down in front and behind the ear, and if a neck lift is also being performed then the incision continues into the hairline behind your ears.
The skin is dissected off from the underlying SMAS (Superficial Musculo-Aponeurotic System) and the SMAS is then lifted, thereby lifting the underlying facial soft tissues and adherent muscles, and suspended through the use of sutures. There are various techniques employed when dealing with the SMAS that are tailored to the individuals needs to achieve optimal results. The skin is the re-draped over the SMAS, stuck back down with the aid of a tissue glue and sutured back in place around your ear with any excess skin excised. Dressings are placed over your wounds over which a facial compression garment is placed. Sutures are removed in clinic one week after surgery and you are requested to wear your compression garments for a period of two weeks, only removing it to perform facial hygiene daily.
Various methods of face lift exist, namely but not exhaustively:
- Skin only face lift – this is the oldest and least effective form of facelift and simply involves excising excess skin. This often creates a tightened, windswept look to the cheeks and is short lasting – scars and the skin stretch usually after about a year or so.
- Short Scar facelift – this is a shorter scar than the traditional (SMAS) facelift, however the effects are less – this is suitable for younger patients with earlier signs of ageing.
- MACS Lift – Popularised by Tonnard and Verpaele, it involves less dissection of the face and cranial suspension of the SMAS with sutures. This is more suited to the younger patient with early signs of ageing.
- SMAS Facelift – this is the more traditional facelift, described earlier that results in a more dramatic effect and is suited to those with moderate to strong facial ageing.
Facial volume can be restored either at the same time as a facelift or as a separate procedure by way of fat grafting – fat is liposucked from one part of the body, specially prepared and then injected back in to the facial tissues.
You will be required to wear a compression garment after surgery (Mr Davis advocates LipoElastic® garments) for a period of two weeks, occasionally longer.
It is usual to stay in hospital one night after surgery.
You will be encouraged to shower the next day after surgery, however you are to dab your wounds and dressings dry, let them dry naturally or to use your hairdryer on a cool setting to blow them dry – you are NOT to rub your wounds for one month after surgery.
After two weeks you will be asked to apply moisturiser over your scar on a daily basis for a period of three months.
You will come for a wound check one week after your surgery with Mr Davis and return to see Mr Davis in clinic between six and ten weeks after surgery – earlier if required. Further follow-ups will be arranged at around six months after surgery or as necessary.
Bleeding & Haematoma
Bleeding can occur at any time in the first 10 days or so after the surgery so you should therefore avoid any trauma to your treated area and avoid strenuous exercise.
If a bleed under the skin occurs, you will usually become swollen and tender and may develop bruising – if this occurs you should return for review as you may require a return to the operating theatre to explore and stop any bleeding vessel(s)and remove any blood.
This is fluid accumulating under your skin, resulting in a bulge and palpable fluctuation/fluid moving. If it occurs it usually settles by itself being reabsorbed by the body, however very rarely it is treated in clinic by using a needle and syringe to aspirate the fluid.
Whilst not common, should it occur your face may be swollen, red, warm/hot and tender – not to be confused with the inflammation of healing. You may also feel unwell in yourself. This is treated with a 5-to-7 day course of oral antibiotics.
Scars are by definition permanent, so will always be there. Initially scars can be red and with time should fade through pink to ultimately be pale and flat. Occasionally scars can become hypertrophic or keloid whereby they are raised, red, lumpy, itchy and unsightly or can stretch to become wider. This is however relatively uncommon.
Nerve damage/Facial paralysis
Damage to the facial nerves is extremely rare with facelift surgery, however in the unlikely event that it occurred you could be left with some paralysis (full or partial) of some of your facial muscles affecting your facial expression(s) and symmetry as well as problems with your oral competence, eyelid function or the ability to raise your eyebrow.
The skin of your face will be numb for a period of time after your surgery. This usually recovers within weeks but can sometimes take longer to fully recover. The area most affected is in front of the ears and often this does not fully recover. Care should therefore be taken when drying your hair as you could potentially burn yourself without realising.
Very rarely the hair follicles in the temple region can die off following surgery resulting in a bald patch.
Very rarely the blood supply to the skin overlying the treated area can be compromised resulting in skin dying - Should this rare event occur it is managed with dressings until healed. Very occasionally the resulting scar requires revising.
The two sides of your face are not symmetrical and will remain so after your surgery. Should there be any glaring difference then very occasionally a touch-up is required to rectify this. This is may also be the case when you have also undergone fat grafting at the time of the face lift.
Very occasionally a blood clot may form in one of the deep blood vessels in the leg (Deep Vein Thrombosis). Blood clots have the potential to break bits off that can travel up to the lungs resulting in a pulmonary embolus. As a way of reducing the risk you will be required to wear compression(TED) stockings on your legs from admission on the day of surgery until 2 weeks after surgery. You will also be encouraged to keep as mobile as is possible and to stay well hydrated.
Swelling &/or bruising
Swelling will almost certainly occur naturally and can take several weeks to fully settle down. Bruising can be treated, unless contraindicated, with the use of Arnica or other such products should you wish.
Further surgery in the future
This is likely to incur more costs
Highlighting other areas
Following face lifting it is possible to then notice other neighbouring areas that you had not previously noticed.