Procedures > Facelift
A facelift refers to the elevation and freshening of the lower part of the face, particularly the jawline and the neck. It is commonly associated with other procedures such as eyelid reduction and your specialist will discuss your various options and it will be for you to decide which will provide you with the appearance you are looking for.
Facelift
In general facelifts are carried out at the age of 48 years and onwards but where there has been premature ageing or where just an upper facelift is required it can be carried out at an earlier age.
In the last twenty years a number of modifications have developed, in particular dissections in the subperiosteal plane sometimes called a 'mask lift' or 'deep plane' facelifts which is beneath the SMAS layer. As with any modification enthusiasm is high during its infancy but with experience the indications for its use become better defined. In general a facelift attempts to improve the jawline and eradicate jowls and also tighten the neck in an upward and lateral direction providing a better cervico-mental angle.
Cutaneous facelifts.
Via an incision passing in front of the ear into the post-auricular groove and into the hairline above, the skin of the face and neck was elevated and drawn in an upward and lateral direction. How far the dissection was taken related to the surgeon and some are more aggressive than others. If minimal undermining is used then a fairly rapid return to society is achieved but results are relatively short-lasting and the surgery might have to be repeated. No adjustment of underlying tissue is carried out and the tension is taken on the skin.
The mini-lft
This procedure corrects jowls and defines the jaw line. The modern modification of the mini-lift is the MACS lift. It constitutes a small scar in front of the ear and the SMAS layer is elevated with three carefully positioned sutures. It is particularly popular in the younger age groups and where the neck is not showing signs of ageing. If the neck is showing signs of ageing various methods can be used to improve specific features. Excess fat beneath the chin can be liposucked away improving the angle between the neck and the chin. If muscle strands are clearly visible in the central area of the neck these can be divided and the rest of the muscle pulled up in a lateral direction. Commonly fat aspirated from the neck or occasionally from the abdomen can be re-injected into the face to enhance various features such as cheeks and lips where thinning has occurred with age and can be described as a 'volumetric' facelift. Facelifts are painless but usually require a night in hospital to ensure that all is well the following day. The scars are usually well-hidden around the tragus of the ear so little can be seen in this region then pass in the sulcus behind the ear and into the hairline posteriorly.
The deep plane facelift
The highly innovative Professor Skoog from Uppsala in Sweden in the 1970s realised that the platysma muscle in the neck extended up into the face as a distinct plane. He took his dissection of the face underneath this plane now described as the SMAS (subcutaneous musculo-aponeurotic system) and pulled these tissues and the overlying skin in an upward and backward direction. In this way tension was no longer taken on the skin and the chance for blood to collect (haematoma) was much reduced. Ageing produces not only laxity of the skin but also the underlying fat tissues and by tightening the SMAS layer these lax tissues are tightened in two planes rather than one. There have been numerous modifications designed to lift the SMAS layer and almost every surgeon has evolved his own technique to produce what he feels is safest and most effective for his patients.
Subperiosteal facelifts (mask lifts)
The principal of this surgery is to elevate the soft tissues of the face from the bone and preserving all the important structures passing from the facial skeleton through to the overlying skin, the whole structure can be lifted in an upward direction. The enthusiasm for this procedure emanated from cranio-facial surgeons particularly Paul Tessier in Paris who used it extensively. It certainly has specific indications such as for remodelling bone around the eye either to reduce or augment it and also for elevating muscle groups which are weak statically. However the enthusiasm for it in cosmetic facial improvement has declined as it does produce a rather unnatural appearance to the upper part of the face and does not address the most common problem of ageing which is the neck and lower face.
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