Changes with Aging
With aging the skin of the face loses tone and elasticity and acquires sun damage. It may be further damaged by smoking. These lead to wrinkling and skin redundancy. The face also loses fat over time and is subjected to the forces of gravity leading to a loss of cheek, lip and facial volume, cheek tissue descent and the formation of jowls below the jawline. Prominent folds between the nose and lips may also be present. Aging also affects the forehead, the eyes and neck. The forehead descends with age producing a tired, aged look and heaviness of the upper eyelids. Loose skin forms in the upper and lower eyelids and fat may bulge forward from the orbit. In the neck, loose skin, descent of the longitudinal, strap-like platysma muscles and the collection of fat below the jaw line can all obscure the angle of the neck and the jaw line.
Aims of a Facelift
Face-lifting techniques comprise a number of procedures used to lift and reposition the facial tissues to the position they occupied when the patient was younger, producing a fresher, more youthful appearance.
These techniques not only remove the excess skin, wrinkles and jowls associated with aging, but also lift and reposition the deeper facial tissues, reproducing the facial contours associated with a natural, more youthful facial appearance without tightness. The aim is usually to increase cheek volume, produce a slimmer lower face and a more defined jaw-line and neck angle.
The SMAS Facelift
The majority of facelifts usually utilise one of a number of procedures to reposition, and often excise an excess of, the tissue layer underlying the skin of the face, the superficial muscular aponeurotic system (SMAS). The techniques most commonly used are the SMASectomy or the SMAS facelift. In patients with a slim face, a SMAS plication may be preferred.
Following the repositioning of these deeper tissues, the overlying skin is redraped and trimmed to produce the improved, more youthful outline and appearance.
A number of associated techniques are frequently utilised such as fat injection and liposuction to further improve facial contour and improve the overlying skin condition. Fat may be added to the lips, cheeks or other areas of the face to replace lost volume or improve facial contour and appearance. Liposuction may be used to remove fat that may have collected below the jaw or small amounts in the lower face further improving facial and neck contour.
Skin incisions are normally hidden in the hairline and placed discreetly in the skin creases around the margin of the ear. These usually fade quickly and settle well over time.
Where most of the correction is required in the face only, a short-scar type technique may be used in which the scar is placed in the hairline and in front of the ear alone. Where significant correction to the neck region is also needed the incision is extended around the back of the ear and into the hairline behind.
A variation of the short-scar facelift is the MACS lift which can be used for some patients with mild to moderate jowling.
Allied Cosmetic Procedures
Facelift techniques are frequently used in combination with an endoscopic browlift, upper and lower eyelid blepharoplasty and additional neck procedures, such as a platysmaplasty, to achieve a full, harmonious rejuvenation of the forehead, face and neck regions. A careful preoperative assessment is required to advise which particular combination of techniques is best suited to the patient to achieve the optimal aesthetic outcome.
The procedure is carried out under general anaesthetic and requires a stay overnight. The majority of swelling is settled at two weeks and patients can usually return to work and social activities by that stage.
Vigorous exercise and hair colourants should be avoided for 4 weeks.