by former Assure surgeon, Dr Lip Teh
Why does my face look so aged?
Facial ageing encompasses changes that occur not only in the skin, but within all our body’s layers (fat, ligaments, muscles), down to and including the facial skeleton. Skin ageing, especially here in Perth, is accelerated by sun exposure. It takes the form of wrinkles (both fine and deep), thinning of the skin, and development of skin lesions such as keratoses and solar lentigos.
With age, the fat cells atrophy causing loss of volume, particularly in the cheek and temple region. The supporting ligaments that hold the fat and skin then become lax, leading to descent of the cheeks. Lastly, thinning of facial skeletal bones further adds to the loss of volume and support of the facial tissues.
Do I need a facelift?
To counteract the effects of ageing, some of the skin and volume changes in the fat can be effectively addressed by non-surgical methods such as wrinkle relaxers, soft tissue fillers, laser resurfacing such as IPL or fractional RF rejuvenation, chemical peels and heat-related skin treatments. However, surgical intervention is required to address issues caused by ligamentous laxity (facelift/necklift surgery) or skeletal changes (implant or bone-grafting surgery).
Patients who benefit most from a facelift are those who have noticeable descent of their mid face, lower face or upper neck.
In the mid face, descent of the cheek drags the lower eyelid down with it, lengthening the eyelid and exposing the fat pads of the orbit giving the appearance of a baggy eyelid. Lower face descent is evidenced by deepening nasolabial fold (‘smile or laugh lines’ – the deep crease running from the sides of the nose down towards the corners of the mouth), marionette lines (running from the corners of the lips down towards the sides of the chin) and sagging jowls.
Although good-to-excellent results can be expected with most facelift techniques regardless of age, patients who are younger (in their 50s or younger) tend to do better than those who are older (over 60) in terms of longevity of results and overall satisfaction. Hence, surgery for mild descent of the face in younger age groups is a reasonable indication for surgery. Rejuvenation of the face at an earlier age – often referred to as a ‘maintenance facelift’ – effectively delays the onset of the development of jowls, marionette lines and other features of facial ageing.
We recommend you see us for an initial consultation, so we can review your condition and discuss your expectations.
Are there different types of facelifts?
There are many forms of facelift surgery in Perth, but they can generally be categorised into three forms:
- Thread lift
These ‘lunch time’ facelifts are minimally invasive. They involve the placement of barbed threads with needles under the skin to hook and pull the facial ligaments tight. However, intermediate to long-term results have been disappointing. In most cases, this type of lift would last no longer than a year. For these reasons, Assure Cosmetic Centre does not offer thread lifts as a surgical option for facelift patients.
- Mini facelifts
Mini facelifts can be performed under local anaesthesia as a day case. They involve placing a short scar just in front of the ear. In the majority of cases, skin is excised and tightened but there is no work done under the skin to address the facial ligaments. Like a thread lift, the results are only short-lived as the skin soon stretches back to its pre-surgical state.
- Full facelift
A full facelift is designed to address the underlying cause of a patient’s facial descent. There are many surgical techniques to achieve this, which are best discussed with your treating plastic surgeon. The procedure almost always involves a scar that starts in the hair-bearing temple down to the front of the ear and often extends round the ear and into the back of the scalp. The vector of pull for the mid face and lower face should be largely upwards rather than outwards to avoid a ‘windswept’ appearance.
Can I have a facelift with other cosmetic procedures?
Facelifts are often combined with a necklift. The scar for a necklift is placed under the chin. Fat grafting can be performed at the same time as a facelift to add volume to the cheek to give a more full and youthful cheek appearance where there is volume loss.
A mid-face lift is usually done together with a lower eyelid reduction, to address a long lower eyelid. Upper eyelid reduction surgery and forehead lifts are commonly performed at the same time.
Following facelift surgery, optimal results are obtained when combined with non-surgical methods to address fine wrinkles in skin and the deep wrinkles of facial animation, both of which cannot be addressed by surgery alone. This is usually in the form of a chemical peel or laser resurfacing (IPL or fractional RF rejuvenation) for the fine wrinkles and wrinkle relaxers for the muscle-related wrinkles (frown lines/crows feet).
How long is facelift surgery and what is the recovery time?
Facelift surgery is a complex procedure and often takes at least 4 hours to perform. An overnight stay in hospital is the norm. A drain may be used and it is not unusual to develop marked swelling and bruising in the face within the first 24 hours, particularly in the case of combination procedures.
A compression garment is placed around the ear, cheeks and neck after surgery for 1-2 weeks and ice packs are applied on the ward. Sutures are removed within the first week after surgery.
Bruising and swelling may take up to 2 weeks to settle, so it is recommended to take this downtime into account when planning your work or social calendar.
What complications are there with facelift surgery?
As with any surgery, there are complications that may occur as a result of a facelift. However, in the vast majority of cases, the surgery and the recovery are uneventful. Complication rates are higher with associated medical conditions such as diabetes, increasing age and organ dysfunction. Smoking around the time of surgery will also lead to a marked increase in wound-related problems.
Your plastic surgeon will discuss what you can expect from this procedure. It is important to carefully follow your surgeon’s advice to reduce the risk of complications.
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