DR G DE AGUIAR

PLASTIC, RECONSTRUCTIVE & COSMETIC SURGEON

Procedures - Facelift


Introduction:
As part of the natural aging process, our skin progressively loses its elasticity and our muscles tend to slacken. The loss of youthful contours in the face can also be due to a variety of factors, including heredity, effects of gravity, environmental conditions (such as sun exposure and smoking), and the stress of daily life. The rate at which this happens varies from one person to another and is probably determined by our genes. Aging of the skin of the face does not necessarily reflect the rate that the rest of our body and mind is aging and many people feel frustrated that the face they see in the mirror is not the one they feel should be there. Substantial weight loss can produce similar changes in facial appearance to those of the aging process.

Visible signs of aging in the face and neck can be seen as follows:

  • Sagging in the middle of your face
  • Deep creases below the lower eyelids
  • Deep creases along the nose extending to the corner of the mouth
  • Fat that has fallen or has disappeared giving a sunken facial appearance
  • Loss of skin tone in the lower face that creates jowls
  • Loose skin and excess fatty deposits under the chin and jaw can give even a person of normal weight the appearance of a double chin


A facelift, also called a rhytidectomy, (which often includes treatment of the neck as well), can improve these visible signs of aging. A facelift smooth’s out and tightens loose skin on the face and neck, tightens underlying tissues and removes or repositions excess fat. The procedure aims to restore the patient’s appearance to a more youthful version of him/herself. The results of a facelift can be dramatic or subtle, depending on how the patient looked before surgery and their individual desired outcome.A facelift can be an excellent way to improve appearance and boost self-confidence.

Facelifting is commonly performed with other procedures to achieve the desired appearance. Other rejuvenating procedures that may be done in conjunction with a facelift include: brow lifting (which corrects sagging or a deeply furrowed brow), blepharoplasty (eyelid surgery), neck rejuvenating surgery (in order to improve loose skin under the chin and tighten lax neck muscles and remove fatty deposits under the chin), soft-tissue fillers or fat injections (to fill in deep wrinkles and to restore facial volume), lip enhancement or chemical peel (to reduce fine to medium wrinkles and remove age spots). You are encouraged to read about these procedures as well.

What a face-lift cannot do:
A facelift can make you look younger and fresher, and it may enhance your self- confidence in the process. As a restorative surgery, a faceliWft does not change your fundamental appearance and cannot stop the aging process, nor can it restore the health and vitality of your youth. A facelift can only be performed surgically; non-surgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery.

A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles of the forehead, additional surgeries may be warranted. Loose skin with fine wrinkles, freckles and rough areas will benefit more by chemical peel or laser resurfacing. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

How long does a facelift last?
A facelift does not stop the clock, but it does put the clock back. Heredity and lifestyle factors influence how long results last. The effect of the facelift is likely to always be there, in that you will not look as old as you would have done if it had not been carried out.Taking proper precautions in the sun as well as keeping your body weight stable will help you maintain your results over the long term.

The Best Candidates For A Facelift:
The best candidates for a facelift are men or women who are in relatively good shape, are generally healthy, non-obese and non-smokers having realistic expectations, whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties as well. It should not be glaringly obvious that a patient has had a facelift, and I have yet to meet a patient who wants a “done-look”. Instead, patients prefer a more natural and enhanced appearance whereby they look younger, more vital and fresher.

The Procedure:
The technique used during a facelift is dependent on the patient’s facial features and conditions as well as the patient’s realistic desires and expectations. Most surgeons will always aim for the less invasive technique, but some patient cases are severe and will require internal tissues, fat and skin to be manipulated. Patients must also understand the procedure in detail, including the level of invasiveness, placement of incisions, what layers of tissues will be corrected, and what risks may be associated with the surgery before moving forward.

Non-Invasive Techniques:
Cosmetic surgery is constantly evolving and always finding ways to minimize the invasiveness of procedures. There are several options that are considered less invasive than a facelift, including wrinkle relaxers such as BOTOX®, injectable fillers, thread lifts, microdermabrasion and chemical/laser peels. These alternatives aim to correct signs of aging such as wrinkles, as well flatten and soften folds and contours. The effects, while effective, are often short-term lasting about 6 months to a year. Although these procedures can be safely repeated, for many patients, particularly with more advanced signs of aging, a facelift may be a better, more permanent option. Of course, these alternative techniques may be used in conjunction with facelift surgery in order to enhance the overall result.

Types of Facelift Surgery:
The public is often confused by the multiple names a facelift procedure can be given. Mini facelift, Full facelift, lower facelift, mid-facelift, non-surgical facelift (stem cell facelift, thread lift etc.) are some of the terms to name a few. In reality facelift procedures can be categorized according to the extent of surgery and location of facial corrections. It is therefore important to consider the specific areas one want’s to target for improvement, desired length of recovery, and your post surgical expectations.

1. Full Facelift (SMAS Facelift)
A facelift improves the deep cheek folds, jowls and loose, sagging skin around the neck that come with age. Incisions usually begin above the hairline at the temples, follow the natural line in front of the ear, curve behind the earlobe into the crease behind the ear, and into or along the lower scalp.

Through these incisions, the skin of the face is elevated, allowing access to the underlying muscles that sag with aging. This SMAS, or superficial muscular aponeurotic system, is the anatomical term for the muscles, suspensory ligaments, and support structures of the face. Modern facelift techniques directly address this vital structure by tightening and re-suspending the SMAS. This technique can also restore high cheek-bones and improve overall definition of the face, providing highly satisfying and long-lasting results. Fatty deposits may be removed as necessary. After deep tissues are tightened, the excess skin is pulled up and back, trimmed and sutured into place. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp. Following surgery, you may have surgical drains in place. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling. Most of the scars will be hidden within your hair and in the normal creases of your skin. The duration of surgery is approximately 2 to 3 hours. After surgery, you'll present a fresher, more youthful face to the world.

2. Mid-face Lift
With aging, there is loss of skin elasticity and tone, causing the lower eyelids and cheeks to sag. The mid-facelift, or cheek lift, procedure can lift sagging cheeks, smooth nasal furrows, and pull up the corners of the lips. This may be performed alone, or in combination with other facial surgeries. This procedure differs from a classic facelift in terms of the length of surgical incisions required and the extent of surgery performed.

3. Neck lift
There are multiple procedures to enhance the appearance of the neck, depending on the patient expectations and problems within their neck. Problems in the area of the neck include increased fat deposits, skin laxity, and muscle laxity. The procedure can be performed alone or in combination with a full facelift. The procedure is sometimes called a cervicoplasty or neck lift platysmaplasty. Nowadays, most procedures can be performed through an incision behind the ears. With more advanced deformities an incision under the chin may be necessary. Liposuction of the neck is usually performed at the same time.

4. Mini –facelift / MACS lift
Also called as a short-scar facelift because of the shorter incisions made, a mini lift is a quick treatment that corrects the middle and lower face. Suture suspension and anchoring of the deeper tissues may be performed (MACS lift –minimal access cranial suspension). Many patients initially consider this technique, but this doesn’t correct any severe issues and usually renders short-term results. Patients who undergo this procedure are most likely to also stage a full facelift as a final step to fully rejuvenate and reshape the face to its youthful curves.

The procedure is most appropriate for younger patients having early signs of facial aging and do not want to undergo a full facelift. The procedure focuses on the sagging of the cheeks, marked naso-labial folds, and to some extent, a loose neck. Through this procedure the patients enjoy a smaller scar, shorter recovery time, and overall improvement in facial appearance. The procedure has less risk in less stress than standard full facelift. It is very important to discuss your expectations during your consultation in order to know if a mini facelift procedure is ideal for you.

Planning Your Surgery:
Facelifts are very individualized procedures. In your initial consultation the surgeon will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery. Your surgeon should check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

If you decide to have a facelift, your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing For Your Surgery:
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If your hair is very short, you might want to let it grow out before surgery, so that it's long enough to hide the scars while they heal. Whether your facelift is being done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.

After Your Surgery:
There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by your surgeon. (Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months. Your doctor may tell you to keep your head elevated to keep the swelling down. If you've had a drainage tube inserted, it will be removed one or two days after surgery. Bandages, when used, are usually removed after one to five days. Following this, asupportive chin-strap is generally worn at night for 2 weeks. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you'll be looking normal. Most of your stitches will be removed after about 7-10 days.

Getting Back To Normal:
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first. Your surgeon will give more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity, including sex and heavy housework, for at least two weeks (walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for several months. Above all, get plenty of rest and allow your body to spend its energy on healing. At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff and you'll probably be self-conscious about your scars. Some bruising may persist for two or three weeks, and you may tire easily. It's not surprising that some patients are disappointed and depressed at first. By the third week, you'll look and feel much better. Most patients are back at work about ten days to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.

Your New Look:
The chances are excellent that you'll be happy with your facelift-especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places-behind the neck and ears-where areas of beard- growing skin have been repositioned.Men may also find it more difficult to disguise the scars and will need to shave their beard closer to the ear in front and also behind the ear where the skin has been lifted.

You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be scarcely visible. The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound. There may be some slight reduction in hair growth in the temples, but this is not usually a problem unless the hair is very thin and repeated facelifts are being carried out. In general therefore, facelift incisions are usually inconspicuous, but are not predictable due to individual variations in healing.

Patient must temporarily avoid exposure to direct sunlight and, for the long-term, be conscientious about the use of a sunblock to protect their skin.

Having a facelift doesn't stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you'll continue to look better than if you'd never had a facelift at all. <

Risks and Considerations:
Although thousands of people undergo face lifts each year and experience no major complications, all surgical procedures do carry some degree of risk.

When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. It is important you are well informed of these risks when considering a face lift. The discussion of potential risks and complications is one of the most important aspects of patient consultation. During your consultation, we will discuss these potential complications with you, listen to your safety questions, and offer recommendations on how to minimise your chance of risk.

Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, wound healing delays, scarring, and hair loss around the incisions. Most of these complications are temporary and resolve. You can reduce your risks by closely following your surgeon's advice both before and after surgery.

Procedures by Dr De Aguiar

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Commitment

Choosing to have plastic surgery requires thorough research and educated decision-making. This website is designed to help guide you get to know a little bit more about my practice and understanding of the procedures and treatments available to you. I look forward to meeting you which will allow you to make a better informed decision around treatments or surgery best suited to you.

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