Sagging of the facial muscles, loosening of the skin and a loss of tone appear as a result of natural aging and under the influence of factors such as solar rays, gaining and losing weight and cigarette smoking. Skin wrinkling, deep lines and sagging in the tissues of the cheeks and bags associated with sagging develop as a result of all these. The process involving the removal of excess skin and fat and tightening underlying layers of muscle in order to improve an aged and tired appearance is known as facelift surgery.
This operation is usually performed after the age of 40, although it can be performed on younger patients with mild sagging in the cheeks by making shallower incisions. The operation can be performed on people who develop early sagging and deep wrinkling without waiting for the age of 40 if this state of affairs is distressing to them. In other words, patient wishes determine age at surgery. Excellent results are obtained in prominent skin wrinkling and sagging, particularly at advanced ages.
What kind of anesthesia is administered?
In operations performed under general anesthesia, an invisible incision is made starting from in front of the hair line in the sideburn region and continuing in front of the ear and the ear lobe to behind the ear, following the natural curvature of the face. Excess tissues are removed by raising the skin of the cheek, and underlying muscles and deep facial structures are strengthened and replaced. Operations of this kind may last from 3-10 hours, depending on the technique and what needs to be done. It is possible to return home that same evening, though an overnight stay in hospital is generally preferred. Additional procedures (nose, eye.id, etc.) can be performed during the same session. Facelifts are not scar-free. But the scars are hidden inside the hair in the temple region and in front of and behind the ear and are thus not visible. If fat is removed from under the chin, a small scar of 3-5 mm may be left. If eyelid and forehead lifting is added, extra scars will remain in the eyelids and hirsute skin on the forehead. However, this scarring on the face is generally not obvious and can easily be concealed.
The early stage after surgery is generally quite comfortable. There may be some general facial swelling and bruising and numbness, and tension may be felt. Because the facial nerves may be mildly affected by anesthesia during surgery there may be some slight facial asymmetry. These will all disappear spontaneously in 3-5 days. Head bandages leaving the eyes, nose and mouth open and cold pads to the cheeks are applied. Silicon tubes known as drains may be inserted in order to avoid blood accumulating in the tissues. The drains will be removed within two days at most. The bandaging will be completely removed within 2-3 days. General monitoring and dressing changes will be performed. The hair can be washed during this period. Stitches will be removed within 5-7 days, unless they are of the biodegradable type.
On rare occasions there may be asymmetries that resolve in the long term or require additional surgical adjustments. It is best to avoid sunlight until the bruising has completely disappeared. Otherwise permanent sun blotches may result.
Subcutaneous blood and fluid accumulation is another rare complication. Loss of sensation and itching in the skin of the neck and face is also occasionally encountered but will improve with time.
The least desirable complication with facelift surgery is damage to the branches of the facial nerves. Permanent loss of facial movement is very rare. Wound infection, delayed healing and opening of the surgical line associated with this are not expected due to good nourishment of the region.
Visible scarring in these regions is so rare as to be almost non-existent. Facelift scars are not at all obvious, especially in older patients. Surgical scars are much slighter in patients with pale complexions.
Returning to Normal Life
Performed properly, the operation gives very good results. Secondary corrections may be required on rare occasions. The patient can get up and do things in the home as of the second day after surgery. The patient can return to work after a week as the swelling goes down, and can wear make-up. We advise patients to avoid strenuous exercise and excessive exposure to sunlight and to protect themselves against blows to the face for two months. The new shape of the face and neck should last for 5-10 years, or sometimes for a whole lifetime, depending on the individual and surrounding conditions.
Lines on the forehead that appear in late middle age in association with the movements of the facial expression muscles may be very deep and hard and lead to people looking old, tired and unhappy. Forehead lift surgery involves removing excess skin and softening the muscles and cause wrinkling. The result is a happier and more youthful face.
Face and necklift surgery is the correction of deformities such as wrinkling, sagging, thickening and displacement that appear in the neck and face regions with advancing age.
Facelift is usually combined with necklift. General anesthesia is generally employed in both. Local anesthesia combined with sedation analgesia is also an anesthesia option, depending on the procedure to be performed. The incision line in face and necklift surgery runs in front of and behind the ear, and sometimes under the jaw.
As with all surgery, scarring does form, but since this is beneath the jaw, behind the sideburn area and in front of an behind the ear it is not noticeable. With facelift and necklift you can regain the look you had many years before, and even attain a youthful and healthy appearance. These operations maintain their effects for many years.
That means you can stave off the effects of time. There is no particular age limit for face and necklift surgery. It is the level and nature of the deformity in the face and neck that matter.
You may experience mild pain, bruising and moderate swelling, especially in the first days after surgery. However, these are not permanent problems and will disappear without trace. Swelling and bruising may change place depending on whether you sleep on your right or left side, and under the effect of gravity. Asymmetries may develop as a result. These will disappear within a week to 10 days. Very rarely, there may be asymmetries that only resolve in the long term of that require additional touch-up surgery. It is best to avoid going out in the sun until the bruising has completely disappeared. Otherwise, permanent sun blotches may result.
Blood and fluid collecting under the skin is a rare complication. A loss of feeling and itching sensations may also occur in the skin of the face and neck after surgery, but this will soon disappear.
The most undesirable complication of surgery is damage to the branches of the facial nerves. Loss of expression may occur on very rare occasions. Wound infection, delayed wound healing and opening of the surgical line associated with this are not expected due to good nourishment of the region.
Visible scarring in these regions is so uncommon as to be almost non-existent. Facelift scars are not at all obvious, especially in older patients. Surgical scars are much slighter in patients with pale complexions.
Sagging in the muscles and wrinkles around the edges of the eyes that develop as a result of age and genetic factors can be corrected with this operation, and a more youthful appearance can be attained. However, a different operation may be required for sagging and bags in the eyelids (blepharoplasty-eyelid lift).
How is the operation performed and under what form of anesthesia?
If the brow lifting procedure cannot be performed together with other surgery (such as eyelid correction, facelift or necklift), then it can be done alone under local anesthesia and sedation. The aim here is for the patient to make a faster return to normal life. The operation involves lifting and tensing the skin, using an open or closed (endoscopic) approach, through incisions made a few centimeters behind the hairline, eliminating excess skin if necessary and setting in a new position using sutures. A softer forehead region is obtained sometimes by removing muscles wrinkling the forehead or sometimes by severing them. The results are permanent. The elimination of lines around the eyes and between the eyebrows imparts a happier, more youthful and fresher appearance and face.
What are the complications?
There may be a temporary lack of sensation or hair loss around the incisions. Your hair will grow back later. There may be swelling in the forehead region. Return to normal life can take places within the first week after surgery. It takes two weeks for the sutures to be removed and for all signs of the operation to disappear. All scars from the operation will be hidden by hair.
The early period after surgery will generally be quite comfortable. There may be a general puffiness and bruising around the forehead and eyes. There may be sensations of numbness and tension. This disappears spontaneously within two weeks. A head bandage may be applied, leaving the eyes, nose and mouth uncovered. The dressing is removed after two days. General monitoring and dressing changes are carried out. The hair can be washed and dressings replaced if necessary. Sutures are removed 5-7 days later.
Returning to normal life
Surgery usually provides good results in a single session. Touch-ups may be required on rare occasions. The patient can return to work after two weeks, and can wear make-up. Patients are advised to avoid strenuous exercise and sunlight and to protect themselves against blows to the face for two months. The new shape of the face and neck should last for 5-10 years, or sometimes for a whole lifetime, depending on the individual and the effects of gravity.