Rhytidectomy (Face lift)
At present two types of face-lift make it possible to remedy age-related unsightly aspects of the face and neck, either in one area or at a wider level. The face- and neck-lift is the most frequent procedure; this means surgical correction of aging of the neck and the face from the forehead to the jowls.
The operation focuses on treating the sagging and laxity of the skin and muscles of the face (forehead, eyebrows, cheeks, jowls, and the oval facial outline) and the neck. Restoring the different anatomical structures of the face and neck (the skin, the muscles and the fat) enables the patient to look as he or she were several years younger.
The muscles are tightened, to correct slackness. The skin is then draped as required over the new curves, without excessive stretching. This dual action gives a natural appearance (as the skin is not over-stretched), which lasts (since the muscular base is strong). The healing process is generally uneventful. Excess fat, if present can be treated by liposuction. On the other hand, if the face appears emaciated, this can be corrected at the same time by re-injection of autologous fat (liposculpture). In this way the face and the neck are ‘rebuilt’ or ‘restructured’. The incisions necessary for the procedure are hidden almost entirely in the hair (at the temples and the nape of the neck) and around the ears. The scars are thus almost entirely concealed.
A face lift can be carried out as soon as signs of aging appear and the patient feels a real need for their correction, generally around the age of 40 or 45. This procedure can be carried out at the same time as another facial aesthetic procedure: blepharoplasty (for the eyelids), forehead lift (endoscopic forehead lift). It can be also completed by other treatments: (laser abrasion, chemical peels, medical treatment of wrinkles).
Aesthetic Plastic Surgery is no longer a female matter…
According to the American Society of Plastic Surgeons (ASPS), statistics indicate that male aesthetic procedures are steadily increasing. Male facelift is indeed a challenging procedure for the Plastic Surgeon who should always bear in mind that, unlike women, scars cannot be concealed with make-up and/or longer hair. Moreover, there are further parameters that substantially differentiate the techniques applied in male facelift:
- Facial hair (beard, sideburns)
- Anatomic differences (thicker skin, denser muscles, robust bone structure, fibrous fat texture)
- Aesthetic differences. A perfectly natural result is sought after. After all, some aging signs in men tend to be stereotyped in modern societies as signs of experience, wisdom and success.
Thus, in male facelift we most often aim at restoring the natural shape of the face (jaw line definition), focusing on the lower third of it.
Waterjet Assisted Liposuction followed by Lower Face and Neck Lift is my procedure of choice for patients with significant jowling, in order to deliver optimal results.
Before the operation
Prior to the operation a thorough examination will be carried out as prescribed. You will see an anesthesiologist in consultation at the latest 48 hours before the procedure.
No aspirin-based medication should be taken over the 10 days preceding the operation.
You should wash your hair the day before the operation and you must fast (neither eat nor drink) for 8 hours before the operation.
Hospital stay and type of anesthesia
Type of anesthesia: A face-lift is usually carried out under general anesthesia.
A 24-48 hours hospital stay is usually required
Techniques are adapted in order to obtain the best results in each case. We can however give some basic points:
The incision is almost completely hidden in the hair, or around the ears. Once these incisions are made, the skin is detached; to a greater or lesser extent in each case, according to the degree of sagging of the skin. The muscle layer is then carefully and precisely tightened to correct laxity, without affecting the normal expression of the face.
If there are localized fat deposits, which can form on the neck, the chin, the jowls or the cheeks, lipoaspiration is performed during the operation. The skin is then re-draped in a natural manner, excess skin removed, and stitches placed without excess tension.
The procedure lasts from three to five hours depending on the individual corrections required.
After the operation
You will be able to go home on the first or second day after the operation. For the first few days you are advised to rest and avoid physical strain. During this period you should not be surprised by, or worried by, the following:
- edema (swelling) which can be worse on the second day than the first.
- bruising around the neck and chin
- a sensation of painful tightness especially behind the ears, and around the neck.
The bruising and swelling generally disappear in the two weeks following surgery. After one month all signs of swelling have usually practically disappeared. The zones from which the skin was detached may feel slightly hardened, this is perceptible to the touch, but not visible.
The scars are hidden by the hair both in front and at the back of the head. The only zone where they are visible, in front of the ears, can be temporarily masked by make-up or concealed by the hair.
After two or three months one can have a good idea of the final result. The scars, however will still be slightly pink and hard to the touch, and will not fade until the sixth month after the operation.
Through progress over the years and techniques of great precision we usually achieve a result giving an impression of considerable rejuvenation which nevertheless looks quite natural. The face does not have a ‘surgical’ appearance and has regained the features which it had eight to twelve years before. The general impression is relaxed and refreshed. This physical improvement is also in general psychological.
In the long term, a face- and neck-lift has beaten the ravages of time, but aging does continue, and a second similar procedure can be envisaged after about ten years.
These can be essentially:
- edema (swelling) which can persist in certain zones three months after the procedure, and which needs to be treated by massage.
- A partial relapse of sagging skin (ptosis) particularly of the neck, when this was a major problem before surgery.
- Visible scars, or hair loss around the temples (alopecia) which can require revision surgery after six months to a year.
A face lift, although essentially an aesthetic procedure, is nevertheless an operation, and this entails the risks inherent to any surgery. Concerning anesthesia, the risks will be explained by the anesthesiologist during the preoperative consultation. You must be aware that anesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anesthesiologist, in a surgical context, guarantees that the risks are practically statistically negligible.
In fact, techniques, products and monitoring methods have progressed considerably over the last decade, giving optimal safety, especially when the operation is elective and the patient is in good general health. Fortunately, real complications are rare following a face- and neck-lift which has been carried out correctly. Practically all the operations go well and patients are perfectly satisfied with the result. However, possible problems may include:
- Hematoma: this must be rapidly drained.
- Infection: This is extremely rare when the procedure is carried out in a sterile environment
- Skin death (necrosis): this delays the healing process.
- Nerve damage: in particular damage to a branch of the facial nerve, this can lead to paresis, or facial paralysis. This is rare and the after-effects usually disappear in a few months.
- Abnormal scars, either hypertrophic or keloidal: they are impossible to foresee, and their development is unpredictable. They can threaten the aesthetic result and require specific local treatment over a long period.
My Way …. “Metron Ariston”
The aim is not to transform the form and aspect of the face! On the contrary, restoring the different anatomical structures of the face and neck (skin, muscles and fat) enables the patient to look as he or she were several years younger…
Respecting my Ancestors’ wisdom: The Golden Ratio (phi)
Forget all about “Nip-Tuck” in Face lift! It takes much more than a doctor “nipping” and “tucking” to create an aesthetically balanced result.
The golden ratio (phi) is the key to restoring FACIAL SYMMETRY.
The Plastic Surgeon needs to have solid knowledge and understanding of facial proportions to decode the changes that have taken place in a face through time. He also needs to possess outstanding surgical skill so as to customize each procedure to restore and enhance facial symmetry, in alignment with the Golden Ratio.
Creating facial harmony through plastic surgery, focuses on balance and proportions and not on dramatically altering one’s facial appearance.
Minimally invasive techniques
Techniques and procedures generally rely on the case and the correction needed.
Under the right indications, I opt for using the Minimal Access Cranial Suspension (MACS) technique which involves less invasive surgery and a smaller scar.
It is a technique designed to lift the lower two thirds of the face. During the operation a limited amount of excess skin is removed through an inconspicuous scar in the crease in the front of the ear and in the hairline above the ear.
This webpage aims to provide some information about the subject. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
American Society of Plastic Surgeons, British Association of Plastic, Reconstructive and Aesthetic Surgeons, French Society of Plastic, Reconstructive and Aesthetic Surgery