What is a “Facelift”?
A facial rhytidectomy (“Facelift”) is a term used to describe a diverse range of surgical procedures for rejuvenation of the face which have in common the excision of an amount of redundant facial skin. There are numerous variations in techniques and ancillary procedures which may fall under this umbrella term.
What procedures can be included in a facelift?
Apart from the obvious excision of facial skin, some of the techniques which are employed by plastic surgeons include the following: tightening of the underlying facial muscle layer, modification of the facial fat by liposuction or fat injection, tightening of the skin by lasers, radiofrequency or other devices. At the same time, surgical modification of the neck skin, muscle and fat is often included. Ancillary procedures often performed concurrently include eyelid surgery and forehead lift or shortening procedures.
Where are the scars usually placed?
The main facelift scar can be considered in three connected parts. The upper portion is placed in the temporal hair, or just within the hairline at the temples. The second portion descends just in front of the ear or a part of this scar may be hidden just outside the ear canal (retro-tragal approach). Generally, I use the pre-tragal approach in males where moving hair-bearing skin onto this landmark is inappropriate. In most female patients, the retro-tragal approach is appropriate. The scar makes a U-turn at the bottom of the earlobe and then ascends along the groove behind the ear. The final portion of the scar crosses either into the posterior hair bearing scalp, or descends just within the posterior hairline. Other additional scars may include an incision under the chin, eyelid incisions, or a forehead hairline or mid-scalp incision. Many surgeons may choose to shorten the length of the first and last part of the scar and these techniques are called short-scar techniques or mini-facelifts. In my view, the word “mini” is used to denote a shorter scar, not a less invasive form of surgery!
How long is the surgery and the recovery?
The extent of the surgery and ancillary procedures will determine the operative time, which may vary from 4 to 7 hours. The surgery may be performed under conscious sedation or (uncommonly) under oral sedation, depending on patient and surgeon preferences. I perform this type of surgery in the office-based theatre as an outpatient. Recovery varies greatly and depends on the amount of surgery and on the patient in particular. Bruising is very uncommon and I have now stopped using drains. I also do not use a “haemostatic net”, but a compression garment is used. Usually, swelling is obvious for 1-4 weeks, with an average return to society of 2-3 weeks. Visible swelling usually subsides by 6 weeks and the patient is usually back to all activities by this time, but full healing may take up to 18 months.
What about “Deep Plane Facelift” Surgery?
The term “deep plane facelift” is becoming very popular in the media, but the technique has been practiced for more than 30 years. It involves dissection at a level below the SMAS layer, which is directly on top of the layer containing the facial nerve branches. This makes this type of surgery far more technically demanding and potentially more risky. While all variants of face-lift techniques have been shown to deliver potentially excellent results, there is some medical literature that notes improvement of the jowl area to be somewhat superior in deep plane techniques. Ultimately, the skill and judgement of the surgeon is more important than the specific technique. Only 5% of surgeons worldwide are performing deep plane surgery. I have been doing deep plane techniques for 7 years now and this is my preferred technique. I follow the extended deep plane approach, with the addition of deep plane neck work and platysma flap.
How much younger can a facelift make you look?
The baseline condition of the patient, their general health and their skin condition influences this substantially, but a recent scientific article has concluded that an improvement of 3 to 8 years in apparent age is expected. Smoking and sun damage may limit the improvement that can be achieved. Additional modalities may be added to improve the result or treat some aspects of ageing that direct surgery cannot address.
How much does a facelift cost?
There is a large price range due to many factors, including the extent of the surgery and the number and extent of the ancillary procedures added to the primary facelift procedure. The types of additional procedures which are often added include, facial liposculpture, chin implants, chemical peels and blepharoplasty. These operations are always privately funded as medical aid does not cover this type of surgery. Please call to get a ball-park figure, but specific quotations can only be given once a consultation has occurred.