Facelift

The truth of the matter is that the need for a facelift have completely declined over the last 15 years. The reason for that is the early implementation of a facial rejuvenation protocol. Over time we may be able to completely eliminate the need for a facelift. But at the moment facelifts are done later in life and we no longer see the need to do two to three facelifts in a lifetime. Thus the aim is to delay a facelift as much as possible by implementation of a facial rejuvenation protocol early in life, before and after a facelift procedure.

A facelift however remains the most reliable method in which to address the sagging neck.

A facelift (rhytidectomy) cannot stop the aging process. What it can to is “set back the clock” improving the most visible signs of aging by removing excess fat, tightening the underlying muscle and re-draping the skin of the face and neck. A facelift can be done alone, or in conjunction with other procedures such as eyelid surgery, fat fills or reshaping of the nose.

Facelift Candidates.

The best candidate for a facelift would be a man or a woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well defined. Those are patients where the facial rejuvenation protocol would either be too expensive, or will not able to create the desired correction. Most patients are in their late forties to late seventies. I have done a facelift in a determined eighty year old patient. The most important factor really is that you are healthy and fit.

A facelift can make you look younger and fresher, and may enhance your confidence in the process. A facelift cannot give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have a facelift carefully consider your expectations and discuss them with your surgeon. All surgery carries some uncertainty and risks.

When a facelift is performed by a qualified plastic surgeon the 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.

Planning your surgery

Facelifts are individualized procedures. During your initial consultation I will evaluate your skin texture, skin laxity and excess, underlying fat distribution and the bony structure. Your goals will be addressed and a plan formulated to address your concerns. It is import that you and I have a clear understanding of the expectations and the surgical outcomes.

I will check for any associated medical conditions that could cause problems during and after surgery. Please be sure to tell your surgeon about any uncontrolled hypertension, blood clotting abnormalities, bleeding, personal or family history of deep vein thrombosis as well as tendencies to abnormal scar formations. Please be sure to tell your surgeon about any medications, drugs, smoking or any other medical conditions. A surgeon may be able to compensate for possible complications if he/she is prepared.

If you decide to have a facelift, I will explain the techniques and anaesthesia used, the type of facility where the procedure will be performed, the risks and complications and the costs involved. Please do not plan a facelift within six months of a major function. This means you cannot have a face lift 3 months before your daughter’s wedding !!! You will not be happy with the result. Cosmetic surgery can only truly be appreciated a year after the surgery. It takes time for the swelling to subside and wound healing takes about 18 months to be complete at a cellular level.

Preparing for surgery

Your surgeon will give you specific instructions regarding smoking, medications, last meals, time and duration of admission.

If your hair is very short you may well have to grow your hair for a period of time so that it is long enough to hide the scars during the healing process.

You would have to arrange for someone to drive you home even if you are having a facelift as a day procedure. It may be wise to arrange that you have a companion for a few days after the procedure to help you out. Allow yourself a period of 4 to 8 weeks for most of the swelling and bruising to settle.

Where will your surgery be performed?

A facelift may be performed in an outpatient surgery facility or as an in-patient. You may have to be hospitalized for a day or two especially in cases where the patient is diabetic or hypertensive.

Types of Facelift

There are many types of facelifts described and the technique vary from surgeon to surgeon. Generally the aim is to address the major aesthetic imperfections and patient concerns via the shortest scar possible. I will show you the expected surgical scar and most likely achievable result prior to your procedure during your consultations.

The full facelift give the most dramatic result, have the longest scar, takes longer and is thus more expensive. I most commonly do a mini-facelift but we need to decide on a procedure which most accurately addresses your major concerns and which you would be happy with for a long time. The aim is not multiple procedures the aim is longevity.

Types of Anaesthesia

A facelift may be performed under a general anaesthetic or under conscious sedation. Conscious sedation has numerous advantages and disadvantages. The advantages are: shorter hospital stay, the procedure is cheaper and a lesser risk of a deep vein thrombosis. However, as the name suggests, you will not be completely unconscious, merely sedated to a level where you do not experience any pain. Thus the surgical team still requires some corporation from you.

The Surgery

A facelift is a long procedure anything from 3 to 6 hours depending on whether any additional procedures are performed.

I addresses one side at a time leaving small drains on each side. The exact placement of incisions and the sequence of events depends on your facial structure and on your surgeon’s technique.

The incisions usually start either in the hair at the temple or along the hairline in patients with excess skin. The incision extends in a natural line in front of the ear and follows just posterior to the tragus or protruding cartilage and follows along the lobule of the ear to the posterior aspect of the ear. The incision then extends posterior along the hair line. If extensive neck work needs to be done a small incision may be made inferiorly below the chin. Small openings <2 mm may be made in areas requiring either liposuction or fat fills.

In general I separates the skin from the fat and muscles below. Fat may be trimmed and suctioned from around the neck and chin so as to improve the contour. I tighten the underlying muscle and fascia by the application of special sutures which resorb over time. The skin is pulled back so as to give an attractive contour and the excess is removed. It is of vital importance that the vectors of pull are distributed correctly so as not to create the swept back look giving a flat and lateral appearance to the face. The incisions are closed in layers and skin clips are used along the hair line. The sutures are removed between 5-7days post-surgery but are area specific.

A thin drain is left behind on each side to drain any blood that may collect. These drains are removed the next day.

Recovering from the surgery

Your head should remain elevated post operatively. Please report any significant swelling and pain to the surgeon immediately. Please call me on my cell phone +27 83 3650 934.

There isn’t usually significant pain post-surgery. You do however suffer significant discomfort in terms of the swelling. You feel and look like “a-pumpkin-with-a-swollen- face” for about 2 weeks. Please be careful not to strain in any way post-surgery e.g. excessive coughing, vomiting etc.

The drains will be removed in the next few days. Post-operative visits and dressing will be advised. Unfortunately swelling may be rather significant post operatively and will gradually subside over the weeks to come. Swelling may be prolonged in cases of fat filling.

Getting back to normal.

Please be gentle with your face and hair. Your face will be both tender and numb. Please avoid any strenuous activities in the first 2 weeks post operatively. Initially your face may feel and look 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 2-3 weeks and you may tire easily. It is not uncommon for some patients to feel disappointed and depressed at first.

By the third week you’ll look and feel much better. Most patients are back to work ten days to two weeks post-surgery. Special camouflage make-up may be used to cover bruising.

Possible complications

Below follows a list of some of the more frequent complications associated with a facelift procedure. The incidence of complications are about 2-4%. Please note complications are more frequent with re-do or secondary facelift procedures.

Complications following facelift surgery can be devastating, particularly because this is a cosmetic and not a life-saving procedure. As with all surgical procedures, complication prevention is paramount. Proper patient selection, mastery of pertinent anatomy, attention to meticulous surgical technique, and conscientious postoperative care are all important factors in preventing facelift surgery complications.

Complications include (1) hematoma, bleeding and clot formation (2) nerve injuries,-complete facial nerve paralysis , mandibular nerve paralysis and cervical nerve paralysis. Leading to an inability to move the face and mouth on side affected and a numb or dead feeling behind the ears and down the lateral aspect of the neck (3) infection, (4) skin flap necrosis, dying off of the skin (5) hypertrophic scarring,- widening and whitening of the scars. (6) Alopecia (hair loss) and hairline/earlobe deformities, and (7) parotid gland pseudocyst, collection of saliva around the parotid gland.

Systemic complication…. your body: Fluid and electrolyte abnormalities, deep vein thrombosis and post-operative lung complications. These are seen more frequently with patients having combination procedures

Your new look

The chances are excellent that you will be happy with your facelift, especially if you realize the result is not immediately apparent. Even after the swelling and bruising are gone, the hair around your temple 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 hair bearing skin has been repositioned.

You’ll have scars from your facelift which may be hidden by the hair around your face or in the natural creases of your face and ears. These scars will dramatically improve over time and fade naturally but will never completely disappear. Scarring is the most significant draw back of a facelift.

Having a facelift does not improve the skin texture nor does it stop the clock. The aging process will progress naturally and it is not uncommon for women to have a second or third procedure at 7 – 10 year intervals. The advantage is that the effects of even one facelift are lasting. Thus although it does not stop the clock, a facelift does slow it down.

 

Introduction

The aim of facial rejuvenation is reversing the hands of time and delaying surgery. The secret of facial rejuvenation lies in starting at a young age. We cannot stop the ageing process but we can certainly soften or delay the effects. The most effective method of achieving facial rejuvenation is by combining procedures as there is no one procedure in isolation that is uniformly effective. These procedures may become very expensive thus it is important to space them over time and not abandon them completely. Below follows a list of recommended procedures:

Botox

Botulinum toxin is a neurotoxin which paralysis the nerve responsible for contraction of a muscle. Once the frown line has formed due to repetitive muscle action, Botox can no longer prevent the line or the furrow from forming but it can prevent the line from deepening and smoothen it somewhat. Fortunately and unfortunately this effect is not permanent. The secret in Botox lies to start early in your life. Initially you would need Botox every 3 months. If you start early enough you will weaken the muscle over time and thus Botox will be needed at less frequent intervals saving time and money. Some may need Botox as little as once a year.

In facial rejuvenation the greatest effect of Botox is seen in the frown lines, eyebrows, and small lines around the eyes, bunny lines, gummy smiles, fascial asymmetry and neck platysmal bands. Thus the major advantage of Botox lies in the upper part of the face.

Another valuable use of Botox is in patients with hyperhidrosis. Hyperhidrosis is the embarrassing condition of excessive sweating seen under the armpits, hands and foreheads of many patients. Executives or patients involved in public speaking find this tool very useful.

Botox may also be used for muscle spasms, stiffness and undesirable muscle development or contraction. I often use Botox in congenital cases in children associated with cerebral palsy where muscle spasms leading to permanent contractures and deformities, making the use of Botox very important. It can also be used for neck muscle spasm and migraines.

In the fitness and professional bodybuilding industry, Botox prevent the inevitable masculinization seen in female athletes provided it is started early and continued. Thus these ladies are able to achieve greater competitive levels.

The cost of Botox depends on the area being treated. For the forehead this is roughly about R1500 rand

Hyaluronic Acid Fillers

Aging is associated with an inevitable volume loss of the fascial structures. The once triangular youthful appearance shifts to a more square appearing face due to volume loss and the effects of gravity.

In addition to volume loss there is also a change in skin texture, thinning, pigmentation and loss of collagen and elastin.

Hyaluronic acid is a naturally occurring jelly-like substance found in the normal skin. As it does not express any tissue or species specificity it is safe for injection. The jelly like substance is hydrophilic which means it has the unique ability to not only enhance volume on its own but like a sponge absorb surrounding fluid further enhancing the volumizing effect.

Hyaluronic acid has recently been shown to be responsible for the formation of new collagen. This is a revolutionary finding as previously we have not been thought to be able to from new collagen. Thus despite the volume enhancing properties of hyaluronic acid it also seems to have a direct antiaging effect by the formation of new collagen further highlighting the importance of including hyaluronic acid in your antiaging regime. It also seems to have a major effect on lighting pigmentation.

According to the literature the effect of hyaluronic acid lasts about 1-2 years. I do agree with this in terms of the volume effect but I also think there is a permanent structural change in the quality of the skin of patients whom regularly use hyaluronic acid filler.

There are different types of Hyaluronic acid products depending on the thickness of the gel. Roughly it can be understood as having a superficial, intermediate and deep role. The thicker the gel, the more dramatic the effect and unfortunately the more expensive the product. Luckily the thicker the gel the longer it seems to lasts.

The amount of Hyaluronic acid needed depends on the timing of the treatment. Thus the later in life you start the more you will need and the more expensive it will be. The precious jelly comes in 1 or 2 millilitre syringes. The thick gel in a 2 mil syringe can be as much as R5000.00 for the raw product per 2 millilitre syringe.

Thus a 2 millilitre change in your fascial structure can cost a lot of money. Luckily the product draws in fluid giving you a further enhancement.

I do not like to use a lot of filler at once as I do not want the unwanted changes seen in so many ladies, the “duck-like” upper lip. I would recommend to start with one deep and one intermediate thickness filler some weeks apart and augmentation following that as desired or needed.

So what can hyaluronic acid filler do for you? It can give beautiful cheek bones, soften the deep lines from your nose to your mouth, enhance your lips and smile and straighten, lengthen or elevate the nose. There are tons of uses of hyaluronic acid fillers. The changes are subtle but certainly effective.

Botox and filler in facial rejuvenation is like food and water. Basic requirements.

Just a word of caution: There have been incidences of irreversible blindness associated with hyaluronic acid filler injection. This is the most severe and painful complication reported. Other side effect include pain and bruising. The procedure is generally uneventful and you can return to work the same day.

Chemical Peels

In my practice I use TCA (Trichloracetic acid) peels. A TCA peel is a superficial peel that removes the top layer of the skin allowing regeneration of the underlying skin. Dead cells slough off and new cells grow form below. The depth of the peel depends on the concentration or strength of the peel. The stronger the peel the greater the effect but the longer the down time. A superficial peel is associate with a mild tingling sensation slight peeling of skin and return to work the same day, much like a very good facial. The deeper peels are more painful thus I prefer to these in theatre under mild sedation/ general anaesthetic generally in association with other procedures. The peeling is more significant and the downtime about a week.

The TCA peel helps to improve the texture of the skin mainly addressing dull complexion, lighting fine lines and managing pigmentation.

Fraxel

Fraxel is non-invasive laser therapy used to resurface the skin. Laser columns stimulates fractions of skin allowing resurfacing or replacing the superficial layer but also stimulating the underlying matrix to improve skin quality and texture.

Fraxel works best for fine lines and wrinkles, surface scarring, enlarged pores, age spots, hormonal pigmentation, sun damage and post-operative scars.

A local anaesthetic gel is applied for 90 min. The procedure is painful thus I would recommend taking some analgesia before the procedure. There will be significant redness, swelling and flaking after the procedure. I can however apply make-up and return to work the same day. As will all resurfacing procedures direct sunlight should be avoid for about 2 weeks after the procedure to allow regeneration of new sin.

We determine a protocol most suited for your skin.

Thermage

Thermage is a very advanced treatment addressing sagging skin. It uses radiofrequency technology to tighten loose skin in the face and body. Optimal effects are said to be achieved within 6 months but I find the effect to be immediate.

The main structural component of skin is collagen. Thermage works by tightening the underlying collagen thus lifting sagging skin. The procedure is not very painful, there will be mild swelling a few days later but the instant results are worth it.

I would recommend the treatment every 2 years. Be warned the treatment is expensive.

Facial Fat Fills

Human fat has been used for many years. It was first used in the late 19^th century, but did not become common practice until after the invention of liposuction in the 1970’s and 1980’s. Currently facial fat fills have gained major popularity in the use of facial rejuvenation.

Fat grafting is a procedure in which fat is removed from one area of the body and transferred to another. The fat is harvested by liposuction in an area of unwanted or excess fat e.g. the belly, love handles or thighs. It is then carefully injected into an area where the main aim is correct a volume deficit.

Fat grafting is used for volume replacement and correction of contour deformities much as we use hyaluronic acid fillers. Aging results in the triangular youthful appearance of face being replaced by a rectangular sagging form. With fat we are able to restore the youthful appearance. 60% of the transferred fat will remain permanently unlike fillers. Recent literature suggest that fat has numerous added advantages. Fat is rich in pro-inflammatory cytokines, growth factors and stem cells. These stems cells stimulate the growth of new cells which regenerate the underlying skin matrix and form new collagen. The skin appears healthier. Dull, powder-looking skin is restored to youthful healthy glowing skin. The facial rejuvenation allows the softening of fine lines and wrinkles, lightning of dark circles around the eyes and improves pigmentation.

The fat fills do not make you look fat it restores volume with a 60% permanent effect just like, and better than hyaluronic acid fillers. However should you gain weight there will be a growth in the transferred fat.

Fat grafting is most commonly performed as a day procedure with local anaesthetic and sedation or in theatre under a general anaesthesia.

Postoperatively there will be significant swelling and bruising which may remain for 3 to 6 weeks thus the procedure should not be performed near an upcoming event.

In Conclusion

Facial rejuvenation involves a combinations of procedure starting early in life. The ultimate goal is to avoid or at the very least delay a facelift as much as possible. The advantage is the ability to age gracefully, unfortunately at a considerable cost.