Facelift & Necklift

There are several operations that can be done to rejuvenate the ageing face which are referred to as facelifting. In the facelift operation the scars are designed to be well hidden. The skin of the temples, cheek and neck is tightened upwards and backwards. In addition the layer of muscle-like tissue which lies underneath the skin (SMAS layer) is also lifted in a similar way to give a longer lasting and natural result. This also improves facial shape returning it to a more youthful outline without giving a pulled or tight appearance.

The decision as to which type of facelift is performed will depend on your particular requests, the anatomy of your face and the effect that ageing has played on your facial appearance. The latter may be assessed with the help of photographs taken ten years or so before and also from your youth which you will be requested to bring to the consultation.

Often the main concern is the neck area. If there is a lot of loose skin or separation of the muscles producing two bands, then a neck lifting procedure may be required. This can usually be performed through the facelift incisions so tightening the neck muscles to a more youthful appearance. Occasionally a small scar, hidden beneath the chin, may also be required to tighten the neck muscles centrally.

What types of facelift are there?

Cutaneous (skin only) Facelift
The traditional facelift has been performed for many years. It is a technique where the skin is lifted from the underlying tissues and tightened backwards and upwards. While the overall facial appearance will be improved there is no improvement to the deeper facial tissues. This technique does not give a very long lasting result and is therefore not used frequently by Haluk Duman, MD..

SMAS Facelift
Beneath the skin of the face lies a deeper layer to which the muscles and soft tissue is attached (Superficial Musculo-Aponeurotic System – SMAS). This can be used to elevate the soft tissues of the face to provide a longer lasting result than with the classical facelift where only skin is tightened. This can be achieved either by removing a portion of the SMAS and tightening it (the SMASectomy Facelift) or by folding a portion of the SMAS itself to preserve volume (SMAS plication Facelift). These types of facelift are useful when there is a need to restore fullness to the cheekbone area as well as removing jowls and redefining the neck. This is the facelift that Haluk Duman, MD. performs on most patients however the direction in which the muscles (SMAS layer) is pulled is individual to each patient and so the result is natural and based on the appearance seen in photographs of you when you were younger which Haluk Duman, MD. will have studied at your consultation.

The ‘MACS’ Lift (Minimal Access Cranial Suspension)
Suitable for patients with mild to moderate jowls but no loose skin in the neck. Permanent sutures are used to elevate the soft tissues of the face and suspend them in a more youthful position. This operation has a shorter scar behind the ears and a relatively quick recovery, although it may not be as long lasting as the SMAS type facelifts.

The Short Scar Facelift
All of the facelifts above can be performed with a shorter scar which means that in addition to the normal scar in front of the ear, the rest of the incision behind the ear is limited and does not extend into the scalp. This does mean that the ability to tighten the neck may also be somewhat limited. Anybody with a moderate amount of loose skin in the neck will be better served with a slightly longer scar to accommodate this. However for patients who need tightening predominantly in the face it provides a useful alternative. These patients are usually in the younger age group (early 40’s).

The Volumetric Facelift
Facial ageing often results in loss of fat in the face and a gaunt or hollow appearance. This procedure uses a different approach to restoring a youthful appearance. Volume can be added by either injecting a patient’s own fat into the face, or by moving the cheek tissues from a lower to a higher position over the cheek bone. Recent advances have made fat transfer a more predictable and reliable option than was previously the case.

Subperiosteal Facelift (mask lift) and Endoscopic Facelifting (endoface)
The mask lift is a completely different concept from other types of facelift. It was developed by a French plastic surgeon, Dr Paul Tessier with ideas which arose from reconstructive techniques which were adapted for cosmetic use.

The soft tissues of the face are released from their deeper attachments, lifted and repositioned to the site which they occupied before gravity produced its downward drift. The most suitable patients are in a relatively younger age group (35 to 45), and have heaviness of the brows, sagging of the outer corners of the eyes and cheeks but without changes in the neck or jowl.

The endoscopic facelift is exactly the same procedure but uses small incisions within the hair and an incision in each lower eyelid rather than a long incision in the scalp

Neck Lift and Platysmaplasty
All deep plane (SMAS) facelifts tighten the muscle of the neck to improve both the jowl area and jaw line. The aim of a neck lift however is to eliminate vertical folds in the neck, to tighten the skin and reduce excess fat beneath the chin. This can usually be accomplished through the incisions made for a facelift although a small incision under the chin may also be required for fat removal or to tighten the neck muscles centrally (known as a platysmaplasty). This will be discussed in detail with you at your consultation with Haluk Duman, MD..

Which facelift is best for you?
There are now a number of options for effective facial rejuvenation surgery and the various types of facelift will be discussed with you in order to decide which would be most appropriate to produce the result you desire. All are designed to give a natural fresh look and will not produce a tight, mask-like appearance. The focus of this kind of surgery should, for the most part, be upon facial shape. A youthful face will have full, high cheekbones with a well defined jaw line and neck contour. As the face ages it tends to become squarer. This trend is reversed by effective facial rejuvenation surgery. Haluk Duman, MD. will give you clear guidance as to what will be most suitable for you.

How long does a facelift last?
This is one of the questions most frequently asked by patients. The answer is that this type of surgery puts back the ageing clock by seven to ten years, but of course, cannot stop it from ticking. Ten years after the surgery you will of course look older but will always appear 7-10 years younger than you would have looked without surgery.

How will Haluk Duman, MD. ensure a natural look?
This is one of the most important concerns for anyone considering facial surgery. The foundation of a good outcome is a thorough consultation and analysis of how your face has aged which requires a review of photographs taken of you about ten years ago and from your youth. You will be requested to bring these with you to the consultation with Haluk Duman, MD. (family photographs are all that is required). This will give an accurate impression of what anatomical changes have occurred and they will act as a “Roadmap” so that your surgery truly rejuvenates rather than recreates an appearance you never had.

The next step is the surgery where Haluk Duman, MD. rejuvenates primarily by moving the soft tissues of your face (SMAS layer) so that rejuvenation of shape is achieved which is usually the main change from youth to middle age and not just by tightening skin. The skin will of course be tightened as well but now can be done without giving a “wind tunnel” appearance. The “Roadmap” (i.e. your previous appearance from photographs) helps Haluk Duman, MD. decide the direction of pull of the SMAS so your procedure achieves a natural appearance maintaining the precise character of your face from youth. Of course, this also requires a certain element of artistic appreciation, so please take a moment to read the section in this website on the relationship of art & surgery so that you understand Haluk Duman, MD.’s philosophy on how important an artistic element is to achieving a pleasing outcome.

Can the scars be hidden?
The scars for all the above types of facelift are mostly within the hairline and hidden around the ear. The incision for the face extends down from the scalp to the top of the ear and then travels for a short distance just inside the ear canal so as to be hidden from view in the cheek area. It then turns backwards at the bottom of the ear to lie deep in the groove between the back of the ear and the side of the head. When it reaches the top of the ear at the back it turns to enter the scalp where it is again hidden. These scars are designed in such a way that you should be able to wear your hair in any style that you choose once the scars have matured.

Preparation for surgery
It is important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin has an adverse effect on bruising as it thins the blood. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen, Nurofen and Voltarol) and vitamin E tablets. Some patients find homeopathic remedies such as arnica helpful to reduce bruising although it is very difficult to “prove” their efficacy scientifically. If you wish to use arnica you should begin 2-3 days before the operation and continue for a week afterward. If you are a smoker it is absolutely imperative that you to stop for 4 weeks before surgery and for 2 weeks afterwards so as not to restrict the circulation to the skin. This restriction applies to all forms of nicotine including patches, inhalers and nicotine chewing gum!

Hair tinting may be continued up to the time of surgery but strong bleach containing colorants should be avoided for six weeks afterwards. Please wash your hair thoroughly with a mild shampoo the day before surgery and come to the hospital with no make up on the morning of the operation.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home.

What happens after the operation?

In Hospital (1-2 days)
A light padded dressing will usually be applied at the end of the operation which remains in place for 24 hours. You will be nursed in a semi-sitting position in bed immediately after the operation, which helps to reduce swelling. There is not usually much pain or discomfort although this can be subjective. On the day after surgery, the dressings and bandages will be removed and your hair will be washed by the nurses before going home.

At home (2-10 days)
It is helpful to rest/sleep with three or four pillows for the first week after surgery in order for swelling to subside more quickly. Swelling will tend to increase during the first 3-4 days after surgery (this is normal) and then subside over the next two weeks. It may be a little slower to subside in warmer weather. Try not to drink too much water. This is not the time to be drinking 1-2 litres of water each day in the hope of “flushing” out the system. The brain releases a hormone after surgery which tends to retain water and so if you drink a lot you will retain fluid and create more swelling. Please just quench your thirst and then drink fruit juice or tea as these will give less fluid retention and swelling.

It is important to avoid bending forwards as this may cause more swelling. It is better to avoid washing hair unless sitting with the head back like at the hairdresser. This will be done before leaving hospital and can then be repeated after 3-4 days. You should also avoid very hot drinks for the first week as well as avoiding very chewy foods as this helps facial swelling to settle quicker. It is very helpful to rest as much as possible for the first five days and then return gently to normal activities over seven to ten days

After a week Haluk Duman, MD. will arrange to see you to remove any stitches near the eye and then at between 10-14 days to remove the remaining facelift stitches and any clips. Any facial or eyelid stitches run beneath the skin and are not visible except at either end. They will therefore leave no stitch marks so do not worry!

The first 2-6 weeks after surgery
The face (and eyelids if they have also been operated on) may feel a little tight. This is normal and related to swelling and scar maturation. Occasionally the eyes may feel a little “gritty” after surgery and if this is the case then it is helpful to use a lubricating ointment at night. The cheeks and ears will feel numb for about three months after the operation; this is quite normal and recovers spontaneously. In general it is best to continue with your usual facial skin care regime as the risk of sensitivity to a new product is best avoided. You may visit your hairdresser after 10-14 days but as mentioned earlier no colorants should be used for 4 weeks.

You should not drive for at least one week after surgery or until such time as your neck movements are comfortable. Most patients can return to work after 2 weeks although you may wish to avoid major social events for 3-4 weeks until the fine swelling has settled. You may resume your usual sporting activity at 3-4 weeks but prior to that it is best to avoid exercise as it will prolong the swelling in your face.

Summary

The modern facelift has reached a point where it is possible to tailor the operation to suit individual needs. For most patients it will produce a significant rejuvenation and improvement in facial appearance for many years without appearing operated or overly tight.