But what exactly is a facelift and who can benefit from it?
To answer these key questions, we spoke to Dr Allen Rezai, Lead Surgeon at Elite Plastic & Cosmetic Surgery Group who is not only an internationally renowned Consultant Plastic & Reconstructive Surgeon with a practice in Harley Street, London, but also an expert with many years’ experience in surgical and non-surgical facial rejuvenation treatments.
Dr Rezai explained that “A facelift, which is actually known medically as Rhytidectomy, is the most extensive and effective way to eliminate or reduce the appearance of wrinkles and facial sagging caused by age. In a traditional facelift procedure, a patient's skin is literally lifted off the face so that the skin and underlying tissues can be tightened, with the skin then being repositioned smoothly over the face. A neck lift, which is often undertaken at the same time as a facelift, tightens sagging jowls and loose skin below the chin.”
According to Dr Rezai, the best candidates are generally considered to be those individuals whose skin quality is still relatively good. Most patients are between forty and seventy years of age, although older patients may also benefit. Indications for having this surgery include looseness of the skin with relaxation of muscles resulting in wrinkles and folds on the face; visible jowls; no longer having a smooth firm jaw line; deep lines in the corner of the mouth, which can often give a “sad” look; and loose skin and wrinkling around the neck.
Dr Rezai explains that over-exposure to the sun can make these symptoms even worse and further contributes to an aged appearance by diminishing the overall quality of the skin. Also weight loss in later life can create a more aged appearance, because older skin has less elasticity than younger and, without the fat, it will become saggy and wrinkled.
Types of Facelift
A variety of different types of facelifts and facelift techniques are performed today. Some of the more common types are described here. Dr Rezai will discuss with you which type of facelift is right for you, or which combination of techniques will give you an optimal result.
Traditional (SMAS) Facelift
Traditional facelift addresses the lower face and neck. During the procedure, incisions are made in the hairline, starting above the ear, continuing behind the ear, curving around the ear and ending in the hairline behind the ear onto the lower scalp. Once the incision has been made the surgeon will carefully separate the skin from the underlying tissue, reposition excess fat and use sutures to lift and reposition the muscle layer (“SMAS” – superficial musculo-aponeurotic system) toward the ears. This allows the structures in the lower face and neck, to be sutured to bone higher on the face, hence tightening the sling running around the lower face and chin/neck. This muscle tightening is thought to provide longevity to the surgical result. The skin will then be lifted and sutured into place along the original incision, the excess skin is removed and the incisions are closed. Most patients will stay in hospital for one or two nights and be able to return to work after two weeks, resuming normal physical exercise a short time later.
The Mini-Lift or Skin Only Facelift
A mini-lift addresses the lower face and neck. This is the most basic of facelifts, and involves little more than a skin tuck. The surgeon first makes the traditional facelift incision, as explained above. He then dissects the skin from the underlying fat and muscle, stretches it back, trims excess skin, and closes the incisions. Due to the skin’s ability to stretch out over time, this facelift is considered to be less long-lasting than facelifts employing muscle tightening. Occasionally, drains may be used. The Mini-Lift has little, if any, effect on folds running between the nose and mouth (naso-labial folds).
The Deep Plane facelift
The deep-plane facelift is modification of the traditional facelift. During this type of facelift, the surgeon will dissect to a deeper plane of the patient's face before lifting and repositioning the muscle. Additionally, the surgeon will separate certain muscle layers off of deeper muscles and or other facial structures. Some surgeons believe it offers certain advantages to a traditional facelift including a more natural result and improved rejuvenation of droopy skin. However, this technique has a higher risk of facial nerve injury and many surgeons dispute that it offers a significant advantage to the traditional facelift.
Endoscopic (Scarless) Facelift
In addition to “traditional” facelift, in certain circumstances there is also the possibility of opting for an “Endoscopic Facelift”, a very modern technique in facial plastic surgery. This is also known as the “scarless facelift”. According to Dr Rezai, this can be beneficial for certain patients who do not have large amounts of excess skin. Through the adoption of endoscopic techniques, this procedure facilitates not only facial rejuvenation but also facial enhancement. The method makes long incisions unnecessary, resulting in quicker healing with fewer side effects. Dr Rezai explains that the best candidates for this type of facelift surgery are those whose skin quality is still relatively good. Patients are typically aged in their late thirties to late fifties.
Neck lift surgery targets a drooping or sagging neck area and involves the removal of excess skin and fatty tissue, leaving the skin around the area of the neck and jaw smoother and more defined. Incisions are typically shorter than those made during a traditional facelift and will normally be placed only at the earlobe and behind the ear. Vertical bands and lines can be eliminated using platysmaplasty; a procedure which involves making small incisions under the chin or behind the ears to tighten the muscles of the neck. Excess fat from the neck area is removed by using liposuction or similar techniques. In patients with excellent skin elasticity, a neck lift may be performed alone. More commonly, when skin elasticity is fair or poor, a facelift is performed as well, to remove excess skin that would otherwise remain.
Alternatively, neck lift surgery, rather than a full facelift, may be sufficient to achieve the results you desire. As with any other cosmetic procedure, your expectations should be realistic. The results of neck lift surgery will depend on the elasticity of your skin and to what degree it has been affected by sun damage.