Face lifting is a general term referring to the tightening of facial skin using standard incisions. Varying for each individual they may run through the temple hair-bearing area, in front of the ear, behind and back into the hairline. There are many confusing terms relating to position and length of scarring and the plane of dissection used. In essence, the length of the scar is proportional to the degree of skin sagging. On the other hand, more invasive surgery, that may produce more durable results, carries higher risks and demands more surgical skill and experience. There are several types:
Skin-only (subcutaneous) lifts – the original and still good for a short operation with little downtime, but the skin is not particularly strong so it does not last long at all. With tension on the scars in the skin, stretch or overactive scars may result.
SMAS (superficial musculo-aponeurotic system) lifts – have almost entirely replaced skin-only lifts as they last much longer. Against the improved longevity is longer downtime and more surgical risk. There is a range of options here too:
- SMAS plication – gathering of the SMAS to effect tightening. Good for limited downtime and safety, but limited effect and moderate longevity
- SMAS excision – again safe, but more invasive. Good long-term stability
- SMAS flap – the SMAS is dissected and the layer lifted and repositioned higher on the face. The most powerful technique, but needs experience as the facial nerve lies directly beneath the SMAS. It also tends to avoid the ‘over-stretched look’. The ‘extended SMAS flap’ may be used to assist with nasolabial folds and sagging cheeks, but requires a degree more skill to perform safely.
- Subperiosteal – this is a layer beneath the SMAS and tightly applied to bone. Its popularity is waning because of the swelling that takes many months to subside and technical issues.
More questions about face lifts?
Detailed consultation includes your medical history, and any medications. Smoking is probably the largest cause of skin slough and healing problems so you must stop. Results depend on many factors including age, skin condition, severity of laxity and wrinkles, surgeon skill and, of course, expectations.
General anaesthetic (GA) is required and you will awake with a light dressing and small wound drains. Both are removed prior to discharge the next morning.
Whilst you can, and should, return to light daily activities quickly afterwards the first 24 hours are best spent in hospital. Here you will have your head elevated, receive analgesia and regular post-operative observation. You should be able to gently wash your hair the next day. Bruising may be present up to three weeks post-operatively, depending on the extent, type of surgery, and patient’s tendency to bruise. However, with proper make-up the patient should be presentable two weeks after surgery.
Stitch and clip removal is required 7 days afterwards.
Naturally, you will have scars, which are generally difficult to see if placed correctly. They continue to improve for many months and are not “mature” for 12-18 months after surgery.
Whilst any operation has the potential for complications, these are rare nowadays. Particularly important are your own expectations as to whether the operation can achieve the result you desire and at what cost in terms of the scar and any risks.
