Facelift

Our face is perhaps our most defining feature and is intimately bound to how we view ourselves and how others views us.

There are certain visual cues which we associate with youth and others which we associate with signs of aging. In youth, a sharply defined angle between the neck and jaw is a prominent feature, with a sense of facial fullness over the cheek bones and a smooth transition between the cheek and upper lip. The lower eyelids blend into the upper cheek and the upper lids display a clear strip of skin visible above the lashes with the area below the eyebrows appearing subtly full.

As we age the soft tissues of the face alter through the combined effects of gravity, sun damage and changes in hormone levels. Underneath the soft tissues the skeleton of the face also undergoes modification with bony resorption leading to loss of volume and decreased support for the overlying soft tissues.

This ageing process blunts the demarcation point between the jaw line and the neck, (at worst resulting in a continuous band (or bands) of skin running from the under surface of the chin and jaw directly to the collar bones) and disrupts the clean shape of the jaw line (resulting in characteristic sagging seen with jowls). The cheeks start to develop a hollowed appearance and a line of demarcation appears between the cheek and upper lip known as the nasolabial fold. As volume is lost around the cheek bones the lower lid appears distinct from the cheek itself and can appear to become puffy. In the upper lid excess skin can cause a hooded appearance and the zone between the eyebrow and upper lid tends to loose volume and hollow.

Each of these features is due to specific changes in the anatomy of the face. Proper treatment is dependant on an understanding and knowledge of these changes and an approach that restores support and volume to the muscles, ligaments and skin where these have been lost.

Like most problems in life, a single approach to correct what are often multiple anatomic changes will not work – one size fits all is never going to be the answer in something as individualised as facial aging. Every person will have their own specific concerns relating to how their face has aged and addressing these concerns with a single treatment or procedure will not work, certainly not for all patients.

An example of this is the perception that a neck lift can only be performed as part of a face lift. For many people the idea of having to go through a facelift to change the shape of their neck is too great an ordeal but if as a surgeon you understand the nature of the problem and the underlying anatomy the neck can easily be treated in isolation with fantastic results.

As a surgeon however, it is only through knowledge, understanding (and most importantly listening to your patients concerns and needs) that you can deliver outcomes for your patients that will meet their goals and this means choosing the correct procedure(s) for that particular patient’s needs.

A midface lift is a different sort of procedure from the other forms of facelift on this page as it works by elevating the whole of the upper cheek soft tissues off of underlying cheek bone and lifting it directly upwards. It can be used to reduce the depth of the nasolabial folds and improve the appearance of the lower eyelids, smoothing the junction between the lid and the cheek.

If there are folds of skin beneath the eyes (known as festoons) these can also be dealt with by performing a midface lift. The procedure is performed by placing an incision directly below the eyelashes of the lower lid providing access to the lift the cheek tissues off the cheek bone. The tissues are then anchored firmly in a higher position and any redundant skin is removed via the eyelid incision.

A neck lift can be performed as part of a facelift procedure but can also be undertaken in isolation (despite many surgeons believing that it can only be done as part of a face lift).

When undertake by itself a neck lift is performed through 3 small incisions – once under the chin and one behind each ear.

The issues that patients frequently seek help for relate to increased volume beneath the chin (usually as a result of subcutaneous fat deposition or enlargement of the digastric muscles), loosening of the edges of the platysma muscles that run from the chin to the collar bones producing parallel vertical lines (known as bands) running from the chin down the front of the neck and excess skin over the front of the neck (or a combination of these problems).

The operation directly removes all excess fat from the neck leaving only a thin layer behind, attached to the skin, to provide a smooth surface once the rest has been resected. Once this has been performed the underlying platysma muscle is examined.

Often the free medial or inner edges of the muscle have become loose and need tightening. Beneath the platysma is another layer of fat and 2 additional muscles (called the digastric muscles) which can contribute to fullness under the chin. If needed this fat is removed and the muscles debulked so that any residual fullness under the jaw is addressed.

The platysma muscle is then sewn together in the midline (which looks a bit like a corset and is known as a corset platysmaplasty) providing sheet like muscular sling that will hold the soft tissue of the neck in place.

Because of the way the surgery directly sculpts of fat of the neck it is also possible to remove the jowls drooping down below the jawline as part of the operation, enhancing the final outcome. Any redundant skin is gathered up behind the ears and excised with the scars lying in the crease behind

As the face ages in addition to the structural changes seen because of the effects of gravity, the individual cells of the soft tissues alter. The densely packed deep fat layers of the midface (the area between the bottom of the lower eyelid to the beginning of the upper lip) shrink.

These areas of fat directly support the overlying skin and muscles and when they shrink (or atrophy to use the technical term) the upper layers can slip down – leading to the deflated and hollow appearance that can be characteristic of the aging face.

Although hyaluronic acid based fillers can be used to bulk up these areas their effects are not permanent and they can cause problems in the long term with persistent swelling and reduced muscle movement.

An alternative approach is to use fat transferred from elsewhere in the body. This is completely natural and compatible with you’re the soft tissues of your face and will not cause and long term ill effects.

The procedure can be performed under local anaesthetic and although it can cause bruising usually has a very short period of down time. In addition to the midfacial area fat graft can also be used to treat hollowness in the temple area and to restore volume in the brow region.