7 THINGS YOU NEED TO KNOW ABOUT FACELIFT SURGERY
1. A Little History
The aim of facelift surgery is rejuvenation and refreshment of the face and often neck. The surgery has been around for approximately 75 years. Until the 1970s if effectively involved wide skin under mining and closure under tension. This resulted in well known sequalae ear lobe migration south and wind tunnel look. In the 1970s starting with the famous Scandinavian surgeon Skoog a recognition was made that structures deeper than skin, in effect the parenchyma, when lifted and resuspended gave better, longer lasting results.
2. Dawn of a New Era
Mitz and Peyronie’s 1976 paper detailing the anatomical discovery of the SMAS (Superficial Musculoaponeurotic system was the revolution that would change facelift surgery forever and usher in a host of new approaches to facial rejuvenation. The SMAS is fancy term for muscles of the facial expression that in places around the face can be as thin as a layer but is responsible for the subtle facial expressions that make our lives.
3. Technique Evolution, Terminology & More Anatomical Discoveries
During the 1980s and 1990s a host of anatomical ligaments around the face and cheek were defined by painstaking anatomical dissection and their role was made clear in contributing to the general process of facial ageing. In parallel various techniques were developed that can broadly be divided into three groups and here we have divided them in the most logical division to avoid many of the confusions around terminology of facelift surgery
- Skin only techniques
- SMAS based techniques
- Deep Plane techniques
- High SMAS
- Extended SMAS
- Lateral SMASectomy
- SMAS Plication (Figure 1)
- Deep Plane techniques
- Subperiosteal techniques
4. Short Scar Vs Long Scar Incision
In a way we can think of facelift surgery as the skin incision and then how we deal with the deeper parenchymal structures, as identified above. Classic facelift incisions commenced in the temporal hairline, extended in front of the ear, extended behind it and finished in the neck hairline. There is still a place for these skin incisions and many surgeons utilise them. More recently a short scar technique has been popularised that starts at the hairline and ends behind the ear.
5. What Can Go Wrong
Perhaps for the patient and the surgeon alike the most dreaded complication is permanent facial nerve damage. One of the largest series of consecutive facelifts reported from London by two London surgeons, including Mr Norman Waterhouse that amongst other fellowships I completed a facial aesthetic with following his training report an approximately 1 % rate of permanent facial nerve damage. This would result in slight or gross asymmetry of the face at rest or in movement. Temporary bruising is more common and as high as 10%. Smoking results in a 10 fold increase rate of skin loss, numbness around the incision site and the ears is also common and may be permanent due to temporary or permanent damage to the nerve branches. Scar formation and minor scar revisions are the most common reason for revision surgery.
6. The Postoperative Swelling
This will take some time to settle down. In the first 2-3 weeks this will be exponential. I always recommend that you be conservative and consider the 3 week as the time for easier public interactions. The remainder of the swelling will settle down over the next 3 months.
7. Do Your Homework
This operation is about attention to detail and meticulous surgical technique. Be sure that your surgeon has formal training in the field of facial aesthetic surgery. Visits to centres are not the same of formal completed fellowships. Ask questions and go back as many times as needed. I have written two landmark chapters on facelift surgery that are part of one our standard international references textbooks used to teach plastic surgery around the world (Fig 2 & 3). And remember and be warned in my and many other expert’s opinion, no self respecting well trained surgeon who wants the best results for his/her patients would ever recommend use of threads for face or neck lift. For more information on this surgery click on the following links.
- For more information:
2. Facelift galleries:
3. Facelift video:
Figure 2 & 3.