Face Lift Surgery IN SYDNEY & CANBERRA

Let’s start with a little lesson in history. Skoog an incredibly talented European surgeon noted, as early as, 1974 that there was a layer beneath the skin, a deep fascia that was less elastic than the overlying skin and surgical manipulation of this yielded better facial rejuvenation results. It was however, Meitz and Peyronie’s 1976 paper that revolutionised facelift surgery. They described the anatomical layer now called SMAS (Superficial MusculoAponeurotic System). In short these are the muscles and membranes of facial muscles of expression. It is these foundations and their related ligamentous attachment to the underlying facial skeleton and overlying skin that need addressing for any long lasting face lift surgery outcome.

So any surgery that manipulates the SMAS is a form of DEEP plane ( ie deep to the SMAS) surgery. There are many versions of this as you can see from the below diagram from our textbook chapter on the topic. The Lateral SMASectomy, the Extended SMAS, The High SMAS and SMAS plication ( the last although a form of deep plane facelift surgery should probably not be included in the list).

Classically, wide skin undermining over the face and neck is made before the manipulation of the SMAS as noted above. Part of the issue as we have come to realise over the years is, that this increases, swelling, risk of skin loss and potential of postoperative bleeding, despite our effort to mitigate this.

Dr Farhadieh’s approach to facelift surgery is to achieve a natural look. These are based on sound, nuanced and detailed anatomical understanding of the facial spaces, first identified by Dr Bryan Mendelson who has taught and mentored Dr Farhadieh after his fellowship in the field in London, to further refine his approach to facial aesthetic  surgery.

SMAS Plication, facelift surgery (Farhadieh et al Plastic Surgery: Principles & Practice, 2021, US, Elsevier).

Lateral SMASectomy a form of Deep Plane Facelift surgery (Farhadieh et al Plastic Surgery: Principles & Practice, 2021, US, Elsevier).

High SMAS facelift a form of Deep plane facelift surgery (Farhadieh et al Plastic Surgery: Principles & Practice, 2021, US, Elsevier).

Extended SMAS a form of Deep plane face lift surgery (Farhadieh et al Plastic Surgery: Principles & Practice, 2021, US, Elsevier).

Facial and neck skin undermining prior to SMAS or Deep plane manipulation. (Farhadieh et al Plastic Surgery: Principles & Practice, 2021, US, Elsevier).

The short answer in my and all self respecting facial aesthetic surgeon’s view is an emphatic NO. Meaningful, long lasting, natural facial rejuvenation can only be achieved with precise and anatomical surgical approach. Everything we know and have learnt over the last 50 years says that lunch time or procedure room based approaches to face lift do not work, do not last and are not reliable in their outcomes.

In recent years much has been made of fillers including natural fillers such as fat. The simple way to look at this is to consider face or for that matter any other part of the body as a balloon with content and special features. Deflation of tour natural fat over the years is one major contributor to the ageing process. So replenishing this JUDICIOUSLY with fat will help, re-inflate the deflated areas, may in fact have some rejuvenation effects based on the adult stem cells in the fat as well. But the key is use it appropriately and judiciously. Dr Farhadieh will discuss this with you, but he routinely injects fat, into lips, cheek and brow.

Yes, facelift surgery is an intricate surgery. General anaesthesia and overnight admissions are the safest way to perform this surgery.

Initially, your scars will be visible. However, as the incision wounds heal, they will become less noticeable. Sometimes scar abnormalities or some skin loss may occur as a result of the procedure. Generally, they can be managed conservatively, at times requiring secondary surgery.

Recovery varies from patient to patient. Majority of the swelling goes away within the first 7 to 10 days, with any remaining swelling resolving in 4 weeks’ time. By the end of 2 weeks, most patients are well enough to be out and about.

While all our bodies have some intrinsic asymmetry, noticeable or persistent postoperative asymmetry due to permanent facial nerve paralysis the scientific literature indicates occurs in about 1% of cases. In the event that a facial nerve is bruised during the operation which the literature indicates occurs in up to 10% cases, it can take a few weeks to recover.

The face is an intricate part of the body and plays a crucial role projecting our sense of identity. Often thought as a subspecialty among plastic surgeons, further training beyond basic plastic surgical qualification is often required to be proficient in this field. Dr Farhadieh, has undertaken two separate clinical fellowships in World Leading institutes in London, England, focusing on the face from both cosmetic and reconstructive perspectives.

We will see you usually at one week and then again at 3, 6, 9 and 12 months. We will also see you as many times as needed in between. Dr Farhadieh believes that the relationship between a patient and a doctor is amongst the most secret and important. He prides himself on his dedication to his patient’s welfare and long term outcomes. We will continue to see you annually after your surgery.

1. There are some general risks associated with ANY operation, which include:
a) Infection in surgical wounds with resultant redness, pain and possible discharge. In severe cases, wounds could break open and need to be washed out and debrided prior to being closed.
b) Possible bleeding in surgical wound(s) with swelling or bruising.
c) Secretions may accumulate in the lungs and cause a chest infection.
d) Deep vein thrombosis (DVT).
e) Death is possible during or after an operation following severe complications.
f) Smoking significantly increases the risk of complications. Therefore, you should completely stop smoking at least 4 weeks prior to surgery, and refrain from smoking for at least 4 weeks.

2. The following facts, risks and complications apply specifically to THIS operation:
a) There are always scars following this procedure. The location and extent have been explained in full. Every effort will be made to make them as inconspicuous as possible.
1. This may be simply in front of or into the hairline, ear and extending to behind the ear into the hairline.
2. And/or include a 4-5 cm incision under the chin.
3. Thickening or poor aesthetic healing may follow any surgical scar.
b) Delayed healing at times occurs along the margins of the incisions and occasionally there is some loss along the skin edges requiring prolonged dressings or additional surgery for correction. This is more common in smokers and men. The areas of loss often heal with excellent aesthetic outcome occasionally requiring secondary surgery.
c) Smokers have a significantly greater risk of skin loss and wound healing complications. Dr Farhadieh expects an undertaking of not smoking for 4 weeks prior and 4 weeks after the surgery.
d) There will be swelling in the face, which may occasionally persist for several weeks and, in rare cases longer, following the procedure.
e) There may be discolouration of the skin (black and blue) for a few weeks.
f) There may be scattered areas of numbness over the face and neck following surgery, which may persist for an indefinite period of time; usually this settles completely within the first few months from surgery. Very rarely there may be burning or pain as the result of the surgery in the related operated field. Whilst this often settles down with time it may be permanent.
g) No guarantee has been made as to the amount of improvement either in terms of apparent age or the permanency of the result.
h) Some patients may develop hypertrophic scars or keloids, which may require additional treatment and incur extra costs payable by the patient. I realise this can happen even though the surgery has been performed correctly and without complication.
i) Any special conditions I may have, such as high blood pressure, etc., means my risk of undesirable side effects is greater than normal and I have considered that factor for added risk in my decision of whether or not to proceed with the surgery.
j) It is possible, though unusual (<2%), to experience a bleeding episode during or immediately after surgery. Should postoperative bleeding occur, it may require emergency treatment and surgery to drain accumulated blood, and/or a blood transfusion. I will not take any Aspirin or anti-inflammatory medication for ten days before and after surgery, as this may increase the risk of bleeding.
k) Infection is unusual after this type of surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary.
l) Deeper structures such as nerves, blood vessels and muscles may be damaged during the course of the surgery. The potential for this to occur varies depends on where in the body surgery is being performed. Injury to deeper structures may be temporary or permanent. Most serious complication of permanent facial nerve injury resulting in facial asymmetry is approximately 0.3%-1%. Some temporary weakness in the facial nerve branches is expected from the surgery (up to 10% of cases).
m) Salivary gland leaks may occur as the result of surgery requiring further treatment and impacting the final outcome.
n) Although rare, any asymmetry as a result of facial nerve or musculature manipulation or damaged may require revision surgery in time and may never be completely rectified.
o) Scarring may be hypertrophic, keloid unsightly and may be permanent.
p) You may not be satisfied with the final aesethetic results.
q) Bone substitutes may be necessary in some cases to achieve optimal facial symmetry and long last results. This increases both the time and cost of surgery as it incurs a separate cost for the material. In rare cases these may become infected and require excision.
r) It is recognised that, during the course of the operation, unforeseen conditions may necessitate additional or different procedures than those outlined. Also, emergency conditions may require performance of additional medical procedures.
s) The practice of medicine and surgery is not an exact science, and no guarantees can been made to me as to the results of the operation or procedure; nor are there any guarantees against unfavourable results.
t) The aim of face and neck lift surgery is improvement rather than perfection. Further operations may occasionally be required to improve the results. You may not satisfied with the final outcome.

Dr Ross Farhadieh  literally wrote the book chapters on this topic, with two textbook chapters (2015 & 2021) in international reference plastic surgery textbooks used around the world by training and practicing plastic surgeons. Dr Farhadieh, principal surgeon of both Sydney and Canberra Panthea Clinics, is an internationally peer recognised plastic surgery educator in this field. He has extended training and expertise in facial aesthetic and reconstructive surgery. He has undertaken two separate aesthetic and reconstructive fellowships with a focus on the face, at some of the World’s leading units in London. Dr Farhadieh has been recognised by his international peers and appointed the Chief Editor of two internationally critically hailed international reference plastic surgery textbooks: Plastic and Reconstructive Surgery: Approaches and Techniques (2015, Wiley UK) & Plastic Surgery: Principles & Practice (2021, Elsevier US).  He co-authored the chapter on facelift surgery and is guiding the next generation of facelift surgeons worldwide by sharing his extensive knowledge and expertise in these book chapters.

Environment, time and gravity eventually take their toll on the way your face looks, leading to wrinkles, a tired look, changes in the shape of the face or a loose neck and jowls. Through a facelift surgery, some of these blemishes can be undone – unwinding the clock on your face – The literal aim of facelift surgery.

Your face is unique to you. As such, there is no one-size-fits-all approach to facelift surgery. Your facelift procedure will have to be tailored to your concerns and unique facial features. Discuss your facelift options in detail with our triple board certified surgeon (Royal Australasian College of Surgeons, Royal College of Surgeons(England) and European Board of Plastic Reconstructive & Aesthetic Surgery) to consult and offer advice on your face.

As the Chief Editor of multiple plastic surgery textbooks, Dr Farhadieh can clarify any doubts you may have and discuss realistic and achievable outcomes. During the initial consultation, he will also discuss your facelift surgery expectations along with the following important factors with you:

• Previous surgeries
• Your medical history
• Current medications
• Allergies
• Family medical history
• Your smoking history

After discussing these in detail, Dr Farhadieh where appropriate, will offer various surgical options that best suit your needs, including whether a full facelift is suitable for achieving your goals. We will provide extensive knowledge and advice for you to make an informed decision about what you want from your facelift surgery. In addition to expert advice, you will also be provided with a comprehensive information pack on your facelift procedure. This includes discussion on complication profile, this includes infection, asymmetry, risk of nerve damage, scarring, post-operative bleeding and leg blood clots.

During your facelift operation, a hairline incision is commonly made in front of your ear, extending behind it to gain access to your facial features. Underlying facial structures like the fascia and shifting soft tissues are connected to underlying bones via an intricate system of ligaments. The scientific literature is clear only by surgically manipulating these structures can you achieve a more balanced, natural, long term results, simply removing excess skin or using threads will not have either a good or lasting outcome.  For revision facelift surgeries, the process may vary slightly due to the intricacies of any revision procedures. If you wish to, your eyelids can also be addressed during a facelift surgery.

When opting for a neck lift, and additional incision will be made under the chin to conceal it as much as possible.

Your facelift operation will be performed under general anaesthesia, and you will need to be admitted for one night. Most patients at Panthea clinics are discharged the next day. You can expect some bruising and swelling after the procedure, but they should subside in 2 weeks time. Most patients find themselves well enough to return to work after 2 weeks, some even returning just a few days after getting discharged from hospital. You will be required to return to our Sydney or Canberra clinic between 5 to 7 days after your procedure so that Dr Farhadieh can remove any drains and reiterate scar management advice.

All surgeries, no matter how big or small, carry risks of complication as indicated above. Our surgical team will further explain the risks of a full facelift operations, possible complications, and discuss all aspects of the surgery with you during your consultation. Dr Farhadieh has extensive training in facial aesthetic and reconstructive surgery his experience with facial nerve reanimation subspecialty fellowship further adds to his overall patient care.

Following your initial postoperative review, we will continue to organise regular follow-up appointments at your preferred Sydney or Canberra clinic.

Throughout your surgical journey, your relationship with your surgeon is crucial to your procedure. Be sure you have read and understood all the information sheets provided. If you have any questions, please do not hesitate to ask them. We will guide you through every step of the way until you have a clear picture and are satisfied.