FACELIFT

The range and sophistication of procedures to restore a youthful appearance to the ageing face has advanced considerably in the last few years. The traditional 'face lift' that tightened and re draped the skin is now only rarely indicated. Better understanding of the changes in soft tissues and muscles of the face has stimulated the development of a range of procedures that are tailored to the needs of each individual.

The aim of a selected procedure is to produce a brighter, fresher more youthful appearance without a' tight' or 'operated' look.

Equally, it is important that bruising and swelling in the postoperative period is minimal and the recovery period is short.

Most patients can return to social and professional activities after two weeks.

All procedures result in scars discreetly placed in the hairline and skin creases. Generally, these fade quickly and are not noticeable. Some techniques do not require a scar behind the ear and endoscopic surgery (keyhole) can avoid any facial scars.

Some numbness in front of the ears is usual but normally disappears after a few months.

Major complications after facelifts are rare. The commonest problem is bleeding in the first few hours after surgery, which requires prompt treatment. This occurs in about 3% of all patients and is more likely for smokers, males, people with high blood pressure and those taking regular Aspirin. (The Prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts, British Journal of Plastic Surgery (2001). 54, Pages 481-486)

Thorough preparation for surgery includes a review of general health, allergies, medication and anaesthetic history. The choice of surgical procedure is determined by assessment of individual facial changes and patients' desires and expectations.

Frequently, facelifts are combined with other procedures including browlift, lip enhancement and eyelid surgery.

THE MASK LIFT OR SUBPERIOSTEAL FACELIFT

Advances in surgical techniques have produced a wide range of different procedures to reverse facial ageing. All these operations are termed ‘facelifts’ which is confusing for the public and potential patients. Despite the variations, almost all procedures involve incisions around the ear and lift the soft tissues ( muscle/fat/skin) of the neck and face. The mask lift is fundamentally different from other techniques in its approach and philosophy. It is not appropriate for most patients with typical features of ageing such as jowls and a loose neck.
However, for a number of specific problems, it is a highly effective procedure.
The mask lift evolved from advances in facial reconstructive surgery where the soft tissues were lifted from the underlying facial bones to allow correction of severe disfigurments of facial bone growth. Surgeons carrying out these procedures realized that the entire facial ‘mask’ could be repositioned and lifted to produce a more youthful appearance.
In general, the mask lift is suitable for younger people with heavy brows, ‘tired eyes’ and sagging of the cheeks.
There are specific problems for which the mask lift is particularly useful.

POST BLEPHAROPLASTY SYNDROME

Lower eyelid blepharoplasty is a popular procedure for restoring a more youthful appearance to the eyes. However, even when properly carried out, it can produce some problems which are difficult to correct with traditional techniques. These problems include; ‘rounding’ or shortening of the eye, descent of the lid , asymmetry of the lids, exposure of too much of the ‘white’ of the eye and a ‘stary’ look. In severe cases, these problems may result in irritability and soreness of the eye. This is often noticed in windy, dusty or air conditioned environments.
The mask lift is a highly effective procedure in restoring a more natural look to the eyes and reducing soreness and irritability.
In my practice, the correction of problems from previous eyelid surgery is the commonest indication for a mask lift.

FACIAL FEMINISATION

The female face differs from a male face in several specific areas. The female forehead is smoother and less prominent, the eyebrow has an upward slope, the cheekbones are more prominent and the overall shape is oval. The mask lift can be used to enhance the femininity and attractiveness of the face by modifying the tissues and the underlying facial bones. For this reason, the mask lift is of singular benefit in transsexual surgery to radically soften and feminize the face.

The mask lift has many other applications in facial enhancement where traditional methods are of limited value. Equally, it is not suitable for everyone and, like all operations, has its limitations and drawbacks. A mask lift should only be performed for an appropriate problem and after thorough discussion and explanation of the procedure.

THE OPERATION

Mask lifts are performed under general anaesthetic as an inpatient procedure requiring an overnight stay in hospital.
There are no incisions on the face or around the ears. The incision is placed in the scalp within the hairline. No hair is shaved. This approach allows the underlying bones to be shaped and changed. The facial tissues can then be re draped incorporating changes to eye shape, cheekbone prominence, eyebrow position and forehead contour. The incision is closed with clips which are removed at ten days.
Active measures are taken to reduce swelling and bruising postoperatively. However, some swelling around the eyelids does occur and may take four to six weeks to completely settle. Some numbness of the scalp is experienced and may take up to six months to disappear.

SUMMARY

The mask lift is a very different procedure from most traditional facelifts. It is of most value in enhancing the forehead, eyes and cheek area rather than the effects of ageing in the neck. The techniques used in this operation are learned from the discipline of Craniofacial Surgery. This is centred on reconstructive facial surgery and requires specific training and experience. The commonest reason for choosing a mask lift is to correct problems associated with previous eyelid surgery.

COMMON TYPES OF FACE LIFT

The 'SMASECTOMY' FACE LIFT
This operation was developed by Dr Baker in the US several years ago. It is applicable for most patients and has the advantages of combining an excellent and natural result with a short recovery time.

The 'EXTENDED SMAS' FACE LIFT
This procedure is useful when there is a need to restore fullness to the cheekbone area as well as the neck and jowls. Swelling after surgery can last for longer than with the 'SMAS' ectomy.

The MACS LIFT
Suitable for patients with mild to moderate jowls, this macs lift operation has the advantage of no scars behind the ears and a very fast recovery.

The 'MASKLIFT'
Although less frequently used, this technique is very effective for patients with ageing in the areas around the eyes and cheeks. It is also useful in correcting 'sad' looking eyes that may occur after eyelid surgery . There are no scars on the face as the incision is within the hair.

The VOLUMETRIC FACELIFT
Facial ageing often results in loss of fat in the face and a gaunt or hollow appearance. The Solution to this is face fat transfer. Particularly useful for thin faces, face fat transfer procedure uses a different approach to restoring a youthful appearance by injecting the patients' own fat into the face. Advances in knowledge of fat biology has made this a predictable and reliable option in combination with modified facelift procedures.

Norman Waterhouse is one of the most renowned surgeons in the field of face fat transfer in the UK.

ENDOSCOPIC BROWLIFT

Endoscopic Browlift Surgery to reverse the features of the ageing face must include the upper part of the face as well as the neck and jowls to ensure a harmonious and balanced outcome. Until relatively recently, traditional eyelid surgery (blepharoplasty) was routinely used for this purpose. However, it is increasingly realised that blepharoplasty has a limited effect and can result in unwanted complications and an 'operated' look.

Endoscopic Browlift is often a more logical and effective way of reducing forehead lines and wrinkles, and elevating the eyebrows to correct hooding of the eyelids. Using 'keyhole' techniques, large scars in the scalp can be avoided. The Endoscopic Browlift procedure is quick and recovery is rapid although some temporary numbness and itching is normal.

The results of Endoscopic browlift are natural and long lasting. A patient evaluation study (published in the British Journal of Plastic Surgery- One hundred cases of endoscopic browlift, British Journal of Plastic Surgery. Vol 55 No 1. 2002. p20-25) has shown a high level of satisfaction with the results.

The Endoscopic Browlift procedure is less suitable for men with male pattern hair loss and women with a high forehead.

If you want more information on face fat transfer, endoscopic browlift, facelift, necklift, masklift and macs lift, call us at 020 7636 4073 in the UK.

[ Before & After ]