Face Lift - Surgery Details

Facelift – A Comprehensive Overview

  • Facelifts have proved to be uplifting experiences for thousands of individuals across all walks of life.  People undergo this cosmetic procedure with {the} hope of regaining a bit of their youthfulness.
  • Long gone are {the} days when only high profile actors, politicians, or influential businessmen had access to this seemingly complex surgical procedure to improve upon their given facial features.  Today, facelift procedures remain one of {the} most commonly performed cosmetic procedures and can boast excellent results.

What is a Facelift?

  • A face-lift or rhytidectomy is a cosmetic surgical procedure of {the} face and neck performed to improve {the} loose skin that causes wrinkles or rhytids. A face-lift smooths out {the} loose skin over your face and neck, improving {the} visible signs of aging and giving you a more youthful appearance.
  •  Undergoing a facelift surgery is a big decision.  Hence, utmost care is required in choosing your surgeon and place of surgery, as these two factors impact {the} outcome of your procedure.
  • For a better understanding of a facelift, a little knowledge about {the} anatomy of {the} face and neck is immensely beneficial. So, here it goes!

Understanding Facial Anatomy

  • Your face is made up of layers of tissues varying in texture and consistency.   These tissue layers overlie {the} bony skull, which provides {the} support for and structure of your face. From a cosmetic surgeon’s standpoint, your face is made up of {the} following components: skin, fat, superficial musculoaponeurotic system (SMAS), platysma muscle, Erb’s point (containing important nerves), deep cervical fascia and {the} retaining ligaments of {the} face. Mastering {the} art of tweaking these components in {the} correct proportion and in an aesthetically pleasing manor is {the} surgeon’s delight and goal, {the} reward being {the} facial improvement that you desire.

  • The thickness of skin overlying your face is variable - your eyelids have {the} thinnest skin while your cheeks and forehead are covered by a thicker skin. Facial skin is repeatedly exposed to {the} sun and elements.  This skin is also affected by aging, resulting in loss of elasticity and {the} development of rhytids or wrinkles. The skin consists of two main layers - {the} inner layer called dermis and {the} outer layer called epidermis. Our epidermis is what everyone sees!
  • Fat is one of {the} most important components of your face and lies just beneath your skin, i.e. subcutaneous fat. It consists of lobules partitioned by fibrous septa which connect {the} inner layer of {the} skin, {the} dermis, to {the} superficial fascia just beneath {the} fat. The distribution of fat in {the} face is variable, with a major portion deposited right beneath your cheek as {the} malar fat pad. It is also found below {the} eyes, lateral to your nose, and in front of your ears. Fat accentuates your cheek bones nicely. The malar fat pad is propped up by connections to {the} orbitomalar ligament, {the} superficial musculoaponeurotic system (SMAS), underlying soft tissue, and bone. With age, {the} malar fat pad shrinks, causing {the} cheeks to droop towards {the} crease between your nose and lips. This drop of cheek tissue results in a deeper fold and shadow-- a definite sign of aging.
  • The SMAS or superficial musculoaponeurotic system covers and connects {the} muscles of facial expression to {the} deeper layers of your face. It lies beneath {the} fat layer of your skin and provides definition to your facial expressions.  The SMAS is a thin layer of connective tissue that lies attached closely with {the} platysma muscle, frontalis muscle, galea and superficial temporal fascia. It is also closely attached to {the} superficial muscles of facial expression (including {the} orbicularis muscle), pre-orbicularis fat and {the} malar fat pad. The SMAS is attached to bone at {the} infraorbital rim, zygoma, and {the} mandible.
  • The Platysma is a thin, flat muscle that begins in {the} chest just in front of your collar bone, {the} clavicle, moving up towards {the} face and covering {the} front and sides of {the} neck.  It eventually attaches to your jaw bone and skin, then merges with several muscles and continues as {the} SMAS over {the} parotid (salivary) gland and cheek. Both sides of {the} Platysma merge at {the} midline just below your jaw line. As one ages, {the} platysma muscle becomes loosely attached to {the} underlying structures resulting in vertical banding and bowing under {the} chin.
  • The Deep Cervical Fascia is a connective tissue in {the} neck that covers and protects {the} muscles, nerves, blood vessels and glands of {the} face. Surgery deep to {the} deep cervical fascia can result in injury to {the} facial nerve, which is {the} primary nerve supply to {the} face.  Damage to any of its five branches could cause weakness of {the} muscles supplied by that particular branch.   Utmost care must be taken to avoid injury to {the} facial nerve or its branches.

  •  Erb’s point lies vertically below {the} ear canal just behind {the} sternocleidomastoid muscle and represents {the} point of emergence of several nerves that provide sensation to {the} neck and lower face. It lies just over {the} sternocleidomastoid muscle. Its largest branch, {the} greater auricular nerve emerges 6.5 cm below {the} ear canal and provides sensations to {the} lower portion of {the} ear and area just behind {the} ear. Hence, it is important to meticulously dissect this area to avoid damaging any of these nerves.

  • Retaining ligaments or tendons provide support to {the} soft tissues of {the} face and also provide points for movement of muscles of facial expression. The retaining ligaments important during rhytidectomy surgery are:
    • Allergy or unpredicted  response to anesthesia
    •  Infection is a possibility with any surgery but is rare.
    • Bleeding and hematomas are more common. Hematomas are seen in 15 percent of cases.
    • Nerve damage is rare but can occur with deeper dissections.
    • Visible scars are {the} bane of any cosmetic surgeon. Surgeons try to keep {the} scars hidden from view as much as possible.
    • Mild pain, sensitivity, bruising and swelling are common after a facelift.
    • Temporary numbness can occur due to sensory nerve interruption.
    • Some incisions take longer to heal compared to others.   Diabetes, autoimmune diseases, lung and heart disease can all contribute to longer healing times.  Diabetics should be in good control prior to and after surgery.
    • Skin necrosis with sloughing is a rare complication and seen most commonly in smokers.
    • Hair loss along {the} hair line is common and is usually temporary. Occasionally, it is permanent and might require hair transplantation.
    • Contour irregularities can occur, may be due to too aggressive sculpting of {the} fat.
    • Distortion of {the} hairline, {the} ear lobe and {the} tragus can occur.
    • Facial nerve injury is reported in 0.5 to 2.6% of facelift surgery.

Dos and Don’ts after Facelift Surgery

  • Take care not to remove any dressing or drains your surgeon has placed.
  • Rest at home and do only moderate work. Do not exert yourself physically, bend, carry heavy objects or exercise for 3 weeks. Walking is not restricted.
  • It is natural to feel tired or weak for 7-14 days after {the} surgery.
  • “Three pillows for three weeks” is {the} dictum to be followed.  Try not lie down on your side.
  • Swelling maximizes during {the} originally two days but then gradually subsides.
  • Apply antibiotic ointment to {the} suture or staple line 3 times a day. Sutures and staples are removed in 7-14 days.
  • You should avoid Vitamin E, Aspirin or related products. It is best to ask your doctor before you take any over {the} counter medications.
  • You should avoid smoking, alcohol and flying for at least 2 weeks.
  •  Avoid hair dyes or perms for at least 6 weeks and wait to shower until 24 hours after surgery.   The shower spray should be directed at your shoulders.
  • Avoid brushing your hair forcefully for at least 7 to 10 days. Use your fingers gently to style your hair.
  • You may possibly wear hypoallergenic cover-up after 1 week. No makeup on incision areas for at least 3-4 weeks 
  • Avoid {the} sun for six weeks as it makes you prone to skin pigmentation and irregularities.
  • Avoid wearing your earrings for three weeks and wear clothes that button down {the} front to avoid entanglements.
  • You should avoid tweezing, waxing or bleaching your facial hair for at least a month.
  • Wait for dental procedures for at least 6 weeks, unless it is an emergency and completely unavoidable.
  • Don’t expect your final results for at least 3 months after {the} surgery.
  • Be careful not to use extremely hot water for warm compresses.
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