A facelift is the name given to a range of cosmetic surgery techniques which aim to give a total lift to the sagging and ageing face.

Facelifts are carried out to counter the effects of ageing where gravity and the effects of exposure to elements have weakened the facial skin and the undelying tissue. The result of this ageing can be a combination of drooping eyebrows, a downward slant to the eyes, a heavier and lined forehead, less prominent cheekbones and loose skin at the jawline.

The age at which this happens depends on a number of factors including heriditary make-up anda stressful lifestyle which can accelerate the ageing process resulting in a look of fatigue.Today there are several different operations which can be carried out in combination and also using keyhole surgery.

The traditional face-lift is aimed at older patients while a deep face-lift repositions fat and muscles on the cheeks and lifts the neck. There are also brow-lifts and a combination of the two. Anyone considering this operation who is overweight and intends to loose it should do so before the operation. Facelifts are best carried out on those who still have some elasticity in their skin but whose face and neck have begun to sag – in the 40s to 60s age group, though treatment can successfully be carried out on older people.

The operation is called a “Rhytidectomy” and removes the excess facial skin which leads to folds and droops. The lower face-lift deals mainly with the neck and jaw line, by pulling the skin back and trimming it behind the ears. The upper face-lift removes surplus skin in the forehead and eye area, by pulling the skin up and trimming and suturing it behind the hairline. The operation will take one to two hours, and both patients and surgeons prefer to do this under a general anaesthetic.

The procedure can be combined with other surgical treatments such as an endoscopic (keyhole) browlift and an eyelid reduction, malar (cheek bone) and chin augmentation and lip enhancement.The face is bandaged for 24 hours and will feel numb for a few weeks. Stiches are removed after about one week and the swelling and bruising will have gone down after about 14 days. Make-up can be worn afer the stiches have been removed. The scarring is concealed as well as possible in the hairline and/or behind the ears. The original positioning of the hairline in front of and behind the ears, changes as a result of the operation. Sometimes the scarsbehind the ears can take longer to heal because of skin tension.

Face-lift surgery carries some risk, including the complication of bleeding under the skin(haematoma), infection, nerve injury, lumps and poor healing, particularly with smokers. Scars depend on the how much has been done and also on your skin as some people’s scar more than others . Usually, though they will be hidden behind the ears, in the hairline, inside the mouth and under the chin.

The immediate effects of this operation can be quite dramatic. But, although the skin has been lifted, the underlying tissues have not and will cotinue to pull downwards throughout the ageing process. Sooner or later the signs of ageing will return and repeat or further surgery may be required – if so desired – in 10 years or so.

The improvement is often best when the operation is combined with blepharoplasty (removal of eye bags). Smokers should stop at least two weeks before the operation as this is themain cause of poor healing and also impairs blood circulation. Patients should also avoid aspirin, non steroidal anti-inflammatory drugs (Voltarol and Indocid) for two weeks prior to surgery to cut the risk of bleeding. Disconfort can be mild to moderate, but is controllable with painkillers. Over the following two weeks the face will be bruised and swollen. The stiches will itch and you will need to sleep with your head raised and keep in as still as possible the rest of the time. All exercise such as jogging and going to the gym is not advised for the following three months.A hospital stay of one to two nights may be required. But you will probably need two to three weeks off work for the worst of the bruising to go.

THE ‘DEEP’ FACELIF

With the standard face-lift, the underlying tissues remain unaltered and pull down on the newly tightened skin, so repeat surgery is often necessary afer about 10 years. The ‘deep’ face-lift uses techniques borrowed from reconstructive surgery, and resites the facial skin, together with the underlying muscles and supportive facial tissues. An incision is made behind the hairline, and the skin is pulled down so the surgeon can work, and then replaced. This should produce a more natural look. This lift should last for 15 to 20 years, and the scar is hidden within the hairline.The deep lift is particularly suitable for treating signs of ageing in the mid-face as the brow is lifted, the area round the eyes is brightened and the eyes augmented, producing a more youthful shape. Cheekbones are restored, lines between the nose and the corners of the mouth are softened, and the jawline is lifted. It is usually carried out at a younger age than the traditional face-lift.There may be slightly more post-operative swelling after a ‘deep’ lift, and the recovery time for puffiness to reduce may be about 20-30 days. Some surgeons feel there may be a risk of facial nerve damage, but the complications risk seems no greater than with the standard facelift, and no facial incisions means no visible scars.