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A facelift is a procedure to rejuvenate the face and give the person a younger fresher look. In the UK, we often want a result which will remove many of our wrinkles but, at the same time, avoid the Hollywood, windswept look. Most people are looking for a natural and freshened look, rather than an extreme tightening.  There are several different types of facelift and each varies according to what we do with the skin, and what we do with the underlying tissues (mainly the underlying muscles and fat pockets). In addition, the facelifts we do vary in the parts of the face they address - the upper, middle or lower face (including the neck). At the same time, many people ask for their eyelids to look a little younger too (removing some of the hooding and bagginess), to make the eyes look less tired.  With so many variations and requests available, the consultation is paramount in determining your wishes and relating these to your particular features. At your consultation, we will discuss the right facelift for you and also talk about any additional treatments that will be of help. We will individualise your treatment to your face and your requirements.  From the age of around 40 onwards, the tissues of the face start showing signs of ageing. The main changes that we see in the ageing face can be considered in three main areas - the upper face, the mid face and the lower face. The upper face is located around the eyebrow and forehead region, the mid face around the cheeks and the lower face around the jaw line and neck. The skin also changes and becomes thinner, less elastic, develops age spots and we start to see wrinkles.  There are two types of wrinkles - dynamic and static wrinkles. Dynamic wrinkles only appear when the facial muscles are being animated and static lines are present even at rest. The appearance of wrinkles first begins with dynamic lines, and these are often treated with botulinum toxins. Static lines, on the other hand, are sometimes best treated with fillers, such as those containing hyaluronic acid. For deep wrinkles that are present all the time, skin and muscle tightening procedures are sometimes the best treatment.  We see ageing changes in all three areas of the face (upper, middle and lower). We see descent of the soft tissues, loss of youthful fat, stretching of skin and the appearance of lines and wrinkles. In the upper face, the signs of ageing are seen with drooping of the eyebrows, the appearance of wrinkles in the forehead and between the eyebrows and in men there is loss of hair with male pattern baldness developing. In the mid face, we see descent of the fat in the upper part of the cheek, loss of some of the youthful fat around the eyes, the appearance of creases between the nose and lips, bulging of fat and stretching of skin around the eyelids. In the lower face, we see the appearance of jowls around the jaw line, the appearance of a double chin, prominent neck lines, fine lines around the mouth, thinner lips and neck muscles that have weakened and stretched. In fact, in all three areas, the muscles weaken and stretch and this is reflected in the overlying skin.  To rejuvenate the face, we need to address all these issues. Because everyone has different degrees of expression of the different effects of ageing, rejuvenating the face is a complex and unique procedure for each person considering it.

The Benefits and Types of a Facelift

Different people with different problems will benefit from different types of facelifts, and this is where the skill of the surgeon is important. There are several different types of facelift and each has its own advantages and disadvantages. When a surgeon analyses your face, he will consider every aspect of your face and will determine which signs of ageing will benefit from which procedure. Some facial ageing features can be addressed with a facelift alone and some features need adjunctive procedures. In all facelifts, there will be several components. The skin needs to be addressed, as do the underlying muscles and some of the fat pads. In the UK, we often want a result which will remove many of our wrinkles but, at the same time, avoid the Hollywood, windswept look. Most people are looking for a natural and freshened look, rather than an extreme tightening.  In conventional facelifts, skin incisions will be made. These will usually be along the junction of the ear and cheek, behind the ear and into the hairline. It is important to realise that it is not the length of the incision that is important, but the fact that it can be hidden effectively in the hair or in natural skin crease lines. In some facelifts, the incisions are placed in the mouth, in the eyelids as well as in the hairlines. The best incisions for you will depend on your exact needs and your surgeon should discuss these during your consultation.  In a conventional facelift, once the skin incisions have been made, the skin is partially lifted from the underlying muscles, and the muscle layer is tightened and lifted. Once the muscle layers have been tightened, any excess skin is removed to remove some of the redundancy. At the same time, fat pads can be lifted and double chin fat can be removed, neck muscles can be tightened or trimmed back, fat can be injected into the cheeks to provide a youthful fullness to the area, and the skin can be peeled in some areas to remove some of the aged skin.  Additional procedures can be performed as part of the facelift. Most often extra surgery is performed on the eyelids and the eyebrows. Sometimes the eyelid bags in the lower eyelids are removed and the muscles and ligaments of the eyelids tightened. If there is excess skin and fat bulging in the top eyelids, these can also be removed at the same time. In some people with hooded eyelids, the eyebrows need to be raised at the same time, either using keyhole surgery or by lifting the whole forehead upwards.  At the end of the procedure, the face will have been rejuvenated. The muscles will be tightened, some of the fat pads will be repositioned, the eyelids may have been tightened and the eyelid bags removed, the brows elevated and the excessive skin removed.  At this point, the rejuvenation is complete and the recovery process begins. With so many variations and requests available, the consultation is paramount in determining your wishes and relating these to your particular features. At your consultation, we will discuss the right facelift for you and also talk about any additional treatments that will be of help. My own personal practice is to individualise your treatment to your face and your requirements, and provide a bespoke service for facial rejuvenation. As part of the assessment it is important to look at the skin, the muscle, the fat and the bone structures of the upper part of the face, the middle part of the face and the lower face and neck.

Recovery and adverse effects

The vast majority of people undergoing a facelift are happy with their results. Just about everyone feels their face is better than before, but many women will feel there are one or two aspects of their final look that could have been better. How long does it take to get to the final look, what can go wrong in a facelift, and is it common to have these problems?  There are three phases to your recovery after having a facelift: during the first few days, during the next few weeks and then finally over the course of the next several months.  The first few days: In the first few days, there will be bruising and swelling. The amount depends on exactly what's been done - the worst swelling is seen with subperiosteal facelifts where the whole face is lifted off the facial skeleton and redraped over the bony structures, and the least swelling is seen with mini lifts, such as the MACS lift, which is still an effective lift but most people are "restaurant ready" after 2 weeks with a MACS and around 3-6 weeks with most other lifts (of course this depends on which type of restaurant you tend to frequent!). Also, during the first phase of your recovery, you will probably have drains and you may have a dressing on the face to keep the area compressed. Drains are small plastic tubes which help reduce bruising in the face and neck skin by collecting small amounts of blood which would otherwise cause bruising. You may also have a bandage or a "face bra" placed around the areas operated on to reduce bruising and swelling. You will probably go home one or two days after your operation feeling and looking battered and bruised with swelling of the cheeks and eyes. The exact amount depends on the type of facelift, but at this stage it's the worst.  It is during this initial phase of your recovery that you can see the early complications of blood clots, infections, and nerve injuries leading to patches of weakness or numbness. Most of these are temporary when they do occur but even temporary nerve injuries can sometimes take a few months to completely settle.  The next few weeks: At around a week or two your stitches and clips are usually removed and this is when you start the second phase of the recovery. At this stage, you should start to see the results you were hoping for. The bruising and swelling will gradually subside and we begin to see more of the benefits of the procedure. You'll probably be quite aware of the changes in your face at this stage, so you might be more aware of minor areas of asymmetry and areas which have swollen differently from one side to the other. Your scars may also be red and swollen at this stage.  The next few months: As the months go by, you will see the final results of your facelift. Your skin will relax a little and some of the youthful swelling will be beginning to subside. Most of the temporary side effects will have gone by this stage, but if there are any permanent adverse effects from your lift they are unlikely to get much better.

Side effects of a facelift

Whilst the majority of people having a facelift do very well, after the recovery period, there are risks that you need to be aware of. These include, but are not limited to:

• Infections
• Blood clots
• Abnormal scarring
• Making you too tight
• Making you not tight enough
• Asymmetry
• Wound healing delays
• Nerve injuries leading to patches of numbness and patches of weakness
• Incomplete removal of all your lines and wrinkles
• Areas of hair loss near the scars that sometimes need to be put into the hairline
• A higher hairline than before
• Areas of rippling around the cheeks where the muscles are tightened
• The need for revision surgery with time, weight gain or weight loss
• The fact that surgery does not last forever and the exact length of time that surgery lasts cannot be predicted - the surgery can turn the clock back, but it doesn't stop it ticking
• The need to change your passport photograph and any other forms of identification!
• These complications and risks do not include the risks associated with other procedures (for example eyelid surgery, liposuction, fat transfers, brow lifts, etc)

Mini lifts

If you prefer to have a more gentle procedure, with less recovery time, then you might be suitable for a mini lift. These can either be short scar facelifts with minimised bruising and swelling, such as the MACS lift, or can be ribbon lifts. The ribbon lift I use is the Endotine Lift and more information on this is available at the endotine web site. Mini lifts are less invasive and have quicker recovery times, but tend to last for a shorter time than full facelifts. Some endotine lifts can be performed under local anaesthetic but other mini lifts require an anaesthetist to help you with relaxation or sleeping during the procedure.