As we age, the skin in our face becomes looser and loses its elasticity. The muscles also begin to slacken. This leads to looser skin and progressive deepening of the natural folds and creases of the face e.g. around the mouth, neck and eyes. Fine wrinkles start to develope around the eyes, mouth and lines of facial expression.
Facelift surgery aims to remove the excess loose skin and wrinkles, and to lift the features of the face again. It mainly affects the mid to lower face and can include the neck. It can be combined with other facial rejuvenation techniques such as blepharoplasty or brow lifts or non surgical techniques such as Botox.
There are several different types of facelifts which vary in the skin incision used and the extent of surgery performed. Two of the most commonly performed facelifts are the SMAS lift which lifts the soft tissues underlying the skin as well as tightening the skin, and the MACS lift which also tightens this layer of tissue under the skin. Purely removing the excess loose skin will have a very short lasting effect. Both of these techniques involve an incision in the skin in the crease in front of the ear and extending into the hairline above the ear and in the case of the SMAS lift behind the ear. If a necklift is a significant part of the procedure, it may also be necessary to place a small incision underneath the chin.
Facelifts are usually done under general anaesthesia in the UK but can be performed under local anaesthetic with or without sedation. Smaller facelifts can easily be performed under local anaesthetic, while more extensive facelifts may be better done under general anaesthesia. Usually an overnight stay is required, but this will depend on extent of surgery. There will be swelling and bruising afterwards which will take a couple of weeks for the majority of the swelling to go down but longer to fully disappear.
It is very important to mention if you smoke or take any medications that thin the blood such as warfarin or clopidogrel or suffer from high blood pressure as these can cause a significant increase in the risk of complications after facelift surgery.
I have put together a short guide to the different types of facelift available:
While guide time frames are given for how long each lift will last, it is more that the facial tissues continue to age and loosen as they normally would and thus gradually relax out again. In general, you will still have a more rejuvenated appearance at the end of these timeframes than if you had never undergone surgery.
“Ms Nugent is not only a wonderful surgeon. She is a lovely person, easy to talk to and reassuring at all times” SB, facelift, necklift and brow lift at the Montefiore Hospital 2016
Fine threads are placed through tiny needleprick incisions strategically placed on each side of your face under local anaesthetic. The threads are specially designed to catch and lift the skin as they are tightened. A subtle lifting effect is seen that lasts up to two years. This lift is suitable for those who want a mild lifting effect and do not have much loose skin.
The one-stitch facelift also offers a mild lifting effect for the lower face and can also remove a small amount of loose skin. The scar is placed around the lower part of the ear and both the skin and the underlying supportive layer of tissue (SMAS) are lifted and tightened. It is usually done under local anaesthetic and lasts up to two years. It is suitable if you want a subtle tightening of your jawline and a quick recovery time.
The MACS lift offers a medium effect facelift and can lift and tighten both the lower face (jawline) and midface (cheek and nasolabial crease – crease between cheek and upper lip). As a result of the lower facelift, some laxity in the tissues of the sides of the neck is also taken up. The scar is placed in the hairline above the ear and running down in front of the ear in the natural crease there. Both the underlying support layer of SMAS and the skin are tightened and more loose skin can be removed. This lift lasts five to seven years and is suitable for those who have more moderate laxity in their facial tissues.
In this type of facelift, the skin and supporting layer of SMAS tissue are individually lifted, repositioned and tightened. Excess skin is also removed. This is a more powerful facelift than the others and can also be used to lift the neck tissue as well. The scar is placed in a similar position to that of the MACS lift as well as running behind your ear. This allows a very effective lifting, tightening and repositioning of your facial tissues, while still allowing a very natural result to be achieved. A SMAS facelift lasts seven to ten years and is suitable for you if you have moderate to severe laxity in your face and laxity in your neck tissue as well.
The SMAS and MACS facelift procedures tighten up and lift the skin and underlying support tissue at the sides of your neck as part of the procedure. This is more extensively done in the SMAS lift than in the MACS lift. Sometimes a separate incision is required underneath the chin to tighten and lift the anterior and under-chin neck tissue including the skin and underlying support layer. Sometimes it is necessary to reposition or remove one of the upper neck salivary glands to achieve the desired shape and contour of the jawline. This extra incison is not always required. Tightening the tissue at the side of the neck may be sufficient on its’ own or a small amount of liposuction through a tiny incision may be enough if the primary problem is fat rather than loose skin. Usually a necklift is performed in conjunction with a facelift but at times may be done on its’ own.