Facelift

Aging and gravity affect all the tissues of the face. Skin, fat, and muscles “sag” gradually over the years. In a facelift surgery, the facial tissues are lifted back into their original positions. If there is any excess skin after the lift, it is removed. After lifting the tissues and removing excess skin, the face appears younger and smoother.

However, a facelift is not just one procedure. A facelift refers to a group of surgical procedures where the facial tissues are lifted. Some of the most well-known types of facelifts include:

Traditional facelift, also known as SMAS lift. In a SMAS facelift, both the skin and the underlying SMAS (superficial musculoaponeurotic system) layer of muscle are tightened.

Facelift focused more on lifting the deeper tissues rather than just the skin. The result is very natural-looking and not at all “tight” or “pulled.”

Not exactly. As non-surgical techniques have developed, knife-free facelifts have become very popular, but they cannot fully replace the surgeon’s scalpel. Non-surgical procedures are good ways to delay the need for a surgical facelift. However, at some point, the limit is reached because the removal of excess tissue will ultimately always require surgery.

The best results are achieved by combining non-surgical procedures with a surgical facelift performed by a surgeon.

A facelift, also known as a rhytidectomy, targets both the facial and neck tissues. The surgical incision typically runs from in front of the earlobe, follows the hairline, and continues behind the ear. A full facelift is most suitable for individuals aged 45–70, but in some cases, the procedure may be performed before middle age.

During a facelift, in addition to lifting the skin, the muscles may also be elevated. Sometimes, along with the facial tissues, the skin and muscles of the neck and jawline are also lifted.

The technique used in a facelift depends on the nature of the procedure and the surgeon’s methods. In most cases, hair is shaved about six centimeters above the ear, from the temple to behind the ear. The incision is then made near the hairline at the temple, continuing around the earlobe and behind the ear, ending at the hairline. The surgeon may then work on the underlying fatty tissue and muscles. Finally, the skin is pulled upward and backward, and excess skin is removed. The entire procedure takes about 2–4 hours.

A facelift is rarely an outpatient procedure. The patient typically stays at the clinic for one night after the surgery.

In a mid-facelift, the tissues of the mid-face are corrected and repositioned. During the procedure, the cheekbones and cheeks, as well as the area around the nose and corners of the mouth, are lifted. The softened and sagging tissues of the cheeks are raised and fixed in place, which smooths out the nasolabial folds that make the face appear older. The outer corners of the eyes and the lower eyelids also gain a more youthful appearance. Since the tissues are permanently repositioned, the results of the surgery last for a long time.

The results of a mid-facelift are visible quickly. The procedure is performed under local anesthesia or general anesthesia. The scars are hidden in the area below the lower eyelids or along the hairline. Typically, individuals seek this procedure after the age of forty. However, if facial features or signs of aging are concerning, a mid-facelift can be performed as early as 35 years old.

Facelift surgery is most often performed under general anesthesia. In some cases, the surgery can also be done with local anesthesia and intravenous sedation. Of course, the patient does not need to choose the type of anesthesia themselves. The differences between various forms of anesthesia are discussed during the consultation.

After a facelift surgery, the patient will need assistance for a couple of days. It is advisable to arrange for the return home well in advance of the surgery day.

The first night after surgery might be a bit uncomfortable, as there may be pain in the surgical area, and the head must be kept elevated using pillows. Swelling and bruising will occur on the face, and mood fluctuations are common in the initial days.

On a pain scale of 1 to 10, facelift patients typically rate their pain around 5. Some degree of discomfort usually lasts for about 10 days.

It’s important to start moving as soon as possible. Calm walking exercises promote healing, but strenuous physical activity should be avoided for several weeks. Patients can generally return to work and daily activities about two weeks after surgery. Most patients feel “presentable” about a month after the surgery. Full return to normal activities typically occurs around 2.5 months after the procedure.

According to an American study, nearly all facelift patients are extremely satisfied with the results of their surgery. The research participants reported that the surgery rejuvenated their appearance, boosted their self-esteem, and improved their quality of life.

Whenever the skin is pierced, some degree of scarring will occur. The scar may be visible or invisible. In facelift surgery, the incisions are made in inconspicuous areas. After the recovery phase, others will not notice any scars or other signs of the surgery.

Complications after facelift surgery are rare. However, it is important to remember that every surgery carries risks. Possible complications include:

• Bleeding
• Scarring
• Infection
• Slow recovery
• Nerve damage

The risks are discussed before making the decision to proceed with the surgery.

SMAS is a muscle-aponeurotic structure located between the skin and the muscle (superficial musculo-aponeurotic system). Since the SMAS is tightly attached to the skin, changes in the SMAS structure are always visible on the surface of the skin as well.

Simply lifting and tightening the skin often provides fairly good results, but these results are usually quite temporary. When the facelift surgery targets both the skin and the SMAS (superficial musculo-aponeurotic system), a strong support is built, resulting in longer-lasting outcomes.

If only the skin is tightened during the procedure, the longevity of the results may be unsatisfactory. On the other hand, if only the SMAS structure is tightened, wrinkles and lines may remain on the skin.

The best and longest-lasting results are achieved when the surgery targets all layers of the skin and the SMAS structure beneath it.

The SMAS structure can be supported and tightened in several ways. One method is to create a flap from the SMAS system that can be pulled upwards. Another approach is to support the SMAS structure with sutures.

Yes — and no.

The results of the surgery are permanent, but aging continues normally in the years following the procedure. Thanks to the surgery, the patient will look about ten years younger than their actual age. This change lasts for life. If you are 50 years old on the day of surgery, after the procedure and recovery period, you will look like a 40-year-old version of yourself. The clock has turned back ten years, but it continues to tick even after the procedure.