Face Lift

 

Face Lift surgery has changed dramatically over the past two decades. Stigmata of early, subcutaneous face lift techniques included an operated, overly lifted and unnatural appearance. These suboptimal results have effectively been replaced by the naturally appearing, predictable and long lasting results of sub-SMAS and deep plane face lift operations.

Modern face lift techniques no longer apply significant tension to the lifted skin. Liposuction of the neck is frequently performed with a modern face lift. Thus an imbalanced appearance between an overly stretched face and an undertreated neck can effectively be avoided.

Placement of the incisions has also been improved. The incision line runs inside the ear canal (retrotragal line), thus rendering the incision lines nearly invisible, even when the hair style is such that the ears are not covered.

General information on the procedure

  • With time, the skin and deeper tissues of the face and neck loosen, lines and furrows form. The fat pads of the cheek descend towards the mouth, creating marionette lines.
  • Moreover, the transition from the face to the neck becomes blunt, the contour of the mandible less visible. Jowls form and fullness under the chin is noted. Although a person typically still feels young and energetic, their face and neck portends a tired and sometimes sad appearance. Various rejuvenation procedures are available to correct different areas of the face.
  • The choice of the right procedure or combination of procedures depends on a variety of factors, most importantly the patient’s wishes and expectations as well as the individual anatomy. The deep plane face lift is among the most definite procedures available for the treatment of age-related facial changes, especially when changes of the neck are present as well.

Preoperative evaluation

  • Most aspects of pre-, intra-, and postoperative care vary considerably among surgeons. The suggestions given herein represent the author’s preferences at the University of Regensburg (Germany) and have proven successful over time. However these suggestions are not meant to be dogmatic or to imply that different preferences are less effectual.
  • Paramount to the preoperative evaluation is a long, thorough and honest discussion with the patient. The surgeon must develop an excellent understanding of the patient’s wishes and concerns. It is also the surgeon’s responsibility to clearly communicate realistic expectations about the treatment effect, both short-term and long-term, and what the risk of a less than perfect outcome would be
  • A separate discussion should also take place between the anaesthesiologist and the patient so that measures to avoid postoperative nausea and pain are employed. Quality photographs are taken and serve both as a guide in the preoperative discussion and as a reference for the surgeon intraoperatively.

Operation

The deep plane face lift is typically performed under general anaesthesia. It is the author’s impression that postoperative recovery is optimized and nausea is avoided if total intravenous anaesthesia is administered.

A 5-10 mm incision under the chin allows access for a 3mm liposuction cannula. Smooth and even liposuction reduces fullness of the neck. A weak spot in the wide muscle of the neck is sutured together to remove the “double chin” appearance. The incisions are well hidden and are placed on the inside of the ear canal (retrotragal line), then behind the ear into the hair.

These incision lines are specifically designed so that the hair can be worn in any style. For male face lifts, the line of incision may be altered to preserve the location of the side burns. In order to create a youthful appearance, a number of structures deep to the skin are repositioned. These include the fat pad of the cheek and the muscles of the neck and face.

Without tension, the facial skin is then very carefully draped over the repositioned soft tissues, the hairline is aligned and the excess skin is removed. Meticulous layered closure with fine suture material minimizes scar formation of the well hidden incisions.

Postop Instructions

The patient may be dismissed home after adequate recovery, typically the same day or the day following the surgical procedure. The dressing is changed the morning after surgery, incision lines should be kept moist with an ointment for 10 days, and a 5 day course of oral antibiotics is completed.

The patient is instructed to regularly clean and moisten the incision lines, to cool the face with ice and to wear a commercial Velcro compression dressing for one week day and night and an additional week just at night. Sutures are removed 5 to 7 days after surgery. The patient is asked to limit physical activity for 10-14 days and to minimize sun exposure for six months.

Make-Up may be worn after 10-14 days, at which time the patient is typically healed enough to return to work. Regular follow-up visits are scheduled until healing has taken place. Visits at 3 months and 1 year postoperatively complete the early postoperative care.

Literature

  • Surgical anatomy of the face: implications for modern face-lift techniques
    Arch Facial Plast Surg. 2008 Jan-Feb;10(1):9-19.
    Gassner HG, Rafii A, Young A, Murakami C, Moe KS, Larrabee WF Jr.
  • Prevention and correction of the “face-lifted” appearance
    Facial Plast Surg. 2000;16(3):215-29.
    Hamra ST
  • Anatomic considerations in rhytidectomy
    Facial Plast Surg. 1996 Jul;12(3):215-22.
    Herris DA, Larrabee WF Jr.
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