All About Facelifts – What is Right For You?
Posted: Monday 5 April 2010 11:12am
Many women and men consider a facelift the last resort in conquering the ageing process. With so many non-surgical facial rejuvenation techniques on the market, such surgery can seem extreme, but for others, there is little alternative if they want to look substantially younger and fresher.
According to plastic surgeon Dr Steven Liew, of Sydney’s Shape Medispa, there is no set age when women should contemplate a facelift. “It can range from mid 40s to late 70s,” he comments.
It really depends on the amount of skin laxity and excess skin, which if in excess, decreases the suitability of non-surgical treatments.
Dr Michael Zacharia, President of the Australasian Academy of Anti-Ageing Medicine and cosmetic facial surgeon at Sydney’s About Face says, “Some people seem to be under the impression that the longer you wait to have a facelift, the better.
“But this is not necessarily the case, as the older you get, the elasticity in your skin diminishes, and the thinner your skin gets.
“This makes surgery a more difficult procedure and the result is not as good as it would have been if your skin was suppler.”
Below are five of the different types of facelifts available for different ages and levels of skin firmness and sagging.
1. TRADITIONAL FACELIFT
What is it: Also known as the full facelift, the traditional lift is major surgery that separates the skin, pulling it back, making it look tighter.
Who’s it suitable for: “Patients who have severe laxity and skin excess in the neck, known as the ‘turkey gobbler’ tend to require the full or traditional face/neck lift to remove excess skin,” says Dr Liew.
What’s involved: Hair is shampooed the night before surgery. “On the day incision lines are marked and the ‘vector’ or direction where the deeper tissue needs to be lifted. Then the patient is anaesthetised, either general or twilight, and the face is infiltrated with a large volume of local anaesthetic and adrenalin to reduce bleeding. The skin is lifted and the deeper layer (SMAS) fibro-fatty muscular layer is lifted and shifted to the right vector and suspended. The excess skin is trimmed and the wound is closed meticulously to ensure minimal tension or distortion to the ear. “I often add some structural fat graft to the cheeks to further enhance results,” says Dr Liew.
What results can you expect: “Patients should expect a very natural refreshed look, That is a fuller cheek, nicely suspended cheeks, nicely defined jaw-lines and neck without the tell-tale traditional over-pulled wind tunnel look,” comments Dr Liew. “Once the wound is fully healed, you should be able to wear your hair which ever way you like, with the scars well hidden.”
Where is procedure performed: Hospital.
Your post-operative state: “Pain is not normally an issue and can be managed with simple pain killers like Panadol or Panadeine.”
How long is healing: Sutures are out by week one and make-up can be applied after seven days. The downtime is usually two weeks. You shouldn’t exercise for four weeks.
Any preparations required: “Maintain good skin condition, stop smoking four weeks prior to the operation, maintain a good diet and sleeping pattern,” comments Dr Liew.
How long do results last: “It varies between patients, but generally from five to 10 years,” he says.
Maximising recovery: “We suggest lymphatic drainage massage and LED light treatments to improve scarring.”
Downtime: Two weeks.
Optimal results: Three months.
If not happy with results: “We can revise the scars, add fat or filler to the cheeks for asymmetry, and in the worst case scenario we can revise the surgery,” says Dr Liew.
Ballpark cost: $18,000 to $25,000.
Claimable: “Only if it can be proven the facial droop is due to disease or trauma,” says Dr Liew.
Maximising results: “Skincare and non-surgical treatments will still be essential to maintain the new look,” says Dr Liew. “I suggest Botox for wrinkles and folds, skincare to improve texture, pigmentation and skin health. Fillers can be used for the maintenance of the cheeks and skin folds.”
2. S-LIFT OR MINI-LIFT
What is it: The S-Lift gets its name from the smaller S-shaped incisions made in front of the ear. Through this incision, the surgeon can lift skin and underlying tissues.
Who’s it suitable for? Especially good for people aged 45 to 55 who want to lift the lower face and fix jowling. Says Dr Jayson Oates, President of the Australasian Academy of Facial Plastic Surgery, and Medical Director of the Academy Facial Plastics & Laser Clinic, Perth, “It is best for someone with early to moderate gravitational change to the face, such as the jowls.
“If someone has a lot of neck sagging then they are better off with a face lift,” he comments. “This usually means a slightly younger age group opts for the mini-lift as opposed to traditional facelift. It is less expensive than facelift so some people will have it for cost saving and accept a lesser result.” He adds that it’s not great for people who require extensive neck and cheek lifting.
What’s involved: Using either general anaesthetic or twilight anesthesia, an incision is made in the creases in front of the ear and curled behind the ear lobe. Says Dr Oates, “The skin of the cheek is elevated for whatever distance is necessary – the fibrous/muscular layer beneath that gives the strength to the lift. The skin is trimmed and closed. Other elements may be incorporated at the same time such as liposuction to the neck or tightening the bands.”
What results can you expect: “Some might say you look 10 years younger, but the results are individual,” he comments.
Where is procedure performed: Usually in a day surgery, day hospital or a regular hospital. Overnight stay is optional.
Your post-operative state: “It is not usually a particularly painful operation, but there is some discomfort and bruising and the face feels a little tight,” says Dr Oates.
How long is healing: There may be swelling and bruising. Use icepacks for the first few days.
Any preparations required: Glycolic peels can help prepare your skin for the operation along with cosmeceutical skincare.
How long do results last: “In some respects, the results are forever as you will probably always look better than you would have before,” comments Dr Oates. “But ageing continues and you might consider redoing the procedure after six to 10 years.”
Maximising recovery: Keep incision lines clean.
Downtime: 10 to 14 days off work, although some people are out back to their normal routine after one week.
Optimal results: After one to two months.
If not happy with results: Go back to your surgeon to discuss alternatives.
Ballpark cost: $6,000 to $10,000
Claimable: No
Maximising recovery: Glycolic peels and use of cosmeceutical skincare is advisable.
3. MID-FACELIFT
What is it: “A surgical procedure to reposition the mid-face fat-pad to its more youthful position,” says Dr George Marcells, cosmetic facial surgeon at Sydney’s About Face clinic. “As we age, the tissues of the cheek and middle part of the face, which give a youthful healthy appearance when we are young, descend ‘southward’. This process usually starts to become apparent in our 30s and progresses in each decade.”
Who’s it suitable for: “It is best suited to people who have descent of the mid-face fat pad, rather than someone with atrophy or wasting,” he comments. “There is no age limit to this surgery, but the signs of ageing usually start occurring in the 30s and progress from there.”
What’s involved: Usually performed under general or twilight anaesthetic, the surgical procedure is performed with an incision hidden in the temple hair. The procedure lifts the cheek fat back up onto the cheekbones, raises the outer eyebrows, and lifts up the corners of the mouth. It may often be performed in conjunction with a neck or brow lift. It usually takes around two hours, but could be more if you select other options such as the brow lift or cheek implants.
What results can you expect: A more youthful mid-face is restored. Cheeks may look higher and plumper, especially if implants have been inserted.
Where is procedure performed: Day surgery or private hospital. An overnight stay may be required.
Your post-operative state: There may be bruising and swelling, but this subsides after one to two weeks.
How long is healing: “Two weeks before being socially acceptable,” says Dr Marcells.
Any preparations required: No smoking, healthy diet, multi-vitamins.
How long do results last: Five to 10 years.
Maximising recovery: Lymphatic drainage, vitamins, arnica. Also hyperbaric oxygen therapy. This form of oxygen therapy raises the levels of oxygen in the body’s blood plasma. Increased oxygen in the plasma leads to higher amounts of oxygen delivered to the body’s tissue, organs and brain and therefore assists in healing of bruising and scarring.
Downtime: Two weeks
Optimal results: Within three months time
If not happy with results: Consult your surgeon for further options.
Ballpark cost: $7,000 to $10,000
Claimable: No
Maximising results: The patient may benefit from non-surgical treatments such as Botox or fillers.
4. LOWER FACELIFT
What is it: “Lower facelift surgery rejuvenates the bottom third of the face by tightening the face’s underlying structures that slacken with age, forming jowls and a fleshy neck,” says Dr Zacharia, cosmetic facial surgeon at Sydney’s About Face. “The procedure also trims excess skin, smoothing it down to eliminate facial creases and giving a visual lift to the bottom third of the face.”
Who’s it suitable for: Men and women whose face and/or neck has begun to sag, but whose skin still has some elasticity, and whose bone structure is strong and well defined. Says Dr Zacharia, “Most patients are in their 40s to 60s, but these lifts can be successfully performed on people in their 70s as well.”
What’s involved: Performed under general anaesthetic, the surgeon wworks through small or hidden incisions, and carefully separates the skin from the tissue below. Excess fat is removed, facial muscles are tightened and restored to a more youthful position, and skin is smoothed before the excess is trimmed away. The surgeon completes the lower facelift by closing the incisions with sutures. Surgery can take 2 – 3 hours, but if a face and neck lift is performed at the same time, it can take about 4.5 hours.
What results can you expect: More defined jaw-line, reduction of jowls, more firmness and youthfulness in lower half of the face.
Where is procedure performed: Day surgery or private hospital. Overnight stay is optional.
Your post-operative state: You will have a bandage on immediately after surgery. On discharge the next day this will be replaced with an elasticised ‘face garment’ which needs to be worn for a minimum of two weeks. You will have some bruising and swelling and will be tender around the ears. “This can be unsettling at first, as the bruising and selling tends to get a little worse over the next few days,” comments Dr Zacharia.
How long is healing: “Recovery for this type of facelift is usually not too bad,” says Dr Zacharia. “However there must be minimal activity for the first five to seven days. Over the next two weeks, general indoor activity is permitted, but there should be no lifting or straining.” He says, “You may want to stay ‘under the radar’ during this time.” At your three to four week post-op visit, you can return to full activities. Bruising and swelling should be unnoticeable to friends at about two weeks.
Any preparations required: “Maintaining adequate nutrition before and after an operation is essential to ensure optimal results for a speedy recovery,” comments Dr Zacharia. “Pre and post operative nutritional support focuses on reducing inflammation, supporting the immune defense system, and minimising scarring and bruising to accelerate healing.”
How long do results last: “The improvement can be expected to last many years,” he says. “The results don’t wear off, but rather the ageing process will continue starting with you new younger appearance. The surgery’s longevity will depend on hereditary/genetics, sun damage at the time of surgery and protection from further sun-damage, whether or not you smoked or continue to and your facial elasticity. Expect the effects to last seven to 12 years, with an average of seven years.”
Maximising recovery: “Patients undergoing surgery also respond well to the anti-inflammatory activity of omega 3 fatty acids from fish oils to help promote wound healing and recovery,” says Dr Zacharia. He adds that mild hyperbaric oxygen therapy is also recommended. This form of oxygen therapy raises the levels of oxygen in the body’s blood plasma. Increased oxygen in the plasma leads to higher amounts of oxygen delivered to the body’s tissue, organs, and brain and therefore assists in healing of bruising and scarring.
Downtime: About two weeks.
Optimal results: Swelling may take four to six weeks to subside.
If not happy with results: Return to your surgeon to discuss further options.
Ballpark cost: $6,600 plus hospital and anaesthetic fees.
Claimable: No.
Maximising recovery: Says Dr Zacharia, “My basic philosophy is that we can lift and tighten the skin tissue, but it will inevitably relax again over time. It is vital to treat and rejuvenate the skin prior to surgery to optimise the healing process and get the best possible results. Regardless of a patient’s skin condition or age, all smokers considering surgery should stop, as it is highly beneficial to the healing process. All patients should stay out of the sun and apply a broad spectrum sunscreen.”
5. THREADS LIFT
What is it: The threads used in the thread lift are lined with numerous, small, directional cogs or barbs which are able to “fix” onto the soft tissues underneath the skin. Once the threads are inserted and the sagging tissue is lifted, the barbs anchor the soft tissue in the corrected position. Over a number of months, new collagen formation around the threads strengthens the support.
Who’s it for: “The thread lift is suited to patients with mild to moderate facial droopiness or excess skin of mid-face, jowls and neck,” says Dr Tony Prochazka, cosmetic surgeon at the International Centre for Cosmetic Medicine, Sydney. “It can also be used for brow elevation”. Dr Prochazka says this lift is not suited to people with heavy features or severe tissue drooping, or those who do not accept the idea of non-absorbable sutures under the facial skin.
What’s involved: “I perform the thread lift under a mild sedative with plenty of local anaesthesia to numb the tissues,” says Dr Prochazka. Once the face is numb, the threads are inserted under the tissue, and the tissue is subtly lifted. There is no excising of skin. A typical facial threads lift will take about one hour, slightly longer if neck and/or brow are also lifted.
Results: Says Dr Prochazka, “Mild to moderate elevation of tissues is possible. You may look a few years younger, but the more likely result is that you will look ‘good for your age’.”
Where is the procedure performed: Typically in a cosmetic doctor’s procedure rooms or at a day surgery. No overnight stay is required.
Post-operative state: The lifting effect is immediate. According to Dr Prochazka, there is always some skin puckering, which can look “quite strange” for a few days. “However, the skin ‘redrapes’ very rapidly, with puckering resolving usually within one to two weeks.” There may be some mild bruising and swelling for the first few days. “Some pain is normal at the sites of suture anchoring, usually behind the temple hairline, or behind the earlobe for neck lifting,” he says. This pain is intermittent and resolves gradually.”
Healing and recovery: Says Dr Prochazka, “As this is essentially a scarless lift, healing time will depend on resolution of puckering, swelling and bruising. Most clients can return to work after 10 to 14 days. However, some care must be taken not to loosen the sutures through strenuous activity. Some activities must be avoided or restricted for up to six weeks.
Preparations: Certain medications and supplements which may prolong bleeding time may need to be ceased (subject to medical advice) for 10 days prior to the surgery.
How long do results last: “The longevity of results is critically dependent upon how well the post-operative restrictions on strenuous activities are observed,” says Dr Prochazka. “Assuming that the threads do not loosen in the first six weeks, most clients will achieve two to four years’ worth of tissue elevation, perhaps longer.”
Maximising recovery: Strict observance of restrictions on strenuous activities. (See above).
Downtime: Most people can return to work after 10 to 14 days.
Optimal results: After two weeks.
If not happy with results: “It is never possible to guarantee a particular outcome from any type of cosmetic surgery,” says Dr Prochazka. “If a client is unhappy with the result – whether due to complications, or because their expectations were not achieved – it’s always best to discuss this frankly and openly with the surgeon who did the work. In most cases, removal of troublesome threads and/or placement of new threads will improve the final outcome.’
Ballpark cost: Between $3,000- $6,000 depending on how many areas, how many threads are used. Typically a facial thread lift costs around $4,500 inclusive.
Claimable: No
Maximising results: There is little point having a thread lift if your skin is heavily wrinkled, in poor shape, or you have lost significant soft tissue volume from your face. Try other treatments in conjunction with the lift, such as laser skin treatments, facial volumisation with fillers or fat transfer, and/or Botox. A home skin maintenance program should be designed to suit each client’s specific needs. “I would never operate on a patient who is medically unwell,” says Dr Prochazka. “Any underlying medical problems need to be stabilised before cosmetic treatments can be contemplated.”
WORTH NOTING:
Finance terms: All Fellows of the Australasian College of Cosmetic Surgery are bound by the ACCS Code of Conduct, which discourages the offering of finance for cosmetic procedures, comment Dr Tony Prochazka. “I do not offer finance, but there are third-party companies which can arrange finance for such procedures – this is a matter for the patient to decide.”
Finding a good cosmetic surgeon for this procedure: Word of mouth is always the best bet. However, it is also useful to check doctors’ qualifications. Membership of the Cosmetic Physicians Society of Australasia, Fellowship of the Australasian College of Cosmetic Surgery, or membership of the Australian Society of Plastic Surgeons, show that the doctor is serious about this field and has both a good training background and the respect of their peers. Always look at before and after photographs. Ask to speak to former patients about their experience.
by Kate Mahon