Thinking Of A Facelift?

Posted: Friday 15 April 2011 12:31pm

QUESTION: I am in my late 40s and considering a facelift, but don’t know if I’m really ready for one. How would I find out what my options are? If I go ahead with surgery, what is involved?

ANSWER: At an initial consultation I will ask a patient about their concerns and the areas of their face that they are unhappy with.

I then work through these concerns with the patient, looking at the specific areas and how surgery could be used to address the problems.

Patient concerns are typically things like:

• Sagging in the mid face
• Deep creases below the eyes
• Deep creases along the nose extending to the corner of the mouth
• Fat that has fallen or is displaced
• Loss of muscle tone in the lower face that may create jowls
• Loose skin and excess fatty deposits under the chin and jaw

I use anatomical diagrams to explain the surgery and show the patient photos of the planned incisions.

The success and safety of facelift surgery depends very much on the complete candour of the patient during the consultation. I will ask the patient questions about their medical history, expectations and lifestyle. These types of questions are typically things like:

• Why the patient wants the surgery, expectations and desired outcome
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries

I will also evaluate the patient’s general health status and any pre-existing health conditions or risk factors and discuss the options available for facelift and facial rejuvenation.

Then I will  examine and measure the patient’s face, take photographs and discuss options and recommend a course of treatment. This will include discussion of likely outcomes of a facelift and any risks or potential complications, as well as the type of anaesthesia that will be used.

Preparing for Surgery

If the patient decides to move forward with the facelift surgery I ask them to undertake certain precautions and they are given detailed instructions to follow in preparation for their surgery. These include:

• Stop smoking
• Stop taking certain medications including: Blood thinners, pain tablets (except for paracetamol and codeine), anything oily – vitamin E, evening primrose oil and especially fish oil, anything homeopathic or herbal (including herbal and green teas), multi vitamins (these frequently contain vitamin E and herbs), hormone replacement therapy (HRT).
• Take Vitamin C (100mg daily) and Zinc (1 daily) to help speed the healing process
• Limit alcohol intake for at least 1 week before and after surgery
• No alcohol in the last 2 days before surgery

The Facelift Surgery

I customise facelift surgery to the individual’s needs, which are determined at the time of consultation. Surgery can range from minimal to total rejuvenation of all parts of the face – a facelift may be performed as an isolated procedure or may be performed together with surgery on the upper and lower eyelids, temples or brow, together with facial skin resurfacing.

Mini facelifts, minimal incision facelifts and minor alternatives may be appropriate and planning of each procedure is customised to fit the patient’s specific medical needs. I perform surgery at either a licensed day surgery or at a private hospital, depending on the patient’s preference.

With all procedures the incisions are hidden within the hairline or within the natural creases in front and behind the ears. Makeup or the hair can usually easily conceal incision lines – if hair is short I recommend letting it grow before surgery so wounds will be hidden while healing.

Given attention to detail it’s possible to totally eliminate the “facelifted” look so common in plastic surgery of the last part of the 20th century. There is not one single method of doing a facelift that will assure a non-facelifted look, rather, I take into account the individual face and apply meticulous attention to multiple small details. Some of the details that are increasingly the focus of facelifting surgery in the 21st century are:

Incisions: The baseline for incisions is that they should be difficult to see even upon very close inspection

Hairline alteration: preservation of the hair and not altering the hairline is one of the most basic and essential ingredients of a natural looking facelift

Skin tightening: Modern facelift surgery focuses on the tissues deep within the skin, taking tension away form the skin and eliminating a great deal of the stretched, ‘facelifted’ look of earlier techniques

Fat preservation: Loss of fat in the face is one of the most marked signs of facial ageing. Fat preservation and judicious use of fat transfer are now commonly used methods in advanced facelift techniques, eliminating the ‘gaunt’ look, particularly around the eyes

Harmony: For best results I take into consideration all aspects of the ageing face and while one area such as the neck may be the major concern, small adjustments to other areas such as the eyelids may be needed to avoid disharmony of areas of the face having incongruous facial ageing

Facial movement: I am keenly aware of the potential for facial movement disorders after facelift surgery and employs modern techniques, including lateral SMASectomy, to ensure the most natural looking results

Aesthetics: Hundreds of small details go into the perfection of facial beauty and aesthetics after facelift surgery. I value a softer, more natural style of surgery that aims to restore the look of facial fullness reminiscent of youth. This can be achieved by redistributing the facial tissues and fat already present, although in some cases the judicious use of fat transfers and implants can be beneficial

The day of Surgery and Recovery from Facelift Surgery

I will take the patient through what to expect of their procedure before surgery and will see patients several times following surgery to monitor their recovery. Patients are given specific instructions for the day of their surgery, which include:

• Do not eat or drink anything from midnight the night before surgery
• Shower and use an antiseptic wash such as Betadine and wash the hair
• Do not wear makeup, moisturiser, lipstick, wigs, and hairpins or use any hair products. Nail polish must be removed and do not wear jewellery
• Dress in comfortable clothes, preferably with a front-opening shirt to avoid pulling clothes over the head
• The procedure usually takes several hours with a further 2-3 hours for recovery and depending on the extent of surgery, the patient may stay overnight in hospital. The patient should arrange for someone responsible to drive them to and from surgery and to help out for a day or two afterwards. Silkwood Medical can assist with the hiring of a private nurse if needed.

After surgery the patient can expect the following:

• For the first few days the patient must rest and keep the head elevated. The patient can move around gently, but must avoid staining, bending or lifting and should eat a diet of soft foods
• Non-aspirin pain relief such as Panadine Forte can be used if required
• There may be swelling for the first 48 – 72 hours and this can be relieved with ice compresses
• Stitches and staples are usually removed within 7 to 10 days following surgery
• Avoid direct sun for the immediate few weeks after surgery to prevent skin from burning
• Avoid strenuous exercise for the first 14-21 days. After 21 days the patient can slowly increase activity levels and should be back to normal by the end of the 4th week
• Most patients can return to work after about 14 days and can resume normal physical activities after about 21 days
• 6 weeks post-operative I consult with patients to check their recovery. Results of surgery will be emerging, but it may take up to 6 months for the final result to be apparent
• 14 weeks post-operative patients will meet with me for final consultation

For more information, call Silkwood Medical on 02 9387 3900.

by Dr Warwick Nettle

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