Facelift Surgery

As people get older, some changes happen in their faces. In fact, the initial symptoms of aging are mostly recognized in face. In addition to aging, sunrays and gravity also have effects on the face. As the muscle tone reduces, muscles and skin sag especially in jaw and neck. Skin gets dry and it loses its brightness. Loss of subcutaneous fat tissue is associated with sagging in other soft tissues. Skin becomes loose, wrinkles develop, elasticity reduces and sagging occurs. Wrinkles increase on skin. Lines occur on skin due to activity of facial muscles for years. Since production of collagen and elastin fiber decreases, vitality and elasticity of skin diminish. New cell formation slows down in the skin. Those changes get prominent especially in the areas that are more exposed to the sunlight; the face may appear tired, aged and sad.

Following deformities can be observed on face:

• Deep lines on forehead and lower eyelid
• Drooping in eyebrows
• Sagged eyelids
• Sagging in middle face (over the cheekbone and sides of nose)
• A deep line extending from nose to the corner of lip
• Jowl beneath the jaw
• Double chin appearance in the neck

It is not possible to stop the effects of aging. Facelift surgeries are performed to reverse the effects of aging and gain a more healthy, viable and young appearance of the face. In fact, facelift surgeries are not only performed to lift the sagging skin or to correct the wrinkles (rhytidectomy). They are three-dimensional “facial rejuvenation” surgeries performed to correct the deformities of other soft tissue elements, such as fat tissue and muscle tissue, in addition to the facial skin. The aim is to carry the displaced tissues to the normal positions at the young ages and achieve a healthy and young look. Although facelift is rather requested by women, it can also be preferred by elderly men, especially those who want to start a new job. Surgery can be performed under general anesthesia or local anesthesia and sedation. Hospital stay for 1 or 2 nights may be necessary depending on the surgical technique. Sutures are removed 7 days later and patients are checked in follow-up visits. Recovery period varies depending on the surgery technique. Patients can return to work 1 to 4 weeks later on average. It may take 3 to 4 months until the swellings disappear and face gains its actual form in some surgeries. Facelift surgeries can be combined with forehead lift, eyebrow lift, eyelid aesthetics, neck lift, liposuction and fat injection.

Who are not good candidates for facelift?

• Individuals with unrealistic expectations
• People with serious diseases that contraindicate the surgery
• Patients who use blood thinners (Aspirin, Coumadin…)
• Smokers

Before the surgery:

• The patients undergo a medical examination.
• Patients who use alcohol and smoke should quit at least 2 weeks before the surgery.
• Blood thinners, vitamin E and multivitamin supplements should be stopped at least 10 days before the surgery.
• Vitamin C supplement at dose of 500-1000 mg is started 3 weeks before the surgery.

After the surgery:

• Painkillers are prescribed.
• Patients are recommended to walk upright and not to look down.
• Do not consume alcohol or smoke for at least 1 week after the surgery.
• Avoid heavy exercises, sexual activities, lifting heavy objects for further 2 weeks.
• Do not drive and do not fly for 1 week.
• Do not have dental examination for 6 weeks.
• Avoid sunlight for at least 2 months.
• You can take shower 2 days after the surgery.

Risks of facelift surgery;

• Bleeding (hematoma)
• Pain
• Infection
• Poor wound healing
• Unwanted scars
• Risks related to anesthesia
• Problems in skin sensation
• Damages in facial nerve
• Facial asymmetry
• Skin contour problems
• Level differences in scalp
• Hair loss
• Fluid accumulation in subcutaneous layer
• Possibility of need for extra surgical procedure(s)
• Deep vein thrombosis, cardiopulmonary problems

Face is divided into 3 regions in terms of aesthetic procedures.

• Upper face: Forehead and eyebrows
• Mid-face: Cheeks, nose and eyes
• Lower face: Mouth, jaw and neck

Different surgical options are applied for deformities in these regions.

Facelift surgery techniques:

• Traditional face lift: An incision is made in front of the ear and extended behind the ears around the earlobes and the helix and subcutaneous tissue of the face is exposed; the sagging skin of face, neck and jowl is stretched and the excessive skin is removed. Position of the subcutaneous fat tissue is corrected or excessive fat tissue is removed.
• Lower (Standard) face lift: here, it is planned to correct the sagging and loose skin of neck and jowl with an incision made in the traditional face lift. The target is one third lower part of the face.
• Endoscopic face lift: tissues are observed and the surgery is performed using long and thin instruments and a camera with smaller incisions. Its advantages include smaller or no incision scar. However, this technique cannot eliminate the excessive skin, when performed alone. It is usually used to lift the upper face and the forehead. It is also used for mid-face lift.
• Mid-face lift: it is used to correct the under-eye and cheek regions. It aims to translocate the sagging fat tissue and other tissues to where they were located at younger ages. It cannot correct the deformities on forehead, upper eyelid and the neck.
• Subperiosteal facelift: position of the deep tissues lying down on the facial bones is corrected and thus, the connection between the bones and the soft tissues is restored. This facelift technique detaches the facial tissue and the periosteum – the membrane covering the osseous tissue – from the bones. Some surgeons believe that it offers more successful and long-standing outcomes and the risk of complications is lower. The target is the mid-face.
• Deep plane facelift: it aims to correct deformities of mid-face, cheeks and lower eyelid. This technique characterized by longer recovery times and higher complication risk.
• Composite facelift: it is planned to stretch/lift the skin, subcutaneous tissue, muscles and fat tissues as a single structure. This technique can correct the sagging fat pad over the cheekbone, which cannot be corrected with standard methods, and also the deepened groves at both sides of the nose. It helps to smoothen the effects of aging in mid-face. Recovery period is longer.
• SMAS (Superficial musculoaponeurotic system) facelift: it is based on the principle of tightening a tissue that is combination of a membrane and a muscle which covers the deep structures of the face in subcutaneous tissue. This technique is successful in patients with deepened line extending from the nose to the corner of lips. It is not effective in the mid-face.
• Full facelift: this surgery is performed to rejuvenate forehead, upper and lower eyelids, mid-face, lower face, lips and the neck.
• Mini facelift: small incisions are made to stretch only the subcutaneous tissue. Recovery time is short. It has no effect on eyebrows. It is not successful in severe facial sagging.
• MACS (Minimal access cranial suspension) facelift: the subcutaneous tissue is accessed and suspended with smaller incisions relative to the traditional method; subcutaneous tissues are translocated in this technique.
• S-LIFT: in this facelift surgery, an incision in the form of a shorter “S” is made in front of the ear. Following the dissection of the skin and subcutaneous tissue, SMAS tissue suspension is performed. This surgery is rather preferred for deformities of lower face.
• Quick Lift: it is a modified form of the S-lift. It is not successful in serious deformities.