The operation in which the excess and wrinkles on the face (forehead-face-neck) skin are removed and the laxity of the subcutaneous soft tissue is corrected is called face lift surgery. Only surgeries in which the facial skin is stretched are no longer considered as facelift surgery.
Three basic changes occur in the face with advancing age.
– Facial skin becomes thinner, wrinkled and loose (face wrinkles),
– Subcutaneous soft tissues droop (face sagging),
– Fat tissue of the face and facial bones lose volume (the face becomes empty).
For an ideal facelift result, it is necessary to intervene in all three of these conditions.
That is, the excess skin should be excised, the sagging soft tissues should be returned to their place, and the emptied parts should be filled with fat-tissue injection.
Our preferred surgical method is the deep two-layer stretching method. Between the facial skin and facial muscles, there is a hard layer rich in fat called SMAS-platysma. In the human face, it is this SMAS layer that essentially creates the drooping image. For this reason, facelift methods that do not interfere with the SMAS tissue cannot create a natural and permanent effect. In the deep two-layer method we apply, the face-neck skin and the SMAS-platysma layer are stripped separately, stretched in different directions and returned to their former places. Thus, optimal rejuvenation is achieved. In most cases, it is also necessary to treat the upper and lower eyelids. Here are the advantages of the method:
- Sagging tissues are pulled to their ideal places,
- It is possible to restore the fullness on the under-eye-cheekbones, which is not provided in the old, classical methods.
- The tension is loaded into the SMAS layer instead of the skin. In this way, after the operation, the tense facial expression that goes to people’s strangeness does not appear. Since there is no excessive tension on the skin, the incision scars heal much better. Even people who know the patient 15-20 days after the operation find it difficult to understand that this operation was performed.
Where are the surgical scars?
The skin incision made for facelift starts from the hair in the temple area, goes down in front of the ear, turns behind the ear and ends at the nape. Although the incision we have described is sufficient to lift the face and partially the neck, it is often necessary to make an incision on the scalp and under the chin. Most of the forehead lift and neck lift are performed from here.
Incision marks in the hair and under the chin are not directly visible. The incision behind the ear is also hidden by the auricle. The only problem is the scar in front of the ear. This can be easily hidden if it is placed on the front of the ear folds. The scars are visible in the early postoperative period when they are red. After a few months, the scars start to fade
What is the best age for surgery?
Depending on the facial structure, this surgery is often performed around the ages of 50-60. However, a full facelift can be performed at an earlier age in fair-skinned men and women who have experienced serious weight changes recently.
These are the ages when the sagging phenomenon of the facial skin and the fatty tissues underneath becomes more evident. However, the signs of facial aging usually start in the 40s, but patients mostly wait for this image to settle down.
In recent years, there has been an effort among plastic surgeons in many parts of the world to increase the age of performing full facelift surgery to earlier years. That is, when signs of aging begin to appear on the face of the patient (around 40 years of age), they say, let’s do these surgeries so that the effect of the surgery will last much longer. According to surgeons who advocate this idea, the younger the patient, the more flexible and tense his tissues will be, so he will be able to maintain the tension exposed during the surgery for many years. Thus, its effect will last much longer.
What is the preparation phase?
As with other plastic surgeries, the facelift candidate should not have a serious health problem. In this age group, high blood pressure and smoking cause problems in terms of surgery. While excessive smoking causes wounds that do not close at the incision sites, high blood pressure causes bleeding under the facial skin in the postoperative period. It is obligatory to keep blood pressure at normal levels with drugs. The use of drugs that dilute the blood such as aspirin and vitamin E and clot the blood such as birth control pills should be suspended, and the intake of herbal supplements of unknown origin should be stopped. Those using prescription medication should contact their doctor.
Where should the surgery be done?
Facelift surgeries should be performed in a full-fledged hospital. Although general anesthesia is the most suitable option, it can also be performed with local anesthesia under sedation. My surgeries take 5-7 hours depending on the additional procedures to be performed. After the operation, it is appropriate to stay in the hospital for one to two days. In particular, people with high blood pressure should stay in the hospital until their blood pressure is under control. Drains placed under skin flaps are removed before discharge. A light dressing is applied to the face only on the first night. Despite such a widespread operation area, there is no pain in total facelift surgery. The general swelling in the entire face decreases very seriously at the end of the second week, it takes 2-3 months for it to completely return to normal. The 15-20-day leave period is sufficient for almost all patients. While the incisions are red in the first days, it gradually fades and completely disappears within a few months depending on the skin structure.
Postoperative problems and complications
Following a facelift, the infection is almost completely seen in an area with impaired blood supply. It is treated with intensive antibiotics and daily dressings. bleeding is a special case in facelift patients. Considering the age group, high blood pressure is often observed in facelift patients. In these patients, in the early hours following the surgery, the blood pressure does not follow regularly, and this may lead to bleeding under the facial skin in the first day. Although different figures are given in various series, this problem is encountered in 2-4 of every 100 patients in general. In the treatment, the location of the bleeding is determined in the operating room and stopped.
Problems related to the facial nerves are the conditions that lead the patient to distress in the long term. The most serious complication of facelift surgery is facial paralysis due to damage to the nerves that stimulate the facial muscles. This condition may be widespread, limited, permanent or temporary.
Temporary, confined to a certain area, muscle weakness is rarely seen and disappears within a few weeks after surgery. There may be cases that extend up to 2-3 months. It is necessary to explain the detailed situation to the patient and to be supported.
Permanent facial paralysis (in a certain area of the face or widespread) is the most serious complication of facelift surgery, although it is very rare. It is not a situation experienced by experienced surgeons.
Apart from this, undesirable surgery resulting from the displacement of the hairline, loss of hair around the incision, enlarged scars, pulling down of the earlobe, inability to straighten the bands on the neck, a tense and depressed facial expression, an unsuitable surgical technique rather than a frequent post-surgery are the results. Although these cause discomfort to the patient, the patient accepts this situation for a long time as their correction requires a new surgery.