Face And Neck Lifting
Face and neck lifting remain the core gold standard facial rejuvenation procedures. Over the last decade or so they have been continually refined to enable us to produce more consistent, more natural and more stable results. However, no procedure is perfect and careful consideration has to be given before going ahead with any surgical facial rejuvenation procedure.
When Plastic Surgeons talk about face lifting they tend to refer to the lower face. If you imagine a horizontal line drawn from the level just below the earlobe across to the front of the face, a lower face lift will tend to address the area below this. It fundamentally targets the jowls and jawline but has less of an effect on the mid face (the upside down triangle below the eye that runs along the side of the nose).
A neck lift is commonly incorporated with a lower face lift as access to the sagging muscle (the platysma) can be obtained through a full face lift incision which can then be tightened from behind.
The fundamental approach to a contemporary face lift requires addressing the SMAS (superficial musculoaponeurotic system). This is the soft tissue facial skeleton that sags and brings the skin and other tissues with it. We have now learnt that by securely tightening the SMAS tissues and gentle re-draping and trimming the skin we can produce the best most natural face lifts, avoiding the wind tunnel look and some of the other stigmata of face lifts one used to see.
Precisely how the SMAS is manipulated varies from person to person and there is no “cookie cutter” or one size fits all procedure. We are all so different, our faces are so different, our genes and the way we age are so variable that it stands to reason that it is impossible to have one procedure that is suitable for everyone.
Any “off the shelf” standard procedure must be viewed with a degree of suspicion and caution as it risks not suiting everyone.
From my personal point of view, my approach to face lifting will vary between men and women and between facial types. For example those with small slim light features which have signs of loss of volume, sagging of the jowls and neck bands that are revealed are approached differently for someone with a heavier neck, thicker skin and a fuller face. My approach and rationale for my recommendations will also be discussed during a consultation and further discussions can be undertaken to delve deeper into our options as required.
Face Lift Scars
My approach to face lift scars is to minimise abnormal displacement to the hairline whilst maximising camouflage of the scars. I do this by placing scars within the sideburn hairline that hug the nooks and crannies of the ear. They go behind the tragus (the part of the ear that sticks out to cover the hole of the ear canal) and then sweep under the earlobe, hugging the ear crease and then going back down along the border of the hairline behind the ear. These scars normally heal very well indeed and after a year or so (having been given time to fade and soften) they tend to be very discreet and subtle. I am always delighted when I see my patients come back for post-operative visits with their hair tied up indicating to me that they have not given a second thought to any issues with scars that they worry might be visible.
For men I tend to place the scars slightly differently so as to minimise the risk of any hair bearing area (that they would need to shave) being moved back in an abnormal position around the ear. Therefore the scars for men tend to be placed in the natural crease in front of the ear rather than going back around the tragus.
A significant proportion of people come to see Plastic Surgeons with their neck as their primary concern and the jawline and jowls being a secondary concern. In my experience if the neck is not fundamentally targeted aggressively (from a surgical point of view) then sub-optimal results will often be produced. Whilst there is considerable variation in the longevity of any individuals’ outcome of surgery, if the neck is the number one priority then my recommendation is always to do as much as possible to the neck. This will maximise the chances of getting a good outcome from neck surgery that will last a long time. Conversely in a glass half empty perspective, if the neck result has relapsed somewhat early despite doing the most aggressive operation possible, then at least everything reasonable has been tried to achieve the outcome desired.
For those who are most concerned about the neck I would often recommend the addition of an open or anterior neck lift as well as the lower face/neck lift (which is performed from scars that hug the ear). This requires an additional scar hidden under the chin but allows me direct access to the anterior or front of the neck and underchin area. It allows me to reduce any fat in this area but also to tighten and re-sculpt the muscles in this area to achieve the best neck angle in that particular individual possible. The lower face/neck lift still remains the core procedure, however the additional open neck lift (incorporating a corset platysmaplasty, digastric muscle tightening and deep fat removal) gives the additional benefit of maximising the effect on the neck.
Volumising Using Fat
Fat grafting (also known as lipofilling or fat transfer) has become an excellent tool to help restore lost volume during facelifts. It can be used not only to enhance flattened cheek areas but also to fill some of the depressions in the nasolabial fold and temple areas. If appropriate I will always discuss fat grafting as an additional procedure that might help the overall appearance following a face lift.
Face Lift Maintenance
It goes without saying that the continual aging process, despite having the face lift, can be slowed down by ongoing periodic treatments after a face lift. I always recommend that my patients look after their skin with either medical grade skin care or regular facial peels. In addition maintenance of volume with hyaluronic acid fillers and the use of anti wrinkle injections to soften any crows’ feet and wrinkles in other areas is invaluable to maintain as good a result for as long as possible.