Why does the face age?
Change in the face cannot be explained by sagging of the skin alone. Change takes place in several layers at the same time:
- Loss of volume. The deep fat pads of the face thin; the cheekbone region flattens and shadows become more marked.
- Slackening of the connective tissue. The ligaments that hold the tissues in place stretch with time; the mid-face and the jawline shift downwards.
- Reduced support from the bone. Thinning of the bone around the eye and of the jaw reduces the support for the soft tissue lying above it.
- Change in the quality of the skin. Collagen and elastic fibres decrease; sun and smoking hasten this process.
For this reason tightening the skin alone often does not give a natural result. Planning needs to distinguish how much change there is in which layer.
Procedures carried out
| Procedure | Region addressed |
|---|---|
| Brow and forehead lift | Drooping brow, lines on the forehead, a feeling of heaviness in the upper eyelid |
| Eyelid surgery (blepharoplasty) | Excess skin in the upper lid, bagging in the lower lid |
| Face and neck lift | Sagging of the mid-face, deepening of the nasolabial fold, loss of the jawline |
| Neck region | Slackness in the neck, excess skin, muscle bands becoming prominent |
| Fat grafting | Support for regions in which volume has been lost |
These procedures may be planned singly or together. The right approach is determined by the person’s facial structure and by the layer in which the change has occurred; the same procedure is not applied to everyone.
Who is suitable?
Suitability is determined by assessing general state of health, medication taken, smoking habit and the realism of expectation together.
Smoking impairs the nourishment of tissue and delays healing, so it is asked to be given up for a certain period before surgery. Blood-thinning medication, uncontrolled blood pressure or diabetes, and disorders of clotting all affect planning.
Discussing expectation is an inseparable part of the examination. Surgery does not stop ageing; it turns the change back, and the process continues.
Assessment before surgery
At the examination facial symmetry, the thickness and elasticity of the skin, the position of the brow and the eyelid, the jawline and the angle of the neck are each assessed separately. Documentation with photographs is part of the planning.
Where necessary an eye examination (before eyelid surgery) and blood tests for general assessment are requested.
Surgery and recovery
The procedures are carried out under local anaesthesia with sedation or under general anaesthesia, according to their extent. The duration varies with the number of procedures carried out.
- In the first days oedema and bruising are expected; the period in which they are most marked is the first 48-72 hours.
- Bruising usually passes off to a large extent within 2 weeks.
- Return to social life is within 2-3 weeks in most cases.
- Complete resolution of the oedema and settling of the result take months; the appearance in the early period is not the result.
The incisions are planned at natural boundaries such as the hairline and the area in front of and behind the ear; the marks fade with time but do not disappear altogether.
Risks
Every surgical procedure carries risk. The headings that need to be discussed in surgery of the face and neck: bleeding and collection of blood beneath the tissue, delay in healing, problems with the scar, temporary or permanent change in sensation, temporary reduction in strength related to the branches of the facial nerve, asymmetry, and change in the hairline.
The frequency of these risks varies with the procedure carried out, the person’s state of health and smoking. The risks are discussed in detail before a decision is made.
The place of non-surgical options
Skin care, energy-based devices and injectable treatments may bring about improvement in the quality of the skin and in fine lines. They do not, however, move sagging tissue back into place. Discussing expectation together with this limit is necessary for the right choice.
Assessment
In surgery of the face and neck the right plan arises from the person’s facial structure and priorities. Two people of the same age may be advised different procedures; in some cases the soundest advice is a non-surgical approach.
You are welcome to book an appointment for an assessment and to discuss the options.