Facelifts

The proper selection of patients for a face lift is as important to the outcome of the procedure as the choice of the operative technique and the plastic surgeons ability. At your initial consultation a detailed history and examination is performed. The examination concentrates on the area in which the patient feels they require rejuvenation. Rejuvenation of the face involves assessing the brow, eyelids, the mid face, the jowls and the neck.

The next step is to see whether the area of concern involves purely skin damage, soft tissue atrophy or ptosis 'droopiness' of the deep facial structures. At times patients show apparent ageing or asymmetry of the facial skeleton that needs to be corrected at the time of the face lifting. Having discussed brow lifting and eyelid surgery elsewhere, the following information will concentrate on areas around the cheek, jaw line and neck.

There are many techniques available to rejuvenate the face. The techniques that Dr Flood uses depend upon the degree of rejuvenation required and desired by the patient. These include:

Suture Lifting

This technique involves the procedure being performed under local anaesthetic and intravenous sedation. Small incisions are made around the region of the ear and jaw line to allow sutures with small barbs on them to be threaded through the subcutaneous tissue of the face. When the sutures are pulled and tightened the deep structures are lifted helping to improve facial contour. This is especially beneficial around the cheek to reduce fullness of the nasolabial fold as well as around the jaw line to reduce the jowls. This technique is very good for patients in their early forties whose skin tone is very good and does not require significant skin removal. The technique can be complemented via fat injections to the face. Suture lifting is also good in the older patient who requires rejuvenation of the neck but does not want to undergo a full neck lift procedure.

The operation is performed as a day surgery procedure and most patients could return to work within one week.

Short Scar Face Lifting

This technique is suitable for patients in their forties and fifties where there is a degree of skin laxity associated with drooping of the underlying soft tissues. The procedure is performed under local anaesthetic with intravenous sedation or general anaesthetic. The operation is performed as a day surgery procedure. An incision is placed along the natural crease lines in front of the ear and just behind the ear lobule. The soft tissues of the face are elevated exposing the SMAS layer. Deep dissolvable sutures are used to tighten the underlying SMAS layer to correct the facial aging. The redundant skin following tightening of the SMAS layer is then trimmed. Given that all the tension has been applied on the deep tissues of the face there is no tension on the closure of the skin. Accordingly the scars usually heal very well and are not noticeable. Patients in this age group are usually encouraged to commence a vitamin A and vitamin C skin care program because of the associated sun damage to their skin.

Extended Face Lift

This procedure is appropriate for patients once they are in their sixties. By that age there is a significant degree of solar damage to the skin and skin laxity. The underlying tissues show evidence of fat atrophy (loss) and degeneration of the facial bones.

Because of the amount of surgery that is required the procedure is performed under general anaesthetic as an overnight stay in hospital. Incisions are required not only in front of the ear but behind the ear and extending into the hair line of the scalp. Often the procedure involves an associated neck lift where an incision is placed beneath the crease line of the chin to help tighten the muscles and re-drape the skin of the neck. In this age group it is important to see whether implants are required to improve the contour of the chin and the cheek. The fat atrophy that has occurred should also be addressed via fat injections. The aim in this age group is to concentrate on volume and a natural look cannot be achieved unless the underlying bony shape and volume has been assessed and corrected at the time of the soft-tissue re-suspension.

Subperiosteal Face Lifting

Dr Flood has expertise in this technique given his extended training in craniofacial surgery. Dr Flood uses this technique selectively in patients where there is significant drooping of the mid facial fat pad. Elevation of the mid facial fat pad in a subperiosteal plane is an excellent technique to correct mid facial and periorbital aging. This technique is very good in the younger patient who does not require skin removal and does not desire scar lines in front of their ears. The scar lines are hidden inside the mouth and in the scalp. The procedure provides a powerful lift to the soft tissues of the mid face significantly improving the contour of the cheek line.

In patients who have undergone previous blepharoplasty and have a 'hollow eye appearance' the subperiosteal mid face lift can help re-suspend the tissues to correct this problem. The procedure is performed under general anaesthetic as an overnight stay in hospital.

It is important to appreciate that no style of face lift suits every patient. It is important to assess the aging of a patient's face to see which technique would be appropriate for them. Focusing on minimal incisions for the forty year old age group, skin rejuvenation for the fifty year old age group and volume and bony structure for the sixty year old age group will help rejuvenate the face more naturally. The complications of bleeding, facial nerve injury, skin loss and scarring are very uncommon in the hands of a plastic surgeon who has a detailed knowledge of facial anatomy and techniques to handle the soft tissues gently.