Facelift Surgery

Facelift surgery is one of the most common surgeries in the field of head-neck surgeries. Ever since the first documentation of a facelift performed on a Polish noblewoman in 1901, surgical methods have been advanced over the years. In the past, the surgery only involved the outer skin layers. This approach failed aesthetically in the immediate term – after the surgery (the face looked too taut and unnatural) and in the longer run (when the facelift sagged a short time after the surgery). The conclusion that was drawn from this surgical method was that a facelift must not only repair the external skin layers, because the skin’s elasticity and its traits vary a great deal from one patient to another.

In the search for more natural and longer lasting results, methods were developed that were based on the treatment of other elements in addition to the skin. So began the era of the composite facelift. This method treats the subcutaneous layers and also the external layer of skin in order to achieve a natural lift that is durable over time. However, as this method began to be used, complications began to appear that primarily included prolonged swelling and the increased risk of damage to the facial nerve.

Following the studies conducted in the 1970s, a muscle connective tissue was discovered that was classified as a superficial tissue – ( SMAS – Superficial muscular aponeurotic system),. This discovery led to a revolution in the field of facelift surgery, which we have seen in recent years. This tissue envelops the saliva gland and is the continuation of the temporal muscles -the neck muscle has a very strong durable appearance and enables considerable stretching of the facial muscles for results that are similar to those of the facelift using the multi-layer method.

Advantages of this method include:

1. Strengthening and tightening of the subcutaneous tissues in the opposite direction of the facial sagging and thus contributing to the restoration of a young and fresh face.

2. A significant reduction in swelling and a shorter recovery period.

3. A significant reduction in complications, primarily with regard to the possible injury to the facial nerve (since the surgical field is superficial to the nerve).

The result can be simulated if we do a hand stand and look at ourselves in the mirror.

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Who is suitable for facelift surgery and what is the desired age?

Facelift surgery is for patients with weakened facial muscles, as manifested in facial wrinkles and sagging. The age range is very wide – from young ages (mostly as a result of a significant loss of weight) or very advanced ages (in which the facelift is performed for the second or even third time). However, the average age for a facelift is around 50 years old.

If you start early, will you need to repeat the surgery?

This is a common misconception – one facelift will not lead to a need to repeat the surgery and the skin will not age more quickly after a facelift. The reasons for the aging of skin vary but are primarily related to heredity, lifestyle, nutrition and other factors such as smoking and prolonged exposure to the sun.

Who isn’t suitable for a facelift?

Counter-indications for a facelift are patients with many diseases, heavy smokers, those who take anticoagulants on a regular basis or those with unrealistic expectations.

How long does a facelift last?

A facelift should last between 5-10 years and on average – 7-8 years. The results will last longer if there is no weight loss, or the appearance of other diseases and depending on the hereditary and lifestyle factors previously mentioned.

Preparations for the Surgery

The preparations for the surgery are routine – patients are asked to have blood tests done or other tests and they will need to refrain from smoking and from taking anticoagulants before the surgery (including various food supplements).

The surgical methods

The facelift methods (known as short incision, mini-facelift and classic facelift) are based on different incisions, including a short incision at the front of the ear and more extensive incisions at the front and back of the ear. We suit the incisions to the problems we wish to repair on the face. Generally, the incisions at the front of the ear deal with the upper/middle and bottom third of the face, while the incision behind the ear will deal with the neck region.

The incision usually begins at the temple, going down to the front of the ear, circling the bottom part of the earlobe and going up behind the ear. This offers good exposure of the entire area of the face and neck and enables us to repair the entire area of the face that sags. In general, the incisions are planned based on need – for example if we want to lift the eyebrows at the sides of the eyes, we will need to make a higher incision. If there is a need for other surgical procedures (such as lifting the eyelids, liposuction of the neck, rhinoplasty, chin enlargement or even ear pinning), all these procedures may be performed at the same time, during the facelift, in an integrated fashion.

The surgery can be performed under general or local anesthesia. The surgery lasts about 3 hours and usually requires one night of hospitalization for observation and the patient is discharged the next day.

Drains will usually be left after the surgery and taken out the next day. The areas of the incision will be dressedwith antibiotic ointment on top of which an appropriate pressure dressing will be applied.

What is the duration of the recovery and when can the final result be seen?

After the surgery, there will generally be edema, which mostly disappears within a week to ten days. The edema that remains will gradually diminish within the next 3 weeks, so that you may return to work after two weeks. The final result of the facelift will be seen within 4 to 6 weeks after the surgery.

Does the surgery hurt?

The surgery mainly deals with soft tissue. Therefore, there will be a pulling sensation but in most cases there will not be considerable pain; and if there is, it can be treated with regular painkillers.

Side Effects and Complications

Bleeding and an accumulation of fluids (seroma) – the incidence of bleeding is about one percent (one in one hundred patients). In general, bleeding will appear on the first day, but may also appear a few days following the surgery. If there is considerable bleeding, it will need to be drained.

Infection – although this is not common, infection may appear along the suture line and effect the nature of the scars.

Asymmetry – a lack of symmetry of the face is a given prior to the surgery and will remain that way afterward. The patient must be aware of an asymmetry of the face prior to the surgery.

Necrosis – is rare but may occur primarily in smokers. The treatment includes local dressing that protects the area until new tissue develops in the area.

Scars – Generally, the surgical scars on the face will heal properly, but in some patients there may be scars that protrude from the face, itch and are sensitive. This is usually due to reasons of heredity.

Damage to the facial nerve – The damage is rare and can appear in one of two ways:

1. Sensory related – (a decrease in sensation in the facial skin) – The symptoms will usually improve within 6 to 12 months.

2. Movement related – This is a significant damage in the mobility of the expressive muscles operated by the facial nerve. This complication is very rare today.

Despite the aforementioned complications, modern facelifts are a safe surgical procedure when performed by a skilled surgeon. The low rate of complication together with the advanced anesthesia methods enable results that look natural and the patient can quickly return to his/her daily routine.