Facelift & Necklift by Dr Alan Evans

A minilift is designed to correct the common signs of lower face aging. These include a sagging neck line, the appearance of jowls, the deposit of fat along the jaw line and neck and a deepening of the lines between the nose and corners of the mouth (nasolabial folds). It may be combined with liposuction or with a temporal or midface lift. Consideration must be given to facial bone structure and skin elasticity in planning and performing a facelift.

A full facelift includes an incision behind the ear along the hairline in order to better affect the neckline. It carries a slightly higher risk of scarring behind the ear and haematoma (bleed). It may require an overnight stay in hospital.

Most men and women who are good candidates for a facelift are between the ages of 35 to 65. However, there are exceptions. Some people age prematurely and consider the surgery at an earlier age. Others age more slowly and can successfully have the surgery in their seventies and eighties. More consideration is given to the patients’ actual appearance and general health than their chronological age.

All facelift patients must be in good health, physically and emotionally. A facelift can make you look younger and enhance your self image, but cannot restore the health and vitality of your youth. Before deciding on surgery, think carefully about your expectations and discuss them with your surgeon.

At your initial consultation, Dr. Evans will ask you to express your concerns about your appearance. Your medical history will be reviewed and a physical examination will be conducted to determine if a surgical procedure is best for you. If you are a good candidate for surgery, Dr. Evans will explain how the procedure is designed to correct your specific areas of concern. Dr. Evans may request that you visit your private medical doctor for a check-up and for any necessary lab work and x-rays.

In the majority of limited incision facelifts, local anaesthesia with or without intravenous (twilight) sedation is used. Dr. Evans and his anaesthetist will help you make this decision based on what type of anaesthetic is best for you.

As recently as the early 1980’s, the only operation that the plastic surgeon had to offer was the “standard” facelift. This was a one-dimensional operation- a simple tightening of the skin by removing the excess skin. Today, more attention is given to the deeper layers of the face which, like the skin, are affected by age and gravity. These multi-level procedures require less pulling on the skin, providing natural, less “surgical” and longer lasting results. Even in the limited incision procedures attention to correction of these layers is made.

A limited incision facelift is generally performed as a day procedure at Shire Cosmetic Medicine Clinic or at a day hospital facility. It may be combined with other procedures, such as cosmetic eyelid surgery and/or a brow lift. Before anesthesia is given, a detailed “map” of the skin and/or fat to be removed or replaced is drawn on your skin using a special marking pen.

After anesthesia is given, incisions are made in concealed areas of the scalp and around the cartilages of the ear. A small incision may also be made under the chin if liposuction is to be undertaken. The skin is elevated from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The underlying muscles and fascia are tightened. The skin is pulled back, and the excess is removed. Great care is taken to avoid a “pulled” appearance or a change in your natural expression. Platelet-Rich Plasma (PRP) and/or fibrin glue may be applied to encourage healing and reduce bruising. These can be discussed with Dr Evans preoperatively. A surgical drain to evacuate bloodclot is used uncommonly. The incisions are then closed with fine stitches.

At the completion of the surgery, a bandage of cotton and linen is applied to your face and neck and a special elastic face helmet fitted. The operation usually takes between 2 and 4 hours. Local anaesthetic as well as systemic pain relief are given to reduce discomfort.

When you are fully alert you will be transferred to the ward or recovery area. You may be able to go home within a few hours if local or twilight anaesthesia has been used. If surgery is undertaken in hospital you are likely to stay overnight. The following morning, all bandages are removed. The surgical sites are inspected and cleansed and a lighter bandage is placed. Instructions are given on how to care for the incisions until the stitches are removed in seven to ten days. Most patients have minimal pain after a facelift. Pain medication is prescribed, although this is usually unnecessary after the first day. Sleeping with your head elevated for three days can significantly reduce swelling and discomfort.

There may be bruising and swelling which may last for one to two weeks. Makeup may be applied after one week. Most patients return to work and social activities after two weeks. Strenuous physical exercise is avoided for two to three weeks following a facelift.

The goal and the result of a facelift are to provide a more youthful looking face. The improvement can be expected to last many years. The results do not “wear off”, but rather, the aging process will continue starting with your new, younger appearance. When further aging occurs, you could choose to have a secondary facelift or tuck which can usually be performed safely and easily.