Facelift and/or necklift

When we age the skin of the face sags. It looses elasticity and the skin between the cheek and chin sags down and is not tight. Also the fat redistributes so we lose fat somewhere and in other areas there is an increase. The wrinke lines also increase especially around the eyes and in the forehead. All these are age changes.

A facelift is an operation that is designed to tighten the cheek and facial skin. It helps to make the face look younger in the right candidate. It is important to know that while it can make someone look younger, it doesnt stop the clock ticking. It can involve tightening the skin on the face, tightening the muscles of the face, removal of adding some fat. It can be done alone or be combined with other cosmetic procedure like blepharoplasty, neck lift, dermabraision, laser resurfacing dermal filler or filler injection etc.

A neck lift operation can be done independently of a face lift or performed together. The face lift addresses the cheeks and the neck lift the neck. The two areas blend into one another so sometimes a facelift involves some component of a neck lift and vice verse.

A facelift or neck lift is not always the right operation or option to address the ageing face and it is important to come for an appointment.

 When to have a facelift or a necklift

The decision to have an facelift / necklift should be carefully made by you and in conjunction with the plastic surgeon. It is important to have an examination with Dr Mahajani who will also like to know a detailed history and perform an indepth examination and discussion. Sometimes face or neckliftis not suitable and other procedures are suitable. It is usually beneficial for patients whose skin is lax. Every plastic surgeon differs in their assessment however Dr Mahajani is very conservative and often suggests to younger patients to wait and not have the surgery until they are older when there will be a large benefit. Patients who are healty with realistic expectations of the surgical outcomes are good candidates for this surgery. There are benefitis of a face/neck lift and there are risks and complications also from the procedure. You should be well informed and comfortable with your decision to have a face/ neck lift. It is important to know what can and cannot be achieved with a face / neck lift.

Before the operation

Discuss any queries regarding the operation and post operation requirements with Dr Mahajani and his staff. Any fee enquiries please discuss with the practice administration. You must not smoke for at least 6 weeks before the operation. If there is any suggestion of smoking, Dr Mahajani will not perform a face / neck lift. Neither can a patient smoke after the operation for 3 months till the tissues are truely healed. Smoking significantly affects the wound healing and will cause significant problems. Stop any medications you have been advised to by the anaesthetist. Go to your anaesthetic appointment. We will give you the name of your anaesthetist so you can make contact with them. We will give you your operation date and time. Please bring the completed consent form with you. We will provide you with a face garment to wear.

What does the operation involve

The operation is performed under sedation or general anaesthetic as a day case or overnight stay. The incision is in front of the ear and in the hairline and extends to a variable way behind the ear. The skin of the face / neck is dissected to the sagging fold on the cheek and is lifted upwards and pulled back. In addition, the muscles fascial layer called the SMAS is also tightened with permanent sutures ( known as a SMAS lift ). The excess skin is removed and drains are sometimes inserted. If the skin under the chin is fatty or the muscles are separate, the fat is sometimes removed and the neck muscles tightened in the midline. This is done by a separate scar under the chin. Once the skin is tighten, then the wounds are stitched and bandages applied. Unlike the older style facelifts which made incisions high in the hair, Dr Mahajani uses a modified facelift with a shorter incision known as a MACS lift

After the operation

In most instances you go home or are admitted for one night. There is pain relief but as this wears off, more pain relief is needed : The drains are removed after 24 hours.

It is important to

1. Rest over the next few days
2. Sleep head up with sometimes cold compress will help
3. Take the antibiotic ointment and and any pain killers
4. The head bandage is worn for a few days as too is the garment.

We will advise when these can be removed. There can be little bleeding from the edges.

Stitches are removed after 1 week in our office. There is a final appointment at 6 weeks to ensure all is fine and take post operative photos. You should rest the next day but resume normal activities 48 hours after surgery. Contact sports however should be avoided for 6 weeks. If you have fever, temperature, discharge or marked bleeding, please notify the practice. Wear the head garment for 6 weeks. You can drive 48 hours post op.

If you have a fever, temperature, increasing redness, pain or signs of infection or heavy bleeding then please let us know.

Risks complications and expectations of facelift

For most patients, the operation is safe and successful, but we would like to discuss what to expect after the operation along with risks and complications.

The face / neck is initially swollen and will bruise. This bruising can extend down to the cheeks into the neck and behind the ears . The face / neck will also feel tight. Sometimes you feel that the facelift hasn't matched your expectations. Often this is initial swelling. It is important to know that Dr Mahajani is conservative and it is better not to overtighten the skin.

Most swelling and bruising settles over 1-2 weeks but occasionally can take longer. 90% is gone by about 2 weeks but the rest of the swelling can take weeks to settle, the majority over 6 weeks.

Bruising of the skin can cause the skin to change colour. This takes a few weeks to resolve but occasionally the colour changes are longlasting. It is not a common event.

The scars usually heal very nicely and are generally inconspicuous and hide behind the ears but occasionally can thicken. We cannot always predict outcomes of scars and occasionally scars stretch or thicken. As we have tightened the skin, the skin can pucker but to a greated degree, this scar smoothens out. The puckering is usually behind the ear where the skin has been gathered and this area is inconspicuous. Sometimes scars in the area of hair cause hair alopecia where there is some hair loss in the scar. It may distort the hairline especially in men. Scars may need revision.

Asymmetry

There may be a little asymmetry after the procedure between the two sides. Note that no one has a completely symmetrical face / neck there is often difference between the left and right side. Often this is a reflection of pre operative asymmetry and the patient notices this more after the operation . This is usually not noticeable and often doesnt need correction. The operation may be slightly different for each side and it depends on the degree of asymmetry however the aim is also to make the face as symmetrical as possible. Despite this, some slight asymmetry does occur.

Pain

This is not usually a painful operation but there is some pain that takes 1-2 weeks in most to settle, sometimes a little longer. It is unusual to have more severe pain, this may mean some other problem and may need investigation including a referral to an eye surgeon ( this is rare)

Numbness can be due to injury to small nerves that we cannot see in the operation. The ear lobe or areas of the cheek or neck could be numb. This usually resolves. Irritated nerves can be painful or produce an altered sensation in the skin . This can take time to settle down and occasionally nerve symptoms are permanent.

Infections are very uncommon and usually settle with ointment or antibiotics. Severe infections like necrotic infections requiring surgery are extremely rare. Sometimes deep sutures need removal if these get infected.

Wound problems occasionally wounds can break down, or if there is poor quality skin or the patient is a smoker ( we dont do facelifts or necklifts in smokers) there can be necrosis of the skin. This may just need dressings to settle down but alternatively may need an operation to fix this.

Bleeding

There may be a little bleeding but this should be slight. If there is severe bleeding please notifiy Dr Mahajani as significant bleeding under the skin can cause a haematoma which may need draining

Injury to the facial nerve

This nerve allows us to move the face muscle, eyelids smile etc, there is a 1/100 chance that this nerve ( or part of the nerve) gets injured. It can cause a variable weakness and asymmetry to one side of the face. The face can be asymmetrical and whilst this can resolve, it can be permanent in some cases. The usual part to get injured is the part of the nerve that controls the side of the lip. This can cause some weakness and the lip may droop. Again, if this is permanent, it may need an operation to fix this.

Injury to deeper structures

When we operate it is rare but deeper structures to the face and neck could be injured. This could be an injury to the muscle or lymph node or salivary gland like the parotid gland. This may cause some bleeding pain or fluid pocket ( seroma ) in the area. Sometimes fluid can come out from the skin ( salivary fistula ) and this can take some time to resolve. Occasionally further therapy or surgery is needed to fix these problems.

Realistic expectations from a face/neck

It is important for your expectations to be realistic. It is not infrequent that a minor adjustment may be needed. Complications are uncommon but if they occur, we will do our best to help you. We will try as far as possible , within the constraints of your physical health and the state of the ears and your wishes to help you achieve your goals. The surgeon cannot guarantee all expectations and nor can guarantee the longlasting effect as the ageing process continues and there may be other variations. Sometimes other procedures are required, and infrequently sometimes severe complications are encountered. We will endeavour to the best of our ability to help you where possible. Rarely, it may be required to seek the help of other specialists. If you however have any concerns at any time please feel free to contact the practice. You are always entitled to second opinions at any stage and we are happy to help facilitate this for you if you so desired.