As we get older, various changes occur in the face, the eyebrows go down, laugh lines start to deepen more, cheek tissues are transferred to lower parts, mouth corners droop, temples area appears hollow, and several small wrinkles appear on the skin, especially around eyelids and mouth.
Among three groups of changes mentioned above, facelift surgery can correct well the drooping tissues (the last case), but in the two formers, we can use non-surgical methods more than surgical ones.
Facelift surgery is one of the powerful methods for facial rejuvenation in which the facial tissues that have descended with age are elevated upward using different methods and are placed in the position they were in during the youth period. This way, some of the signs and symptoms of facial aging (e.g., skin wrinkles, and smile lines and marionette lines) decrease. The aim of this cosmetic surgery is to cause your face to look younger than its status quo.
The general appearance of one’s face turns from a youth state (inverted triangle) to an old state (square shape) due to sagging facial tissues. Surgery plays a key role in restoring the triangle of youth.
Besides facelift surgery, non-surgical methods can also be used to elevate facial tissues. Although their power and lift durability is less than that of the surgery, the non-surgical methods are very effective in the early stages in which there is little facial droop with no need for surgery.
By facelift surgery, we mean the correction of sings of tissues drooping in the middle face and lower face regions. As shown in the following picture, in the analysis of the face beauty, the face is divided into three parts: upper face, middle face, and lower face. These three parts are equal to each other.
The middle face and lower face droop is corrected in the facelift surgery. In most people who undergo the facelift surgery, the upper facelift and rejuvenation (forehead and brows lift) are also needed and we address them later.
In the facelift surgery, an incision the same as the following picture is made. The facial skin and tissues are lifted and pulled back. Moreover, the facial deep tissues are changed in a way that a younger appearance is created. Finally, the sagging and excess skin is removed before suturing and the incision site is repaired with fine sutures. Skin incisions are made in a way that their trace is hidden within the hair and grooves after repairing so that no trace of the surgery can be seen.
Note that facelift surgery cannot eliminate fine skin lines and wrinkles and other signs and symptoms of skin layer aging. Other beautifying methods are thus required to be used for skin rejuvenation.
In most cases, the neck lift is needed to be done at the same time with facelift surgery to better correct the lower face droop.
The cheek tissue droop is corrected and protruded to some extent as the youth period.
The depth of the smile line and marionette line is reduced and a part of the drooping mouth corners is corrected.
Skin laxity and wrinkles in the lower face, especially in the lower jaw line and around the ears are eliminated.
Jaw line and jaw angle become prominent, especially in people who perform neck lifts at the same time. The border between the face and the neck is thus well defined.
Despite the above changes, you should bear this in mind that in a facelift, fine lines around the lips, under the nose, and lower eyelid wrinkles will not be eliminated, and other measures are required to be taken to correct them.
Facelift surgery provides a more youthful look than before, but after the surgery, you will experience the new laxity and descent of the facial tissues as you age, like the ordinary people in the society. Actually, facelift surgery corrects the sagging skin that occurred before the surgery and has no effect on the sagging or folds of skin that will occur in the future with age. Therefore, although we say that the facelift surgery effect is permanent (you always look younger than your hypothetical twin), you will experience the new facial lines and wrinkles caused by aging. It is approximately expected that a person who undergoes facelift surgery will not need to again undergo a facelift surgery for an average of 10 years (or more).
All surgeries have their own risks, and facelift surgery is no exception. Many complications of this surgery are minor and eliminated spontaneously over time or by non-surgical pharmaceutical therapies. Fortunately, dangerous and permanent complications of this surgery are very rare. The main complications observed in this surgery are as follows:
Subcutaneous hematoma: Approximately in all cases, this occurs in the first 24 hours after operation. Mild cases need no treatment and resolve by themselves. In cases where hematoma is too large, it can be removed by surgery.
Seroma or accumulation of fluid under the skin: Seroma signs and symptoms may resemble a hematoma. Fortunately, a seroma can be drained using a syringe and needs no surgical procedure.
Surgical scarring or scar: The trace of a facelift surgery is permanent. That is why the surgery incision is made in a way that it can be concealed within hair or skin folds. Some people develop the surgical scars as a red or raised mass. In any case where the trace of surgery is visible, the surgical incisions can be repaired and hidden using pharmaceutical therapies or non-surgical methods.
Regarding the sensory branches, the nerve branches damage appears as numbness and paresthesia. Fortunately, this condition does not cause any negative effect on the appearance of the face in terms of facial beauty. On the other hand, it is fortunate that sensory nerve damage is repaired well. However, you should know that your sensation at the incision site is a little different from before surgery. Damage to the motor nerves appears as facial asymmetry and asymmetrical lip movements. Fortunately, many of these conditions occur due to tissue swelling and will improve over time as the swelling resolves. The surgery is rarely needed again to correct motor nerve damage.
Hair loss (alopecia): hair loss after surgery is most likely to occur around the incision site. Temporary hair loss is very common and will resolve by itself within a few months. Sometimes hair loss is permanent and hair transplant is required if the hair loss is significant and is visible in appearance.
Necrosis or loss of part of the skin: It is rare that a part of the skin near the incision site is lost and undergoes necrosis due to the reduction of blood supply to the skin. Fortunately, many of these problems are reduced and improved by pharmaceutical therapies and non-surgical care.
Like any other surgery, facelift surgery can have general complications, such as wound site infection, post-surgery bleeding, and anesthesia-induced problems. Some of these complications are associated with the medical underlying conditions and lifestyle of the patients, for example, bleeding and hematoma are more common in people with uncontrolled high blood pressure. Therefore, your cooperation in careful pre-operative examinations is of paramount importance in preventing these complications.
Medicines and foods that affect blood clotting: you should stop taking all anticoagulants and blood thinners before the surgery. Let your physician know about all the medicines you take, including aspirin, plavix, vitamin E, all kinds of medicines and herbal teas, fish oil, and painkillers.
Physical diseases and current therapies: Some medical underlying conditions, such as hypertension and diabetes, and a history of bad surgical wound healing can be effective in predicting the complications you may experience. Therefore, stating these things will be a great help to prevent complications.
Your life habits: Smoking alone can increase the risk of hematoma, poor surgical wound healing, and skin necrosis. Extreme changes in weight are among factors affecting severe tissue sagging. Therefore, I recommend that you minimize smoking and avoid extreme weight changes following surgery.
Facelift surgery can be performed under general anesthesia, by putting in a sleep-like state, or under local anesthesia. Besides your willingness, the opinion of the anesthesiologist also affects the selection of each of these methods. This surgery is performed on an outpatient basis and you will be discharged on the same day. However, you can stay in the surgical center or hospital if you want.
Either an online or face-to-face initial consultation with you is done to check your request, evaluate your history and health status, and record them in your record. At this stage, it is required that the medicines you take, your medical underlying conditions, history of previous surgeries, possible complications of cosmetic surgery, history of smoking and alcohol, and any information the is related to your health are recorded in the record.
The final consultation session is held face to face. In this stage, first medical photos are taken from different angles of your face, your face is then analyzed aesthetically, and the result of the complete facial examination is recorded. Your surgeon asks you questions about your expectations from the surgery, talks to you about the surgery limitations and its complications, and explains about the way in which the anesthesia (general anesthesia or putting into deep sleep) is performed. The proper surgical center (Hospital or Clinic) is selected in coordination with you. Finally, the date of surgery is determined. This stage can immediately follow the initial consultation or be postponed to another day.
Pre-operative preparation stage: At this stage, the required tests are done on you and, if necessary, our colleagues in other specialties will check your cardiovascular and physical condition. You are sad to stop taking some of your medications (such as aspirin and blood thinners) two weeks before the operation. Medicines required to be taken before surgery to control blood pressure and diabetes, reduce stress, etc. are administered to you and you will receive an educational pamphlet about the pre-operative recommendations.
On the day of surgery: The facelift surgery is performed on an outpatient basis and you are discharged from hospital on the same day as surgery. You can stay overnight in the surgical center if you want. On the day of surgery (and even some days after surgery) avoid sensitive tasks such as driving due to swelling around the eyes (which can be accompanied by blurred vision) and relative weakness and lethargy.
During surgery: prior to surgery, you are informed about all measures that are going to be taken for you during surgery. Therefore, as you were told in the preoperative consultation, the surgical incision is made, the skin is separated from underlying tissues, and SMAS and deep tissues are lifted and fixed in the upper region. Some parts of facial fat may be removed or transferred from one place to another place. Finally, the skin returns to its previous place and the excess parts are removed and the incision sites are repaired. Taking all of these measures lasts 3-5 hours depending on the extent of surgery.
After surgery: The post-surgery support group will inform you about the required instructions for your care after surgery. You are provided with educational films and texts about this care. Moreover, you can ask again your questions online or by phone or even you can make a video call. Visiting days are determined for you to be examined by the physician and you are informed about it. It is normal to have symptoms such as pain, bruising, swelling and numbness in different facial parts and neck regions, and the administered medicines are set in a way that they control these symptoms. You will be provided with the required information about the important and serious symptoms.
From the day after surgery, you can take a bath or a shower and remove your dressing. Dressing is no longer required after 24h unless you tend to use it as a cover for swollen areas and bruises.
Post-surgery follow-ups and visits: Your visit and examination time during the next days and months is determined by the support team and you will be informed about it. Your most important visit times are as follows:
The day after surgery: This visit can be done first using a video call. In cases where the physician detects that a face to face examination is needed, you will be examined in person the same day.
Three to 5 days after surgery visit: If hemostatic sutures have been used for you, the sutures will be removed on this day and the required examination will be performed.
Subsequent visits: Depending on the case, one week, one month, three months, six months and one year after surgery visits may be considered for you. In many cases these visits are done online through video calls. The time of in-person visits is determined for those who tend to have an in-person visit.
You will be often asked to periodically send us new pictures of yourself so that your recovery process can be investigated. All people who come from other countries to undergo surgery are asked to be monitored for at least 2 weeks post operation (in some cases, this period can be reduced to one week according to your request, but be sure to inform us prior to surgery).
People whose real age is less than 40: The laxity and descent of facial tissues are not very evident in these people and I recommend them to use non-surgical methods if they tend to lift their facial tissues.
People whose apparent age is estimated to be less than 40 years: some people may be older, but look much younger than they are. For example, a 47-year-old person may have a young face as a 35-year-old person. These persons had better use non-surgical methods for facelift.
People with uncontrolled physical diseases and medical underlying conditions: Any uncontrolled disease that affects the healing process can lead to unfavorable results of facelift surgery. Uncontrolled diabetes, severe heart disease, uncontrolled respiratory diseases, etc., will all cause unfavorable surgical results.
People who are very perfectionist and have unreasonable expectations from surgical results: Facelift surgery reduces only part of the signs of aging in your face. Certainly, by undergoing the surgery, your face will not look exactly like the face of your 20s. Besides facelift surgery, you are required to take measures to rejuvenate the skin and correct the atrophy of facial tissues so that your facelift surgery yields the best results.
Smokers with high cigarette consumption: Although smoking alone is not a barrier to facelift surgery, excessive smoking may adversely affect the healing of surgical wounds. Therefore, these people are recommended to reduce their consumption to avoid possible complications.
People above 40 years of age with visible signs of facial and neck tissue sagging;
People who despite their sagging facial soft tissue have augmented and strong bones;
People who have young and highly elastic skin despite facial tissues drooping;
People with facial tissue descent, but not severe soft tissue atrophy;