FaceLift – Rhytidectomy

Factors such as aging and environmental effects cause signs of aging and sagging facial skin and reduce the freshness of the skin as compared to youth. There are several ways to correct sagging face and neck skin and restore its softness including face lift surgery. In this article, the effective factors in the aging of facial tissues have been investigated and appropriate treatment methods have been proposed.

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What is a face lift?
What effect does aging have on facial tissues?
Factors affecting the acceleration of the aging process
How can we eliminate the sagging of facial tissues and the signs of aging?
Facelift surgical procedures

What is a face lift?


In medicine and cosmetic surgery, lift means correcting the signs of aging and rejuvenating the face in people. Using different methods, the sagging of tissues in any area of the face can be corrected. The lift has been performed in any way that corrects these sags.

What effect does aging have on facial tissues?


What changes do facial tissues undergo with age? What is the difference between a young person and a middle-aged person’s face?

We know that people’s faces are made up of different layers. With age, each layer of the face changes. The most superficial layer of the face is the skin, which becomes thinner with age and the collagen-making ability gradually decreases, and the face also loses parts of its collagen and is thus no longer as elastic as it was when it was young.

Also, with age, parts of the skin degenerate (atrophies) which causes wrinkles in this layer, which eventually leads to sagging skin.

The lower part of the skin is fat. This part also weakens with aging and degenerating over time and loses diameter and thickness, which is why we see facial thinning in the elderly. these changes are not necessarily the same in all people and aging and skin changes may appear faster and more intense than some other.

In succeeding layers of the face, we see differences in young and middle-aged people. In young people the muscles are bulky and strong, but as people grow older, muscle mass decreases and muscles become weaker and smaller.

In the bones, the signs of the passage of time and aging are also quite visible and even if the person loses no teeth, bone resorption will still develop over time.

In young people, the chin is usually prominent and elongated, which not only gradually decreases with age, but also parts of the chin bone and the angle of the jaw, and even the cheeks become thinner and smaller with age.

These changes may be mild or severe, depending on the individual’s genetics and the environment in which we live.

Factors affecting the acceleration of the aging process


What factors accelerate the sagging of facial tissues and increase the signs of aging in the face?

Both genetic and environmental factors play a role in the development of signs of aging in the face.

Influence of environmental factors


People who are constantly under a lot of stress, develop symptoms of aging at a younger age.
Also people who have an unhealthy lifestyle, such as smoking, not exercising, not eating healthy, not drinking enough water, or being constantly exposed to sunlight, are more likely to show signs of age on skin.
To better understand this, consider the following example;
Consider identical twins, one of whom is more prosperous than the other with a healthier lifestyle and in a mentally and psychologically calmer and more stable environment, while the other one is in a difficult situation and has an unhealthy lifestyle.
Although the two people are genetically identical, their facial changes will be completely different over time.

The effect of genetic factors


But are genetic factors also effective in the aging process of the face?

The answer is yes. Some people experience signs of aging on their face at a younger age. For example, in people who genetically have a short distance between eyes and eyebrows where the eyebrow raising muscles are genetically weak and their depressors are very strong. This causes the eyebrows to lower when laughing or frowning and lead to drooping eyebrows with age, which are completely genetic.

As we know, Botox injection in certain areas of the forehead make the eyebrow lowering muscles weaker for lifting the eyebrows, so if someone before the middle age undertakes Botox injections (in consultation with a doctor) can expect to delay the drooping of eyebrows.
People who take skin care seriously and take care of their skin regularly can hope to reduce the signs of aging.

r example, regular use of sunscreens or skin moisturizers can reduce the effects of environmental factors on the skin. Thus we can influence both genetic and environmental factors and speed up the onset of symptoms.

As we age, tissues weaken and also sag that leads to drooping.

For example, the fat in the cheek area lowers over time and we no longer see the protrusion of the cheeks as in the past, because the fat tissue lowers and sits around the mouth and causes the protrusion of this area and eventually shows itself in the form of laugh lines. Tissues of the face lower with aging, in another example, and at sit at the border of the head and neck to blur this area which will reduce the beauty of the face.

How can we eliminate sagging facial tissues and the signs of aging?


In a variety of ways, sagging tissues and muscles can be partially restored to their original position. These methods can be divided into two categories of surgical (invasive) and non-surgical (noninvasive).

The methods used for facelift in younger people are totally different with the methods used for facelift in middle-aged people.

Of course, the symptoms of aging in a 35-year-old are mild and we see minor changes. In this age it is recommended to use non-surgical methods to rejuvenate the face, so facelift surgery is not recommended at all for people under 40 years old.

Non-surgical methods include thread lift, laser, hypnotherapy or RF. Using a thread lift, we can create a gentle stretch in the facial tissues to some extent to correct minor sagging in facial tissues.

It is interesting to know that by doing some methods, instead of the direct lift, by correcting the volume reduction caused by the breakdown of fats and muscles, the signs of aging can be reduced. For example, by injecting fat into the face of a 35-year-old we can make their face look younger.

It is therefore not always necessary to use surgery for a facelift, especially in people under 40 years of age, who are rather recommended to use non-invasive facelift methods.

It is quite obvious that the duration of the effect of non-surgical methods is short and they need to be repeated after a while. These methods have a short-term effect, are highly safe and have satisfactory results in young people.

Conversely, in people over the age of 45, the depth and severity of sags are greater, and because these sags are more severe, non-surgical methods are no longer effective and facelift surgery should be used. In all of these methods, the overall goal is to return the sagging facial tissues to their original location so that we can see the freshness and rejuvenation on people’s faces.

In the past, pioneer surgeons in this type of surgery, when performing the lift, only removed the facial skin and cut the extra skin because they thought that aging is limited only to changes in the facial skin. By removing and stretching the skin, stitches remained long, while over time, people’s face sagged anyway. For this reason, with increasing surgeons’ experience and the advancement of medical science, various techniques for deep tissue lift were invented. Therefore, today there are various methods for lifting deep facial tissues that can be used.

If we have complete knowledge of the different layers of the face and know each layer, we know they are connected using anchors, some of which reach the bone and connect the tissues to the bone.

These anchors are located between the different layers of the face, so they prevent us from being able to pull the tissues upwards.

As a result, there are two modes of lifting deep facial tissues;

  1. Releasing the interstitial anchors and then performing the lift.
  2. Stretching the deep tissues with the anchors in place.
    Of course, in the first method, if we release the anchors and then lift the deep tissues, the lift result will more lasting.

Surgery methods for face lift:


Endoscopic surgery and open surgery.

One method of facelift surgery is endoscopy.

In this method, the lift is done by making small cuts. This method can be used for forehead lift and middle face lift.

In this procedure, after small incisions are made in the skin, surgical instruments, as well as a camera with which the surgeon can see the tissue, enter the deep tissue, separate the tissue attached to the bone from the bone, and then pull the released tissues upwards using threads that remain for a long time or forever, and perform the act of fixing and stabilizing the tissues.

In endoscopic lift surgery, the surgeon can only perform lift in certain layers (usually in the tissues attached to the bone) and it is not possible for the surgeon to lift different tissues and soft layers.

This method is not appropriate for people who have a wide face and want to do a middle face lift because it disturbs their natural harmony and symmetry.

In contrast to the endoscopic (closed) method, there is also an open surgery method.

Advantages of open surgery method are:

  • A. The doctor can choose which layer of the face to lift
  • B. As we have seen, in endoscopic lift surgery, the surgeon could only perform the lift in certain layers, while in the open lift, the surgeon can choose which depth and what tissue to lift.
  • C. Open lift surgery makes it possible to remove excess skin, while endoscopic lift doesn’t do so.
  • D. In open lift surgery, with the doctor’s discretion, face lift can be done on one layer, two layers or several layers.

Each part of the face can be lifted individually or as a whole.

Among the parts that can be lifted separately, are the forehead and temples. The forehead and temples can be lifted alone. Especially people with drooping forehead and eyebrows at an early age can use direct forehead eyebrow lift that can be performed in both open and endoscopic methods.

Direct eyebrow lift can be performed separately in people with drooping eyebrows and show signs of aging. Of course, this surgery can be done in combination with other surgeries such as eyelid surgery, forehead lift etc.

Medium face lift by endoscopic method, like the open lift can be done both separately and in combination with the forehead and temple lift. The face and neck lift can also be done separately or together.

It is better for the elderly to do both face and neck lifts for better results, and at a younger age, if they suffer from a sagging part of the face, can lift that area separately.

For example, someone can have a very small chin with a large double chin. The best solution for this person is to use a chin prosthesis and reduce their double chin.

In the open surgery method, there are two very important points to note:

First point: Note that the face lift is separate from lifting the area around the eyes and mouth!
Many people think that by lifting surgery, the wrinkles around the eyes and radial mouth wrinkles that are around the lips will be completely eliminated !!

But we must know that these parts are separate from the face lift and other measures must be taken to correct the defects in this area. For example, for eye wrinkles, eyelid surgery or for wrinkles around the mouth, gel and Botox injections will be effective.

The second point that must be considered is the location of the surgical incision as well as the extent of the incisions. The question that is on the minds of all applicants for this surgery is whether the surgical incision is visible in the lift surgery and whether its effects remain on the skin?

It is quite clear that by making incisions in any part of the body and performing surgery, the incision remains and does not disappear completely, and always remember that the skin at the surgical site will never be like the skin before surgery. But how much of the scar remains and whether it is obvious or not depends on the technique that the surgeon performs during the surgery.

The surgeon should use methods and techniques that hide the incision as much as possible and cover them more by hiding these incisions in certain parts of the face and creating a visual error. For example, an incision made behind the ear or inside the hair or on the hairline, will be easily hidden.

At the end, a word of wisdom from Dr. Akbar Bayat for brow lift surgery applicants: The applicant must see the sample of surgeries, so that they can decide to perform surgery with holistic knowledge and with complete information.

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