Facelift

Definition:

Facelift can be defined as the correction of anatomical changes on the face that occur with age and cause the face and neck to look old.

General Information

With aging, visible changes begin on the human face. As a result of the effects of sun, gravity, social conditions and aging, the skin and subcutaneous tissues on the face and neck start sagging and deepening of the lines and wrinkles start appearing over time. The fatty tissues on the cheeks start shrinking and sagging, the transition line from the face to the neck becomes vague and the sharp edges of the chin disappear. A fuller appearance appears on the neck and under the chin. An old, tired and sometimes sad look on the face and neck may occur. The aim of face lifting is to obtain a younger and healthier facial appearance. Especially in developed countries, the prolongation of the average human life and the increase in the level of welfare has led to the fact that facelift operations are one of the most preferred and applied aesthetic facial surgeries. Facelift does not stop aging and does not reverse time. However, it can help you feel younger, increase your self-confidence and rejuvenate your looks.

Before face lift, you should be informed about how this operation will change your appearance, what to expect from the surgery, and how the surgery is performed. Factors such as skin type, ethnicity, degree of skin tension, tissue healing rate and strength of the individual, the structure of facial bones can affect the surgery to varying degrees. These factors should be thoroughly evaluated by your doctor before surgery.

Different rejuvenation techniques are used to correct different areas of the face. The anatomical features of the patient’s face and neck as well as their personal desires and expectations are important in decision making. For example, liposuction may also be added to the neck in order to prevent the unbalanced appearance of the neck skin. In order to achieve more effective results, operations such as nasal aesthetic surgery, lower and upper eyelid surgeries, forehead lift and eyebrow lifting can be performed.

The technique of facelift has changed dramatically since the 1970s. Previously, the skin-stretching techniques used were specific, highly stretched and unnatural. Today, these techniques are replaced by modern facelift techniques with long-term and predictable results that provide natural rejuvenation without creating significant tension on the facial skin.

Facelift can be performed by qualified ENT specialists as well as by plastic surgeons. Facelift operations are usually performed under general anesthesia. However, deep sedation anesthesia similar to sleep may be preferred in some patients. The choice of anesthesia depends on your ddiscussion with your doctor. Preoperative blood tests, films and electrocardiography (ECG) may be required. The results of these examinations will be evaluated by your doctor and anesthesiologist together by taking your general health condition and additional diseases into consideration. Anesthesiologist will give detailed information about the anesthesia methods.

Your face will be photographed from different sides before face lift. These photographs are important in terms of both preoperative and intraoperative planning and postoperative recording.

In face lift, the patient’s face shape, skin structure, facial bones and surrounding tissues are all evaluated. By analyzing the physical properties and all these components of the patient, the best possible result is tried to be obtained.

Opening the Surgical Field (Incision Types)

There are different types of incisions to open the surgical site. Which of these incision types will be applied will be determined by your doctor’s preference and your face’s condition. The incision shape is different in men and women. However, the skin incision is usually passed through natural lines around the ear and extended backwards to hide in the scalp. In minilifts, a more limited incision is usually sufficient whereas in more extended facelifts the incisions can be longer. If the excess fat tissues in the neck are to be removed, a separate incision of 5-10 mm length is made under the chin for the entrance of the liposuction cannula. These incisions are closed with a suitable suture material at the end of the surgery. The cut line is generally expected to heal so that it cannot be seen from the outside. However, some patients may have scarring after the healing is completed.

Operation

This surgery is primarily surgery of the skin and subcutaneous tissues that cover the facial skeleton. A proper and balanced liposuction process reduces the amount of fat tissue in the neck. To create a younger face, the skin is cut down to a certain depth after the incision. By maintaining this level, the skin and subcutaneous tissues are separated from the layer on which they adhere. The released subcutaneous tissues are suspended and fixed to new locations. The facial skin is then carefully laid over the soft tissues that have been fixed; the hairline is realigned; excess skin is removed. The incision is closed using appropriate sutures and / or sometimes by stapler. In some patients, vacuum drains may be placed to prevent blood accumulation at the surgical site. At the end of the operation, a face wrap is made which is not overtight. The patient may be discharged from the hospital on the same day or the following day. The operation may vary depending on the size of the operation, but may take 2-6 hours.

Expected appearance after surgery

Depending on the process, the face is often wrapped up by a dressing. Usually on the first postoperative day, this dressing is replaced. Swelling and bruises may appear on the face and around the eyes after surgery. After facelift, time is needed for the swelling to subside and the wound site to heal. Although it varies according to the personal characteristics of the patient and the size of the intervention, many patients can return to work within 1-2 weeks. At the end of this period, swelling and bruises will be significantly reduced. At the first postoperative month, your recovery will begin to show the changes on the face; however, you may have to wait up to 6 months for the actual result.

Precautions before surgery

• Tell your doctor whether you have had regular / irregular medications, whether you have had previous surgery or if you have an inherited disease from the family.

• Medications such as aspirin, baby aspirin, coumadine, ibuprofen, various analgesics, and vitamin E should be discontinued a certain time before surgery. Painkillers that are safe to use will be indicated by your doctor.

• Tobacco products such as cigarettes, pipes and cigars and alcohol should be left before surgery. These substances adversely affect wound healing and surgical success by disrupting healthy blood circulation; it puts you in a higher risk group for general anesthesia.

• If you are allergic to any medicine, you must inform your doctor.

• You should inform your doctor if you are pregnant.

Day of surgery

If your surgery is planned in the morning, the night before surgery after 24:00, nothing should be eaten or drunk, including water. If the surgery is in the afternoon, a light breakfast can be served as early as 6:00 am, provided your doctor has given you permission. If these rules are not followed, surgery may be postponed.

Regularly used drugs such as blood pressure  or blood glucose regulating drugs, can be taken with a sip of water in the early morning.

• Shower can be taken in the morning. However, make-up, hair spray, gel or nail polish should not be used.

• Easy to wear and comfortable clothes should be preferred on the day of surgery. Clothes to be worn in the operating room will be provided by the hospital.

• Jewelry such as rings, necklaces, earrings should not be worn and valuable items should not be brought to the operating room.

• Materials such as contact lenses and dental prostheses and any metal objects on the body should be removed before surgery.

Postoperative recommendations

1- The head should be as high as possible and please try to sleep on your back or slightly sideways as far as possible, and you should not lie down. Placing 2 or more pillows under the head while lying down will reduce facial pressure and swelling and help to sleep more comfortably.

2- The pain that will occur after the facelift can usually be controlled with simple painkillers. Severe pain can be a precursor to undesirable consequences; in this case, it is recommended to see your doctor without waiting.

3- It is recommended to apply cold on the cheeks once every 1-2 hours and for 15-20 minutes each time; this will help improve swelling, redness and bruises faster after surgery. It is usually unnecessary to continue the cold application for more than 1 day. Swelling and bruises decrease within 1-2 weeks and disappear largely in 2-3 weeks. However, it is necessary to wait at least a few months for the swelling to disappear completely.

4- Only medicines prescribed by your doctor should be used. Your doctor will prescribe the pain medication you will use (usually analgesics containing paracetamol, acetaminophen or dipyrone are preferred). Aspirin or aspirin-like painkillers and other blood thinners should not be used until your doctor tells you otherwise.

5- The face bandage will be removed by your doctor. You will be told how to use additional  bandages.

6- Suture lines should not be wetted and kept dry until your doctor deems appropriate. You can shower and bath so that water does not come to these areas, you can wash your hair backwards with the help of a relative or your hairdresser so as not to wet the suture lines.

7- After obtaining the consent of your doctor, the facial skin can be gently cleaned with a mild soap or skin care lotion with vaseline after the facial dressing has been removed. This cleaning should be applied very softly and carefully. Make-up should not be applied for at least 2 weeks. It is helpful to get your doctor’s advice about makeup.

8- Antibiotic and / or emollient ointments recommended by your doctor should be applied on suture lines twice a day.

9- Contact lenses can be used 2-3 days after the operation.

10- Excessive facial movements such as laughter may stretch the suture lines and should be avoided for 10-14 days. Besides long speech should also be avoided.

11- Foods that are difficult to chew or require chewing for a long time should be avoided. A slight salt restriction in the daily diet for 1 month will be beneficial.

12- The sun or sun baths should be avoided for at least 6 weeks and the face should be protected with a hat when the sun goes up. Heat can cause swelling on your face and direct exposure to sun may develop skin reactions.

13- At least 3 weeks of intensive exercise and sports and swimming for a month should be avoided.

14- The front or back buttonhole should be worn for a week, narrow clothing over the head, T-shirt or pullover should be avoided.

15- The removal of the stitches after the operation depends on the operation performed, the suture material used and the healing ability of the skin. Your doctor will tell you whether stitches will be removed or not, and when they should be taken.

Postoperative Undesirable Conditions (Complications)

FACELIFT IS A SURGICAL PROCEDURE. Like all surgical interventions, this surgery has risks, including death. Some adverse events that have been reported in the medical literature that may develop after facelift are listed below. These situations, which are not expected during a normal operation and recovery process, that cannot be predicted before the operation, but are likely to be encountered, are listed to inform you, not to intimidate you. In this way, it is aimed to have more information about the risks you may encounter after surgery. In case of an undesired situation, your doctor will inform you, take appropriate actions and refer you to other specialists if necessary.

1. Bleeding: As with any surgical intervention, there is a possibility of bleeding in face lift. In rare cases, bleeding may occur during or after surgery. This is usually not life-threatening and can be stopped with simple interventions, but sometimes may require further interventions. In order to reduce the risk, it is useful to explain to your doctor in detail all the medications you are currently using or taking until recently, and to talk about your previous surgical experiences or trauma. The cause of bleeding may be related to the unpredictable vascular structure or coagulation problems of the patient despite the preoperative bleeding-coagulation analysis. If you have a family history of some rare bleeding disorders, you should tell your doctor. Risk of bleeding:

a. In hypertension patients,

b. Aspirin or similar blood thinners

c. In patients who smoke and drink alcohol,

d. It is more common in patients who do not follow postoperative recommendations.

2. Edema (swelling): Facial swelling and edema, which is expected after face lift, usually lasts for 2-3 weeks. Edema gradually decreases within days and disappears in different time in each patient. Prolonged and persistent swelling may be the cause of underlying allergic, hormonal or circulatory problems.

3. Accumulation of blood in the surgical site (hematoma): After surgery, it is usually the accumulation of blood under the skin near the suture lines. It rarely occurs and is due to the re-bleeding of some vessels after surgery. You should tell your doctor if you notice limited swelling on a particular area of ​​your skin. Hematomas usually do not reach large sizes, but still require intervention. Your doctor may apply dressing according to the nature of the swelling, the rate of development and size; evacuate the swelling with a needle or other device; with a small intervention that does not usually require general anesthesia but needs to be performed in a sterile environment, or very rarely under anesthesia in the operating room, may want to check for bleeding and reopen the wound to drain the blood that has accumulated inside.

4. Inflammation (infection): Inflammation (infection) may develop in and around the wound edges. Every surgical procedure is a disruption of the skin’s integrity, which is an important defense organ of the body. There is a risk of microbial contamination of the skin integrity. Abscess may occur due to microorganism-trapped wound; inflammation can spread to surrounding tissues, to any other part of the body, or even to the whole, leading to death. The risk of infection is extremely low in facelift performed by a qualified physician in an appropriate environment and by the use of antibiotics. It usually occurs in scalp areas around the wound. Infection may present with excessive redness, pain, inflamed discharge from the wound. Mild tenderness, increased pain and pink-red color changes can begin. Infections that may develop can often be controlled by appropriate treatment. In order to prevent infection, appropriate hygienic conditions should be provided by the patient after surgery and wound care must be taken into consideration.

5. Hair Loss: Although it is more in the temple area, hair loss may rarely develop in the area behind the ear. In most cases, hair regrowth was observed within a few months. In male patients, the beardless skin section narrows in front of the ear and the direction of the beard may change. These are the natural outcomes of surgery.

6. Skin problems: Skin tissue changes such as redness, bruising or increased vascularity may occur. Malnutrition and skin loss may develop in the incision area. In patients with darker skin, skin color around the surgical site may become darker (hyperpigmentation). This darkening can maintain its presence for a long time or even can be permanent. These problems are rarely encountered. Post-operative bruises usually disappear in two to three weeks (although they may disappear at different times for each patient). Slight discoloration of the skin may occur due to bruising and changes in skin thickness. Thin and light skinned people and thin people have been reported to be more susceptible to this condition. In some patients, the skin may become slightly dandruffed and dehydrated as a result of the loose and abundant skin being replaced by stretched skin before surgery.

7. Nerve Injury: Although the nerves that make the facial muscles work are usually located in similar areas in patients, they may sometimes show anatomical differences. Less than 1% of facial nerves have been reported to be affected during facelift. Although the nerve varies depending on the region affected; difficulty in raising the forehead, closing the eyelids, and elevating the corner of the mouth may occur. Facial muscle weakness is usually expected to improve within a few months; however, nerve damage can be permanent. In this case, if your doctor thinks you will benefit, he may recommend a second operation to repair the damaged nerve.

8. Pain, numbness, tingling: They may rarely occur in the earlobe and around the ear. Postoperative serious pain is very rare. In such a case, you must inform your doctor.

9. Abnormal tissue  healing (keloid or hypertrophic scar): Some people may develop an abnormal tissue healing with pink, red irregular hypertrophic appearance. This tissue is called keloid. Although it is mostly seen in the black race, it has been reported to occur in patients with very dark skin and very light skinned patients with hypersensitivity. In the case of keloid development, drug injections or additional surgical procedures may be required.

10. Scar: After all kinds of surgical intervention, more or less, a scar remains. It is tried to ensure that the wound is healed with minimum scarring by means of proper placement of the incisions, selection of appropriate suture materials and the use of appropriate suture technique. However, normal wound healing may leave a visible scar depending on the reaction of the patients own skin type which is not always very easy to  predict. 

11. Separation of the wound edges: It can very rarely occur immediately or within a few days after removal of the sutures. It is more common in patients with general health problems and especially those who smoke heavily. You must tell your doctor, the edges are joined again with a simple intervention.

12. Irregularities under the chin: Patients with fatty tissue under the chin may rarely have slight irregularities.

13. Excessive skin folds (Dog Ear): Skin excess after facelift may cause slight swelling at the wound corners. These blisters disappear over time in most patients, but they can be corrected by simple interventions if not.

14. Asymmetries: It is rarely reported that after facelift, disproportionate changes may occur in a small area, ranging from asymmetries that can only be noticed by careful observation to asymmetries that cover larger areas and are easily recognizable. Generally, preoperative asymmetries on the face of the patient became more prominent postoperatively. As a general rule, half of any healthy person’s face is not fully symmetrical with the other half. It should be noted that absolute symmetry is not present structurally and should not be expected postoperatively. Do not forget to get detailed information from your doctor about your own characteristics while analyzing your face during the pre-operative consultations.

15. Earlobe appearance disorder: In some patients whose earlobe sagging or prolonged too much, the earlobe may appear attached to the skin after surgery. This very rare condition can be corrected with a small additional intervention.

16. Revision surgery: A second cosmetic surgery may be required due to the failure to achieve the desired result, development of irregularities, and asymmetries. Additional surgical procedures and surgeries may also be required if the above-mentioned undesirable conditions are encountered.

As with almost all aesthetic surgeries, a number of corrective procedures may be required after facelift. In the event of a postoperative complication or a condition that needs to be corrected, it is usually necessary to wait 6-12 months for corrective procedures. This time is necessary to eliminate post-edema and swelling, complete tissue healing and evaluate the final result more accurately.

For simple corrective interventions, your doctor will not charge you an additional fee. However, the costs of the operating room, anesthesia, boarding will be covered by you. 

Please feel free to ask your doctor any questions you may have.