Surgical face and neck lifting – Dr Tony Prochazka answers the Frequently asked Questions
What exactly is face and neck lifting?
This is a type of surgery (or other procedure) which lifts and tightens the skin of the face and/or neck, in order to create a more youthful and refreshed appearance. Ideally, such procedures are selected to maximise results while minimising risks.
What types of face and neck lifting are available?
There are many different procedures available for face lifting and neck lifting. Some are entirely non-surgical – e.g. radiofrequency, infra-red and ultrasound devices. Others are minimally-invasive (no scars) – for instance, thread lifts. Then of course we have the more invasive “open” surgical procedures: traditional long-scar facelift, and the more modern “short-scar” lifts such as MACS Lift, central neck tuck, and lateral neck resuspension.
Am I a suitable candidate for a face and/or neck lift?
Both males and females are suited to these procedures, although the surgical techniques may vary slightly. Anyone in reasonably good health who is concerned about sagging facial tissues, loose jawlines with jowl formation, and/or “turkey-gobbler” necks, could be a candidate. Most patients will be in their forties, fifties or sixties. However, we have operated on healthy patients outside these age groups, where substantial improvement was likely.
How is open facelift surgery performed?
“Open” facelift and lateral neck lift surgery is usually performed under twilight sedation, with extensive local numbing of the areas to be operated upon. This type of anaesthesia ensures maximal comfort during the surgery, and a very rapid return to full awareness afterwards.
After local numbning, incisions are made in front of the ear, running around the earlobe and upwards behind the ear. The length of these incisions will depend on the desired extent of surgery.
The skin is then dissected off the underlying supportive membrane of the face and neck – an anatomically distinct structure called the SMAS. The SMAS is then elevated and tightened; excess skin is trimmed away; and the incisions are sutured shut.
The most commonly-performed procedure at Me Clinic is the short-scar facelift, also known as the MACS Lift. This lift starts with a small incision around the ear lobe, running up in front of the ear, then turning forward to follow the hairline of the temple. Through this incision, the facial skin is undermined for a distance of a few centimetres (slightly less than for a traditional facelift).
Two to three “purse-string” sutures are then placed in the SMAS, the first one running down into the neck, second one over the cheek and, if needed, a third one high over the cheek bone. These sutures are all anchored to the cheek bone to provide secure facial tissue repositioning and tightening.
The sutures are absorbable and gradually disappear over several months. Nonetheless after the sutures dissolve, the facial tissues stay in their new elevated position, thanks to internal fibrosis. Because lifting of the SMAS has occurred (just as in a tradional facelift), the benefits of this procedure are long-lasting over several years.
What about neck lifting?
In patients who only require neck skin tightening, a modified and shorter MACS-lift incision can made around the earlobe on each side. The procedure is similar to MACS Lift, but with the deep tightening sutures placed only into the lower (neck) portion of the SMAS – also known as the platysma. This procedure is called lateral platysma resuspension. The resulting scars are shorter than that of a MACS lift.
Another technique, known as central neck tuck or platysma plication, starts with a small incision just under the chin. The central section of platysma muscle is resected and the edges sewn together in the midline. Finally, the incision is closed. This procedure is very often combined with neck liposuction, to unweight the hanging neck tissues and stimulate further skin tightening.
Very often neck liposuction, platysma plication and lateral platysma resuspension are combined together, to create a more comprehensive neck lift.
I look gaunt, and/or my facial skin is in bad shape. Will face lift improve this?
Maybe, maybe not. For this reason, we often recommend ancillary procedures – such as fat transfer, anti wrinkle injections, Factor 4 treatment, and/or laser resurfacing – to address these problems. These extra procedures may be performed as part of the same surgery, or scheduled for a later date. It is very common for the basic face/neck lifting procedures to be combined with other modalities in order to achieve the best and most balanced results possible.
How about the recovery?
These surgeries are always performed as “day” cases. The patient can usually go home two or three hours after completion of the procedure. Some wound dressings, padding and compression bandaging will be applied, and oral antibiotics are commenced. Patients should sleep propped-up on pillows for a day or two. Medium-strength pain-killer tablets are usually all that is necessary to ensure comfort for the first two or three days.
Some swelling and bruising will always occur; however, this is often surprisingly limited. Some areas near the incision lines may be numb initially; this usually resolves in a few days or weeks. Bed rest is not required, however patients should not undertake any strenuous activities for at least ten to fourteen days.
We review our patients the day after surgery, again at around 5-6 days for removal of the incision sutures; and one or two times after that to ensure that progress is satisfactory and the patient is happy.
What type of result can I expect?
Your doctor will explain to you in detail, at the first consultation, what kind of long-term result you can expect. The aim is always for facial/neck skin tightening with the most natural possible result, so that you look younger and fresher without that tell-tale “operated” appearance. The SMAS tightening performed during “open” procedures ensures that results will last long-term – often for eight to ten years or even longer.
What are the risks?
Many people are scared off undergoing face/neck lifting through fear of complications, but in fact the risks are generally very low. When side-effects do occur, they can almost always be treated.
The main three groups of complications are as follows:
– Bleeding. This usually occurs within the first 24 hours of surgery, and causes pain and obvious swelling on one side of the face. It must be dealt with quickly. The patient is returned to theatre, where the blood clot is evacuated, the bleeding point found and cauterised, and the incisions sutured again. As long as this is done promptly, rapid and complete recovery is expected.
– Infection and wound breakdown. This is more common in smokers, diabetics, and those with chronic underlying medical problems. Treatment is with antibiotics, daily wound dressings, and supportive measures. Sometimes the incision sutures are removed, and the wound allowed to heal from underneath. Later revision of the scar may be necessary.
– Nerve damage. This may result in patchy numbness of the facial skin (relatively common and often temporary). A more serious but very rare complication is damage to motor nerves, resulting in muscle weakness. In very rare cases this may be permanent, resulting in facial droop or palsies.
As always, your doctor will discuss the risks of surgery with you in greater detail during your consultation. The above is only a broad guideline. The vast majority of face and neck lift patients get great results, with rapid recovery and no complications.