Face lift surgery aims to improve the contours of the face and neck and thereby reduce evidence of ageing. Sagging skin is removed and tightened. Deep tissues are lifted and supported. It is a significant operation and raises lots of questions in patient’s minds.
The most common initial question is whether they are suited and should they have it now. Suitability to facelifting depends on two things. It depends on how concerned the patient is about their appearance and whether facelifting will bring about the changes they are looking for. Whether they should have the operation now depends on a combination of those two factors.
Patients also commonly ask about whether the facelift can be carried out under local anaesthetic or whether it requires a general anaesthetic. There is no doubt that mini facelifts can be carried out under local anaesthetic. This is often a cost effective and suitable way to do things. Once facelifts become more extensive however, it is appropriate to consider general anaesthesia. There is quite a bit of operating to do. Skin has to be lifted extensively and muscles and fat also rearranged. General anaesthesia can make this a far more tolerable procedure for patients.
Common questions about the operation itself include things like, how long it will take; the operation can range between 2 hours and as much as 6 hours, will I have drains; the answer to which is that for a large facelift I do use drain; will I have a lot of bandaging on my face when I wake up; the answer to which is we generally use foam as soft tissue support with an elasticised balaclava-like garment over the top.
Post operatively, patients are interested in knowing in particular how long they will have to wear the support garment. In short it stays on without interruption for roughly one week, after that I will see the patient in the rooms and then we review how long it stays on but in general it is appropriate to wear a support garment when it is socially acceptable (that is to say about the house) for about 4 weeks.
Another common question relates to scarring and hairlines. The scarring for facelifting is designed to be hidden. Scars are also getting shorter. I guess if we take the scenario of a major facelift, the scarring might extend from the temple down and under the sideburn area, back towards the ear, drop into the ear and then around underneath the ear lobe, back up the posterior aspect of the ear and a variable length backwards into the hair on the back of the neck. This scar is designed to sit in skin folds or to be hidden by hair itself. Fortunately the insistence of thickening of this scar is very low and the scar becomes very acceptable after only a short period of time.
Hairline doesn’t tend to change much with this scar. The scar runs around and just inside the hairline causing very little disturbance to the hairline itself. Hair growth is interesting however; it is not at all uncommon for hair to thin out a little after a patient has had a facelift. This is a temporary thing and the hair comes back to its normal status before too long.
Traditional questions like how painful will it be and how long will the swelling last are also very common. The pain associated with a facelift is generally not severe. Most patients go home using only Panadol or Panadeine. If there is severe pain, it may reflect something concerning happening and it is probably appropriate that the patient get back and sees their doctor. The amount of swelling that is present also varies from patient to patient. Some patients do swell more than others and take longer for the swelling to resolve. Swelling and bruising are generally quite acceptable within a one to two week period post operatively but all the swelling will take several weeks to go. The patients themselves usually find they are socially quite acceptable by the end of 2 weeks.
Another quite common question is how long will it last. The answer to this is that a facelift lasts forever. To allow patients to understand this I explained that if they have a facelift at 50 and there appearance after the facelift is the appearance they had when they were 40, then that 10 year gap between their true and apparent age has been created and will last. When they get to 60 they will of course look closer to 50. Skin care, protecting skin from the sun and not smoking reinforce that age/ appearance gap.
Another common concern expressed by patients is will they have “wind tunnel look”. Very aggressive older style face lifts did produce a wind tunnel look initially and we are all aware of the photographs displayed in Women’s magazines of what appear to be severely over done facelifting. Responsible modern surgery does not produce this effect. The aim is to rejuvenate the face, not to change it dramatically.
Last but not least, patients ask about serious complications of a facelift. I think there are 2 serious complications. They are nerve damage, to one of the motor nerves of the face and skin dying off. In the case of nerve damage with modern facelifting techniques the probability of significant nerve damage is low, but it is never zero. There is always a small potential for branches of the facial nerve to be damaged. This can lead to weakness of one side of the face. If the nerve is cut, it does not regenerate and reparative surgery may be required. If the nerve is stretched or bruised it generally recovers relatively quickly.
Skin dying off is also very rare. The skin of the face is lifted, excess skin is cut off and then the wounds are closed under some degree of tension. This process could embarrass the blood supply to the skin sufficiently for skin to dye off. This is rare unless the patient has had prior surgery or is a smoker. (The instance in smokers is much higher than in the non-smoking population). If skin dies off it is obviously a very difficult problem and may well require further surgery at a later date to repair an unfortunate appearance.
It is very common to have concerns and doubts about facelifting surgery. Plastic Surgeon’s understand this and you should not hesitate to ask any questions that you would like to ask.
When choosing your Plastic Surgeon you need to make sure that your surgeon is qualified in both reconstructive and cosmetic surgery. It is advisable to check that your surgeon is registered trough the Australian Society of Plastic Surgeons; all members are Fellows of the Royal Australasian College of Surgeons (FRACS), the benchmark standard for surgical training within Australia.