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Who should have a facelift?

This operation is indicated for people who have reached a point in their lives when they feel that the signs of ageing in their faces are a source of distress for them.

The age at which this happens can differ widely from person to person but may be at any time from the late thirties or early forties.

The only legitimate reason for having this type of surgery is to feel better about one self and one should only undergo this type of surgery for one self and never to please others.  

How is the operation done?
This operation addresses the problem of drooping and jowliness of the facial skin and musculature.

The operation involves making incisions in front of and behind the ears in order to allow the surgeon to free the skin of the face from its underlying attachments and then to remove the excess skin. Before the skin is tightened, the underlying muscles are dealt with, taking up any slack which contributes to the sagging appearance of the face.
Once this has been achieved, the excess skin is carefully measured and cut away.
The skin is then sutured using very fine material in front of the ears and slightly stronger sutures behind the hairline and behind the ears.
The fine sutures are removed on the fourth postoperative day and the rest on the tenth day or as soon thereafter as is practically possible.

The incisions are planned to be as invisible as possible and this includes placing them in natural curves e.g. along the edge of the pointy bit in front of the ear known as the tragus.

Where there is associated wrinkling of the skin particularly around the mouth, procedures such as laser resurfacing or chemical peels are added to the treatment plan.

What sort of anaesthesia is required?
While it is possible to perform this operation under sedation with local anaesthesia, I find it far more comfortable for the patient to have the surgery under general anaesthesia. The anaesthesiologist is able to pass a tube into the trachea (windpipe) which gives him complete control over the patient's breathing. This is what makes general anaesthesia the safest route to follow.

How long does the operation take?
A facelift on its own takes on average 2-2 ½ hours.

This operation almost always involves treating the baggy eyelids as well and the whole operation, if performed to include the necessary wide undermining of the facial skin, usually takes 3 ½ to complete.

Is the operation very painful?

While the surgery is quite extensive, it involves primarily the skin and this type of surgery is generally not very painful.

After having an injection for pain on waking up from the anaesthetic, you will probably only need occasional oral analgesics.

There is discomfort particularly of the eyelids as they rapidly become swollen and sometimes bruised. This usually lasts a day or two before beginning to subside.

If a peel or laser resurfacing is required, this may be safely done at the time of the operation only around the mouth. If more extensive resurfacing is required, this will have to be done at a later stage as doing the two procedures together can jeopardise the blood supply of the skin.

After the operation, you will need to be very careful about protecting yourself from the sun and the use of sunscreens with the highest protection factor available is recommended.

How long will I need to remain in hospital?
Depending on how you respond to the anaesthetic and how you feel by the end of the day, you might well be able to go home on the day of surgery. If not, you will not need to spend more than one night in hospital.

Will I be very bruised and swollen?

While this differs from person to person, the bruising is generally not very extensive and is usually only noticeable on the neck where any bleeding tends to collect under the influence of gravity.

In most cases the last yellow vestiges of bruising are gone by ten days.

The postoperative swelling becomes very obvious within 24 to 48 hours but then subsides as rapidly being virtually gone by 7 to 10 days.

It is important to be aware that there is a continual, gradual improvement in terms of loss of further, minimal swelling over some months after this operation and the final result of a facelift is only really seen at six months when it will be at its best.

How long will I need to hide from friends or work associates? ! !

To be fair to yourself you should arrange to be at home for ten to fourteen days.

Despite the attempts by some surgeons to minimise the extent of their dissection in this operation, achieving the desired results as well as a long lasting effect requires a relatively extensive dissection with concomitant bruising.
It is for this reason that it will take up to ten days time before it will not be obvious to others that you have had facial surgery.

In most cases the last yellow vestiges of the bruising are gone by ten days after which you will look presentable and able to face the world with confidence.

There are, however, a number of people who bruise so minimally that they are able to be out and about within forty-eight hours wearing a pair of dark glasses and those around them are none the wiser!

What about exercise?
You should not undertake any strenuous exercise for at least two weeks following facelift surgery. Your blood pressure rises during heavy exercise and it is possible to induce secondary (late) bleeding if you start exercising too soon.

Are there any complications associated with this operation?

Other than possible complications from the anaesthetic, which are very rare in healthy people who are in the hands of a specialist anaesthesiologist, the two significant potential complications of this operation are:
  1. Damage to the facial nerve, which supplies the muscles of facial expression.
    In the hands of a well-trained and experienced specialist Plastic Surgeon, nerve damage is very rare and when it does occur is usually temporary in nature.

  2. Skin loss in front of or behind the ears resulting from damage to the blood supply of the skin. Skin loss due to errors of surgical technique is very unusual and, when it does occur, is almost always due to the patient smoking in the perioperative period. The surgery by its very nature temporarily decreases the blood supply to the skin and smoking during this period is almost guaranteed to lead to death of portions of the skin in front of or behind the ears.

How long will the operation last?

The result of this operation will usually last for eight to ten years. The ageing process continues unabated but the patient will always be ahead of where he or she would have been had they not had the surgery. The belief that the surgery hastens the ageing process is fallacious.