Cosmetic Surgery

As people age, the effects of gravity, exposure to the sun and the stresses of daily life begin to take their toll on the face. Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds and fat deposits appear around the neck.

A face-lift is a surgical procedure performed to improve the most visible signs of the ageing process, by eliminating excess fat, tightening the muscles beneath the skin of the face and neck, and remove any sagging skin. Many times this procedure is performed in conjunction with eyelid or even forehead surgery. A well-performed face lift should revitalise the face without distorting or changing ones facial features. A facelift can make you look younger and fresher, and it may enhance your self-confidence in the process. However it can't give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them at your consultation.
 
Am I a suitable candidate for this surgery?
The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity. There is no need to wait until hanging folds or almost irreversible changes have taken place. While the facelift procedure is probably the most sought after within the over 40's group, increasingly these are being carried out on younger patients. In fact these days, many patients prefer earlier corrections to maintain youthful appearances, and therefore avoid living through a period of looking "old and tired". Although the occasional film star may undergo a celebrated facelift, the vast majority of patients are those normal people who take pride in their appearance and feel younger than they look.

A facelift has always been regarded as a major surgical procedure, but in reality need hold no fears. It is important to remember however that surgery cannot erase permanent creases, particularly on the lips, and that it does not stop the ageing process. A facelift just "sets the clock back"; it does not stop it running.

At the time of consultation Mr. Karidis will ask you about your general medical history, specifically pertaining to any medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or a tendency to form excessive scars. Slight differences in facial symmetry are normal and will be pointed out as many times these are unnoticed by the patient. It will also be explained that certain areas of the face cannot be helped by surgery, such as the lines around the mouth, frown, and crow feet region. The newer skin resurfacing lasers covered under separate notes best deals with these areas.

If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you should avoid these.

If you're contemplating facelift surgery, this information will give you a basic understanding of the procedure. It can't answer all your questions since a lot depends on the individual patient. However, any specific questions should always be addressed at the consultation.
 
Are there different types of face lifts?
Over the years the classical (skin only) operation has undergone a number of modifications to improve the overall results. These modifications were aimed at lifting not only the skin but also the underlying structures (i.e. muscles), which were equally subjected to the effects of the ageing process. By addressing these structures, the face could be lifted to enjoy a longer lasting effect.

The SMAS type of lift is that favoured by many competent surgeons although there are now many variations such as the, extended SMAS lift, Composite Lift and Sub-periosteal Lift. Each of the above modifications can be tailor made to suit individual needs. It is equally important to remember that different methods do not indicate a departure from any formally established standard. Many times liposuction is carried out during a face-lift so as to ensure that the neck and jawline is clearly defined.
 
How long does a Facelift last?
It is impossible to answer this or generalise, as each individual has different skin quality and texture. However in one sense, ten years later, you will look better than if you never had any surgery. Remember however your face will continue to age with time. Many patients never have a second lift, while others may desire further surgery seven to 15 years later.
 
What does the operation involve?
In broad terms the incision used for both men and women is the same, although there is a slight difference, as result of the hair bearing nature of the male facial skin. Generally speaking the incision starts high in the temple area (hidden by the hair at this point) then courses down in front of the ear, round the earlobe and up behind the ear before curving gently back into the hairline of the neck. It may on occasion, be necessary to add an incision in under the chin.

Using the above incisions the skin is lifted forwards onto the cheeks and down as far as the jawline and into the neck. The underlying muscles are then lifted accordingly so as to ensure a longer lasting effect. Having repositioned the deep tissues, leaking blood vessels are then sealed with the use of a cautery. Following this, the loose expanded skin is elevated upwards and any overlapping or excess skin is trimmed. The wound is then closed with a combination of sutures and miniature metal clips. If bleeding is deemed excessive, drains may be used which are placed beneath the skin to evacuate any accumulation of blood which may arise postoperatively. A bandage dressing is then gently applied around your face in order to apply light pressure over the wound area.
 
What type of anaesthesia is used and how long does the surgery take?
A facelift can be performed either with local anaesthesia or a full general anaesthetic. This may also depend on whether you will be having extra work done to the eyes or brow area. In general terms, the longer the surgery the better it is for the patient to have a general anaesthetic, so as to avoid feeling any duress or discomfort from lying still for a long period of time under local anaesthetic. Surgery for a facelift can take between 2-3 hours, although this takes longer when combined with additional surgery i.e. eyelid surgery.
 
What happens after the surgery?
Bandages and drains (if used) are removed the day after surgery. Your hair will be carefully washed and you may then return home. Over the next few days your hair should be washed daily with a gentle shampoo, obviously exercising care in the suture area. Stitches in the skin and metal clips used within the hairline, are removed at eight days. You will be provided with full postoperative care instructions, which you are kindly asked to follow.
You will also experience a feeling of numbness and tension in the neck and cheek areas as well as around the ear. This is a result of the small sensory nerve fibres in the skin being separated during the operation. Sensation usually returns to normal but may take anytime up to 9 months.
 
What kind of after effects should I expect?
Following surgery you will experience swelling and bruising of the face to varying degrees, which can last up to 3 weeks. Occasionally, isolated bruised and hardened areas can take up to two months to resolve. The appearance of tiny thread veins on the cheeks can rarely occur. Swelling may produce some temporary lag in the normal motion of the facial muscles but this should gradually subside without permanent change.

You will also experience a feeling of numbness and tension in the neck and cheek areas as well as around the ear. This is a result of the small sensory nerve fibres in the skin being separated during the operation. Sensation usually returns to normal but may take anytime up to 9 months.

It is important that both men and women alike are aware that the position of the hair in front of the ear is altered, and may be elevated for 1-2 cms. In men the beard may be repositioned underneath and behind the ear, necessitating shaving in these areas.
 
What are the scars like?
A scar will obviously form at the incision sites. This is always red and slightly lumpy in the first few months following surgery. One must remember, it is always impossible to ultimately predict how any individual's scar will appear. However behind the ears, and rarely in front of them, scars of certain skin types can stretch. These skin types cannot be identified prior to surgery. Often, these are easily hidden by longer hairstyles but may become visible if the hair is cut short or lifted. Occasionally a bald strip can develop adjacent to the scar that is situated in the temple area.
 
Is it painful?
You will experience a tight feeling around your face following surgery as a result of the bandages used. However it is safe to say that the majority of patients experience a surprisingly small amount of discomfort following a facelift. In fact most patients experience a numb sensation once the bandages are removed. This of course improves with time.
 
What could go wrong?
All surgery carries some uncertainty and risk. When a Facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Conditions such as high blood pressure and smoking increase the chances of complications and therefore will be discussed in greater detail at the consultation.

Complications that can occur include a haematoma (a collection of blood under the skin that must be drained by the surgeon), injury to the nerves that control facial muscles (usually temporary and less than 1% chance), infection, delayed wound healing and skin lumpiness or distortion (usually temporary).