The facial aging process does not happen all at once. Instead, there are gradual, almost in apparent changes that involve several components of the face. The skin envelope is the main reflector of the aging process, which eventually affects all the tissues of the face. It slowly ages over time, resulting in the loss of elasticity, dehydration, and atrophy. With increasing laxity the face sags, creating folds of skin. The skin’s outer layer appears tired and may have numerous fine lines and even deep wrinkles. Sun damage occurs concurrently and results in changes very different from aging. The skin becomes thicker and less elastic with the appearance of deep creases and, often, visible blood vessels.
           The rate of aging is often hereditary, but it can be accelerated by the environment and abuse (i.e., wind, tension, food, drink, and smoking). Reassertion of fat in some areas of the face along with atrophy of its muscles will further aggravate and accentuate laxity of the skin. In time the skull becomes thinner and smaller, thereby causing sagging and excessive overlying skin tissue in the face due to shrinkage of the bones themselves. Most of the change is due to laxity of the supporting structures of the skin.
          Aging is different in each of us. The deep wrinkles of the skin are most apparent in the forehead, between the eyebrows (glabellas frown lines), at the outer corners of the eyes ("crow’s feet"), and at the junction between the upper lip and cheek (nasolabial folds). If you look closely, finer wrinkles and etching of the skin are seen throughout the face. Often there is a puffiness associated with parts of the aging face, the eyes, the jowls and of course with many, the double chin. We are not always aware of the overall toll aging is taking on our face. Seldom do we notice that the tip of the nose droops and cartilage grows slowly throughout life, causing it to appear larger and longer. The ears similarly grow and the lobule gets longer. The upper lip gets thinner and less full and the lower lip tends to lose volume but also turns out more. There is, then, a discrepancy between the upper and lower red part of the lips.
          Not all aging signs or combinations of the above problems are seen in everyone. However, at least a few signs are apparent, in an aging face. This is why face lift surgery is designed and tailored for each individual. The Face lift (rhytidectomy) operation is most frequently referred to when one mentions surgery for rejuvenation of an aging face. It is designed to lift sagging facial tissue and folds of skin that have developed in the cheeks, along the jaw, and in the neck. This operation consists essentially of the tightening and redistribution of facial and neck skin tightening the underlying tissues with excision and tailoring of the excess.
           Although often spoken of as a single operation, facelift surgery is complex and encompasses numerous levels of surgical procedures. Most surgeons will at least discuss some of these techniques involved although it may be counterproductive to discuss or see the intricate details unless the patient is truly interested. Be aware that many surgeons are trained and comfortable in performing only a few of these variations. For example, there are surgeons who still do not perform deep plane facelifts on patients for fear of injuring the facial nerve (a devastating complication resulting in loss of animation of a portion of the face). Unfortunately this level of the procedure is the only way to correct a specific problem of the face. It is important to have your surgery done by someone well trained and comfortable in performing whatever surgery you require to look your best.
          Most people assume that a face lift operation implies surgery of the total face. This is not always the case. It usually is done primarily for the face and neck (not the forehead or eyelids). Sometimes only the face is done and occasionally only the neck. Various other combinations of procedures may help to achieve total facial rejuvenation. It is suggested that combina-tions of procedures be performed, so as to correct as many problems as possible and safe with one procedure and resultant healing time. Some procedures cannot be coupled with others and staged procedures are planned.

When to Have a Face lift
          Often the question is asked, "When should I have a facelift?" A rhytidectomy can be done when the signs of aging begin to manifest themselves, or it can be done long after these physical defects are well established (i.e., the aged person who desires to look much younger). This means as late in life as seventy or eighty. Though it is possible to have some things done no matter what your age, the results depend on the skill and experience of your surgeon and the condition of your skin, muscles, and bones. If the surgery is done at a younger age, the effects are longer lasting. At least a minimum change should be had after something as complex and serious as cosmetic surgery.

What to Expect
          The amount of improvement in the face is directly related to the amount of facial deterioration. If the degree of facial skin laxity is pronounced, the results of surgery will be dramatic; if it is slight, the improvement will be subtle. Either way your face will look less tired, more youthful, and alive. If a patient is eighty and has had no surgery before having a face-lift, people may easily see the difference. The dramatic change in appearance will be somewhat startling. This is especially so if, in addition to the face-lift, the patient has other procedures performed.

Preoperative
           You will be asked to arrive without makeup or jewelry. Some tests may be made, but most lab tests will have already been made on your previous visit. Wear comfortable, loose-fitting clothing and a front buttoning shirt so that nothing needs to be slipped over your head following the procedure.

Surgery
           Surgical techniques used to rewrap facial skin have dramatically improved in the past ten years. Each year new techniques are being employed for safer, more acceptable results. The best surgery is one which corrects the problem for a long period of time without severe risk. The methods employed depend on the objective of the surgeon in achieving what you have discussed.
          With facial rejuvenation, as a rule, an incision is made at a level of the sideburn just at the level of the upper third of the ear which curves down into the front portion of the ear then behind the triages (that little protuberance partly covering the ear canal), beneath the earlobes, and back behind the ears to the hairline and then extending for a variable distance within it. This incision line may be modified in the male or for certain other facial features to optimize the final scar and not appreciably alter the hairline (if possible). The skin is gently lifted from its bed and re-draped across the cheeks and neck. Today’s newer techniques also treat the underlying tissue and muscles referred to as the SMAS layer. In other words, there is a tightening of the underlying muscle and tissue in order to give the face a firmer, more youthful look. In this way, the contours of the face, fat pads and orbital muscles can be repositioned to a more youthful balance. By resuspending this deeper layer, the procedure will have longer lasting effects. It will look more natural and reduce tension on the overlying skin, thus produc-ing less of a scar. All excess skin at the hairline and ears is trimmed away, and the tightened skin is sutured in place at the ears and hairline. Care is taken to hide all incision lines as well as to close with tension. This closure is very important in order to avoid thickened or widespread scars.
          The operation is done while you are essentially asleep. Prior to surgery, you will have been instructed to shampoo your hair and remove all cosmetics the evening before. If you wear dentures, they must be worn to the operating room. A small amount of your hair may be trimmed, but not enough to show. Most of the incisions will be hidden within the hairline and are not easily seen. Therefore, you may wear your hair pulled back off your face without embarrassment. The procedure lasts two to four hours or more. A blepharoplasty (see eyelid surgery

 

This lady had a face life, forehead lift, cheek implants, and chemical peel.

 

and/or forehead lift) operation may be done at the same time. Often additional procedures may be necessary to tighten the neck skin and underlying supporting muscle. An additional small incision just under the skin may be necessary to tighten this area to an acceptable level.

 

 

She has had a face lift, forehead lift, cheek implants, and chemical peel to look much more attractive.

 

This lady lost 10 years by having a face lift, temple lift, chin implant, chemical peel, and nose enhancement

 

Postoperative
            You may or may not have dressings around your head and neck following surgery depending on the techniques of your surgeon. There may or may not be drains in place for the same reasons.

 

This lady had a face life, forehead lift, cheek implants, and chemical peel.

This lady lost 10 years by having a face lift, temple lift, chin implant, chemical peel, and nose enhancement.

She has had a face lift, forehead lift, cheek implants, and chemical peel to look much more attractive.

           The discomfort is usually minimal and a few pain pills taken the first night are usually all that is required to control the pain. The face and neck may become somewhat swollen and discolored, but this quickly fades in ten to fourteen days. Sutures will be removed from different areas of your incisions at different times as directed by your surgeon. This is done to minimize scarring. You may shampoo your hair by the second to fifth day and should expect to return to work within two weeks. Some numbness about the ears and cheeks should be expected, but it gradually disappears over time. A tight sensation may be experienced behind the ears and in the neck where the tension from the supporting sutures is the greatest. There is no tension placed on the incisions of the face; otherwise, this would create a widened scar.
           At first, the skin of the face will appear quite smooth and tight due to swelling of the tissues beneath. In time the swelling subsides and the skin should drape softly and gently over the facial contours in a natural fashion. This is to be expected and anticipated, for it will impart a natural appearance to the face with a rested composure, the goal of complete facial rejuvenation. The swept back and over tight look of yesteryear can largely be avoided today except, perhaps, in those persons who have the facelift procedure multiple times.

Mini Face lift
          The mini-lift may be performed several years after a full facial lift. It is designed to tighten up and maximize the lasting effects of the original surgery. For the younger patient who needs no major skin tightening, the mini lift can offer a fresh, more youthful appearance. The mini-lift still uses the same incisions as the full lift, but the undermined areas of facial skin are smaller. In both procedures, the surgeon may tighten the underlying muscle. Swelling and discoloration from the mini-lift is much less and recuperation more rapid; frequently only a few days.

After Surgery

• Follow prescribed medications.

• After the fourth day, light activities only.

• Sleep in a semi-sitting position on your back. Upright at all other times to decrease swelling.

• No excessive face and neck motion for six weeks. ( e.g. golf or tennis)

Rare Complications
          As with any surgical procedure, complications can occur. Numbness for a period of time, bruising, and swelling are quite common. This is the natural result of surgery on the face. They do not last long and can often be hidden after a few days by careful application of makeup. Problems such as an expanding hecatomb (bleeding beneath the skin), infection, nerve injury, contour irregularities, and skin slough or loss are very uncommon. The surgeon will discuss how the risk can be minimized. For example, some of these complications are much more frequent in persons who smoke cigarettes or who are using aspirin-containing medications.

Conclusion
           There are some facial rejuvenation methods that enhance the skin and remove lines, but they lack the ability to rejuvenate the over all appearance of the face, as does a face lift. The face-lift operation is a safe and effective means to achieve a more refreshed, vitalized, and youthful you.

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