FACE

1. Overview

A facelift, or rhytidectomy, treats the visible signs of aging in the face and neck. As we age, the skin and soft tissues of your face lose their elasticity and as a result, gravity can start having a negative effect on your appearance. A facelift is a cosmetic surgical procedure which can effectively restore a more youthful appearance to your mid- and lower face by removing excess skin and tightening the underlying tissues.

2. Ideal Candidates

In general, candidates for a facelift procedure should: be in good health, be non-smokers, and have realistic expectations with regard to their surgical outcomes.

Indications for the different facelift techniques vary, but can be grouped into two main categories: traditional facelift and minimally-invasive facelift procedures.

2.1. TRADITIONAL FACELIFT PROCEDURE

• Outcomes are usually more favourable in older patients who have neck laxity, jowling and mid-facial sagging.
• If you bothered by one or more of the following signs of aging, a traditional facelift may be a suitable treatment option for you:
• Mid-facial sagging
• Deep creases below the lower eyelids
• Deep creases along the nose that extend to the corner of the mouth
• Facial fat that has descended or displaced, creating jowls
• Loose skin and excess fatty deposits under the chin and jaw (causing a “double chin”)

2.2. SHORT SCAR FACELIFT PROCEDURE

• Ideal candidates are adults between the ages of 40 and 50, with minimal to moderate skin laxity involving the mid- and lower face. Patients who have favourable facial bone structure of the face and have lost some, but not all, skin elasticity, are also good candidates for a short scar facelift.

3. The Procedure

3.1. ANESTHESIA

• The procedure is performed under local anesthesia with intravenous sedation or with general anesthesia.

3.2. TECHNIQUES

• Facelift procedures range from simple short scar procedures which are completed through incisions in front of the ear, to more extensive face- and necklift procedures which extend behind the ear as well.
• Most modern facelift techniques address not only the skin, but also tighten the underlying soft tissue layer known as the SMAS (superficial musculoaponeurotic system).

3.2.1. TRADITIONAL FACELIFT PROCEDURE

• The traditional facelift treats the mid-face, jowls and neck.
• The traditional approach is performed by making an incision that runs in front of and behind the ear.
• Skin is tightened and excess skin and fat from the mid-face, lower face, and neck are removed.
• A traditional facelift procedure takes approximately 4 hours to complete and requires several weeks of convalescence.

3.2.2. SMAS FACELIFT PROCEDURES

• A variety of different SMAS facelift approaches exist.
• SMAS (superficial musculoaponeurotic system) facelifts build on the traditional facelift by elevating the skin, as well as deeper tissue layer of the face and neck (deep tissue layer of the face, as well as the neck, are collectively known as SMAS).
• Although the technical aspects of each SMAS approach vary, each approach tightens the deep tissue layer which not only enhances the longevity of the result, but also optimizes the quality of the scar.

A. SMAS PLICATION OR SMASECTOMY TECHNIQUE

• Through an incision placed just in front of both ears, the SMAS is raised and partially removed then tightened, or simply just tightened.
• The overlying skin is subsequently tightened, excess skin is removed, and incisions are closed with sutures.
• The SMAS plication or SMASectomy is performed at the time of a traditional facelift procedure.

B. SHORT-SCAR FACELIFT TECHNIQUE

• This procedure limits the length of the incision behind the ear.
• A common incision used in a short scar facelift is an S-shaped incision at the temple or in front of the ear (without any extension behind the ear).
• Short-scar facelifts are most suitable younger patients with mild to moderate aging.

4. PREOPERATIVE CONSULTATION

Dr. Lee will perform a thorough medical evaluation during your consultation to ensure that you are medically fit for surgery. He will also revise your medication list, as certain medications may need to be temporarily stopped before your surgery. After carefully evaluating your facial anatomy and assessing your aesthetic goals, Dr. Lee will review your available surgical options and help you choose the facelift technique which is right for you based on your anatomy and desired outcomes. Since smoking is known to be associated with poor/delayed wound healing, wound dehiscence, wound infections, skin flap necrosis, and increased scarring postoperatively, smokers will be asked to stop smoking prior to surgery. Patients will also be scheduled for routine pre-operative blood testing and an electrocardiogram 1-2 weeks before surgery. If necessary, further recommendations will be made once the results of these tests have been reviewed.

5. RECOVERY

The operation is performed on an outpatient basis and only rarely do patients have to stay overnight in our facilities for post-operative monitoring and/or pain control.

You will have a dressing wrapped around your face and/or neck after surgery to minimize swelling and bruising. There may be one or more thin plastic tubes beneath the skin to drain any excess blood or fluid that may collect under the skin. These are usually removed by a member of our team, the day after surgery.

Although most patients experience very little discomfort, Dr. Lee will prescribe pain medication to minimize any discomfort you may experience throughout your recovery. Some degree of swelling and bruising is expected; this usually resolves in the first 3 to 4 weeks after surgery. You will be instructed to keep your head elevated when lying down, and to avoid physical activity as much as possible during the first week of your recovery in an effort to minimize postoperative swelling and to reduce the risk of bleeding. Any permanent sutures will be removed in our clinic 5 to 10 days following surgery.

Patients are encouraged to walk immediately following surgery. Most patients are able to return to work within 2 to 3 weeks; however, we recommend that full exercise and vigorous activities be avoided for at least 6 weeks.

Before leaving the clinic, you will be given specific guidelines to follow for the care of your wounds during the recovery period. All dressings should be left in place since changes will be made at our clinic by a member of our team during a postoperative appointment.

6. RISKS AND COMPLICATIONS

As with any surgery, there are risks associated with a facelift procedure. Smoking, diabetes, peripheral artery disease (poor circulation), as well as heart, lung, or liver disease may increase your risk of perioperative and/or post-operative complications.

Risks and complications include:

• Risks associated with anesthesia
• Bleeding (hematoma)
• Infection
• Poor wound healing
• Skin loss
• Injury to the facial nerve with permanent or temporary facial weakness
• Temporary or permanent hair loss at the incision site
• Fluid accumulation (seroma)
• Altered skin sensation
• Persistent post-operative pain
• Scarring
• Prolonged post-operative swelling
• Skin irregularities and/or discolouration
• Deep sutures may irritate the skin until they are fully resorbed
• Skin/scar contour irregularities, facial asymmetry, unsatisfactory surgical scar location
• Deep vein thrombosis
• Cardiac and pulmonary complications

Scars form as the body’s natural response heal tissues. As with any scar, the extent of post-surgical scarring depends on a number of modifiable factors (i.e. avoidance of UV light exposure, tension-free wound closure, appropriate wound care, etc.) and non-modifiable factors (i.e. patient age, comorbidities, skin type, genetics, etc.). While it is not possible to perform scar-free surgery, Dr. Lee makes every effort to minimize the appearance of your post-surgical scars through careful pre-operative planning, the use of meticulous surgical technique, and by ensuring appropriate wound care and follow-up post-operatively.

It is not unusual for scars to appear red and be slightly raised/firm for the first 4-6 weeks following surgery. Scars will flatten and become more pale over time, and can take up to 12 months before achieving their final appearance.

Dr. Lee will thoroughly discuss these risks (and possibly others) with you and answer any questions you might have prior to obtaining your consent for surgery.