Facelift Q&A

The Consultants

• Mr David Crawford is a consultant plastic and cosmetic surgeon at The Clementine Churchill Hospital, The Hampshire Clinic and The Princess Margaret Hospital
• Mr Wesam Aleid is a consultant oral, facial plastic and head and neck surgeon at The Alexandra Hospital and The Beardwood Hospital
• Mr Gary Ross is consultant plastic, reconstructive and aesthetic surgeon at The Alexandra Hospital

What is facelift surgery?

Mr David Crawford: Face lift surgery is surgery to the face and neck with the aim of restoring a youthful and natural look, i.e. restoring elegance to the face and neck.

My technique is individualised to each patient but may be summarised by tightening and elevating the deeper tissues, removing excess loose skin and addressing the volume changes that take place with ageing. The extent of the scarring will depend upon the extent of surgery required.

Mr Wesam Aleid: A facelift is a procedure that improves visible signs of ageing in the face and neck such as sagging skin and deep creases.

Mr Gary Ross: Facelift surgery involves the manipulation of the skin and soft tissues of the face. It can be performed under local or general anaesthetic and aims to rejuvenate the face and reduce the effects of ageing.

What are the reasons for having facelift surgery?

Mr David Crawford: Most patients want to simply look as young as they feel, for example their facial appearance does not match their youthful spirit and energy levels. Some patients want a facelift to stay looking youthful to maintain their career, as in many occupations and careers looking youthful is important. Although the majority of patients seeking facelifts are female, in my practice the number of male patients has been increasing year on year.

Mr Wesam Aleid: The best facelift patient is in good health, a non-smoker, and is able to avoid blood thinning medications for two weeks before surgery. He or she is unhappy with the sagging skin of the face and neck, which leads to a tired, aged appearance.

Mr Gary Ross: Patients often request facelift surgery to give them back what nature has taken away with age. The most common age for patients requesting facelift surgery is between 50-55 although it can be performed in both younger and older patients and there is no upper age limit.

What does the procedure involve?

Mr David Crawford: Patients are admitted on the day of surgery and have their operation under a general anaesthetic. The procedure usually takes two hours (or up to one hour longer if eye bag correction, blepharoplasty, is carried out at the same time) and I prefer to keep my patients in hospital for two nights to allow a smooth and well supervised recovery. All sutures are removed by 10 days and most patients are back at work and socialising at two weeks.

Mr Wesam Aleid: You will be given a general anaesthetic or in some cases, a local anaesthetic with sedation. A facelift can take two to three hours. The surgery itself involves a series of incisions above the hairline, which pass down in front of the ear and continue behind the earlobe to the lower scalp.

A small incision may also be made underneath your chin to reshape the skin around the neck. Then fat will be trimmed or suctioned to help improve facial contours and give you a clearly defined look. The fat will be separated from the skin and muscle below which will tighten both of these. The facial skin is lifted and re-draped. The skin is pulled back which tightens and smoothies it and helps to remove any excess.

This will give you that younger looking appearance. The incisions are closed with a series of sutures (stitches). A bandage may be applied around your head to reduce the risk of bruising and swelling afterwards.

Mr Gary Ross: It involves an incision that is often placed along the side of the face in such a way that it is hidden around the ear. It is often extended into the hairline in the temple and around the back of the ear into the scalp. Through this incision the soft tissue or SMAS can be elevated in a variety of vectors in order to reduce the appearance of ageing. Often the soft tissue is repositioned higher into the cheek bones and the lower jaw line and neck muscles are tightened.

What are the benefits of having facelift surgery?

Mr David Crawford: The main aim is to look facially 5-10 years younger than they did before surgery, which means fresher and more youthful with facial elegance restored.

Mr Wesam Aleid: I often ask patients to bring photos of themselves from their youth to see how things have changed. My goal is always to make people look like the best version of themselves as possible. Your skin will be firmer, tighter and fresher looking. You will have a younger looking appearance, which will improve your confidence and self-esteem.

Mr Gary Ross: Facelift surgery can give patients a new lease of life at a time when they feel less confident in themselves.

What are the alternatives to facelift surgery?

Mr David Crawford: Facelift is the gold standard in facial and neck rejuvenation. In some patients where surgery may not be suitable, they could benefit from facial fillers which can be used to camouflage the effects of facial ageing and treatment injections can be used to reduce forehead frown lines and crow's feet lines in the temples.

Mr Wesam Aleid: Minimally invasive aesthetic procedures such as Thread lifting (silhouette soft) provides an excellent alternative to surgical facelifts for those patients who want to avoid surgery and its down time.

Mr Gary Ross: There are many non-surgical techniques that have been proposed as an alternative to facelift surgery including peels / laser/ dermabrasion and non-surgical devices such as radiofrequency. Autologous fat transfer to increase volume and liposuction and fat dissolving therapies are also now available. To increase and decrease volume in the relevant areas.

Are there any risks or side effects of having facelift surgery?

Mr David Crawford: Most patients (over 95 %) have a smooth recovery and a good result after surgery. However, there are always risks with surgery and the particular risks of facelift surgery include:

• Adverse scarring
• Numbness of parts of the skin and scalp
• Infection and bleeding
• Necrosis of the skin (this is when parts of the tightened skin do not survive the trauma of the surgery; it is rare in non-smokers and healthy patients)
• Damage or bruising to one of the branches of the facial nerve that enables facial expression (less than 1% risk)
• Blood clots in the deep veins of the legs (the wearing of antithrombus stockings and the use flowtron boots as well as early mobilisation after surgery help markedly reduce this risk)

Mr Wesam Aleid: Adverse events are rare. One possible but uncommon risk is bleeding, which occurs under the skin. Usually, this bleeding will stop using compression, and no surgical intervention will be required.

Very rarely, a patient will need a blood clot removed and bleeding controlled during a very quick surgical procedure. In all cases, the bleeding is not life-threatening. Skin or Nerve damage is also reported after facelifts, and may involve sensory or motor nerves. In the former case, numbness of the face will be experienced for several months, but this usually recovers. If a motor nerve is stretched, there may be slight weakness of certain facial muscles.

Infection is possible but rarely occurs because of the face's abundant blood supply. Healing is usually uneventful unless a patient is a smoker, and nerve damage is usually temporary.

Mr Gary Ross: Infection, bleeding, skin necrosis, poor wound healing, nerve damage are just some of the risks that need to be discussed at a consultation. The pros and cons of surgery need to be weighed up in order that patients can be empowered to make a decision to proceed.

How long does it take to recover from facelift surgery?

Mr David Crawford: Most of my patients are back at work and socialising at 10 to 14 days after surgery.

Mr Wesam Aleid: After a face lift your recovery and your job will dictate when you can return to work. I usually would advise patients to leave two weeks before returning to work although this does vary depending on each individual. You should plan to take one to two weeks off of work, so swelling and bruising can resolve. Exercise should be avoided for about three weeks after surgery.

Mr Gary Ross: The recovery depends on what surgery is performed and every surgeon will advise different post-operative care and recovery regimes. In my practice where no drains are used and patients are mobilised immediately, recovery is relatively quick and patients usually stay overnight and go home the next day. It is not unusual for patients to be able to socialise and go back to work after one to two weeks following surgery although every patient is different