What is a facelift?
A face lift is an operation performed to apply lifting forces to the lower face and neck in the opposite direction to the ageing vectors in order to improve aging changes, and create youthful appearance.
How is a facelift surgery performed?
The facelift is performed under sedation or general anesthesia. A facelift incision begins horizontally beneath the sideburn, and carried on inferiorly in a native preauricular crease in front of the ear. The incision follows a post-tragal course in females, and a pretragal course in men so as not to move bearded skin into the external ear canal. It is carried on to the back of the ear around the lobule and continued for few centimeters superiorly. It is then curved posteriorly and inferiorly into the hair bearing portion of the scalp behind the ear. After the incision the skin is raised, a thin muscular layer lying underneath the skin called SMAS is incised, dissected and prepared as a flap. Then the SMAS flap is pulled in a direction opposite to the ageing vectors and suspended with sutures to create the youthful appearance. If neccessary, the concurrent liposuction is performed to remove excess subcutaneous fat, and a corset platysmaplasty is performed through a horizontal submental incision Excess skin is excised, and the skin is sutured.
What are the types of facelift surgery:
There are mainly two facelift techniques concerned with the depth and extent of dissection.
1. SMAS lift techniques
Imbrication and plication of the SMAS are the most common facelift techniques. Plication techniques involve in-folding of SMAS without any SMAS incision, and suture suspension. Imbrication techniques involve a SMAS incision with or without a limited subSMAS dissection, and suture suspension. Ageing changes in the lower face and neck may be successfully treated with SMAS-lift techniques. Since the retaining ligaments of the midface are not released, these techniques can not improve aging changes at the mid facial region and nasolabial folds.
2. Extended facelift techniques
Extended facelift techniques involve surgical release of retaining ligaments in the midface that prevent the transmission of traction to the malar portion of the facelift dissection. Advancing the subSMAS dissection toward the midface allow repositioning of the ptotic malar fat, restoring the cheek volume, and diminishing the nasolabial folds. Extended facelifts produce combined, balanced and harmonious rejuvenation of the midface, cheek and lower face without requiring a separate midface lift procedure. There are different extended facelift techniques with similar extended midface dissection, each with some variation. A deep plane facelift involves undermining of a skin-SMAS flap as a single unit following a more limited subcutaneous dissection. A composite plane facelift, in addition to the deep plane facelift dissection, the lower part of the orbicularis oculi muscle is also dissected and included in the flap. Since deep and composite flap facelifts involve a single unit, they allow excellent blood supply to overlying skin which is important, especially in smokers, to prevent vascular compromise and subsequent skin necrosis.
Does an extended technique (such as deep or composite plane facelift) would have a more superior result than a classical facelift?
There are retaining ligaments on the face anchoring the dermis, subcutaneous fat and SMAS to the bony periosteum or deep fascia. The role of these ligaments to support facial soft tissues against forces of gravity. The attenuation of retaining ligaments with aging leads downward displacement of soft tissues, and responsible for many of the stigmata that occur with aging. Inadequate release of these retaining ligamentous attachments during facelift prevent the transmission of traction toward mid face which may lead to an unbalanced, unnatural appearance with unopposed nasolabial folds. Additional attempts to improve untreated nasolabial folds such as fat grafting to malar region are more likely to result with a “stuffed look”, “operated appearance”. Extended techniques such as deep and composite plane facelifts involving the surgical release of mid facial ligaments produce combined, balanced, and harmonious rejuvenation of the midface, cheek, and lower face without requiring a separate midface lift procedure.
Are deep and composite plane facelifts more dangerous than other type of facelifts?
Preservation of the facial nerve is crucial in facelift. It is important that the surgeon understands the relationship of the facial nerve to the anchoring ligaments and the anatomy of the SMAS and subSMAS tissue spaces accurately to perform a safe and successful surgery. Actually, extended techniques such as deep and composite plane facelifts while identifying and preserving the anatomy often leads to lower complication rates than blindly working around vital structures.
Which facelift technique does Dr. Ozcan Cakmak prefer, why?
Dr. Ozcan Cakmak prefers his modified composite plane facelift technique which is published in one of the most prestigious journals “Aesthetic Surgery Journal” in 2019. His facelift technique produces combined, balanced, and harmonious rejuvenation of the midface, cheek, and lower face without requiring a separate midface lift procedure
What can I expect after surgery?
After surgery pain is minimal to moderate and is usually well managed with pain medications. There would be mailed to moderate swelling and the ecchymosis of the skin, which may differ markedly from patient to patient. The ecchymosis will barely be visible after 4-5 days, and most swelling subsides after 5-7 days. Complete healing will take 6-12 months but the major part of this process is most often completed 1-2 weeks after surgery.
Will I have a drain, bandage or dressing after surgery?
Yes, you will have a bandage after surgery wrapped around your head to apply light pressure over the face and neck and to minimize the risk of a blood collection under the skin (hematoma). This bandage, and the drains placed behind the ears to prevent blood from collecting under the skin will be removed a day after the surgery. Removal of the bandage and the drains are typically pain-free. You will be asked use an elastic bandage for the next few days.
Will I need my sutures to be removed?
The sutures are taken out 6-7 days after the surgery. The procedure of suture removal is almost always painless.
Will I have any visible scar?
There is no such thing as a scarless surgery and any type of incision on the skin will leave a scar. However, facelift incisions are placed either inside of the hair or in natural creases around the ear. Due to effective camouflage, facelift scars are often not visible or barely discernible.
How long does a the facelift result last?
It is not possible to stop the effects of aging and after surgery this process continues. In time your face will age and the effects of surgery will decrease. The aging process is extremely variable among people so it is impossible to tell how long the effects of face lift surgery will last, but it is generally expected that the results of surgery last approximately 10-15 years.
How long will I be off from work?
You will be asked to refrain from strenuous exercise for 2-3 weeks, but you may start working 7-10 days after surgery.
Can I wear make-up after surgery?
You can start wearing make-up after the third day of surgery.