Facelift

If the touch of time has been unfair and if well meaning remarks, such as “cheer up” or “you look tired”, are undermining your confidence, then a facelift may be the remedy you seek. A consultation with a skilled and experienced surgeon at Bristol Plastic Surgery can be your first step in restoring an outward appearance that more truly reflects how you feel on the inside.

There are many signs that betray our age. Lax skin is dull and lacks the bright reflected highlights of youth, fine wrinkles may crease the surface, deeper ones begin to cast shadows where none should be and the corners of the mouth may droop and jowls form. These can all be targeted in a carefully planned plastic surgery facelift.

Despite the apparent ease and simplicity with which we tighten our own face skin with our fingertips, the long training of a plastic surgeon pays dividends when dealing with the complexity and multiple aspects of facelift surgery. This general outline will supplement the discussion you have at your consultation and will explain the important issues in this complex but rewarding rejuvenation surgery.

Prices start from £6,800

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Assessment

There are various types of facelift and the extent of surgery you need will depend upon the pattern of the skin laxity whether it be in the neck, cheek or jowl area. The experience of your BPS surgeon will be your guide but you have the ultimate choice and you will not be pressured into more surgery than you wish. Neither will your surgeon agree to more than would be appropriate.

Many pre-existing features such as bone structure, dental condition, body weight and skin texture have an important bearing on the successful outcome of your facelift. We can inherit good bone structure but the care of our teeth is our responsibility. They form the foundation for the facelift. An ideal and stable weight avoids the changes in appearance that fluctuating weight causes and skin texture is a significant limiting factor in the re-draping of the skin.

There are also other features in the face that change and give the age game away. The upper and lower eyelids acquire extra skin and puffiness. Even the nose and ears can subtly change and become less youthful over the years. These features are not affected by a facelift, but once identified, they can be corrected by appropriate separate procedures which can sometimes be combined with a facelift.

The remedies are not always surgical and other procedures such as Botulism toxin injections, chemical peeling, Thermage and the injection of fillers may contribute to the overall improvement. Changes in lifestyle, diet, exercise and, in particular, the stopping of smoking will make a significant contribution.

Your BPS surgeon can now advise you on the type, extent, cost of a surgical facelift and any additional procedures. Appropriately, there is a fee for this service but you are now free to take time to reach your decision.

Preparation for surgery

All the recommendations in General Advice are very relevant for Facelift surgery. Your appearance has so much to do with all aspects of your well-being. Wash your hair shortly before arriving at hospital and do not apply lacquer or hair sprays. Wear no makeup and ensure that all traces of old makeup have been removed. Bring some dark glasses and a head scarf to wear upon discharge.

Procedure

Your specialist consultant anaesthetist will take care of you throughout your quite long operative procedure (average 3.5 hours) and will ensure your comfort, during the recovery phase, until your discharge.

Under general anaesthesia, your surgeon will make a number of unobtrusive incisions. Depending upon on the facelift type, these will be in front and behind the ear, into the hair above and behind the ear and occasionally beneath the chin. No hair is shaved. Through these incisions, the skin is lifted and the underlying tissues tightened. The excess skin is now trimmed and re-draped and sutured in place to leave a fresh firm appearance. Liposuction may be used to sculpt the jawline and the area beneath the chin.

When you wake up in recovery, your head will be cradled in a supportive bulky bandage. There may be drains in place (small tubes beneath the skin) to ensure free drainage of any blood ooze. These will be removed and the dressing reduced by the time of discharge home. Bandages will be in place for seven days.

Aftercare

You will stay in hospital for 1 to 2 nights after your operation where you can be under the close supervision of the BPS team. Before discharge, we will give you detailed instructions about aftercare and supply you with contact numbers for the BPS team.

Continue the regime to combat the swelling by staying upright during the day, propping yourself up with pillows during the night for 4 days, and avoiding too much bending. Resting cool packs on your face may also help.

Depending on the type of facelift you have, there may be staples behind your ears at the side of your scalp. If so, they will be removed at your follow-up appointment. You will also have stitches around your ears. Some may be dissolvable, but others may need to be removed.

The area of surgery including the hair may be gently washed with water the day after surgery and you may use a mild shampoo after 2 – 3 days. Avoid rubbing and do not use a flannel. Gently pad dry with a towel. Do not use hair dyes for several weeks.

You may feel the knots and ends of dissolving sutures under the skin for some weeks but they eventually disappear. If you feel some lumpiness under the skin of your cheeks, treat this with gentle massage in upward circular movements for five minutes twice a day using a moisturising cream that we will supply. Start doing this 2 to 3 weeks after surgery, or when the bruising and swelling have settled.

Your relationship with your plastic surgeon and his team does not end when you leave the operating room. We will always be here to answer your questions and concerns. Please contact us.

Implications

There is likely to be bruising around the eyes, cheeks and neck and there will also be swelling. Minor bruising can be hidden with camouflage make-up once the stitches have been removed and the wounds have sufficiently healed over. This takes about 10 to 14 days.

Your face will feel tight and numb following the operation. A tingling sensation in the skin may precede a return to normal over six months. During this time you should wear a sunblock to avoid burning.

Depending on your occupation, you may consider returning to work in two weeks. Strenuous exercise should be avoided for 6 weeks after surgery. This includes jogging, repeated bending, heavy housework or any activity that increases your blood pressure. Driving should be avoided for two weeks following your surgery.

The scars will take 12 to 18 months to fully fade but they are often unobtrusive and easily masked long before this. Their final appearance varies from person to person.

Expectations

A facelift is a rejuvenation, a winding back of the years, not a transformation. The greatest potential may be achieved by several procedures working towards the same goal. It is very important that your facelift is not overdone. If your skin is simply pulled too tightly and your expressive features lost, you become a caricature of the over lifted patient. This is not the BPS way.

You will continue to age naturally following a facelift procedure and in time the face will line and sag again. We each have a unique potential for tightened skin to re-stretch and it is not uncommon for some patients to gain benefit from a re-tightening some 18 months later. This then provides a more long-lasting benefit.

At BPS we do our utmost to achieve the best possible result for you, but because of patient individuality, this cannot be guaranteed. Factors such as bone structure and the extent of the surgery undertaken will affect the durability of the result. If further procedures are required, there may be additional fees.

Complications

Certain risks common to all surgery have more significance in facelift surgery. This would include infection, delayed healing and skin loss. The risks are very small in experienced hands.

Blood clots may form underneath the skin following a facelift despite the use of drains, and this may mean a second operation to remove the clot. The risks of this will be much reduced by following the recommendations outlined in General Advice and the restrictions on activity following surgery.

Some scars may tend to become lumpy and may remain raised for up to 18 months. Fortunately, this is unusual but alert your surgeon if you have experienced this tendency before.

Because of the complex anatomy of the face, there is potential for damage to the nerve which supplies the muscles of the face, particularly where it runs over the jawbone and the cheekbones. If this occurs it may leave you with some weakness of the forehead or at the corner of the mouth. This is usually temporary as it is unusual for the nerve to be cut, though it may be bruised. There is also potential for damage to the nerve that supplies feeling to the bottom of the ear. If damaged, this is repaired and sensation usually returns within two years. The risk of these complications is very small.

Where incisions extend into the scalp there is an uncommon potential risk of small patches of local hair loss. If this occurs it is fortunately usually an annoying but temporary phenomenon.

The Bristol Plastic Surgery surgeon’s knowledge of these risks, their causes and how to avoid them is your justification for selecting a surgeon.