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1. What kind of facelift should I have?

My role as a surgeon is to select the overall facelift plan that will best satisfy each individual patients needs. This involves selecting the appropriate facelift plan for the modern options available. The selected plan must meet the patient’s realistic requests while remaining minimally invasive for the quickest recovery and the least down-time. I inform each patient of their options for facial rejuvenation and these include non-surgical techniques such as Botox and Restylane treatments.

There are two main facelift options available. The first option is a “full face and neck lift” which is best for those with significant ageing of the face of neck. The second option is the “short incision lower facelift” and is more appropriate for those with less advanced ageing or those who, for personal reasons, request a shorter procedure. The short incision lower facelift involves shorter surgery; however, it is usually only appropriate for people whose main concerns are limited to the jaw line, mouth and jowl. All incisions are kept to a minimum and, with meticulous care, these usually result in a virtually imperceptible scars that blend into the hairline and around the ears.

While beauty may appear to be only skin deep, modern understanding of facial ageing has shows that the actual cause of an aged appearance in the face and neck is sagging of the tissue layer underlying the skin. The skin simply covers this sagging deep tissue layer, much like a thin bedspread may cover a thick but crumpled blanket.

To best smooth the loose and wrinkled appearance of the face, one should correct the sagging and laxity of the underlying blanket of deep facial tissue, as well as conservatively removing any excess skin. Small ligaments attach the skin to the deep layer beneath, which means that when this deeper layer is lifted and smoothed, the skin is automatically smoothed along with it. Surgeons call this deep tissue layer the SMAS. An optimal and lasting facial rejuvenation is obtained when this SMAS is repositioned and securely re-supported with permanent sutures.

At the level of the jawline, the SMAS layer of the face becomes continuous with the platysma muscle layer of the neck skin. Attached to the surface of the SMAS tissue blanket are the fatty tissues of the cheeks and jowls. Lifting and re-supporting the SMAS layer will therefore also lift and smooth sagging cheeks and jowls, creating more youthful facial shape and contour.

2. What about the mini-lifts and stitch lifts I see advertised?

Many people ask me about various “named” mini-lifts and stitch lifts that they hear advertised in the press.

We all know that painting over cracked and peeling paint on a house will result in a poor and short lived renovation. Similarly, “quick-fix” skin lifts which only tighten skin cover, but do not correct the sagging and ageing of the underlying SMAS layer, will result in suboptimal and relatively short-lived changes. There are many procedures promoted that provide little, if any, deep tissue support. Most of these techniques are basically skin depth procedures and results will be similar to the traditional skin-only facelifts of the 1980s. Most of these techniques have been shown by experience to be flawed by design and may produce unnatural appearances.

Modern cosmetic plastic surgery has evolved beyond limiting itself to one particular “brand” of facelift.

The surgeon should draw from the range of advanced plastic surgery techniques to best meet the patient’s individual requirements. Each person has a unique facial shape and ageing pattern so the exact facelift plan must also be individualised. I regularly attend national and international conference to ensure that the most up to date and proven techniques are available to my patients. Modern techniques reduces invasive surgery, swelling and down time to a minimum, while maximising results and safety.

3. Will my facelift look obvious?

The SMAS face lift I perform avoids the tight or pulled look at all costs! This has been made possible via recent advances in the understanding of facial ageing. Modern SMAS facelift surgery focuses on truly reversing the actual ageing processes, blending artistry with effective surgical technique. This produces a younger and better appearance without making you look different, or like you have had surgery. People will notice you look fresher and healthier but usually just assume you are well rested or have recently returned from a holiday.

The SMAS deep tissue layer, the platysma neck muscle and the fat of the face that has dropped to the jowls and neck folds are firmed and re-supported so that natural and youthful contours in the cheeks and jawline are reclaimed. Skin smooths automatically over this firmed base so skin removal and surgery can therefore be kept to a minimum. This avoids the pulled or tightened look that was once seen in the traditional skin only facelifts of the 80’s.

It is now known that with ageing there can also be deflation of the mouth and lips and well performed fat cell transfer treatments offer a reliable option for rejuvenating hallowed or wrinkled areas. Accumulation of excess fatty tissue in the howls and neck can be reduced with liposculpture.

Naturally, the most important way of avoiding overdone or unnatural facelift is to choose your surgeon very carefully.

4. What can I do about my saggy neck?

In some, the neck can be contoured using liposculpture alone. However, when there is excess skin and neck muscle laxity a necklift is needed for optimal results. To achieve a harmonious facial rejuvenation, the neck, brow or eyes will often need to be treated at the same time as the facelift. The short incision facelift technique provides effective correction of prominent jowls and looseness of the mouth and jaw line; however, benefits in the cheeks and under the chin are less marked. For optimal face improvement the “full face and neck lift” is needed and involves an incision behind the ear to tighten the neck muscles and allow removal of the lax neck skin. These inconspicuous incisions are carefully hidden within the scalp hair allowing women to wear their hair up.

5. How much younger will I look?

As a general indication a modern facelift can take around 8 to 12 years off your apparent age. This means that if you are 50, you return to the appearance of say 40 years of age and the final result still appears age-appropriate for your decade of life. Naturally the ageing process does continue however good skin care and a healthy lifestyle will reduce the development of future ageing changes.

The techniques I use will provide improved support that slows the ageing process so that you do in fact age slower than your friends. Of course the immediate benefit is looking 8 to 12 years younger.

6. When is the best time for a facelift?

The most appropriate time to consider a facelift is when the ageing of your face, brow or neck starts to impair your self-esteem and confidence. This is usually between the ages of 45 to 55 years. Once these changes have set in, it is beneficial to perform surgery earlier than later. This is because delaying surgery will cause unnecessary wrinkles and loss of skin quality so any surgery required in the future will therefore be more involved. Performing surgery earlier means that the required changes will be more subtle.

7. How is the surgery performed?

For your safety and comfort, all procedures are performed under an anaesthetic by a specialist anaesthetist. Most patients prefer a general anaesthetic, so that they are fully asleep throughout the surgery. Many patients prefer to spend a night or two in hospital, however for shorter surgeries there is the option of returning home the day of the surgery after recovery from the anaesthetic.

No bandages are used to cover the eyes or face after surgery. Most stitches are absorbing so therefore do not need removal. Some fine non-absorbing stitches are used in delicate areas in order to produce the finest possible result. These are all removed by seven days after surgery.

8. What are the risks of having a facelift?

Naturally any procedure has its associated risks and these are carefully explained all before surgery. The risks of surgery include, among others, dissatisfaction with the result, wound infection, bleeding and excess scar tissue formation. Whatever technique a patient selects, they should check their surgeon’s credentials carefully. To check if their surgeon is a member of the Australian Society of Plastic Surgeons they can call (02) 9437 9200.

9. Will I have pain and bruising?

There will be some bruising that varies between individual patients. Due to delicate surgical technique this is usually mild. Medications are provided before and after surgery to reduce both swelling and bruising. Almost all patients report that, contrary to what they expected, discomfort or pain are minimal and easily controlled by our analgesic programme. There can be a feeling of tightness in the neck or face that resolves after a few weeks.

10. How long before I can get back to work or go out in public?

Almost all patients having facelift surgery have busy schedules and it is vital that they get back to work and social activities without any unnecessary delays. With advance plastic surgery techniques and an optimal after-care plan, most are back to work and in public within 10 to 14 days. To help the healing process it is important to physically rest during the first week following surgery. By two weeks almost all detectable swelling has resolved and any mild redness or discolouration can be covered with make-up.