Before the surgery:
You asked me at what age a face lift is desirable. I answered that there was no age (though not before 40), because face ageing is very variable from one person to another, according to the osseous structure of the face, the nature of the skin, the variations of weight, the exposure to the sun.
I told you that it was desirable to have a face lift done when a bajoue appreared, when above the mouth in the prolongation of the natural wrinkle which is located between the cheek and the upper lip, tho two begin to separate :
It is preferable to intervene at this time to put the cheek back in tension, if not a wrinkle will form and organize itself starting from the corner of the mouth, giving an impression of age and a late face lift will only be able to attenuate it. On the other hand, it is always possible to retighten the slack skin of the neck.
I estimated the state of your skin, the degree of subcutaneous fat, the tonicity and the distribution of the face and neck muscles. It is sometimes only necessary to retighten the cheeks, without touching the neck, and exceptionally the opposite. The bulk of the work is done at the muscle level and not at the level of the skin. The re-establishment will avoid the “fixed” effect (+ + +) give a natural aspect to your face.
This intervention is often associated with eyelid surgery, or a pulsed laser (treatment of lip wrinkles).
The surgery:
I do not sacrifice any hair (+++), the implantation of the hair does not change.
Anaesthetic: the face lift is often carried out under general anaesthesia or local anaesthesia deepened by intra-venous tranquillizers.
I explained that the scars are usually in the hair at the level of the temple, along the edge of the ear, and very well hidden. Round the lobule, behind the ear and going back into the hair. The only possibly visible part of the scar will be behind the higher part of the ear, between the ear and the hair, rather high one and a half cm in length. You will be able to wear your hair short or in a chignon when the scars grow blurred after six months to year. If your neck is fleshy, it can be necessary to make an additional incision of a few millimetres under the chin to remove fat at this level by a lipoaspiration.
It will leave only one small scar dissimulated very well in the natural fold of the chin.
I will remove the skin surplus, and sometimes a little fat at the level of the neck and the bottom of the cheeks. I will sometimes perform an aspiration to remove surplus fat. In many cases, I would also put back in tension the muscles and the aponevroses (the SMAS).
I will then carefully suture. The seam will be placed primarily in the hair, and there will be no hair cut or shaved on either side.
i also recommended you to wash your hair the day before the operation, before you arrive at the clinic.
After the surgery:
You will have a bulky bandage that I will remove the following day. You won’t suffer, but you will feel uncomfortable during a few days, because of the feeling of tension due to the swelling and the stitches.
You will be able to stand up, to move, but while avoiding moving the neck. You must turn and lean down by moving your shoulders and not the neck. You will leave the clinic two days after the operation. It is recommended to sleep with your head elevated.
The third and fourth days you will be able to wash your hair. If you are fortunate enough to be only a little swollen and not to have bruises, you will be completely presentable after a dozen days.
It is nevertheless advisable to consider four weeks without obligations because this time is often necessary for the deflation and bruises to attenuate and so that you are able to have your hair dyed (after six weeks), by a hairdresser who knows how to take care of these problems.
After four weeks, the traces of an operation have usually vanished.
For yourself however, it will be necessary to wait between six months and a year at least so that the scars completely flatten and bleach and so that you feel, by touching your cheeks, the same flexibility as before the operation. Your skin will also need this lapse of time to regain its complete sensitivity. On the cheek and neck level, where the skin was separated to be put back in tension after the ablation of the surplus, there will be a reduction in the level of sensitivity.
What elements of concern can there be following the surgery?
The occurrance of an signifiant swelling of the cheek or neck.This is a bruise which generally occurs during hospitalization. It is more frequent among patients suffering from hypertension. It will be evacuated while at the clinic, and will maybe require a new anaesthesia. Treated strait away, it will be without notable consequences, apart from a few days for the recovery of the normal aspect of the face.
- Problems of scaring: appearance of scabs, in particular behind the skin of the ears, delays the healing of scars and can leave traces.
I will carefully check the aspect of your skin shortly after the intervention and I will prescribe treatments for you to carry out during ten days to avoid any problems of scar healing.
These problems are more frequent for smokers. It is obligatory to stop smoking a month before the face lift takes place.
- A mouth deviation in the days which follow the intervention; this is every patient’s fear. It is related to a paralysis of a branch of the chin of the facial. It is generally transitory and very exceptional. This exceptional risk must nevertheless be explained to you.
In the long run:
Of course the result is obviously not final, but it usually takes six to nine years for the skin to slacken sufficiently to return to the state where it was at the time of the first operation. It is possible to have another face lift done without any particular difficulty, a rotation of the temple enabling me to avoid pulling back the hair.
I think that a face lift not too late, far from damaging the skin, on the contrary improves it by maintaining it in tension and prevents the formation of deep wrinkles. Studies of cutaneous cuts even showed that a face lift caused an effect of rejuvenation of the skin.
Dr Thierry BONVALLOT