The first visible signs of aging appear in the face.
Usually consultation is sought by the patient to improve facial skin quality and to tighten it.
Sagging of forehead skin, sagging of cheek fat, prominent nasolabial folds (crease between the cheek and the lip) and jowling (skin folds hanging by the sides of the jaws) are the signs which one sees. Also can be seen, are the neck folds or turkey neck as it is called.
As one can see in this morphed picture of a guy and how he would look when older, the changes are pretty evident.
1. The skin quality is poor
2. The skin has lost tone and elasticity
3. The eyebrow has drooped
4. The malar pad of fat has dropped
5. The cheeks are hollow
6. The jowls have appeared making the face look broader at the bottom rather than at the top giving the shape of an ""truncated Triangle”
7. Deeper folds
8. Drooping of the outer angle of the mouth
So, these changes of aging are partly because of loss of skin quality, loss of volume because of loss of sub cutaneous tissue, effects of gravity and of course effects of sun damage and pollutants.
Face lift is the last in a series of procedures designed to counteract these effects and correct these signs of aging.
Face-lift is a procedure done to tighten the facial and neck skin producing a youthful appearance by effacing the deep folds.
The incision or cut is hidden in front and behind the ear and within the hairline. A formal face lift involves raising the skin right from the ears to the lips and pulling the skin up and back and simultaneously tightening the SMAS which is the thin muscular layer under the skin to help tighten it and keep it that way. The excess skin is excised and removed.
Post operative care is very important as the patients have a tremendous amount of swelling and may even have their eyes shut because of the swelling. Most of the swelling goes down by the first week but numbness and tingling sensation may persist till about 4 – 6 months after the procedure. You are also required to wear pressure garments and supports to keep the skin in its new position. As the swelling goes down and things start settling the results will be better appreciated.
Face lifts require a lot of co operation from patients in the sense that they have to go through the waiting time till the swelling subsides and numbness settles down. Also they have to refrain from smoking at least 10 days in advance and 15 days post operatively to prevent complications like skin necrosis. And need proper skin care later on. The results of the procedure are long lasting, but over a period of time the effects of gravity and aging do take a toll and the jowling / sagging skin may recur.
Immediate complications can be bleeding, infection and wound gape. Another important complication is the risk of nerve injuries. Bleeding may need to be evacuated in the operation theatre and infection is treated conservatively. Wound gape may require resuturing in rare instances.
Nerve injuries can occur because of the extensive dissection involved and the proximity of the superficial nerves of the face even though every care is taken to prevent such an incident. If they occur most of them usually recover spontaneously within 3-6 months as it is a painful and slow process of recovery. Though these are rare they are known to occur. Very rarely the nerve may be cut in which case a re-exploration and nerve repair may have to be done
Skin necrosis is another dreaded complication though rare. The skin at the edges may die because of lack of circulation. More commonly seen in diabetics and smokers. If it occurs may need a skin grafting with a resultant scar.
Late complications can be Scar hypertrophy which has to be treated on its merits to try and reduce it, hair loss in the suture line which can be treated with single hair transplants.
MACS Lift: ( Minimal Access Cranial Suspension Lift)
This is a relatively newer approach to face lift. This approach minimises the extent of dissection thereby potentially reducing the complications but providing decent results to the face and the neck. This is gaining popularity because of the early return to work patients can have. The extent of dissection is less so the swelling post operatively is also less. Also it gives good neck contours as the direction of pull is vertical.
The basic approach is a smaller cut most of it in front of the ear and extending into the hairline. After the liposuction of the neck is carried out, the skin is dissected. Then three suspension sutures are placed from the tissues in the upper neck and cheek and the malar fat pad and these are hitched to the tissues in the head giving the lift that is required. The excess skin is removed.
Dr.Surindher has modified the MACS lift by using barbed “Quill Sutures” for the loops instead of the regular PDS or Prolene sutures which prevents bunching up of the tissues and gives smoother contours and filling to the mid face.
Studies have shown no long term difference in the conventional face lift vs the MACS lift. But since the complications are less along with good results and early return to work, the MACS lift is becoming more and more popular.
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