Facelift

What is a Facelift?

A facelift (medically also called rhytidectomy) is a surgical procedure in aesthetic and plastic surgery in the human face. The procedure allows tightening the facial skin and the underlying connective tissue, which gives the skin a higher tension. This appears as "smooth skin" in the human eye.

Usually, a doctor carries out this surgery when the patient wants to look younger. Face-lifting seems to be an ancient subject: confirmed documents from the 20th century already report about it, and also records of the ancient Egyptians prove that they had already been engaged in cosmetic surgery at that time.

How Exactly Does the Facelift Work?

Usually the procedure is limited to the deep subcutaneous tissue. In exceptional cases, a cheek lift can reach the periosteum below the zygomatic, for example. In the neck area and for long-term effects, deeper structures are also used; e.g., when tightening the neck tissue, the platysma (a thin muscle on the neck) is pulled up.

To tighten specific areas, they are tightened by sutures, which may or may not be absorbable, and reattached to fixed structures. The tightening of different regions is also carried out in different directions. The lifting usually results in excess of skin, which is removed before the skin is sutured together again, invisible, and without tension.

The facelift can be carried out endoscopically using a camera or by several smaller incisions. The latest mentioned technique is mostly used in the forehead area because there is usually no excess skin. There are also surgical possibilities without using incisions. Thread lifting with gold or plastic threads using a barbed hook means that no more incisions are needed, but excess skin cannot be removed, which limits using this method in young patients.

Facelift Surgeries

SMAS Lift

it has been found out that a particular layer of tissue needs to be tightened to achieve long-lasting and effective results. This layer is the superficial muscular aponeurotic system (SMAS). There are many methods and techniques currently available to prepare, reduce, reposition, duplicate, and finally suture this layer of tissue. Depending on the desired effect, the surgical preparation and reattachment are individually adapted, especially the tissue direction in which the layer is attached.

In 1917, Passot first described a method called S lift based on the SMAS lift, which is carried out as follows. The surgeon gains access via an S-shaped upper arch in the hairline in front of the ear, then runs partly in a straight line in front of the ear, only to finally disappear in a lower arch behind the ear. The S-Lift can be further modified by varying the modification of the holding seams and access cuts via the Fogli-Lift, Soft-Lift, or MACS-Lift (minimal access cranial suspension lift).

Mini Lift

Only the skin is tightened in a small surgical procedure in a mini-lift. Although the surgery is quite simple and straightforward, the results of the tightening are not very long-lasting.

Liquid Lift

Liquid lifting refers to a process in which liquid injection materials are used. They act as placeholders to refill the lost volume, which minimizes the visible wrinkles of the large static facial fold (marionette wrinkle, nasolabial fold, etc.). However, the biocompatibility of these fillers has not yet been extensively clarified. The underfilling material has its volume that can store water to increase the volume even more.

Most of the solutions used for injection are collagens, hyaluronic acid, own autologous fat, and calcium hydroxylapatite. Although these substances are all more or less absorbable and are broken by the body after some time, histological studies have shown that the treated tissue differs significantly from untreated tissue. The liquid-lift technique is not as long-lasting as surgical lifting methods because the tissue is only filled up and not surgically tightened. On the other hand, this technique can be used to tighten areas that cannot be tightened by surgical procedures, such as the perioral zone or the temporal region.

The botulinum toxin A, also known under its trade name Botox, is also often used. The toxin is injected into the tissue of the mimic musculature to paralyze it to reduce wrinkling. Botox is usually broken down by the body after about six months, so the effect is also not very long-lasting.

Another method is to remodel the face with the help of silicone-type implants. This technique is used, for example, when there is no projection in the cheekbone, the angle of the lower jaw, or a receding chin.

Thread Lifting

Developed in Korea, this technique, which initially comes from acupuncture, uses polydioxanone (PDO) threads to place these threads under the skin to minimize wrinkles and sagging skin. The procedure takes place without an incision, and the threads are positioned by small micro-needles. The unique characteristic of PDO sutures is that they dissolve in the body over time. They have been used as a suture material for a long time. They are also intended to stimulate the body to promote collagen production and cell regeneration. Thread lifting effects for up to one year and three months, after which it may require renewed treatment.

In very many cases, the upper and lower eyelids are also tightened as part of a facelift to reduce the aging process more. In combination with facelifts, liposuction in the neck area also contributes to this to intensify the rejuvenating effect. After facelifts, additional cosmetic treatments such as dermabrasion, peelings, and laser treatments are often carried out to keep the result as optimal as possible.

Usually, facelifts are carried out under local anesthesia in combination with or without a total intravenous anesthetic. Local anesthesia is used in combination with general anesthesia for safe and easy handling of the tissue layers during the surgery and to avoid perioperative pain. The anesthesia, which ranges from 15 ml to 50 ml, is absorbed and broken down by the body during and immediately after the surgery so that the muscles can be used again quickly after the treatment.

How Long Does Healing Take After a Facelift?

The healing time of facelifts is as individual as the different lifting methods. Depending on which method was used, how extensive and complicated the surgery area was, the post-operative healing period ranges from one week to eight weeks. Post-operative swelling and redness caused by the traumatization of the tissue during the surgery cause the patients' limitations.

Risks in a Facelift Surgery

As in any other surgery, complications can also occur during a facelift. General risks may include swelling, redness, bleeding, infections, and wound healing disorders with an extended healing phase. Scars might also develop. In people who tend to have hypertrophic scarring, post-operative follow-up treatment with scar cream can help.

Special risks in facelifting include the lifting or intensification of asymmetries in the face. Every face has partial asymmetries, which can be accentuated or reduced after a facelift, which can negatively influence the natural facial expressions. It is in the surgeon's hands and depends on his experience with his careful approach to minimize or even avoid this risk.

Nerve Damage

Furthermore, the nerve branches of the facial nerve can be damaged during the surgery. The branches of the facial nerve are generally responsible for the motor skills and facial expressions of the facial expression muscles. They numerously branch in the face and can be injured at the end of the branch. Usually, it comes to the new formation of the nerve branches after six months of limited movement of the affected facial areas after a small irritation or injury in the small branches. In some cases, however, the nerves may have been damaged to the extent that they no longer resume their original function. Especially when smiling, it comes to a grimace due to a lack of motor activity.

Besides, the motor nerve branches, the sensitive branches of the trigeminal nerve, which is responsible for the facial expression of emotions, can be separated or traumatized by hematomas, swellings, and tension due to the sutures to an extent where function becomes restricted. Typically, this results in numbness in the affected area, which can be temporary or permanent depending on the size and location of the damage.

Which Doctors and Clinics Are Specialized in Facelift Germany and Switzerland?

Plastic surgeons, oral and maxillofacial surgeons, dermatologists, ear-nose-throat doctors, and ophthalmologists can carry out facial surgeries. Since carrying out those surgeries is not attributed to a specialist title, there are no German medical standards. Accordingly, the search for a competent, trustworthy surgeon is usually tricky.

We help you to find a specialist for facelift surgery. All listed doctors and clinics have been checked by us for their outstanding specialization in carrying out a facelift and are waiting for your inquiry.

Sources:

• Deutsche Gesellschaft für Ästhetisch-Plastische Chirurgie www.dgaepc.de
• Prof. Dr. Peter M. Vogt; Klinik für Plastische Chi Medizinische Hochschule Hannover: Praxis der Plastischen Chirurgie : Plastisch-rekonstruktive Operationen - Plastisch-ästhetische Operationen - Handchirurgie - Verbrennungschirurgie. Berlin, Heidelberg: Springer, 2011.