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Facelift (Rhytidectomy)

Real Self - TOP DOCTOR - Facelift 2013-2016
What is Facelift surgery?

As part of normal ageing, there is a combination of some drooping of the skin of our face and neck with loss of volume and elasticity. Ageing starts to show in our late 20’s with the development of fine wrinkles and lines and speeds up significantly from our mid 40’s where descent of the face with volume loss causes droopiness of the lower facial third of the face with jowls, loss of a smooth jaw line as well as laxity of the neck skin. Some women describe to me an acceleration of ageing through the menopause with more laxity of their skin, further loss of their jaw line and bands with loose skin in the neck. A facelift and neck lift can rejuvenate your facial appearance by turning the clock back, reversing signs of facial ageing, lifting sagging of facial soft tissues and skin, correcting the loss of a sharply defined neck and lifting deep facial lines that have occurred as a consequence of facial droop.

Facelift surgery (called Rhytidectomy with medical terminology) was first described over one hundred years ago, however there have been marked advancements in technique and surgical innovation over the past ten years. Many patients come to see me, as they are concerned about looking too different and want to have a natural rejuvenation with hidden scars and a fast recovery. We have also seen media photographs of celebrities who look quite different to their youth and a natural looking rejuvenation is important for most of my patients. Having a facelift or neck lift surgery is a “big” decision for many patients as it is a choice to undergo surgery. I have respect for each person’s decision and provide a personalised evaluation and treatment options to enable you to make an informed decision about undergoing surgery. This begins with a consultation to discuss the changes that you have noticed, the expectations you would like to see for improvement and a discussion regarding recovery and potential risks. “Every patient I treat as a representation of my work and artistry, looking natural and refreshed is of key importance to every patient I treat”

ASOPRS 47th ANNUAL - FALL SCIENTIFIC SYMPOSIUMFace and Neck Lift Course ASOPRS / AAO Chicago 2014

Dr. Julian De Silva Director of Facelift Course at International Meeting 2016

What do you know already?

All of us receive constant marketing messages from the media on a daily basis although some information we receive is credible, much information is of biased opinion, scaremongering or dubious content. There are continually claims of creams & lotions that offer instant rejuvenation, unfortunately many of my patients are disappointed by these, as most are purely moisturisers which hydrate the skin, only when used. There are claims of the latest non-surgical breakthrough offering incredulous quick fixes, with branded logos and unique contents or celebrity endorsements. I see my role as helping guide you though treatment options that will help you achieve your desired result.

Case Study

This woman had disliked the appearance and general sagginess of her neck for more than 10 years. She…..[Read More]

Before and After 1 week

Before and After 6 weeks

What Facelift is best for me?

Every person’s face is unique and has characteristics that are distinctive to you, to give you accurate information on what is the best treatment for you requires an assessment of your face and an understanding of what you are looking to achieve and knowledge of your general health and well-being. The initial consultation is an opportunity for you to talk about what you notice and for me listen. For each patient I like to understand what has led to my patients seeking advice on improving their appearance. There is a popular misconception, that patients seeking correction of signs of aging are motivated by just vanity, however this is not usually the case. Many patients see me as they have noticed a more tired appearance that does not fit with how they feel, this can affect relationships, social interactions and professional opportunities. For most of us, we do want to look our best, and when we have renewed confidence and energy that affects every aspect of our lives. Facelift and neck lift surgery is a substantial step for some patients however it does offer a facial rejuvenation that currently cannot be achieved by other means (such as non-surgical treatments or creams). It is a big step and decision to undergo facial surgery by choice, my team and I take a personal approach to facelift surgery will fully support you during your journey, our principals are to take care of our patients like we would our own family.

 

 

I ask all patients to bring an old photograph to show how you have individually changed over time, this is very helpful as each person’s face has unique characteristics that will change differently with time. Often I will make suggestions that may either improve your final result to give you a natural rejuvenation. I also have incorporated the latest innovations and technology to give you the fastest possible recovery over the first 2 weeks, this includes using the latest in fast healing Bio-Technology, to use your own body’s growth factors to heal your body faster. Occasionally, surgery may not be the preferred option and for these patients I may suggest alternatives that provide you with a rejuvenation that does not require undergoing face or neck lift surgery. The reasons may be that the degree of ageing is too early to justify undergoing facelift surgery or it may be related to general health issues. In consideration of facelift surgery, I consider the first aspect is safety, the second is natural looking rejuvenation with fast recovery and thirdly is a favourable patient journey to make your experience as smooth and as trouble free as possible.

What are the different facelift types?

The earliest techniques with facelift surgery focused on pulling and stretching skin. These are fast procedures, however not suitable for a natural rejuvenation as they give a stretched and fake appearance. Beneath the skin is a layer called the SMAS layer, important for a natural rejuvenation is lifting this anatomy as this is what has dropped with facial ageing. Although many different descriptions of facelift have been described most involve variations on lifting the SMAS layer. I teach the international facelift course at the ASOPRS and AAO meeting in the USA each year and impress to training surgeons the importance of this anatomy for a natural result.

banner - fall scientific symposiumDr. Julian De Silva teaches at the 43rd Annual ASOPRS Scientific Symposium

Dr. Julian De Silva teaches on Advanced Face-Lifting Techniques at the 43rd Annual ASOPRS Scientific Symposium in Chicago, IL, USA.

Key to a natural appearance is a individual evaluation of your face and plan that is based upon your individual changes and ageing, this may include facelift surgery with an associated technique such as fat transfer or skin resurfacing to give the best possible result.

The techniques used to lift the face can be categorized into three broad types of facelift according to the surgical technique and associated recovery. I see my role in advising patients what is the most preferred form of facelift for your individual needs. The optimal rejuvenation of facelift and neck lift surgery requires effective and long-term elevation of the neck and jaw soft tissues, restoration of the neck angle and contour, and the minimal downtime from surgery.

Dr. De Silva classifies facelift procedures into three main types: 1. Minimally invasive or non-invasive procedures. 2. Mini-Facelift procedures 3. Classical facelift and neck lift procedures.

Minimally invasive or non-invasive procedures

The quickest procedures are described as lunchtime procedures and are sometimes referred too as minimally invasive or non-invasive facelift procedures, these include the use of: facial fillers, platelet rich plasma (Vampire facelift), Radiofrequency, Ultrasound (Ulthera), lasers (Carbon dioxide), skin resurfacing (Co2 Laser), thread lift sutures and others. The principal benefit of these techniques is they avoid surgery, the non-surgical treatments have short-term effectiveness and are best suited for patients with early facial ageing. Patients with more marked facial drooping, skin laxity and bands in the neck are better suited and have more effective longer lasting results from surgical facelift and neck lift options. Dr. De Silva advises his patients on the most appropriate treatments to rejuvenate your face after an assessment of your face and discussion about your goals.

There are patients with early facial ageing who benefit from a non-invasive treatments, however this does depend on the degree of facial ageing and is not suitable for patients with more that early facial ageing. Dr. De Silva does use a signature non-surgical facelift that utilises FDA-approved US fillers to augment natural Phi-lines on your face. These can provide a natural rejuvenation without surgery using the concepts of “structural volumisation” along cheek and jaw bones to give a natural rejuvenation.

There is a continual evolution of these non-surgical techniques, some are more effective than others. More recently there has been increased marketing of thread lift techniques (barbed or coned stitches) that offer lifting without surgery. Unfortunately many patients who come to see me have been left disappointed by these techniques as their effects can be compromised with bruising and swelling, with a short effect of a few months and the stitches can give arise to lines and marks in patients with thinner skin. Unfortunately a few small stitches cannot address the lose skin, volume loss, sagging neck or neck bands that can be treated with surgery. Although I have had a number of patients ask me would I be prepared to use them, I can only advise patients to have treatments that I personally would recommend to my friends and family, and patients who come to see me are frequently disappointed by these thread lift sutures. Unfortunately this procedure has been advertised as a non-surgical facelift however this is not true as they achieve far less, with a several month life span, tension lines in patients with thin skin, and the possibility of traumatic bruising and a recovery period comparable with surgery.

Click here for more information about non-surgical facelift.

 

Mini-Facelift procedures

The second category are smaller and faster surgical facelift techniques including small-incision face lifts which will have use in some early signs of facial ageing: Mini-face lift, MACS lift, neck liposuction, fat augmentation facelifts. These techniques have a role in younger patients in there forties who have some signs of facial ageing without the need for enhanced lifting techniques. I complete these procedures for patients with early facial ageing, if there is more substantial ageing including loose bands in the neck and heavy jowls softening the jaw line, a complete facelift may be indicated to give you the result you are looking for. I talk through the treatment options with each patient, as my role is to inform you of what will give you the most natural result with the time frame you have for recovery.

Read more about mini-facelift.

 

Customised Facelift & Neck Lift

Celebrity Facelift
Celebrity Facelift

I prefer to use a customised facelift surgery that restores the natural curvature of the neck, to give a sharp and youthful neck angle requires elevation of the soft tissues and SMAS layer beneath the skin. I ask patients to bring an old photo to their appointment as I am able to use your old photo as a blueprint to plan your customised facelift. I spend additional time with each facelift and neck lift procedure as each requires meticulous attention to detail to give natural looking results. These facelift techniques are given different names and include SMAS surgery (Superficial musculo-aponeurotic system including SMASplication, SMAS imbrication, SMAS excision) composite facelift, deep–plane facelift, sub-periosteal lift, endosocopic facelift techniques.

I have customized my approach to face and neck lift surgery, with the focus of giving a natural looking result and fast recovery. I utilize specialized techniques with my surgery to do more than rejuvenate the face, in addition I use specialized techniques to redistribute areas of lost volume, restore the natural contours around the eyes and skin resurfacing to make the face look more beautiful than before” Dr. De Silva.

Dr. De Silva acquired his experience in the spectrum of face and neck lifting techniques with training in the cosmetic meccas of Beverley Hills in Los Angeles and Manhattan in New York. Dr. De Silva tailors his surgery to a patient’s face, using a modified deep plane lower face & neck lift to redistribute drooping jowl soft tissues back to its youthful location above the jaw line, giving an attractive and natural look. Dr. De Silva performs different types of facelifts to treat various degrees of facial ageing and customizes his approach to an individual’s face, no two faces are identical. Often the earliest features of facial ageing are a combination of sagging of the eyelids in combination with loss of the natural neck contour. Dr. De Silva often utilizes complimentary specialized techniques to augment bone and soft tissue structure, such as the use of facial implants to compensate for loss of boney volume and the use of volume filler such as fat stem cell grafting to restore soft tissue volume loss (deflation). In some patients, particularly younger and male patients Dr. De Silva may do an isolated neck lift or partial facelift for neck folds and lines.

neck anatomy - illustration

What journey does a Facelift involve?

The traditional journey of undergoing a facelift surgery was daunting, surgery performed under GA in a large impersonal hospital with busy unsympathetic staff, delays and parking trouble are all too familiar. Dr. De Silva spent time after working in London Hospitals to visit the cosmetic capitals of LA and NYC, to bring the latest innovations in technical surgery, use of technology and patient experience to patients in the UK. His philosophy has been to improve each patient experience to give the highest possible safety, the most natural looking results, faster recovery and an experience that patients can be both comfortable and at times enjoy. From this experience he looked at each aspect of the facelift experience, refined and improved each part to give each patient a personalised experience.

Dr. De Silva designed and built a custom based facility in West London, with favorable parking and a private location with easy transport into town and to Heathrow Airport for foreign patients. Since 2012, we have refurbished the facility each year, to deliver the latest in high-tech features including 3-D camera technology, telescopic micro-incision cameras, imported laser technology from the US and the latest in fast recovery Bio-Technology from Germany. The facility was custom built purely for facial cosmetic and plastic surgery, with the equivalent regulation by CQC of a private hospital.

Dr. De Silva has hand picked each and every staff member not only for their expertise but their expertise and clinical skills, also for their approach, communication and personal skills. Our proposal is to give you a choice to have surgery within a safe environment, with the care each person would like to personally receive, performed by Dr. De Silva and supported by his team. We are constantly refining the model to give each patient the best experience possible.

Dr. De Silva’s staff and assistants discuss in detail with all my patients, all you need to know about before and after surgery planning, everything is considered. From hair colouring, pre operative medications, supplements and specifics to avoid such as blood thinners including medications and herbal medicines. We also will make recommendations on ways to enhance your recovery. Over 20% of the patients we help have had previous surgery elsewhere, patients often report to us a more satisfactory experience and recovery with our staff and facility.

The facelift process begins at the initial consultation and we take time to discuss your expectations from surgery, discuss all the options available and the risks before undergoing surgery. You will also see one of Dr. De Silva’s team and be given time to ask all questions you have. I see all patients for a second preoperative consultation to discuss further aspects such as measures you can take to speed up your recovery and this is an opportunity to ask further questions.

On the day of surgery all patients can feel nervous, however this is only short-lived as once we start the sedation anaesthesia, all patients are relaxed and calm. Patients are allowed to change to a hospital gown and special socks. Dr. De Silva sees all his patients before surgery, to check his patient and to put specific markings that are unique for each patient. Dr. De Silva works with two specialist anaesthetists who are very experienced in sedation anaesthesia having completed 1000’s of cases. Dr. De Silva has streamlined the sedation anaesthesia commonly used in the US for his patients in the UK, unlike in the NHS where sedation often uses a single medicine, we used 4-5 medicines that are collectively far more effective at giving sedation anaesthesia, and a fast recovery. Once in the theatre, all patients are monitored by an anaesthetist for their entire procedure and recovery period. Only when you are sleeping does Dr. De Silva use a customised water based anaesthetic solution (termed tumescent) to gently numb the whole face and neck. As you have sedation anaesthesia, you will sleep through this part, the anaesthetic solution will last many hours longer that the surgery.

The facelift procedure is then started, Dr. De Silva takes special care with the incisions as this is key to hiding the scars from facelift surgery. The droopy soft tissues of the face are repositioned to a more youthful position and associated techniques completed such as fat transfer and skin resurfacing to improve the final result. Dr. De Silva only uses fine stitches in the face, some surgeons use staples to save time, these can leave track scars and are very uncomfortable to remove. Dr. De Silva only uses stitches which take additional time to insert, however this avoids removing staples after surgery. Dr. De Silva often uses a micro-drain, this can enhance recovery for some patients with a 20% reduction in swelling. Dr. De Silva utlises the latest in Bio-Technology, using your own growth factors from your body to enhance recovery. Once the surgery is complete, the sedation is switched off, and as you have only been sleeping the recovery is usually 30minutes or less. All patients are able to walk out of the operating theatre, this is unlike traditional surgery with general anaesthetic where your recovery make take six hours or more. Dr. De Silva continually looks to innovate and refine each patients experience to give you a natural looking result, fast recovery and a smooth experience.

What is different about Dr. De Silva’s Facelift?

With facelift surgery I believe that there are three important aspects to the surgery: 1. Safety always comes first 2.Best possible natural result and fast recovery 3.A personalized journey where we support you during your recovery. Each of these aspects we have refined and improved to give you a smooth experience and recovery.

To give each patient a natural looking rejuvenation requires a detail orientated approach to facelift surgery. Each person’s face is unique, different techniques of face and neck lifting, volumisation and neck contouring are tailored to each individual. A standard facelift that uses the same identical technique for everyone results in a standard appearance, can benefit some patients, however not suit others. Scars in front of your ears, steps in hairline all result in an unnatural look. The traditional facelift procedure involved a prolonged recovery associated with general anaesthesia, artificial blood pressure management resulting in more bruising and swelling, a breathing tube that give a sore throat, overnight stay in an uncomfortable and life-less private hospital room requiring high dose pain relief medicine. We have reverse-engineered the facelift experience to give patients a modern contemporary experience and facelift result:

  • Gone are 5-6 hours recovery from general anaesthesia, with our sedation anaesthesia, you can walk out of the operating theatre 30minutes after surgery.
  • Gone are substantial nausea, feeling sick and a sore throat from conventional surgery, with our services, less than 1% of patients have nausea and sickness.
  • Gone are linear scars that are visible after surgery. With our surgery I will hide the scars in your natural hair-line and natural curves of your ear. We will utilize the latest in bio-technology and micro-drains to enhance your healing, offering a 20% reduction in conventional swelling, our aim is to give you the fastest possible recovery at 2-weeks after surgery. At two weeks you will feel some numbness and tightness, this is normal. Dr. De Silva spends meticulous time on each case to ensure the scars are hidden as far as possible, to close just one side of the fact takes 45-mintues with his technique, other techniques in front of the ear can be completed much faster, however may result in visible scars.
  • Gone are the serious risk of general anaesthesia including a blood clot in the leg (termed deep vein thrombosis). With our sedation anaesthesia all your natural protective reflexes are working normally throughout the surgery, you are essentially sleeping during the surgery like you sleep at night.
  • Gone is the need for multiple strong pain relief medicine after anaesthesia. More than half our patients do not use any analgesia after surgery, and those that do only use a few medicines the first 24-48 hours. Many patients are concerned about pain after surgery, with our techniques you do not need to worry.
  • Gone are hospital staff that give a you a sterile feeling of being sick. Dr. De Silva’s hand picked staff will care for you. Dr. De Silva will personally see you the morning after your surgery to check you personally.
  • Gone is a machine line process where paid assistants following up your care. Dr. De Silva sees all his patients personally, he want to see how you are personally doing.
  • Gone are the same old techniques used for decades. We are continually improving, enhancing delivering more advanced technology.
  • There are always risks undergoing surgery, no surgery can be completely risk free. We have looked at each of the potential risks and how to minimize or eliminate them. For example smoking caries an additional risk of healing issues and scars after surgery. Dr. De Silva will not advise you to undergo facelift or neck lift surgery while smoking or using any nicotine products, this is purely for your own safety. Dr. De Silva will give you the same advise he would give to his own friends and family. There are surgeons who may offer you surgery while smoking, unfortunately we cannot advise this.
  • Dr. De Silva has developed a Fast Healing Bio-Technology, utilising the latest in science and technological advance to enhance healing and recovery. Dr. De Silva developed this technique after listening so some of his patients who found a longer recovery from laser resurfacing. Dr. De Silva developed a combination of Bio-Tech PRP, Micro-Needling, Micro-Drains and Micro-Fat Transfer to deliver faster healing. Full face laser resurfacing can result in several weeks of redness in some patients, using Dr. De Silva’s combination Fast Healing Bio-Technology there was a marked reduction in redness at 2-weeks. This fast healing technology uses your own body ‘s growth factors to heal your body faster and was first used by professional athletes to heal joint injuries by localised treatment enabling athletes to recovery faster. Dr. De Silva has pioneered the use of this technology to enhance recovery and results of facelift surgery.
  • Safety is always of primary importance, and there are specific checks based on your general health and age that we will complete before your surgery (e.g. blood tests) to ensure safety and speedy recovery. Occasionally these identify a condition such as anaemia, which means we can treat this before undergoing surgery.

At the forefront of medical research is the use of Stem Cell Technology to trigger natural body repair mechanisms, Dr De Silva uses this cutting edge technology in specific patients to enhance natural looking result and trigger natural reparative mechanisms that enhance recovery. Dr. De Silva continually looks for innovations and science that may enhance facelift surgery in the future.

 

Dr. De Silva has evaluated the entire facelift procedure and modernising each part of the surgery to improve conventional downtime and recovery, and provide natural looking results. By using sedation anaesthesia (also known as twilight anaesthesia) your recovery is faster than with the prolonged recovery associated with general anaesthesia. Most patients are surprised by how minimal discomfort they have after surgery, with more than 50% not requiring pain killer medicine from the next morning. In addition the use of advanced US techniques favour rapid resolution of swelling so that at 2-weeks less swelling is present than with conventional techniques. For most patients a recovery of 2 weeks is adequate with some patients returning to social activities even 48-hours after surgery.

Dr. De Silva modifies his surgical technique depending on an individual’s requirements and frequently combines the use of other technology to improve the results of his patient’s facelifts, common combination techniques include:

  • Volume loss around the cheeks, mouth and temples are common signs of facial ageing and can be effectively treated with volume augmentation. Dr. De Silva prefers the use of a natural volume to restore the face using a patients’ own soft tissues. Fat transfer is the term given to describe transferring fat from one part of the body (commonly around the belly-button area), processing to concentrate the fat that contain stem cells, which are then transferred into areas of deficiency in the face. Dr. De Silva utilises state-of-the art fine cannulas to apply the fat to areas where the fat has been lost, giving a longer-lasting natural result. Fat transfer to faces that have had a substantial loss of volume, can be very effective in restoring the curvature of the cheeks giving a natural and youthful look. Click here for more information on Fat Transfer
  • Eye changes are a very common indicator of facial ageing, and include drooping of the skin in the upper eyelid, dark circles and bulging pockets of fat in the upper and lower eyelids. These eyelid changes are commonly treated by Dr. De Silva at the same time as a facelift in at least half of patients.
    Click here for more information on Blepharoplasty/ Eyelid Lift
  • Ageing of the skin from damage by the sun and environmental elements, results in lines and dark spots that may be effectively rejuvenated and smoothened with a combined facelift and laser resurfacing procedure. With the use of facelift and CO2 laser resurfacing of the skin an excellent result can be obtained. Dr. De Silva takes precautions with the use of laser on the skin to ensure high quality result and may include skin area testing. Laser treatment of the face does result in some discomfort on day-1 after surgery, oral analgesia is adequate to relieve any discomfort. After1-week, the face has largely healed although a minority of people may have residual redness that can be covered with conformer. Dr. De Silva only uses the very latest in laser technology, as there is continued innovation in laser design, improving effectives and reduce downtime.
    Click here for more information on Laser Resurfacing
  • Facial imbalance secondary to the underlying boney structure cannot be addressed by a facelift alone. Dr. De Silva analyses the face as a whole, common shortcomings are in the chin and cheek areas, in some patients these are addressed with volumetric addition with facial implants. Dr. De Silva prefers the use of silicone implants these are very safe and have been used in the body for many decades and are undetectable once inserted.
    Click here for more information on Chin Implants & Cheek Implants
  • Lumps & Bumps removal and repair commonly occur in the skin. Dr. De Silva sends thees offer for pathological evaluation as safety comes first and occasionally these lesions can be a minor malignancy.
    Click here for more information on Lump Removal
  • Enlarged ear lobes can occur as a consequence of ageing and natural growth of the ears or as a consequence of prolonged use of earrings over a period of years. Click here for more information on Ear Lobe Reduction

Facelift surgery requires artistry and each patient requires surgery that is tailored to their unique needs to give a natural looking result. Dr. De Silva’s “Natural Looking Facelift,” was featured on ITV, incorporates the use of the high-tech procedures listed above in combination with rapid recovery to create a more natural lift with longer lasting results. Dr. De Silva has pioneered the use of these techniques and the use of bio-technology to expedite the healing process with decreased bruising and swelling.
Click here for more information on minimally invasive facial surgery.

 

Facial ageing - figure

 

Dr. De Silva’s approach to Facelift Surgery
Dr. De Silva is specialised in only facial cosmetic surgery and performs no other surgery. He trained in London Teaching Hospitals in Surgical Specialities including Anatomy, Emergency Surgery, Neurosurgery, Ophthalmic Micro-Surgery before focusing entirely on Facial Cosmetic & Plastic Surgery. He travelled to the cosmetic centres of Beverley Hills and New York with specialised Facial Plastic and Oculo-Facial Plastic Surgeons to bring back to the UK the latest advances in facelift surgery. Dr. De Silva tailors facelift and neck lift surgery to each individual patient. Different facial shapes, ethnicity and individual anatomical architecture require different types of facelift, customized to the individual patient to achieve a natural looking and long lasting results. Dr. De Silva teaches facelift surgery internationally, and is the course director for the annual ASOPRS & AAO Facelift Course in USA, teaching internationally other surgeons the latest facelift techniques.

Dr. De Silva characterises ageing of the face by three principal changes, loss of volume of the fat and soft tissues in the face, gravitational descent of facial soft tissues and laxity of the skin. Key to natural looking results is an artistic and anatomical understanding of these three elements so the elements of the facial ageing can be both restored to their previous appearance. Facelift surgery requires elevation of the soft tissues of the face to ensure the skin is not stretched as this reduces both scarring and gives natural looking results. Elevation of the skin alone in older techniques leaves stretched scars that are the hallmarks of surgery, Dr. De Silva takes meticulous attention to elevating the soft tissues beneath the skin to enable scars to heal better free of tension.

“I prefer to use a customised facelift and neck lift procedure that restores the natural curvature of the neck, to give a sharp and youthful neck angle that requires the elevation of the soft tissues and SMAS layer beneath the skin. I ask patients to bring an old photo to their appointment, as I am able to use your old photo as a blueprint to plan your customised facelift. I see my role to inform and advise patients and treatment options include faster healing non-surgical techniques and more comprehensive facelift procedures with associated techniques, there is no single fit for all patients, each patient requires a customised plan to suit their individual needs”

What are the common indications for facelift?

Everyone ages differently although most patients have some changes in their 40s, some patients have changes earlier in the 30s, and some fortunate people can have a good jaw line even in their 50-60s. As we age a combination of genetic and environmental factors including gravity, sun-exposure, exercise, life stresses and trauma all combine to loosen and sag our facial tissues (muscles, fat and skin). Dr. De Silva spends much time talking to patients to advise them against having surgery if they have early signs of facial ageing, as there are no procedures that carry no risks and no recovery time.

“In my opinion if you have early signs of ageing, it is difficult to justify undergoing a facelift procedure as this does have a recovery period and small but not insignificant risks, for these patients with early changes I recommend a customised non-surgical solution”

Facial ageing commonly result in sagging of soft tissues in the lower third of the face, this can result in loss of a smooth jaw line and jowls. In addition there can be deepening of the folds between the nose and mouth (termed Naso-Labial Lines) and accumulation of fat under the chin may produce a double chin and loss of the sharp angle between the jaw and neck that is associated with youth. Loosening of the principal neck muscles (Platysma muscles) may produce the appearance of vertical bands. It is important to note that a facelift or neck lift procedure must address the muscle layer, fat and skin in order to give a natural looking result and achieve longevity.
Click here for more information about facial ageing.

 

Facial ageing - figure

What is a Natural Looking Facelift?

An optimal facelift result will rejuvenate the unique characteristics of an individual’s facial ageing by restoring their jaw line, elevating descended soft tissues of your face and softening deep facial lines that have occurred secondary to dropping of the face with gravity (termed in medial jargon the Naso-Labial lines). For this reason Dr. De Silva asks his patients to bring a photograph of when they were 10-20years younger to evaluation how the ageing process has changed their appearance, each person is unique and Dr. De Silva is able to use your old photograph as a blueprint to plan your surgery. Dr. De Silva previous experience in microsurgery is utilised in all his techniques to hide facial scars around the ears and hairline, and meticulous closure of the skin to ensure smooth and natural curvatures of the tissues avoid unnatural irregular lines and displacement of hair. Dr. De Silva regards that hidden and discrete scarring is an essential requirement so patients can have short hair or choose to wear long hair up after surgery. Shortcuts for facelift surgery include making a scar in front of the ear or hairline with surgery, although this is quick to complete, it leave highly visible and distressing scar. Dr. De Silva does not use these scars, he takes meticulous time to shape the scars around the natural curves and shapes of the ear, this takes more than 1-hour extra for each patient, making the scars discrete and practically invisible in the majority of patients. Less than 1% of patients have issues with visible scarring taking these precautions in hiding scars.

What is the recovery time after facelift?

Recovery after traditional facelift surgery could be as long as two months. Dr. De Silva has utilised the latest technology to reduce this period to two weeks, at this point 80-90% of the bruising and swelling will have subsided. Dr. De Silva has reverse engineered the facelift procedure to focus on using science to enhance recovery and reduce healing time.

 

In place of general anaesthesia that results in large fluctuations in blood pressure resulting in more swelling and bruising after surgery. Dr. De Silva prefers to use a customised sedation anaesthesia this ensures a stable physiological blood pressure minimising swelling and bruising from the outset.

Dr. De Silva has developed a Fast Healing Bio-Technology, utilising the latest in science and technological advance to enhance healing and recovery. Dr. De Silva utilises a combination of Bio-Tech PRP, Micro-Needling, Micro-Drains and Micro-Fat Transfer to deliver faster healing. Dr. De Silva developed this technique after listening so some patients were not able to tolerate the recovery from laser resurfacing. Full face laser resurfacing can result in several weeks of redness in some patients, using Dr. De Silva’s combination Fast Healing Bio-Technology there was a marked reduction in redness at 2-weeks. Dr. De Silva will not complete skin laser resurfacing without this technology. This fast healing technology uses your own body ‘s growth factors to heal your body faster and was first used by professional athletes to heal joint injuries by localised treatment enabling athletes to recovery faster. Dr. De Silva has pioneered the use of this technology to enhance recovery and results of facelift surgery.

At three weeks most patients are able to return to social activities and the work place. Each person is different Dr. De Silva has had some patients return to work and take flights less than 1-week after surgery, however Dr. De Silva advises each patient to allow a minimum of two weeks as an investment of time to maximise the speed of their healing. Doing too much too early can result in potentially more swelling and bruising occurring after your surgery.

Measures can be taken both before and after surgery to aid healing and recovery. Dr. De Silva gives each of his patients specific instructions on medications and herbal medications that are best avoided before and after surgery to reduce potential for bruising and swelling, and speed up post-operative recovery.

Learn more about how to speed up recovery after cosmetic and plastic surgery.

Patients’ undergo surgery as a customised facial cosmetic and plastic surgery facility in West London or a Central London Private Hospital, fully accredited by the Care Quality Commission, independent regulator health care services in England which ensures the highest levels of surgical care and safety. Dr. De Silva personally sees all his patients the day after surgery as he wishes to know how you are healing. Most patients have minimal discomfort the first 24 to 48 hours, more that half his patients do not need to use their oral analgesia. Some tightness in the neck and face is expected for first two weeks after facelift and neck lift surgery. Dr. De Silva will see you at all follow-up appointments and most stitches are removed in 7-10 days. Dr. De Silva does not use any clips or staples, this avoid unnecessary scars and considerable discomfort on removing them, in their place Dr. De Silva uses fine dissolvable stitches.

Natural Looking Results in Male Facelift Surgery
Customized various facelifts were developed for male patients, who comprise one quarter of Dr. De Silva’s patient group. Often men are better suited to a facelift focused on the neck areas as this give a natural looking result. Over-lifting in men’s faces can result in feminization of the face and Dr. De Silva is focused on giving natural looking results and takes measures to avoid this. Specialised techniques including the use of a smaller incision that is hidden behind the ear, which is particularly important for balding men. In order to achieve an excellent neck contour with a smaller incision around the ear and none in the hairline, it is necessary to address the neck additionally from under the chin, in some cases a small high definition telescope is used to guide removal of fat and tighten the platysma muscle beneath the skin. With the use of innovational techniques and latest technologies Dr. De Silva is able to enhance the natural looking neck contour and increase the longevity of the neck lift.

Facelift and Neck lift surgery are the forth most common cosmetic surgery after breast and eyelid surgery. One of the earliest signs of facial ageing are changes and sagging of the lower third of the face, the presence of jowls (prominent soft tissue at the jaw line) and a sagging neck with loss of the natural curvature and defined neck angle. Along with eyelid changes, the neck is one of the first signs of facial ageing. Facelift surgery, that usually includes a neck lift, restores the natural contours of the jaw and smoothens the angle of the neck beneath the jaw. The rejuvenation that results from a natural neck angle can turn-back the years and may make a person look years younger.

Dr. De Silva utilises a spectrum of different face and neck lift techniques from Los Angeles and New York. Every person differs in their facial shape, size, symmetry, ethnicity, genetic and exposure to environmental elements such as sun and smoke. As a consequence no two faces are the same, Dr. De Silva tailors his surgical technique in accordance with multiple patient factors. In order to give his patients the most natural looking and long-term results he prefers to use an innovative technique that focuses on lifting the deep SMAS (Superficial Muscular Aponeurotic System) layer beneath the skin also termed modified deep plane face lift. The benefits of this lift is that it rejuvenates the face by restoring soft tissues to their youthful position and avoids stretching of the skin under tension, the traditional method of performing facelift surgery. By reducing the amount skin flap dissection the operation is safer with less trauma to the innervation to the skin and less bruising from avoiding damage to local blood vessels.

Facelift surgery requires an incision in the skin around the ear and hidden into the hair, and the sculpting of a skin flap and underlying SMAS layer. Dr. De Silva uses a two layered tightening that results in uniform and even elevation building the facelift from the foundations of the face, result in a natural rejuvenation. Dr. De Silva trained in microsurgical techniques and utilizes the same surgical principles to hide the incision on the inner aspect of the ear and through the front and back hairline. By hiding the incisions Dr. De Silva preserves the sideburn area in front of the ear and the natural hairline behind ear allowing the hair to be worn up after surgery. Dr. De Silva is meticulous about his choice of incisions so that they are small as possible, hidden in natural creases of the skin and by building up from the foundations of the face avoid pulling or stretching of tissues. Dr. De Silva is fastidious in ensuring that no tension occurs on the skin which promotes the formation of hidden scars, in some cases he may use medications that soften scar appearance by preventing the formation of fibrosis or scar tissue.

How do I choose a facelift surgeon?

Your ideal choice in selecting the right doctor is to look for a surgeon who specializes in facial cosmetic and plastic surgery, one who has an extensive background of experience to give you a safe and successful outcome. Facelifting is a surgery of millimetres as small differences between the two sides of the face can be seen. Seeing a surgeon who specialises in the entire face is important, as the forehead, eyelids, nose exist in balance with the lower half of the face and other treatments at the same time as a facelift may enhance the final result. A surgeon with artistry will be able to advise you if other techniques utilized at the same time as the facelift surgery. Dr. De Silva frequently uses other treatment options in conjunction with facelift techniques including fat stem-cell augmentation to the mid-face and skin resurfacing to give the enhanced natural-looking result. It is always worth asking the surgeon to see before and after pictures of patients he or she has treated. It is key that you feel comfortable with the surgeon and that they will be there for you after the procedure. A natural looking facelift requires a combination of understanding of an individual’s characteristic facial ageing, meticulous technique and appreciation of the artistic element that give a face both balance and harmony.

For a consultation we charge a nominal fee, this is redeemable off the cost of your surgery. The fees cover the costs involved including the facility, staff, equipment and expertise. Is anything truly free in life? If a consultation is free, it will be paid for by a more expensive procedure, product or by other means. If you are considering having surgery with a large clinic, please due adequate research to find out if the surgeon is based in the UK. Unfortunately we have seen too many patients left in uncompromising situations when they have been unable to track down a foreign surgeon, the large multi-clinic providers are able to absolve their responsibility. With facelift surgery it is important to invest time to research your surgeon and clinic, time well spelt.

What are the risks of facelift surgery?

Facelift surgery is the third commonest facial cosmetic procedures to be completed in and is regarded as a relatively safe procedure. As with any surgery there are potential risks and complications that may occur. Dr. De Silva and his team have looked at each of the risks associated with facelift surgery and taken measures to reduce each one. Complications can be defined as any unforeseen occurrence during or after the surgery, and can be divided into four categories; intra-operative, immediate post-operative, early and later post-operative.

  • Intra-operative complications occur during the surgery. For example, these can occur due to a reaction to some medication or due to the general anaesthesia given and are managed by the surgical team at the time of surgery. General anaesthesia carries a small yet serious risk of a blood clot in the leg (termed deep vein thrombosis), with sedation anaesthesia this risk is eliminated. Dr. De Silva prefers sedation anaesthesia over conventional general anaesthetic as it safer, has faster recovery and reduced side effects such as nausea and sickness.
  • Immediate post-operative complications occur immediately after the surgery when the patient is in the initial recovery stage and may include bleeding or a medication. These complications need to be handled immediately by the surgeon who performed the operation. With conventional technqiues the reported risk of bleeding collection (haematoma) is 2-3% in the medical scientific literature. Dr. De Silva has found using a combination of sedation anaesthesia the use of Bio-Technology and micro-drain technology this risk is reduced to <1%. Dr. De Silva sees all his patients less than 24 hours after surgery, this is important as early treatment of such complications is important as it will give a natural and unaffected result.
  • Early post-operative complications in facelift occur once the patient has been discharged. These appear almost immediately after the person returns to normal routine. They can include bleeding or collection of blood, a reaction to a medication, infection and can be corrected by contacting the doctor immediately. Rarely there can be a weakness of facial muscles can sometimes be seen as a stretching of nerves supplying the muscles of facial expression, this improves over a period of weeks as the nerve regains its function.
  • Late post-operative complications associated with facelift surgery may occur when the patient fails to take proper care after the surgery, the surgical technique used or the patient’s healing process. These complications include those of the facelift (asymmetry, scarring). Most of these complications are relatively minor and either self-correct or can be easily corrected. Dr. De Silva takes care to ensure a nautral rejuvenation that involves placing additional stitches to support healing and a natural result. Although conventional facelift surgery involves the use of clips and staples in the hairline behind the ears. Dr. De Silva does not use staples, he only uses dissolvable stitches, although these take longer to put in they avoid track scars associated with staples that are very uncomfortable to remove.
  • Complications in facelift may occur because of several reasons. One of the most important factors responsible for the success of surgery is the surgeon. The surgeon must have complete knowledge of how the surgery has to be performed. Facelift, requires in depth knowledge of the anatomy of the nerves, blood vessels, ligaments in the face and attention to detail. Dr. De Silva’s specializes only the face area and uses his experience in microsurgery in facial cosmetic and plastic surgery.

The commonest complications are bruising, bleeding and swelling, all of which are treatable. The risk of complications is reduced before surgery with comprehensive assessment and reducing factors that may thin a patients’ blood and encourage bleeding. The most serious and feared complication of facelift surgery is pebbrmanent damage to the nerves that supply the face with facial expression, this is an extremely rare complication and in depth knowledge of the anatomy is key to avoiding this. Facelift is the third most popular facial cosmetic procedure with high patient satisfaction and low risk of complications.

Case Study

This woman had disliked the appearance and general sagginess of her neck with for more than 10 years. She was very anxious about undergoing treatment and although had been offered non-surgical treatments, no treatments had made any real difference to her neck. She presented for a consultation with Dr. De Silva, to discuss neck lifting options, she was not keen on undergoing invasive surgery with a prolonged recovery time. On assessment, the skin along her jaw had begun sagged considerably with time, with loose skin and some accumulation of fat, softening her jaw line and leaving her jaw looking uneven. Dr. De Silva assessed her neck and discussed with her the best possible improvement with the least downtime and advised a combine face and neck lift procedure with fat transfer and the use of bio-technology to enhance her recovery from surgery. With natural neck elasticity there are more treatment options available to improve a sagging neck. She underwent micro-cannula neck liposuction with reshaping of the neck and jaw angle to restore a more youthful jaw and neck angle. Dr. De Silva does not use body liposuction techniques (including traditional liposuction and ultrasound-assisted Vaser techniques), and she underwent a specialized micro-cannulae (fine) technique that enables finer control and natural shaping and refining of the neck contours.

Only 12-hours after treatment, the photos show a marked improvement in her jaw line and neck associated with a youthful appearance. There is some bruising of her neck, however Dr. De Silva uses advanced biotechnology to enhance recovery after surgery, the ecchymosis is largely resolved by 1-week after surgery. Dr. De Silva completed the surgery with twilight sedation, enabling the patient to avoid the side effects and long recovery associated with general anaesthesia. The patient was able to leave the surgery less than 1-hour after the surgery completed.

Photo: Facelift (Rhytidectomy) - Before Treatment - Female, frontal view
Photo: Facelift (Rhytidectomy) - After Treatment - Female, frontal view
Photo: Facelift (Rhytidectomy) - Before Treatment - Female, right side view
Photo: Facelift (Rhytidectomy) - AfterTreatment - Female, right side view

The next set of photos show her appearance at 1-week after surgery. Dr. De Silva uses fast recovery techniques to enhance recovery after face & neck lift surgery and a dramatic improvement in her neck can be seen. Dr. De Silva customizes each facelift and neck lift procedure for each individual patient, to improve the neck to this level requires advanced surgery techniques that focus on improving all the underlying structures in the neck. Dr. De Silva’s focus for each patient in terms of priority are firstly Safety, secondly the best possible result and thirdly.

Photo: Facelift - Before Treatment - Female, frontal view
Photo: Facelift  - After Treatment - Female, frontal view. Photos show the scars at 1-week after surgery
Photo: Facelift - Before Treatment - Female, right side view
Photo: Facelift  - AfterTreatment - Female, right side view. Photos show the scars at 1-week after surgery
Photo: Facelift - Before Treatment - Female, right side view (ear)
Photo: Facelift  - AfterTreatment - Female, right side view. Photos show the scars at 1-week after surgery (ear)
Photo: Facelift - Before Treatment - Female, left side view (ear)
Photo: Facelift  - AfterTreatment - Female, left side view. Photos show the scars at 1-week after surgery (ear)

Dr. De Silva hides the scars from facelift and neck lift surgery around the natural curves of the neck and in the hairline. These photos show the scars at 1-week after surgery, using the natural curves of the ears takes additional time however makes scars difficult to see. Some surgeons place the scars in front of the ear or in front of the sideburn, this can result in visible scars which can be very difficult to treat. Dr. De Silva believes that scars should be made as discreet as possible. Less than 1% of the population may have troublesome scarring such as keloid scars, by placing the scars in discrete areas the scars generally are difficult to see even soon after facelift and neck lift surgery.

Photos: Facelift (Rhytidectomy) - Before Treatment - Female, frontal view.
Photos at 6-weeks after surgery: Facelift (Rhytidectomy) - Female, frontal view
Photo: Facelift-Before Treatment - Female, right side view
Photos at 6-weeks after surgery: Facelift (Rhytidectomy) - AfterTreatment - Female, right side view

The next set of photos at 6-weeks after surgery shows resolution of all of the early bruising and 95% of swelling. The patient has had a dramatic rejuvenation in her face areas. Multiple people commented on how refreshed she looked although they were not able to tell she had undergone surgery as the result is completely natural.

Photo: Facelift - Before Treatment - Female,right side view (ear)
Photos 18-months after surgery: Facelift  - Female, right side view (ear)
Photo: Facelift - Before Treatment - Female,left side view (ear)
Photos 18-months after surgery: Facelift  - Female,left side view (ear)
Photo: Facelift - Before Treatment - Female,frontal view (neck)
Photos 18-months after surgery: Facelift  - Female, frontal view (neck)

The scars are show at 6-weeks after surgery, have faded further. Although the final result from scars is as long as 18-months after surgery, by hiding scars in the natural creases Dr. De Silva finds that scars can be made discrete far earlier, unfortunately scars that have been placed in more visible areas are very difficult to treat. The patient was very happy with the results of her surgery, she had been extremely nervous of undergoing surgery and had waited more than 10years before she had made the decision to undergo surgery with Dr. De Silva.
Request a consultation at our office in London to take the next step and learn more about your cosmetic options. You can call the London Centre for Advanced Facial Cosmetic Surgery at 020 8748 2860 to schedule your appointment with Dr. De Silva.

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West London: The Centre, 89 Hammersmith Grove, London, W6 0NQ, UK | Phone: 020 8748 2860

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