Facial ageing results in changes in all layers of the face, including the skin, the soft tissues and the underlying bone. A facelift restores soft tissue drooping and laxity of the face, neck and jowls. To give a patient a natural rejuvenation, Dr De Silva often combines facelift surgery with other procedures in order to give a fully rejuvenated natural-looking result.
Volume deflation of the mid-face and cheeks are common signs of facial ageing and can be effectively treated with a filler or fat augmentation. Dr De Silva prefers the use of a natural filler to restore the face using a patients’ own soft tissues. Dr De Silva often utilises fat transfer augmentation, as from our experience this gives a longer-lasting natural result. Fat transfer to faces that have had a substantial loss of volume can be very effective in restoring the malar mound and curvature of the cheeks giving a natural and youthful look.
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 with blepharoplasty at the same time as a facelift in at least half of patients.
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 a 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 effectiveness and reducing downtime.
Facial imbalance secondary to the underlying bone 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.
The nose undergoes ageing changes that include a drop of the tip of the nose with gravity and reduced bone support at the base of the nose resulting in rotation. In cases where there are prominent ageing changes of the nose, Dr De Silva recommends a combine facelift and rhinoplasty procedure; this will restore the nose to a position and shape to suit a more youthful face, In addition, irregularities such as a nasal hump can be sculpted and reshaped.
Facial ageing is characterised by the laxity of the skin, loss of facial volume and descent of soft tissues with gravity. In the lower face, this results in a saggy appearance to the neck with loss of the natural neck angle and descent of soft tissue below the jaw that gives rise to the jowls. Face and neck lift cosmetic surgery rejuvenates the soft tissue descent to its site above the jawline and tightens the lax skin. In the neck, there is a loss of elasticity and thinning of the skin that results in increased folds and sagging. In addition, the platysma muscle that underlies the skin in the neck can be seen as a pair of vertical bands. Dr De Silva uses a precision technique in neck surgery to double stitch the platysma muscle that restores a natural curvature to the neck that is both youthful and more effective than commonly utilised single stitch techniques. Double stitch imbrication technique evens out irregularities in the neck contours and recreates a long-lasting rejuvenated neck angle.
Non-surgical facelift techniques use a variety of volume fillers and tissue stitching while avoiding opening of the tissues with surgery. These techniques do have an effect in rejuvenating the face by resorting facial deflation. Facial ageing is a combination of skin, soft tissues and underlying skeletal changes. Although non-surgical lifts can aid some of the signs of facial ageing, they will only give a temporary effect. Patients that are prepared to have non-surgical facelift treatments should understand the effects are modest and will not be long-lasting. To rejuvenate weathering of the skin, counteract facial descent, and skin laxity requires surgery. Dr De Silva provides advice and guidance on any of the latest cosmetic technological innovations; he only utilises techniques that give patients both natural-looking result and longevity. Many new devices over the past 5-years have promised incredible results without surgery; often, they are heavily marketed and unproven. Most are only available for a short period of time, after which the devices are found to be less effective. Good advice is if something sounds too good to be true, it generally is. For legal reasons, specific devices cannot be discussed on a public website. Dr De Silva understands the difficult choices that patients have in deciding what to believe and will only use treatments that he knows are effective and appropriate for use on his family members and friends. Dr De Silva served as the clinical representative of the Ethics Committee at St. Mary’s Hospital from 2002-2006.
Facial ageing is a combination of genetic and environmental factors. Particularly, sun exposure on the skin causes cumulative damage to the skin resulting in dark spots, fine lines and wrinkling that appear on facial movement and deeper lines on the face. Our understanding of facial ageing has changed over the past 5-years. Prior to that, facial ageing was considered to be secondary to gravity and drooping of the face and neck. The major leap in our understanding of facial ageing over the past few years has been the concept of fat compartments of the fact that not only descend with gravity. In addition, but also lose volume termed “deflation”. Why does this matter? Although isolated treatment of facial soft tissue droop or restoration of facial volume will have an effect, facial beauty is about symmetry, balance and harmony all of the multiple factors. What leads to a great natural-looking result is a simultaneous rejuvenation of the skin, soft tissues and underlying skeletal changes. Volumetric fillers that have revolutionised the non-surgical approach to facial rejuvenation in the past few years will restore lost facial volume, soften deep facial lines and youthful appearance of the cheeks. However, in isolation, they can lead to the “over-filled” or “over-done” appearance that is characterised by some actors and actresses in the media. The artistry in giving patients a natural result requires a harmonious approach that both restores volume and treatment of facial decent. Different faces will age in a unique manner; Dr De Silva tailors his treatment of every patient on an individual basis. Some faces will require greater restoration of volume, and others will require greater rejuvenation of soft tissue descent.
A facelift will have the effect of rejuvenating the face, taking years off a persons’ appearance by restoring features of the face to a more youthful time. Society places value on youth and beauty, through more successful jobs, more attractive partners and inner confidence and self-belief. Although cosmetic surgery was once considered a premium luxury, it is now considered an investment in oneself, and an opportunity to revitalise and recapture a youthful external appearance that a person feels on the inside. Commonly Dr De Silva patients describe feeling many years younger than they look, a facelift is a way of lifting a patient’s esteem and restoring a balance between these factors. Dr De Silva advises all his patients that successful rejuvenation of the face is about looking better, a complete absence of lines and wrinkles is not a desirable goal, as this looks fake. Dr De Silva considers success when friends comment on how great you look after surgery without knowing that you have had surgery, a natural rejuvenation.
Patients seeking a facelift are often looking for a more youthful appearance that can help with job prospects or in finding a partner, and the confidence that comes from a more youthful appearance. Dr De Silva utilises the most advanced treatments from the US; the surgery is completed as a day-case procedure which means that all patients go home on the same day of surgery. There is no requirement to stay in hospital overnight; hospitals are associated with increased risk of infections. In the UK, some hospitals still keep patients overnight, as hospital inpatient stays is the old way in which cosmetic surgery was practised. Patients usually take 1-2 weeks off work and social engagements, although after a couple of days, patients can do most non-strenuous activities. Dr De Silva usually recommends the use of one of his overnight team to care for you over the first night. After 3-weeks, patients can return to all normal activities.
Dr De Silva’s approach to facelift surgery is based on two principles, a natural-looking result and the quickest recovery using the most modern and innovative techniques.
Dr De Silva utilises his own modified facelift technique that uses a double-layered lifting that restores the youthful position of the soft tissue muscle layer (SMAS) underlying the skin. This technique was developed from his experience from training in London Los Angeles and New York. Currently, he is publishing his technique as lead editor in a new multi-disciplinary book that includes international experts in facial cosmetic surgery. A double-layered closure gives a more permanent lift designed to last many years and creates a natural look as it avoids tension on the skin, which is one of the hallmarks of surgery other single-layered techniques. All faces change with time and at different speeds dependent on environmental and genetic factors. Dr De Silva’s technique uses a smaller incision that is hidden in the natural creases of the skin, behind the ear and in the hairline
Dr De Silva tailors the facelift to an individual’s patients facial ageing, underlying bone structure and soft tissue changes. In some patients’ faces, particularly men, restoration of the neck curvature is important, and Dr De Silva may use a double stitching imbrication technique to enhance the result. Sometimes a natural look is about what not to do, in men over pulling off the soft tissues in the cheek does reduce lines in the face (e.g. nasolabial folds), however, can result in the feminisation of the male face. Dr De Silva tailors his technique to the features of the face, keeping a natural look is a combination of technique and artistry, Dr De Silva may suggest focusing entirely on a neck lift in some faces.
Dr De Silva’s approach to a face is an evaluation in symmetry, balance and proportion. He completed his first facial surgery in 2002 at Imperial College London and has continued his passion for facial aesthetics over the past decade. He often utilises other techniques in combination with a facelift in order to give the most natural-looking result. A combination of a facelift with laser skin rejuvenation has enhanced the results of many patients, by alleviating deep facial lines caused by exposure to the elements, principally the sun.
Dr De Silva often utilises fat grafting at the same time as facelift surgery. Fat grafting contains stem cells that have a rejuvenating effect on the soft tissues of the face. At the Anti-Ageing Medicine meeting in New York 2012, there was a great deal of excitement of the large potential of stem cells in cosmetic surgery and its benefits in enhancing rejuvenation.
The anatomy around the lower eyelids is complex; the eyelid is unique with an arrangement of bone vectors, muscle, natural fat compartments, fibrous tissue and a covering with the thinnest skin in the entire body. Expertise is required in the rejuvenation of this area to avoid issues such as lumpiness and lid retraction. Dr De Silva has special expertise in this area and has treated numerous patients who have had non-specialized treatment in this area. Dr De Silva advises patients seeking volume replacement with fat transfer to the face and eyelids to see surgeons specialising the face to avoid problems.
Dr De Silva will hide the facelift incision, behind the ear and in the hairline that they are invisible months after surgery. In addition, every stage of the procedure has been meticulously enhanced to speed recovery and look natural. The use of a modified deep plane facelift aids restoration of the natural facial contour of the cheek and lower face. Dr De Silva tailors the deep plane to the degree of facial ageing and soft tissue structures.
The use of fibrin tissue glue can avoid the need for surgical drains by preventing unnecessary bleeding. Dr De Silva pioneered research in this area by a detailed evaluation of tissue glue in eyelid surgery; this is regarded as the gold standard in research as it is free from bias. Older techniques in face lifting used surgical drains and kept patients in hospital overnight. Although still practised by some surgeons, Dr De Silva utilises techniques that are contemporary and used in the cosmetic centres of Beverley Hills and Manhattan. Dr De Silva trained in Los Angeles and New York, acquiring the most progressive and innovative experience from some of the best facial cosmetic surgeons in the world.
The use of meticulous surgical technique and technological advances including electrocautery, meticulous technique and tissue adhesive glue and drains can enhance recovery after surgery.
Dr De Silva may choose to use newer medications to reduce the likelihood of scar formation in patients with a history of scarring. These are applied as creams on the skin surface or administered through the skin to ensure even healing and absence of scarring.
Dr De Silva was teaching his facelift technique in the US in autumn 2012. -ASOPRS 2012
There are various descriptions that are used to describe a facelift. Numerous facelift terms have been described, trademarked and marketed, often they are variations of the techniques.
The older and conventional facelift used an incision that followed the hairline beginning at the temple and going down, behind the ears and back up to the other ear and returning into the hair. After completing the incision, the skin is lifted, pulled upwards and backwards. The underlying muscles termed SMAS is usually elevated with a mixture of techniques in front of the ear. The excess skin that overlaps will now be trimmed away and re-stitched where the cut was originally made. The skin was closed with the use of stitches or metal clips. A hospital stay for a minimum of one day was required, and all patients had general anaesthesia.
MACS lift (Minimal Access Cranial Suspension)
A MACS lift involves smaller incisions than the traditional surgical method. In this procedure, slits are made in the temple and in the front part of the ears, which is followed by permanent re-stitching. The MACS lift is suitable for relatively mild facial ageing as the surgery involves the use of 2-3 sutures to lift the face, the support to the face is substantially less than other facelift types. This facelift has a shorter duration than deeper facelifts that result in lifting the underlying muscle/ SMAS tissue.
Mini Facelift or Short-Scar Facelift
A Mini Facelift is a cosmetic procedure performed that involves a shorter incision around the ear; it is useful in treating younger patients with facial ageing with soft tissue changes of the lower part of the face and jowl area. This surgery does not treat any sagging of vertical banding of the platysma muscle in the neck.
A midface lift is a cosmetic surgery that is used to elevate the area of the cheeks and can be formed with open incisions under the eyelid or hidden incisions in the hair or mouth. Elevation of the midface does improve the middle third of the face; however, facial ageing tends to also affect the upper and lower thirds of the face.
Deep Plane Facelift
The face is organised in layers of tissue that includes the skin, underlying SMAS and skeletal structure. Dr De Silva uses a modified deep plane lift to maximise the elevation of the face in natural planes, avoiding unnecessary injury to vessels and speeds up recovery. Keyhole surgery in which a telescope is used to evaluate the soft tissues and muscle layer that underlies the skin, enabling smaller incisions to be used and hidden scars. The advantage of Dr De Silva’s deep plane is an improved lift that is longer lasting lifting of the face, added safety and reduced recovery time.
In some patients, the predominant features of facial ageing are laxity of the neck; this is seen as creases, folds and neck bands. A neck lift is a modified facelift in which the platysma muscle underlying the skin is tightened. Although there are different ways in which the platysma muscle can be tightened the key to low downtime is lifting of the muscle and strengthening its attachments. Dr De Silva utilises deeper plane elevation and double stitching method to give a longer-lasting result. By supporting the deeper tissues, the excess loose skin can be trimmed without tension, leading to a softer look by avoiding scars. Although some surgical techniques have suggested that only a single stitch is necessary to support the neck platysma, this will not be able to support the neck from gravity long-term. Dr De Silva believes that a good result is one that has a quick recovery and also gives a good long-term result. In patients that have increased volume of soft tissue, this can be substantially improved with the use of liposuction, Dr De Silva often combines with 3D telescopic imaging to aid in dissection and recovery.
Facelift surgery was traditionally all performed in a hospital under general anaesthesia with an overnight stay. However, with modern-day techniques, utilised in New York and Los Angeles, facelift surgery is performed in private operating theatres under sedation and as day-case procedures. Sedation is also termed “twilight” anaesthesia and is generally regarded as safer than general anaesthesia, patients’ breath on their own, have rapid recovery after sedation and are able to home quicker without symptoms of nausea or the hangover of general anaesthesia. There is no need to stay in hospital as a hospital stays are associated with issues such as infection and MRSA.
Traditionally all facelift surgery was performed under general anaesthesia; many patients do not like the idea of general anaesthesia, it is often associated with feelings of nausea and sickness, slow recovery, hospital stays and issues such as deep vein thrombosis. Dr De Silva prefers the use of sedation as this is safer, enables rapid recovery and avoids side effects of general anaesthesia with no nausea or sickness. Dr De Silva only performs surgery in private hospital and treatment centres that have full accreditation by the Care Quality Commission.
Sedation anaesthesia is also known as Monitored Anaesthesia Care or MAC. The main advantages of sedation are: (1) it does not require putting a breathing tube in the throat as for General Anaesthesia (2) it does not require a breathing machine, (3) the recovery is much faster, (4) there is less nausea after surgery. All of these elements mean a better experience for patients with greater comfort and safety.
Dr De Silva only operates in CQC accredited facilities.
A facelift will typically last for between 5-10 years. Different surgical techniques will impact the longevity of effect. Dr De Silva believes that a patient who is undergoing cosmetic surgery is investing in their appearance and uses a modified deep plane SMAS facelift to give patients a more durable and longer-lasting result. There are patient factors, including genetic makeup and exposure to the elements such as the sun that will influence the duration of a facelift. Dr De Silva advises all his patients on lifestyle changes that maintain the results of their facelift and may suggest referral to one of his specialist colleagues. Patients are frequently attending for 2nd, 3rd and even 4th facelifts. Other areas of the face age differently to the lower face and neck.
Typically patients will go home on the day of surgery. There is a support bandage that applies pressure to the face and neck for the first day. There is usually only mild discomfort that is relieved by oral analgesia; neck lift surgery usually results in feelings of tightness after the surgery. Dr De Silva advises his patients to apply ice packs to their face for the first 2-days as this speeds up recovery and reduces swelling. Patients often feel good after a few days, and the face is usually swollen and bruised for two weeks. Occasionally patients can feel really drained for the first couple of weeks. After 1-week patients may return to most normal activities, although strenuous activity should be avoided for 3-4 weeks. Most of the stitches are removed between 1-2 weeks. Dr De Silva avoids the use of staples as these promote scar formation through tracks. In addition, Dr De Silva takes steps to minimise leading, with meticulous techniques and fibrin tissue glue and drains in the face to enhance recovery after surgery. Dr De Silva follows his patients very carefully after their surgery and is readily accessible 24-7, he also advises patients on minimising scarring and may use medications that facilitate hidden incisions with the use of creams or local treatments.
Cost is tailored to an individual patient needs and is based on whether it is a full facelift, neck lift and if there are associated procedures to enhance the result. Additional techniques that include volume augmentation, skin resurfacing and specialised eyelid contouring techniques. A good long-lasting result that is free of problems is worth its weight, the quality of your care and outcome is most crucial Lower cost surgery may result in compromises in quality of the result and safety. For an accurate assessment of price, a consultation is required. If you decide to have surgery, the consultation fee will be deducted from your surgical fee.
The average person having facelift surgery is between 50 and 70 years old. Younger ages for a facelift are the 40s, all faces age at different rates, where a combination of natural genetics and exposure to the sun may result in early ageing. In younger patients, a facelift can be used as a form of preventative maintenance, a requisite in some professions such as the actresses and actors in the movie industry. There is no fixed age limit to undergo cosmetic surgery; the person must have good health and be a non-smoker as safety always comes first. The father, one of my surgeon’s colleagues, was in good health and underwent a facelift at the age of 85, he was absolutely delighted with the results. There are no absolutes to age in having a facelift it is necessary to do a comprehensive series of blood tests, electrocardiogram (heart tracing) and chest x-ray to establish good health.
The aim of a facelift is to rejuvenate the face by restoring drooping soft tissues of the face (malar cheeks, jowls at the jawline), remove excess skin that has become lax, restore the youthful curvature of the neck and jaw-neck angle. A good facelift is one that is natural-looking, by this avoids a fake wind-swept appearance that has been characterised by some cosmetic patients in the media. Dr De Silva is known for creating a natural look, to do this, he uses specific techniques including a double-layered tightening, modified deep plane technique, hidden incisions and complementary techniques such as facial volume replacement. “My objective is for friends and family to notice you looked freshened up and rejuvenated, however not know that you have undergone surgery.”
For the first couple of weeks after surgery, there will be a degree of bruising and swelling. For the first week, it is best to take things easy and generally keep a low profile. After one week, the residual bruising can be camouflaged with cosmetics, most patients will have some swelling, and can return to some more social activities if they like. Dr De Silva generally recommends patients leave 1-2 weeks for recovery, and from 2-weeks patients can return to regular social activities.
A bandage is placed around your head from the top of your head to under the chin, this gives support to the face and reduces swelling. Dr De Silva uses micro-drains for some patients to reduce swelling and enhance recovery. By the use of meticulous techniques, patients are able to leave the surgical centre and go home after 1-2 hours. Most patients have little or no pain; however, they should take things relatively easy and avoid all forms of exercise. Dr De Silva will see all of his patients the day after surgery and provide you with contact details so he may be reached 24-hours a day. The following day you are able to have a shower and wash your hair. From 5-7 days, Dr De Silva will remove facial stitches, and by 2-weeks most of the swelling will have resolved. The scars are hidden behind the ear and in the hair, the remainder fade over a period of months.
Facelift and neck lift surgery is a common cosmetic, and as with any surgery, there are potential risks and complications that may occur.
Complications in face and neck lift surgery 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 and neck lift surgery is demanding, and requires in-depth knowledge of the anatomy, experience attention to detail.
Complications can be defined as any unforeseen occurrence during or after the surgery. The complications that can occur during or after blepharoplasty and can be divided into four categories; intra-operative, immediate postoperative, early and later postoperative.
Intra-operative complications occur during the surgery. For example, these can occur due to a reaction to some medication or due to the local or general anaesthesia given and are managed by the surgical team at the time of surgery.
Immediate postoperative complications occur immediately after the surgery when the patient is in the initial recovery stage and may include bleeding or medication. These complications need to be handled immediately by the surgeon who performed the operation.
Early postoperative complications in facelift and neck lift surgery occur once the patient has been discharged. These appear almost immediately after the person returns to a normal routine. They can include bleeding or a haematoma (collection of blood), a reaction to a medication, infection and can be corrected by contacting the doctor immediately.
Late postoperative complications associated with facelift and neck lift 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 asymmetry, scarring, hollowing, numbness and facial muscle weakness, delayed healing and hair loss. Most of these complications are minor and can be easily corrected.
The commonest complications are bleeding and haematomas, all of which are treatable. The most serious complication of face or neck lift surgery is permanent damage to a branch of the facial nerve resulting in reduced facial expressions following surgery; this is an extremely rare complication. Face and neck lift surgery is generally a popular surgery with high patient satisfaction and low risk of complications.
All patients have a degree of bruising and swelling, that resolves over a period of weeks, 90% over the first two weeks. Patients who smoke have delayed healing as a consequence of smoking, Dr De Silva will not perform facelifts on patients who smoke, because of the risk of delayed healing, safety must come first.
A facelift restores drooping of the soft tissues of the face and the sagging skin of the neck. A facelift will not treat volume loss, termed deflation, in patients with volume loss, Dr De Silva advises volume replacement with fat augmentation or filler that will enhance the facelift result. A facelift will not rejuvenate the skin, fine lines, dark spots and wrinkles. Dr De Silva will advise a combined facelift and skin-resurfacing technique to enhance the results. Commonly a CO2 laser is used to resurface the skin, in some patient of darker skin tones, it is advisable to use an alternative skin resurfacing technique.
A good candidate for a facelift is facial ageing with symptoms of sagging of the skin and soft tissues of the face, deepening of the nasolabial folds (a line between nose and mouth) and loose skin below the neck with loss of the angle between the chin and neck. The patient should be in good health, and a non-smoker with have realistic goals of rejuvenating their face.
Meticulous surgical technique:
What can you do to improve your facelift scars?
In the UK, most facelift surgery is completed under general anaesthesia; an alternative is a type of sedation used in conjunction with local anaesthesia. Sedation is also known as “twilight anaesthesia” or MAC (Monitored anaesthesia care). Twilight anaesthesia means that your body is sleepy and relaxed; you are still conscious and able to respond to questions and instructions, unlike general anaesthesia where you are unconscious, and the recovery after surgery is longer. Typically, you won’t remember the procedure or the short period of time following it, though you will feel a little euphoric. The benefits of sedation are that it relieves your anxiety around surgery and the recovery after surgery is faster.
The one-hour facelift is the name of a procedure that suggests it will be fast to complete, with local anaesthesia and fast recovery. Unfortunately, any short cuts with the surgical technique are reflected with both limited effectiveness and short-lived results.
The risk of a one-hour facelift is a fast technique that results in a small improvement that lasts for a short period of months. A surgical technique that is so fast to be completed in one hour can only be superficial beneath the skin, not lifting the deeper facial tissues and hence only lasts a short period.
Facelift techniques vary from mini facelifts, to complete face and neck lifting techniques, and take from 3 to 6 hours. More extensive techniques are usually required as a result of further ageing. True facelift techniques require general anaesthesia or sedation anaesthesia; the results take several hours to complete and last for a period of years.
Often patients require additional procedures such as fat transfer, blepharoplasty or skin resurfacing to get the best possible results. In addition, to give fine or hidden scars takes meticulous time and consideration and would take more than one hour just to close the incisions.
In recent years there have been a large number of advertised techniques that promise a great deal, there are no techniques that get something for nothing, and many patients are disappointed by their results. The reality is that as with many things in life, there are few short cuts, quick to complete, and quick to wear off. Considering a small 2cm cut in the skin requires five or more stitches to repair effectively, the lower part of your face cannot be supported effectively by a single stitch. The techniques required to give long-term effectiveness and natural-looking results are meticulous and take both time and expertise to complete.
Sedation is also known as “twilight anaesthesia” or MAC (Monitored anaesthesia care). Twilight anaesthesia means that your body is sleepy and relaxed; you are still conscious and able to respond to questions and instructions, unlike general anaesthesia where you are unconscious, and the recovery after surgery is longer. Typically, you won’t remember the procedure or the short period of time following it, though you will feel a little euphoric. The benefits of sedation are that it relieves your anxiety around surgery and the recovery after surgery is faster.
Facelift surgery does require some form of anaesthesia; there are three principal types of anaesthesia – local, sedative anaesthesia and general anaesthesia.
Local anaesthesia involves injecting numbing medicine at the area to be operated on. The face is a sensitive area of the body, and local anaesthesia alone is not usually sufficient for facelift surgery.
Sedative anaesthesia, also known as twilight anaesthesia, means an anaesthesiologist gives you some medications that make you sleep during the surgery. Dr De Silva offers sedation anaesthesia for facelift surgery, which ensures a comfortable experience, as patients have a rapid recovery and go home approximately thirty minutes after the surgery with an escort or chaperone.
General anaesthesia means that the patient is completely unconscious, requires a breathing tube and the recovery is slower, taking a minimum of 4-6 hours. For facelift surgery, general anaesthesia is safe, effective and commonly used.
The ideal choice of anaesthesia for facelift surgery does differ for each patient, as depending on your medical history, previous experiences of anaesthesia and allergies, different types of anaesthesia are best suited.
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A pulled look from a facelift is the result of an unsatisfactory aesthetic that is an un-natural rejuvenation of the face. A natural rejuvenation is one that restores parts of the face to their original position taking into account both individual facial ageing utilising specialised surgical techniques that respect the natural contours of the face.
For a natural-looking facelift and rejuvenation, Dr De Silva believes there are several facial plastic surgery factors that are of key importance:
The weekend facelift is the name of a procedure that suggests it will be fast to complete under local anaesthesia and with a fast recovery. Unfortunately, any short cuts with facelift surgical technique are reflected with both limited effectiveness and short-lived results of the technique.
The risk of a weekend or one-hour facelift is a fast technique that results in a small improvement that lasts for a short period of months. A surgical technique that is completed very quickly in less than two hours can only be superficial beneath the skin, not lifting the deeper facial tissues and hence only lasts a short period. There is an increased risk of a pulled and unnatural appearance with a fast skin lifting technique.
The reason why patients chose these mini facelifts is often related to price. Often, they are economically favourable on consideration of comparison of price alone. However, they are less favourable once taking into account their short period of effectiveness, as they may last for only a period of months, usually less than one year, and the cost of further surgery.
Facelift techniques vary from mini facelifts, to complete face and neck lifting techniques, and take from 3 to 6 hours. More extensive techniques are usually required as a result of further ageing. True facelift techniques require general anaesthesia or sedation anaesthesia; the results take several hours to complete and last for a period of years. To result in a fine or hidden scar takes meticulous time and consideration and would take more than one hour just to close the incisions alone. In recent years there have been a growing number of advertised techniques that promise a great deal, there are no techniques that get something for nothing, and many patients are disappointed by their results.
For the reasons above, Dr De Silva does not recommend the weekend facelift. Often patients require additional procedures such as fat transfer, blepharoplasty or skin resurfacing to get the best possible results.
How long a facelift procedure lasts is dependent on several factors: The facelift technique, Additional procedures, Environmental factors and Genetics.
A facelift procedure rejuvenates the face by lifting soft tissues of the face that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, volume loss. Facelift surgery is effective to treat facial characteristics, including:
The facial ageing changes usually occur present from the forties, however, are dependent on environmental factors (including smoking, sun exposure, poor nutrition and stress) and genetic factors. Often to give the best result from a facelift, the surgery needs to be combined with additional procedures, including fat transfer to treat facial volume loss and skin resurfacing to restore sun-damaged skin.
Non-surgical treatments, including the use of wrinkle injection and hyaluronic acid fillers, have been substantial innovations in the past 10-years that have advanced cosmetic surgery. Patients with early signs and symptoms of facial ageing including dynamic wrinkles (wrinkles on facial expression) and early volume loss around the cheeks, below the eyes (termed tear trough depression) are effectively treated with non-surgical treatments.
The changes described above, including deep nasolabial lines, jowls and excess skin in the neck are not effectively treated with non-surgical methods and require facelift surgery to give a natural-looking rejuvenation.
A facelift procedure rejuvenates the face by lifting facial soft tissues that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, and facial volume loss with facial ageing.
The indications for a facelift are to treat characteristics of the face include, Deep Nasolabial lines (from the nose towards the outside corners of the lips), Jowls (the soft tissue that has descended below the jawline resulting in loss of a smooth jawline), Excess skin or vertical bands in the neck (secondary to laxity in the platysma muscle) & Marionette lines (from the corner of the mouth to the chin region)
The facial ageing changes above that are suitable for facelift surgery usually present from the forties onwards; however, they are dependent on environmental factors (including smoking, sun exposure, poor nutrition and stress) and genetic factors.
How long a facelift procedure lasts is dependent on several factors: The facelift technique, Additional procedures, Environmental factors and Genetics.
Facelift surgery generally lasts for 5-8 years, depending on the factors above. A person who has undergone a facelift will always look younger than that if they had not had a facelift, however with time to maintain that look a further facelift may be required. Patients working in professions where appearance is key to career prospects commonly undergo multiple facelift procedures to maintain their appearance over multiple decades.
The facial ageing usually presents the from the forties, however, are dependent on environmental factors (including smoking, sun exposure, poor nutrition and stress) and genetic factors.
The indications for a facelift are to treat characteristics of the face include, Deep Nasolabial lines (from the nose towards the outside corners of the lips), Jowls the (soft tissue that has descended below the jawline resulting in loss of a smooth jawline), Excess skin or vertical bands in the neck (secondary to laxity in the platysma muscle) & Marionette lines (from the corner of the mouth to the chin region)
Often to give the best result from a facelift, the surgery needs to be combined with additional procedures, including fat transfer to treat facial volume loss and skin resurfacing to sun-damaged.
Non-surgical treatments, including the use of wrinkle injection and hyaluronic acid fillers, have been substantial innovations in the past decade that have advance cosmetic surgery. Patients with early signs and symptoms of facial ageing including dynamic wrinkles (wrinkles on facial expression) and early volume loss around the cheeks, below the eyes (termed tear trough depression) are effectively treated with non-surgical treatments.
The changes described above, including deep nasolabial lines, jowls and excess skin in the neck are not effectively treated with non-surgical methods and require facelift surgery to give a natural-looking rejuvenation. Age itself is not an accurate indicator for facelift surgery. Most 40-year olds would not have the indications for facelift surgery as described above (jowls, deep nasolabial lines and vertical bands in the neck). However, as a consequence of genetic and environmental factors if these symptoms and signs are present in a facelift may be the most suitable facial rejuvenation.
A facelift procedure rejuvenates the face by lifting soft tissues of the face that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, volume loss. By your 70s there will be most if not all of the changes above which will be effectively rejuvenated with a Facelift. There are several further considerations.
Overall there is not a specific age that is good or too old for facelift surgery more significant is your general health and level of fitness. Dr De Silva find from his experience, taking into account the steps above, patients in their 70s and 80s can have a good rejuvenation from facelift surgery.
When completing facelift surgery, some surgeons will insert a fine tube into the soft tissues at the end of the surgery (termed a drain) on both the right and left side to continue to drain fluid after the surgery these are then usually removed one day after surgery.
In a small proportion of cases, after surgery, as a consequence of further bleeding, a collection of blood can occur that needs to be removed. Some surgeons believe that the use of a drain may reduce the chance of this complication. However, the drains are often uncomfortable for patients and cause discomfort on removal. Dr De Silva does not use drains, using meticulous and deeper plane techniques the risk of bleeding is reduced. There are other innervational techniques that can be used to minimise the risk of bleeding, including the use of fibrin tissue glue and post-surgery medications.
Scars from facelift surgery are important to place to ensure they are discrete and difficult to see. Dr De Silva hides the scars in your natural hairline natural curves of your ear. 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-minutes with his technique, other techniques in front of the ear can be completed much faster, however, may result in visible scars. Many surgeons use staples to save time in the hair; these can leave track scars and are very uncomfortable to remove. Dr De Silva only uses fine stitches in the face, which take additional time to insert; however, this avoids removing staples after surgery. Although no scars are invisible, most scars once healed are relatively discrete and difficult to see, only 1% of patients have issues with scars healing that may require additional treatment, e.g. keloid scarring.
A scar from facelift surgery can include wide visible scars on the face, elongated pixie shaped ears as well as the loss of hairs or stepped pattern in the hairline, these results are avoidable by using specialised surgical techniques and meticulous attention to detail.
For a natural-looking facelift and rejuvenation that avoids scars, Dr De Silva advocates:
With the factors above scarring from facelift surgery can be avoided, once scars have been made on the face, they are more difficult to treat and may require revision facelift surgery to reduce tension on the healing skin or the use of laser resurfacing.
The salivary glands are located under your jawline (termed submandibular and submaxillary salivary glands) and are usually hidden behind your natural jaw and soft tissue of your neck. In some people the glands can be lower down and create bulging in the neck, this can create a more bulbous or irregular shape and contour of your neck. Most people who undergo facial rejuvenation with face and neck lift surgery do not require surgery on their salivary glands. In some people, as a consequence of their natural anatomy and facial ageing, the position of the glands could affect the final surgical result. In these patient’s partial removal of the salivary glands as part of the face and neck lift surgery may be beneficial and improve the result of the surgery. The anatomy of the salivary glands includes a very powerful blood supply. Hence surgery on the glands needs to be both cautious and reserved for when necessary to avoid the unnecessary issue from surgery. If your salivary glands are more prominent in your neck, then partial removal of the salivary glands at the same time as facial rejuvenation surgery may improve the results of your surgery, an assessment is required to determine your individual needs and suitability for this surgery.
A mini facelift procedure is a technique that benefits a person with relatively early features of facial ageing, including facial sagginess with deep facial lines (termed nasolabial folds) with or without early jowls (softening of the smooth jawline) and some skin laxity in the cheeks and lower face. Key for suitability for a mini-facelift is relatively good skin elasticity and relatively mild changes in the lower third of your face and neck. The advantages of a mini facelift are a small incision and hidden scar with rapid recovery after surgery.
There are circumstances where a mini-facelift procedure is not adequate. If you have is substantial skin laxity, marked jowls, droopiness in the neck including vertical bands (termed platysmal bands). With these features usually from your 50s, a full facelift is required to provide a natural rejuvenation. A full facelift requires a larger incision as more surgery is required to lift and rejuvenate the face. The incision is longer as it needs to extend behind the ear into the hairline principally to treat the increased skin laxity. At the same time, the incisions can be largely hidden in natural creases and contours to avoid visible scars after surgery. The recovery from a full facelift is approximately 2-weeks, although the final result is 6-12 months later.
Key to a natural rejuvenation in both mini-facelift and full-facelift techniques include meticulous attention to detail, lifting beneath the skin including the SMAS and deep soft tissue layers (to avoid a wind-swept appearance) and multi-layered closure (to avoid visible scars). Both techniques are effective at rejuvenating your face depending on your clinical needs, and an assessment is required to determine your individual needs and suitability for this facial surgery. Both techniques may be completed with other facial techniques, including blepharoplasty (eyelid lift), fat transfer (volume rejuvenation), and CO2 laser resurfacing to augment the natural results.
Surgeons use a variety of different techniques for closing the incisions after surgery. If your surgeon only uses superficial stitches, all of these may be removed between 1-2 weeks after surgery. Dr De Silva utilises three layers of deep stitches in closing the incisions to ensure no tension on the wound, with the intention of leaving the finest possible scar. These specific stitches dissolve as much as 6-months after the surgery, ensuring that the soft tissues are held in place during the healing period. On occasion, as the swelling resolves the very edges of theses stitches can be felt along the incision line, these stitches are difficult to see as they are clear in colour. If they are irritating or uncomfortable, they can be removed. However, they are not causing any issues they can be otherwise left as they will naturally dissolve between 3 to 6 months after the surgery. There are deep stitches beneath the skin that dissolve between 3-6month; these are important as the support the face during healing and reduce scarring. Sometimes as the swelling goes down, you can feel an edge of a stitch. The stitch will dissolve, if it is uncomfortable, Dr De Silva can take it out for you.
During face and neck lift surgery, the face is rejuvenated by lifting the soft tissues that have dropped with facial ageing and restoring them to their natural position. As part of the surgery, the excess and floppy skin that has become lax with time is partly removed. As part of the face and neck lift surgery, it is completely normal to have a degree of numbness around the face and neck during the healing period. The sensory nerves that provide sensation gradually improve after surgery between 6 weeks to 6 months. Numbness during this period gradually improves as the sensory nerves recover. It is rare for the numbness to persist after 12months, however in the same way every person has relatively unique facial characteristics, very rarely numbness can be long-lasting. Patients who have difficulty adapting to this change may also find some tightness in their neck during the healing period. For these patients, MLD, manual lymphatic drainage a specific type of neck massage may be effective in improving their symptoms and reducing their recovery time.
Accusculpt technology uses a laser to reduce fat and in principle is similar to liposuction. The treatment reduces fat in the neck, which may be useful for reducing fat and neck in younger patients. The technology does not benefit facial ageing that has resulted in effects of gravity or skin laxity, i.e. patients with jowls or loose skin, are not treated. Accusculpt is marketed as a form of a facelift; however, it is not a true facelift. A true facelift involves lifting the layers beneath the skin, where gravity has resulted in jowls or deep lines in the face and removing the remaining loose skin. Every few years there is a new non-surgical technology that promises results that avoid the need for surgery, although these techniques have a role for some patients there are limitations and cannot be used for all patients.
The risk of an Accusculpt facelift is a fast technique that results in a small improvement that lasts for a short period of months. A surgical technique that is so fast to be completed relatively quickly can only be superficial beneath the skin, not lifting the deeper facial tissues and hence only lasts a short period.
Facelift techniques vary from mini facelifts, to complete face and neck lifting techniques, and take from 3 to 6 hours. More extensive techniques are usually required as a result of further ageing True facelift techniques require general anaesthesia or sedation anaesthesia, the results take several hours to complete, and last for a period of years.
The length of a neck lift will depend on the complexity of the surgery, the degree of laxity and facial ageing and patient ethnicity and sex. On average a neck lift will take from 1 and a half to 3 hours, less than 90 minutes is a short length of time. There is a great deal of individual variation in the neck, and good surgery requires a meticulous attention to detail, including measurements and time. It is important that your surgeon takes adequate time to complete the surgery cautiously and without rushing. Combined face and neck lift takes on average 4 to 6 hours.
Dr De Silva allows a minimum of 3-hours for most neck lift procedures and allows additional time to ensure the best possible result. For more complex revision neck lifting and combination treatments including facelift, fat transfer and blepharoplasty additional time may be required up to 7-8 hours. Dr De Silva generally limits neck lift to 4-hours as, after this time, there can be increased swelling that can affect the appearance of the neck.