Facelift in London

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 patients of darker skin tones, it is advisable to use an alternative skin resurfacing technique.

In the UK, most facelift surgery is completed under general anaesthesia. Dr De Silva does generally use an alternative type of sedation in conjunction with local anaesthesia. This 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.

A pulled or unnatural appearance after a facelift usually results from techniques that focus on tightening the skin alone. A natural-looking facelift restores the face to its more youthful position by addressing the deeper layers, such as the SMAS, rather than stretching the skin. This approach requires time, precision and specialised surgical skill.

Meticulous technique is essential to ensure scars are fine, hairlines remain natural, and the ears are not distorted. Over-tightening the skin can lead to visible scarring and an artificial look, which careful surgery helps to avoid. Procedures such as brow lifts must also be used conservatively, as over-elevation can create a surprised appearance.

Finally, each surgeon has a unique aesthetic, so reviewing before-and-after photographs is important. In some cases, the most natural rejuvenation is achieved by combining a facelift with complementary treatments such as fat transfer, skin resurfacing or eyelid surgery.

When completing facelift surgery, many 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 between 1 day to 14 days 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, instead employing meticulous fine stitching techniques to eliminate the need for them. There are other interventional techniques that can be used to minimise the risk of bleeding, including the use of fibrin tissue glue and post-surgery medications.

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. The key to 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 that it allows for a small incision and a hidden scar with rapid recovery after surgery.

There are circumstances where a mini-facelift procedure is not adequate. If you have substantial skin laxity, marked jowls and droopiness in the neck, including vertical bands (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 includes 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 procedures, including blepharoplasty (eyelid lift), fat transfer (volume rejuvenation), and CO2 laser resurfacing to augment the natural results.

The duration of a facelift procedure can vary depending on the extent of the surgery and additional procedures being performed. Typically:

• Mini Facelift: Approximately 2 to 3 hours.
• SMAS Facelift: Approximately 2 to 3 hours.
• Deep Plane Facelift: Approximately 4 to 5 hours.
• Vertical Deep Plane Facelift: Approximately 4.5 to 6 hours.
• Extended Procedures: If combined with other surgeries such as neck lift, brow lift, or eyelid surgery, it can take up to 8 hours or more.

A facelift will typically last for between 5-10 years. Different surgical techniques will impact the longevity of the 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.

The best age to have a facelift varies depending on individual factors, but most patients consider it between 45 and 75 years old. However, earlier or later interventions can be appropriate based on specific ageing concerns.

Considerations for Timing:

• Early Signs of Aging: Some individuals in their late 30s to early 40s opt for a mini facelift to address early signs of ageing. Dr De Silva often finds that younger patients have genetic factors such as hypermobility or early menopause.
• Moderate to Advanced Aging: Patients in their 50s and 60s often seek full facelifts to address more significant sagging and wrinkles.
• In good health 70-80s: If in good health there is no age limitation for surgery. It is estimated that 50% of people who are born after 2000, will live to 100!
• Overall Health: Ensure you are in good overall health to undergo surgery at any age.

Measures to Determine Timing:

• Detailed Consultation: Have a detailed consultation with your surgeon to assess your skin condition, ageing pattern, and objectives from surgery.
• Non-Surgical Alternatives: Explore non-surgical treatments if you have minimal ageing signs, delaying the need for surgery.
• Maintenance Procedures: Regular maintenance treatments, such as fillers or skin resurfacing, can prolong the youthful appearance and potentially delay the need for a facelift.

London, New York, Los Angeles, South Korea, and Brazil stand out as top destinations for those seeking a youthful and rejuvenated appearance through facelift & neck lift surgery. Caution is required in hospital tourism as some countries package lower-cost surgery with poor regulation and clinical safety standards. There have been an alarming number of tragedies from British and American citizens travelling overseas to have low-cost procedures in countries including Turkey, South America, and Thailand. Safety is an important consideration when undergoing a procedure.