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.
These can include:
– Natural fillers
– Laser resurfacing
– Facial implants
Facial ageing results in changes in all layers of the face, including the skin, the soft tissues and the underlying bone. While a facelift restores soft tissue drooping and laxity of the face, neck and jowls, other procedures can also be done.
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.
After one week, the face has largely healed although a minority of people may have residual redness that can be covered with conformed.
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.
Non-surgical techniques use a variety of volume fillers and tissue stitching while avoiding the opening of the tissues with surgery. These techniques do have an effect in rejuvenating the face by resorting to 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 results 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 that causes dark spots, fine lines and wrinkling.
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. They not only descend with gravity but also lose volume due to “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 descent. 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.
It 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. Dr De Silva’s patients often describe feeling many years younger than they look.
A facelift is a way of lifting a patient’s self-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.
Here are a few benefits of having a facelift:
– Dr De Silva utilises the most advanced treatments from the US.
– The surgery is completed the same day, allowing patients to go home on the day of surgery.
– There is no requirement to stay in hospital overnight, reducing the 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 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 customised facelift technique that uses a double-layered deep-plane lifting that restores the youthful position of the face with respect to the natural lines and golden ratio.
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, and 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 of 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 about 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 in the face to avoid problems.
Dr De Silva will hide the surgical 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.
Dr De Silva has pioneered the development of techniques that enhance recovery.
These have included the use of regenerative medicine (growth factors and amniotic membrane products), use of scientifically proven oxygen and light therapy to speed up recovery. Although general anaesthesia is practised by some surgeons, Dr De Silva has developed sedation anaesthesia techniques that avoid the longer recovery, risks and hangover associated with general anaesthesia.
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.
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 the absence of scarring.
Dr De Silva teaches his skills and experiences in face and neck lift surgery, as director of an international facelift course, to other surgeons annually in the US. -ASOPRS
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, it 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’ breathe 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 hospital stays are associated with issues such as infection and MRSA.
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 hospitals 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 like 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.
The aim of surgery 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, do 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 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 result. A facelift will not rejuvenate the skin, fine lines, dark spots and wrinkles. Dr De Silva will advise a combined technique to enhance the results.
Commonly a CO2 laser is used to resurface the skin, in some patients with darker skin tones, it is advisable to use an alternative skin resurfacing technique.
Meticulous Surgical Technique
Surgeon’s complete facelift surgery using different techniques. Meticulous care and attention are required to hide incisions.
Location of the Incision
The incision and thus the scar in front of the ear can be hidden in women by placing the visible portion of the incision inside the ear canal, or opening behind the little lump in front of you rear called the Tragus.
In men, this is not ideal as it means the beard hair will grow up towards the ears which are not ideal long-term, Dr De Silva will often use a natural crease that lies in front of the ear to mask this incision. Other steps were taken by meticulous surgical technique to hide incisions.
Multiple-layered Meticulous Closure
This ensures that there are deep stitches to support the soft tissues once the superficial skin stitches are removed. It is key to avoid widened scars and does take additional time to complete, making it more challenging for the surgeon.
Dr De Silva always closes the incisions with multiple layers to give the best possible final result.
Additional techniques can include careful bevelled incision in the hairline to avoid hair loss, SMAS or Deep Muscle Tightening before skin closure and avoiding tension on the skin on closing the incision are all important aspects of the surgery.
The Method Used to Close the Skin
Dr De Silva will avoid the use of staples in skin areas as the best healing is from the use of fine sutures in non-hair bearing skin. This takes additional time and meticulous care to complete. Dr De Silva does not compromise time for giving the best final result.
What can you do to improve your scars?
Choose a surgeon specialising in facial cosmetic & plastic surgery. All surgical scars are red to pink for 6-12 months after surgery; most scars are white after this time period. When the scars are pink, they can be effectively covered with makeup or concealer or hair.
Avoidance of sun exposure with the use of hats and a high-quality sunblock of SPF 30 is important for 12-months after surgery to avoid redness and darkening of the incision sites.
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).
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 shortcuts 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. Techniques vary from mini facelifts, to complete facelift techniques, and take from 3 to 6 hours.
More extensive techniques are usually required as a result of further ageing. True 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 shortcuts, 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 or 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 look from a facelift is the result of an unsatisfactory aesthetic that is an unnatural 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 shortcuts with the surgical techniques 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.
For the reasons above, Dr De Silva does not recommend the weekend facelift.
How long a facelift procedure lasts is dependent on several factors: The technique, additional procedures, environmental factors and genetics. Dr De Silva’s preference is to use deep plane facelift techniques in suitable patients who are considered to last for a longer period of time.
Thread-lifts, mini-lifts, 1-hour facelifts and other similar procedures often have a much shorter duration of between 6months and one year. Dr De Silva does not advise patients to have these quick techniques as they do not give good long-term results or reach patient expectations.
Used in conjunction with facelift surgery, it will enhance the effectiveness and longevity of the surgery. Fat transfer to restore volume loss and skin resurfacing to restore sun-damaged skin are two common procedures that will enhance the facelift procedure.
These will speed up facial ageing and reduce the longevity of a facelift include smoking, sun exposure, poor nutrition and stress.
Genetic and Ethnicity
Both influence facial ageing and longevity of a facelift, a useful indicator for genetics is looking at how your parents have aged relative to their peers.
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 results, 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 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 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 procedure lasts is dependent on several factors: The facelift technique, additional procedures, environmental factors, and genetics.
Surgery generally lasts for 5-8 years, depending on the factors above.
A person who has undergone a facelift will always look younger, however, with time to maintain that look additional treatment 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 (smoking, sun exposure, poor nutrition and stress) and genetic factors.
Age itself is not an accurate indicator for facelift surgery. Most 40-year olds would not have the indications for surgery. 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 surgery more significant is your general health and level of fitness. Dr De Silva finds from his experience, taking into account the steps above, patients in their 70’s and 80’s can have a good rejuvenation from surgery.
When completing 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 surgery are important to place to ensure they are discrete and difficult to see. Dr De Silva hides the scars in your natural hairline and 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 surgery can include wide visible scars on the face, elongated pixie shaped ears as well as the loss of hairs or stepped patterns in the hairline, these results are avoidable by using specialised surgical techniques and meticulous attention to detail.
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 these 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 they 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 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 are partly removed. As part of facelift 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 12 months, 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.