After the incision in the skin is completed, a subcutaneous flap is developed that enables the lax skin to be taken up and the face to be lifted.
The flap is continued from the incision anteriorly towards the cheek and lips as shown by the dotted blue line above, anatomical landmarks include the zygomatic arch, parotid gland, lateral canthus and lateral commissure and the mandible.
At this time it is key to release deep facial ligaments that tether the skin to the bone that has the potential to reduce lifting, care is required to preserve the functioning of the delicate underlying structures including the facial nerves and muscles. Dr De Silva takes meticulous attention is paid to the creation of the flap and haemostasis to reduce both bruising and swelling.
Speedy lifts that take only an hour may only lift the skin; this does not give a natural-looking result as it results in a wind-swept appearance.
The flap is continued behind the ear in the hairline, and care is required to preserve superficial nerves that supply sensation to this area. Dr De Silva is cautious in this area to elevate the skin in a natural arc, so a person can wear their hair up after surgery if they so choose.
Dr De Silva’s technique was devised from the cosmetic centres of New York and Los Angeles that involves a deep plane lift that moves from the subcutaneous tissue, from the SMAS to a deeper facial layer.
This reduces both bruising and swelling and lifts the face at a deeper layer resulting in a more extended period of effectiveness.
Technically deep plane lifting is more challenging as it requires a detailed understanding of the underlying anatomy and facial nerve branching.
Alternatively, the SMAS (Superficial Muscular Aponeurotic System) layer can be elevated, stitched or part of the SMAS removed (SMASectomy), this technique avoids a deep plane lift.
The SMAS is lifted, and the orientation or vector of lift is assessed to give a natural-looking elevation that varies in different people and faces (The vector of lift is shown in the figures above with arrows).
The lift is then supported with deep stitches, Dr De Silva uses long-lasting stitches that help the face during healing for several months. Below and inferior to the ear is a sheet of muscle termed the platysma, Dr De Silva creates a flap from this muscle and lifts the soft tissue to enhance the youthful angle of the neck at the same time as surgery.
In some cases, Dr De Silva uses 3D telescope to enable a more profound lift while preserving the natural anatomy and preserving essential anatomy in the face.