Written by Dr Julian De Silva
One of the most frequent indicators of facial ageing are changes in the neck. The appearance of vertical bands in the neck and fullness below the jaw are common signs of facial ageing.
Lifting of the neck restores the sharp angle between the jawline and neck associated with youth and removes the unsightly vertical bands in the neck.
Ageing of the face is characterised by three key changes, loss of volume of the fat and soft tissues in the face, gravitational descent of facial soft tissues and laxity of the skin. For some patients, the majority of the changes are in their neck as a combination of facial ageing and often genetics.
A neck lift in London can improve your jawline, restore a youthful angle to your neck and remove loose skin and fullness. Many patients can result in a better neck than they had even in their thirties.
Key to natural-looking results is an artistic and anatomical understanding of these three elements, so the elements of facial ageing can be rejuvenated naturally.
With neck lift surgery in London, Dr De Silva’s philosophy is that there are three important aspects of facial surgery:
Each of these aspects we have refined and improved to give you a smooth experience and recovery. A great looking neck lift requires a balance of respect to a patient’s genetic makeup surgical technical excellence and the surgeon’s artistic talent.
Dr De Silva has developed a signature neck lift that incorporates his artistry. Dr De Silva customises every neck lift to the patient’s facial characteristics and often will use complementary treatments to improve his patient’s results and enhance their recovery. Some patients can benefit from a smaller procedure limited to one-hour; other patients may need a combined facelift for the best result.
Many patients come to see Dr De Silva, as they are concerned about looking too different and want to have a natural rejuvenation with hidden scars and a fast recovery.
We have also seen media photographs of celebrities who look quite different from their youth and a natural-looking rejuvenation is important for most of my patients. Having a facelift or neck lift surgery is a “big” decision for many patients as it is a choice to undergo surgery.
Dr De Silva has respect for each person’s decision and provides a personalised evaluation and treatment options to enable you to make an informed decision about undergoing surgery.
This begins with a consultation to discuss the changes that you have noticed, the expectations you would like to see for improvement and a discussion regarding recovery and potential risks.
There is a large spectrum of techniques to improve the shape of the neck; the key is customisation to an individual person’s needs. Procedures include:
Immediately beneath the skin of the neck is the platysma muscle, this muscle forms a sheet in the neck that extends from the collarbones up to the jawline.
A common sign of facial ageing is vertical bands in the neck that result from the separation of the platysma muscle.
Ageing of the neck results in the appearance of these vertical cords and herniation of soft tissue below the jaw.
Natural-looking facial surgery requires a restoration of the natural neck angle between the jaw and the neck and repair of the platysma muscle.
Treating the neck is one of the most difficult aspects of facial plastic surgery, many revisions that we see are difficult cases where the natural planes and elevation of tissue has not been respected.
We see a number of unnaturally pulled vectors or directions in the neck, so the vector or direction of elevation is very important.
Dr De Silva, a London neck lift specialist, places importance on establishing a smooth jawline as one of the most important aspects to an excellent result while avoiding the pulled tight look.
The vector of elevation should be parallel to the jawline in the front and at a slight angle towards the ear in the back to avoid puckering at the post-ear and achieve the most natural outcome.
The aim of the neck lift should be to get a distinct jawline along the mandibular bone, with a sharp angle to the neck.
The area may be filled with a layer of fat, which may be amenable to soft tissue reduction (including fat); alternatively, Dr De Silva will directly sculpt and stitch the soft tissue layer under direct visualisation.
Neck lift surgery requires repair of the neck muscle that results in vertical bands in the neck with age and restoration of the sharply defined angle between the jawline and the neck associated with youth. Often elevation of the soft tissues of the neck results in excess skin that requires removal.
Dr De Silva hides such incision behind the ear to avoid visible scars while giving the best possible neck profile. Elevation of the skin alone in older techniques leaves stretched scars that are the hallmarks of surgery, Dr De Silva takes meticulous attention to elevating the tissues beneath the skin to enable scars to heal better free of tension.
Dr De Silva focuses on lifting the neck to restore the natural shape of the neck and restore the definition between the jawline and the neck. The anatomy of the neck is intricate with layers of muscles, blood vessels and nerves.
Elevation of the neck requires maximising the lifting of the neck that has descended with facial ageing and gravity. The vessels in the neck are important as they provide the blood supply to the head and neck.
The platysma muscle is like a sheet that extends from the collar bones (clavicle) to the jawline, with facial ageing this muscle often becomes floppy with bands. The platysma can be seen in the figure below:
Dr De Silva infiltrates the neck areas with a highly diluted local anaesthetic solution to reduce bleeding and numb all areas of the neck. Incisions are hidden under the chin and immediately behind the ear.
Key to the surgery is addressing the thin platysma muscle that becomes lax in the neck, often resulting in vertical bands running down the anterior part of the neck. The edges of the platysma muscle are identified through a keyhole incision in the neck; the muscle is sculpted and stitched together to smoothen the neck contour.
The soft tissue under the chin requires elevation with a combination of sculpting and refining the soft tissues and including accumulated fat.
A neck lift in London requires suturing of the platysma muscle in the midline of the neck to restore and support the neck. Dr De Silva uses a specialised double imbrication technique to maximise the tightness of the neck, to give the best support possible against gravity and the longest possible result.
Dr De Silva tailors neck lift surgery in London to the individual and their facial anatomy. Heavy neck and subsequent tissues require additional techniques and sutures to lift the neck and support the neck against gravity.
Patients who are not good candidates for an isolated neck lift are those with extreme skin laxity and with soft tissue that is present over the jawline, termed jowls. These signs of facial ageing are suited to a combined technique that includes both face and neck lift surgery.
Dr De Silva utilises the latest innovations in surgical techniques to improve the results of neck lift surgery. These include the use of fibrin tissue adhesives in patients that have increased risk of bleeding; this works to reduce bleeding by triggering the clotting cascade.
Dr De Silva may suggest the use of additional procedures to enhance the result of a neck lift. The position of the chin in relation to the jaw and lips is an important consideration. Small chin results in weakness of the lower third of the face and chin augmentation at the same time as the neck lift surgery will enhance the result.
The images on the left are taken from Dr De Silva’s forthcoming book on Facial Cosmetic & Plastic Surgery, the sequence of figures show the principles of neck lift surgery only, no two people have identical changes, Dr De Silva tailors the neck surgery to the individual person depending on factors including gender, age, skin & soft tissue laxity.
Patient safety is of key importance for all facial plastic surgery. The intricate anatomy of the face requires precision and care.
Dr De Silva is a keen advocate of patient safety and has championed the need for patient safety on Sky news and medical conferences.
Many of our patients are very nervous and have not undergone previous surgery. We take a great deal of time to ensure we provide both emotional support before and after surgery.
Our aim is to provide the best possible experience and to foster a long-term relationship with our patients to provide ongoing care for years to come.
Please read about some of the glowing patient experiences with us. Dr De Silva has hand-picked each and every staff member not only for their expertise but their expertise and clinical skills, also for their approach, communication and personal skills.
Our proposal is to give you a choice to have surgery within a safe environment, with the care each person would like to personally receive, performed by Dr De Silva and supported by his team.
We are constantly refining the model to give each patient the best experience possible
Most patient’s recovery after a neck lift is rapid, and patients return to normal activities after one to two couple of weeks, however, everyone’s journey is unique to them.
Everything in life, including surgery, is an emotional experience, and for some patients, the recovery may be longer.
We have a supportive and empathetic team that will continue to guide every patient through their recovery.
Dr De Silva has published over 30 journals, and book chapters in peer-reviewed journals and several randomised control research studies, regarded as the gold standard in medical research.
Dr De Silva has published several books on facial surgery and has the complete guide to facelift and neck lift surgery for publication next year.
A neck lift is regarded as a challenging cosmetic surgery procedure and requires in-depth knowledge of the anatomy and attention to detail. One of the most important factors responsible for the success of surgery is the surgeon.
In Dr De Silva’s hands, complications are uncommon, but some swelling and bruising are the most common aspects of recovery. Pain or discomfort is uncommon and resolves within 24-hours. Infection is rare, and the gold standard is prophylactic antibiotics to protect against infection.
Dr De Silva avoids the side effects of general anaesthetic (deep vein thrombosis and allergies) by using safer sedation anaesthesia.
Two rare and serious complications are skin necrosis (delayed healing of the skin) and stretching of a motor nerve (recovers over a 6-month period).
Some other possible risks of neck lift surgery may include:
Dr De Silva takes multiple levels of precautions to avoid these issues in the first place. Although Dr De Silva advises all patients, they must stop smoking; we have utilised advanced oxygen therapy and regenerative medicine to heal the body where this has not been possible.
Although there is no surgeon completing neck lift that has no revision cases, measures can be taken to make these minimal by using the most advanced techniques. Over 20% of Dr De Silva’s patients have had surgery elsewhere.
There are genetic factors that can result in excessive soft tissue (including fat) beneath the jawline and laxity in the platysma muscle that is not improved by weight loss, and this can result in a poorly shaped jawline and neck appearance at a relatively young age 20s-30s.
Weight loss will have an effect on improving the condition of your neck as there is fat that can accumulate under the neck.
However, with increasing age (over 40) there is reduced natural elasticity in the skin, and weight loss can result in loose skin below the neck. Loose skin cannot be effectively treated non-surgically and requires a surgical procedure to give a natural-looking rejuvenation.
Ageing changes in the neck including vertical bands in the neck, skin laxity and soft tissue changes below the jawline are not effectively treated with non-surgical methods and require neck lift surgery to give a natural-looking rejuvenation.
Non-surgical treatments, including the use of hyaluronic acid fillers, can be used to treat early soft tissue changes along the jawline (termed jowls).
These non-surgical treatments may be effective short-term in the early stages. The limitations with non-surgical treatments are with increased laxity of the skin, excess soft tissue below the neck and vertical bands in the neck (laxity in underlying platysma muscle).
Wrinkle injection has been used to treat platysma bands in the neck; it does have limitation in that it is only effective for early bands, relatively short duration of 4-6months and ineffective to treat skin laxity.
Fat-dissolving medicines have limited effect in the neck; often, they require multiple treatments and are painful. There are less effective than fat reduction and neck tightening stitches in most patients.
Radiofrequency or ultrasound devices (Ultherapy) to tighten the neck tissues have some effect, however usually a modest improvement and relatively short duration.
The changes described above, including vertical bands in the neck, skin laxity and soft tissue changes below the jawline are not effectively treated with non-surgical methods and require neck lift surgery to give a natural-looking rejuvenation.
Wrinkle injection is a muscle relaxant that can be used to reduce the neck platysma muscle contracting. The platysma muscle is a thin sheet-like muscle under the neck skin that with facial ageing becomes lax and results in vertical bands.
Anti-wrinkle injections are a neurotoxin that weakens the platysma muscle from contracting.
Non-surgical treatments including the use of Wrinkle injection have been used to treat platysma bands in the neck; it does have limitation in that it is only effective for early bands, relatively short duration of 4-6months and ineffective to treat skin laxity.
The limitations with non-surgical treatments are with increased laxity of the skin, excess soft tissue below the neck and vertical bands in the neck (laxity in underlying platysma muscle).
With these characteristics, a surgical neck lift procedure is required to give a natural-looking and long-term rejuvenation.
Most patients are able to return to social and professional activities after one to three weeks. The truth is that recovery after facelift and neck lift surgery does depend on several factors.
Swelling is the main aspect of healing after facelift surgery, and by 2-weeks after surgery, 80% of the swelling will have resolved. Although the swelling will continue to resolve, most resolves by six weeks. The final result when all of the swelling has resolved can take as long as a year.
Most patients have minimal bruising that resolves over 1-2 weeks. Occasionally, less than five per cent of the time, there can be a marked bruise immediately below the eyes where the skin is very thin, this bruising can take 6-weeks to go, though it can be covered with makeup 1-week.
There is numbness around the ears and chin in the recovery period; this continues to improve over the first six weeks, although it can take 6-12 months to disappear completely.
In terms of pain, there is surprisingly little, and usually for less than 24 hours. Oral analgesia is adequate for the first day after surgery, and many of our patients never take any analgesia.
The position and shape of the scar can be camouflaged around the natural curves and lines behind the ears, and under the chin, they reach their final endpoint 6-12 months later.
They are discrete and generally difficult to see after a few weeks; there are steps that can be taken to speed up their recovery and soften their appearance. One week after surgery, they can be covered with concealer makeup for social activities.
Most can be restarted after 2-3 weeks; there may be some residual bruising and swelling; generally, this can be covered up with concealer. On average, at 2-weeks after surgery.
With an important event such as a wedding, you should allow 6-weeks as a minimum to allow the majority of the swelling to have resolved.
As a general rule three weeks.
The type of surgery you have influences your healing; not all facelift is the same. Factors influencing healing included whether the surgery is principally mini-neck lift surgery, revision surgery, ethnicity, fuller neck and the use of associated techniques.
The techniques your surgeon employees to complete the surgery. Dr De Silva performs conservative surgery that limits trauma to the natural anatomy, and where appropriate innovative techniques to speed up the recovery process.
Dr De Silva has pioneered the use of regenerative medicine (utilising our own growth factors) to heal the body faster; we are committed to providing our patients with the latest advancements from scientific research.
Some people have ‘sagging’ necks primarily due to fat accumulation under the chin and jawbone. In some people, with good skin elasticity, controlled removal of this fat (termed neck or double chin fat reshaping & reduction) can be used to improve the neck appearance, by reducing the soft tissue beneath the chin.
Dr De Silva carefully assesses his patients’ neck for suitability for fat reduction, as there are specific shapes of neck and skin quality that will benefit from this procedure.
Dr De Silva does not use body techniques (including traditional liposuction and ultrasound-assisted Vaser techniques) and uses a specialised micro-cannulae (fine) technique that enables finer control and natural shaping of the neck contours.
The benefits of this technique over a neck lift is surgery with hidden incisions avoiding visible scars and relatively short downtime and recovery. In most individuals, the benefit of fat reshaping and reduction can be seen in a few weeks though the final result will be after a 6-12-month period.
There are many prescription and herbal medications that should be avoided both before and after surgery, as they can encourage both bruising and swelling.
Dr De Silva and his team give comprehensive advice to all his patients on what should be avoided before and after surgery. In addition, there are some herbal medications, such as arnica, that should be taken to reduce bleeding, Dr De Silva provides his patients with a specialist herbal medicine than enhances recovery.
Icing around your face and neck for the first three days, in the form of ice in a zip lock bag, frozen peas or gel mask all have a beneficial effect on reducing swelling when applied to the area for ten minutes regularly after surgery.
There are other factors such as resting and taking things easy during the daytime that will maintain relatively low and stable blood pressure.
Keeping your head elevated when sleeping will also reduce bruising and swelling.
There can often be some lumpy-bumpy changes soon after fat reduction as part of the healing process; there is often some uneven swelling that settles down with time. In the majority of people, the unevenness improves over a period of weeks, although it may take as long as 6-months.
In the period soon after surgery, MLD, manual lymphatic drainage by a professionally trained specialist may be beneficial in helping the process.
The earliest time to consider any further surgery is 6 to 12 months after surgery, although assessing the healing after the surgery will give information on how the area is healing.
Although all of us like to get to the final endpoint faster, early intervention with further surgery is generally not recommended as this can lead to further lumpy, bumpy changes.
The body will naturally heal bumpy areas, and early intervention will not necessarily improve the final result.
Dr De Silva frequently combines neck lift surgery with other facial procedures to give a natural-looking result and avoid the use of scars associated with conventional techniques:
Accusculpt technology uses a laser to reduce fat and in principle is similar to fat reduction.
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 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 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.
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.
Facial cosmetic surgery rejuvenates the soft tissue descent to its site above the jawline and tightens the lax skin.
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
– Blepharoplasty
– Laser resurfacing
– Facial implants
– Rhinoplasty
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.
Other Treatments
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
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.
Additional Procedures
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.
Environmental Factors
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.
Dr De Silva teaches facelift surgery to other international surgeons every year. Teaching has always been a passion, and Dr De Silva has been the lead course director for an international facelift course annually since 2016.
Dr De Silva teaches on Advanced Facelifting Techniques at the 43rd Annual ASOPRS Scientific Symposium in Chicago, IL, USA.
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and in natural looking results
