Facelift

Aging and cosmetic surgery

Since ancient times, humans have had an intense desire to look beautiful. We know with certainty that the ancient Egyptians performed certain types of surgery in order to create a particular appearance as early as 2500 B.C. What is less known, is that cosmetic surgery was the first known type of surgery. Cosmetic surgery is a group of operating techniques, which is aimed to correct changes in appearance caused by aging, or congenital deviances.

Signs of aging are inevitable – they often appear sooner on the face than elsewhere on the body and in the mind. At least, that is how many feel. As time goes by, the skin looses its elasticity. Gravity pulls the skin, fat and muscles down. The result is well known: Bags and folds that appear where you least want them, especially in overweight people. In addition, the face muscles are in constant movement, and this naturally creates wrinkles. Creases and wrinkles first appear along the jaw line, under the mouth, on the side of the nose and under the chin. At the same time, the skin of the eyelids stretch, fat bags become more visible and smile lines appear. The sun, wind and temperature swings influence on the changes, and stress smoking and alcohol accelerate the process even further. Several diseases and medications also speed up the ageing process of the face. Many of these signs can be corrected with a cosmetic operation, but the ageing continues. No operation can ”rejuvenate” the face completely.

The facelift is the procedure most people think of when cosmetic surgery is mentioned. During an operation like this, the loose skin of the lower part of the face –the side of the mouth, along the jaw line and under the chin is tightened. Sometimes the muscles are also tightened, and excess fat may be removed.

History

The first attempts to tighten ageing face skin, were in the early 1900’s. The operations were done in strict secrecy. Back then, surgery was associated with saving lives, and operations in order to change the patient’s appearance were out of the question for most surgeons. Thus, facelift surgery was a kind of ”underground activity” until World War II. Eventually it was accepted that movie stars and people in the media underwent such operations. Of course, this attitude held the development back.

For many years, only so-called ”mini-lifts” and simple eyelid operations were performed. Mini-lift means that a piece of the skin in front of the ear is removed and the edges are sewn back together again. This may be effective for a brief period, but the operation had to be repeated rather often. With the development of modern anesthetics, as well as an increasing acceptance of these types of operations in countries like USA and France, cosmetic surgery was developed further after the war. Later, methods used to tighten loose muscles of the face, were developed. Nowadays, the introduction of liposculpture or liposuction, combined with facelift, has improved the method even more. The results are now good and lasting. Thus, it has also become easier to gain recognition for these operations among the common man and woman.

Nevertheless, it was not until the 1980’s that cosmetic surgery really started to get popular. The media’s focus on looking good has been important in this development. New ideals and the increase in prosperity have also played an important role. In particular, the eyelid operations have become common.

1. Who will benefit from a facelift?

Some are better candidates than others are. The ”ideal candidate” is between 40 and 60 years of age, with no overweight and mentally fit. Even more important; the ”ideal candidate” has realistic expectations! It is primarily ”bags” and loose skin that can be stretched. A face with ”Nordic” features is better suited than a relatively flat face. The ideal candidate is a healthy non-smoker, with a varied diet and low medicine consumption.

Those who expect miraculous changes of appearance should not go through with the procedure. Neither do we operate on anyone who is under pressure by someone else or believe that a facelift is the way to solve a marital crisis.

Smokers, who are unable to stop smoking before the operation, run a higher risk of infections. Patients who need Dispril, Albyl and/or other medicine containing acetylsalicylic acid, should not be operated on due to the risk of bleeding. Allergies to anesthetics may sometimes be of hindrance to such an operation. Chronic cough and skin with severe impurity are also not compatible with an operation like this. Mentally unstable patients need to wait until they enter a more stable period.

A few people have diseases that make an operation too risky. Hemophilia and hearth or lung problems are examples of this. We do not operate on people with alcohol problems. Those who know that they form foul-looking, thick scars (Keloid) are also not suited for a facelift.

2. The improvements

The loose skin on the neck, under the jaw and along the jaw line, will be substantially tighter and smoother after the operation. The fold on the side of, or underneath, the corners of the mouth, will usually also be improved. The folds from the nose and down to both corners of the mouth will only be slightly improved. The same goes for the folds on the side of the eyes (”smile lines”).

Pores, fine lines or wrinkles – especially wrinkles from excessive sunbathing, will not be smoothened. The right treatment for such changes, are different types of medical treatment, such as vitamin A acid, dermabrasion, laser resurfacing or chemical peeling. Scars, blood vessels and pigment spots will remain unchanged. A (lower) regular facelift will not affect the forehead, eyelids or lips. Neither will the operation have any effect on loose skin further down on the neck (near the collarbone).

A facelift will not renew the entire face – you will not get a new, unrecognizable appearance. To a certain extent, the operation is rejuvenating. Your face will not become stiff or ”drawn” as long as the surgery is performed correctly. Your facial expression will be as it was before the operation. ”Hollywood lifts”, where the skin is tightened to such an extent that it looks unnatural, are not performed in Norway.

No creams, herbs, exercises, massage or other treatment, can replace a facelift. The type of treatment given by dermatologists will prevent and postpone aging of the skin to some extent, but no miracle cure can tighten loose skin or remove bags. Surgery is the only way to achieve this.

3. When is it best to do a facelift?

It is not necessary to wait until the age has left profound marks on your face. On the contrary, it is better not to wait too long – until deep lines appear. We often get questions like: ”Is it too soon? Am I too old?” The answer is the same: Have the facelift done when you feel that you need one! Most patients, who have facelifts, are between 45 and 60 years of age.

The ageing process differs from person to person. Thus, the need for cosmetic surgery will appear at different ages in different patients. Have you developed bags along the jaw line and loose skin on the neck – something many will feel uncomfortable with – there is no reason to wait. There is no ”the best age”. Some are very particular about their appearance, and they are likely to want surgery even though the signs of ageing are minimal. In such cases, it is up to you to decide whether the desired changes are worth the time, pain and costs. The patient, in consultation with the surgeon, is the only one who can make this decision.

As for facelifts in older patients (older than 65-70 years old), we require that the patient is completely healthy. If the operation is performed on a patient with very loose skin, the patient is likely to want to repeat the procedure sooner than younger patients will.

4. Before the operation

The consultation
No one can be operated on without first seeing the surgeon for a consultation. Sometimes there is a dermatology nurse present during the consultation. The consultation can take place by personal appearance, or it can be done on the phone after we receive photos of your face. The consultation prior to a facelift, usually take about 20 minutes. During this time, you will have a chance to show the surgeon which signs of ageing you want to remove. By stretching the skin of your face with the palms of your hands, you will get a certain impression of what can be achieved. During the consultation, other potential changes will also be considered: such as, whether there is fat that needs to be removed, muscles that need to be tightened, or perhaps loose skin is the only problem. Alternative procedures are also considered. Perhaps you need another type of procedure in addition to the facelift, such as an eyelid operation. Or perhaps a forehead lift is a better approach.

At the end of the consultation, photos are taken. This is no requirement, but photos will enable the surgeon to plan the operation, should you decide to go ahead with surgery. Out of town or foreign clients, may send photos of their faces taken from different angles. These photos need to be of good quality. Along with the photos, you will be asked to send us a form with information about your health and a description of what you want. Once we receive the photos, the consultation can take place over the phone. After the consultation, we encourage our patients to spend some time to think before they decide whether they want to go ahead with the operation or not.

5. Planning

We recommend that the facelift is performed during Winter. This is because the sun can complicate the healing of the wounds. It also feels uncomfortable to wear a bandage around the face on warm days. Medications that contain acetylsalicylic acid (Dispril, Albyl, etc.) and large doses of vitamin E must not be used for two weeks prior to the operation. Cigarettes, snuff and nicotine gum will delay the wound healing and must be avoided for at least the two last weeks before the operation. Patients who smoke more than 20 cigarettes a day must quit smoking at least six months prior to the operation. In addition, there must be no smoking for at least one week after the operation. Avoiding alcohol a few days before surgery and for at least one week afterwards, will help reduce the swelling and the risk of bleeding of the wound. If you have decided to go on a diet, it should be done before the surgery. We do operate on overweight patients, but the result will be much better if you are of normal weight. The operation should not be performed right before or during the first days of a menstrual period. By growing your hair longer, it will be easier to hide the scar. It is important to plan the operation well. Make sure that you have a chance to get plenty of rest the first two weeks after the operation.

6. The day of the operation

Prior to the operation, you will receive a ”To Do” list. This list will contain important information about fasting, washing your hair and make-up removal, and must be followed carefully. Meet well rested on the day of surgery. Some of your hair above and behind your ears will be removed. This will be done by a doctor or nurse at the clinic at the same time as some of the hair is tied up with rubber bands.

The operation is also performed under local anesthesia along with a sedative. The injection of local anesthesia will feel like a sting on the skin of your face. During the operation, you will be asleep most of the time and notice little or nothing of what is happening. An incision will be made around the one ear, and the skin that is about to be tightened is separated from the underlying tissue. If necessary, the face muscles are tightened and fat is removed. Then the skin is pulled, excess skin is removed and the skin edges are stitched nicely together. The surgery is continued on the other side.

The bandage goes all around the head and is to be left on for 4-6 days. It is quite large and may feel uncomfortable, but can be hidden somewhat with a headscarf.

7. After the operation

It is vital that you follow the instructions you have received orally and in writing. For instance, you must not turn your head, talk a lot or chew for the first 4-5 days after surgery. We recommended that you eat only pureed or ”non-chew” food during the first days after surgery. Keep your upper body placed high and avoid any physical or mental strain until the last stitches have been removed. Sleep with your upper body high and preferably on your back the first week.

After surgery, you will spend 8-10 hours resting in one of our clinic beds. The first night must be spent close to our clinic. We recommend that you spend the night in the SAS Hotel right next to us. Remember that you talk to the surgeon or receptions about your accommodation. Out of town patients must stay in the Oslo area for 3-4 days after surgery.

The bandage and stitches in front of the ears will be removed after 4-6 days. Right before the stitches are removed, your hair will be washed. It is best that the hair wash is done in the shower and with assistance. Most clinics prefer to have the patients' hair washed at the clinic.

When the stitches are removed, they are replaced with tape. The remaining stitches in the scalp are removed after approximately 10 days. By then, the bandage can come off. There will still be a few bruises around the mouth and on the lower part of the neck. These can be easily concealed with make up and disappear in a few weeks time.

The swelling that normally occurs in the weeks after the operation causes the fine lines to vanish temporarily. The swelling, which varies from patient to patient, usually disappears in two weeks. All physical exercise and heavy labor must be avoided during the first four weeks after the operation. You can have your hair done by a hairdresser a few days after the stitches have been removed, but avoid strong setting lotions for yet another month. Inform your hairdresser that there is a scar in your scalp!

Apart from the two check-ups after surgery, during which the stitches are removed, there is one 3 months later. Patients from out of town who have difficulties making it to these check-ups, should at least come to the clinic to have the first stitches removed (the check-up after 4-5 days). Then you can have the last stitches removed by your own doctor at home.

The facelift surgery is a procedure that normally causes little pain afterwards. The most painful part is usually the injections of local anesthesia during surgery. Some degree of pain for about 2-3 days is normal, and the same goes for feelings of ”stiffness” and ”numbness” for the first couple of weeks. The numbness in front of the ear may last for many months.

8. What kind of results can I expect?

- is completely dependent on what you looked like before surgery. If your skin used to be very loose and folded along the jaw – perhaps with a ”turkey neck” in addition – then the difference between before and after will be considerable. With moderate changes due to age, possibly in combination with sun damages and moderate wrinkles of the skin, the result will not be as obvious. The result also depends on your expectations. Sometimes too high expectations result in disappointment. That is why it is important to know that the operation is not meant to result in a complete change or rejuvenation. It is more about improvement. In popular terms, the procedure represent a surgical ”restoration”. Often you will get comments like ”how well you look”.

9. Can a facelift be repeated later in life?

We are often asked about how long the result of a facelift will last. As an example, if one of two identical twins are operated on, the one who was operated on will have tighter and smoother skin than the other one for many years ahead, provided that they live in the same type of environment. The difference, however, will gradually become less visible as the years go by. The ageing process will continue with or without surgery. Therefore, some patients will think that another facelift is needed in 5-10 years. This does not mean that the result only lasts a certain period. It more likely means that the patient was pleased with the first operation and knows what to expect from second facelift. We are hesitant to do a third facelift. The reason for this is that the blood vessels may become too visible.

10. The scar

During the consultation, we will explain where the scar will be. It begins in the area above and in front of the ears, continues down in front of the ears and then behind the ears, and ends a few centimeters further back on the scalp. The only visible part of the scar will be in front of the ear. If the incision is made right along the contours of the ear, it will practically be invisible to the naked eye. Should the scar become visible, it can be covered up easily with a lock of hair or with a concealer. Those who form visible scars usually know this beforehand and may want to decide against doing the facelift.

In all cases, the scar will appear reddish for a month or two after the operation – longer in rare cases. During this period, the scar can be hidden with a concealer or by changing your hairdo. Scar formation in the face after cosmetic surgery is not a problem for Nordic people with fair skin.

11. Possible complications

The most common side effects of facelifts are reduced sensation of the facial skin and unevenness of the skin. The numbness may be permanent in the area right in front of the scar, while larger areas with numbness are very uncommon. As mentioned before, it is normal with numbness during the first couple of months.

Occasionally, tiny spots if pigmentation may appear – they look like the ones that appear after long-lasting exposure to the sun. Some loss of hair right above the ear may occur, but the hair usually grows back in a year or so. There may be unevenness of the skin under the chin when large amounts of fat have been removed. These irregularities may appear as thin lines or small pits in the skin. However, they will be hardly visible.

About 2 % of all facelifts will result in hematomas under the skin. The symptoms are pressing pain and swelling. The blood can be removed with a syringe or by removing a couple of stitches, and it will not make any impact on the result. Some skin loss may occur near the scar, especially behind the ear of patients who smoke. It appears as a graze, which takes a few weeks to heal. In such cases, the scar may be a little wider, but the hair will cover it.

Another, rare complication is an allergic reaction to the anesthetics.

In our experience, complications after facelifts are a lot less likely to happen if the surgeon is experienced with this type of operation.