Face-Lift

The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity. There is no need to wait until hanging folds or almost irreversible changes have taken place. While the facelift procedure is probably the most sought after within the over 40's group, increasingly these are being carried out on younger patients. In fact these days, many patients prefer earlier corrections to maintain youthful appearances, and therefore avoid living through a period of looking "old and tired".  Although the occasional film star may undergo a celebrated facelift, the vast majority of patients are those normal people who take pride in their appearance and feel younger than they look.

A facelift has always been regarded as a major surgical procedure, but in reality need hold no fears. It is important to remember however that surgery cannot erase permanent creases, particularly around the lips and mouth, and that it does not stop the ageing process. A facelift just "sets the clock back"; it does not stop it running.

At the time of consultation  Mr. Karidis will ask you about your general medical history, specifically pertaining to any medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or a tendency to form excessive scars. Slight differences in facial symmetry are normal and will be pointed out as many times these are unnoticed by the patient.  It will also be explained that certain areas of the face cannot be helped by surgery, such as the lines around the mouth, frown, and crow feet region. The newer skin resurfacing lasers, fillers and peels covered under separate notes best deals with these areas.

If you are a smoker you will be asked to stop smoking well in advance of surgery as well as for a period after the operation(generally 4 weeks before and 4 weeks after) . Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing.  Aspirin and certain anti-inflammatory drugs and other medications (discussed in DO'& DON'TS section) can cause increased bleeding, so you should avoid these.

If you're contemplating facelift surgery, this information will give you a basic understanding of the procedure. It can't answer all your questions since a lot depends on the individual patient. However, any specific questions should always be addressed at the consultation.

Over the years the classical (skin only) operation has undergone a number of modifications to improve the overall results. These modifications were aimed at lifting not only the skin but also the underlying structures (i.e. muscles or SMAS), which were equally subjected to the effects of the ageing process. By addressing these structures, the face could be lifted to enjoy a longer lasting effect.
The SMAS type of lift is that favoured by many competent surgeons although there are now many variations such as the, extended SMAS lift, Composite Lift and Sub-periosteal Lift. Each of the above modifications can be tailor made to suit individual needs. It is equally important to remember that different methods do not indicate a departure from any formally established standard, as there is no- one standard. Many times liposuction is carried out during a face-lift so as to ensure that the neck and jawline is clearly defined.

More recently there have been newer 'mini' techniques that have been popularised such as the MACS lift, S-lift and thread lifts. These have been devised with the aim of minimising scars, extent of surgery and to generally shorten recovery times. While these techniques may have some place in patients with very early ageing signs, most have limited spectrum of facial improvement and probably don't last as long. Of course, it's a great deal for the surgeon - lots of repeat business - but not such a great deal for the patient. Because if you keep pulling on the skin, before long your face looks over stretched, giving you that "facelift look."

Generally speaking  Mr. Karidis feels that 'less' will always be 'less', and that the effectiveness, and longevity is always compromised with these more minimal techniques. 'Mini' techniques or surgery generally gives you 'mini' results. Our practice viewpoint is that if you have decided to subject yourself to surgery to address any ageing aspects of your face, then you should not really look at the immediate short term, i.e. very quick recovery and minimal swelling, because 3 or 6 months later, you will more than likely be disappointed with your decision to 'cut corners'. Unfortunately, a facelift is like everything else in life. If you want more out of it, you have to put more into it - meaning, you have to be patient with the recovery period. But our advice for looking your best over the long haul is to do a facelift LESS OFTEN and MORE THOROUGHLY.

It is impossible to answer this or generalise, as each individual has different skin quality and texture. A surgeon relies on the quality of your tissues afterwards to help maintain the results of your facelift. If a patients skin has lost a lot of the elasticity within the skin then the facelift will not last as long as someone with better elasticity. Think of it in terms of a rubber band. If a rubber band has been left in the sun, it dries out and becomes more brittle and less elastic. Pulling on this excessively, will result in the band snapping. Obviously a fresher rubber band has the ability to stretch and hold much better than one weathered over time.
Another way to look at the lasting effects of a facelift is to imagine you have an identical twin. Say you have a facelift and your twin sister or brother does not. In ten years from the surgery, although you both will have aged, you will still look better than your unoperated twin will!  So in that sense, the effects from the benefits of the surgery will be permanent.

Occasionally some patients start to panic 4-5 months after surgery because they notice some degree of laxity or loosening appearing in their face and neck, and feel that their face is starting to drop all over again and will become like before. This loosening is normal in the first few months after the initial surgery. This is just the natural settling process that occurs and contrasts with the initial tightening and swelling from the first few days after surgery.  However don't panic. This process does mean that your face will completely drop again. It is just your facial muscles and skin adjusting to the new contours of the facelift.

Of course one must remember that we cannot stop the clock altogether and therefore your face will continue to age with time. Many patients never have a second lift, while others may desire further surgery seven to 15 years later.

In broad terms the incision used for both men and women is the same, although there is a slight difference, as result of the hair bearing nature of the male facial skin. Generally speaking the incision starts high in the temple area (hidden within the hair at this point) then
courses down in front of the ear, round the earlobe and up behind the ear before curving gently back into the hairline of the neck. It may on occasion, be necessary to add an incision in under the chin. Mr. Karidis has modified his facelift technique over the years to both minimise the extent of  the scarring, but at the same time not compromise the anti ageing effects and longevity of the surgery.  He has developed and adopted only those techniques which deliver a highly predictable,  and, above all else:  natural result.

Using the above incisions the skin is lifted forwards onto the cheeks and down as far as the jawline and into the neck. Importantly, the underlying muscles are then lifted accordingly so as to ensure a longer lasting effect. Having repositioned the deep tissues, leaking blood vessels are then sealed with the use of a cautery. Following this, the loose expanded skin is elevated upwards and any overlapping or excess skin is trimmed. The wound is then closed entirely with dissolving sutures. Having modified his technique over the last 10 years Mr. Karidis has also dispensed with the use of drains, which he believes do not contribute in any positive way to the surgery and on the contrary make it more painful for the patient afterwards. A bandage dressing is then gently applied around your face in order to apply light pressure over the wound area.

Watch the procedure in Virtual 3d

Mr. Karidis's prefer to perform  facelifts with a full general anaesthetic although technically it can be performed with a local anaesthetic. This may also depend on whether you will be having extra work done to the eyes or brow area. In general terms, the longer the surgery the better it is for the patient to have a general anaesthetic, so as to avoid feeling any duress or discomfort from lying still for a long period of time under local anaesthetic. Surgery for a facelift can take between 2-3 hours, although this takes longer when combined with additional surgery i.e. eyelid surgery. It can therefore be quite daunting and awkward to lie still all this time under only a local anaesthetic!

Patients need to understand that the post operative period following a facelift can be quite a daunting one. It is not so much a question of pain although the bandages can make it feel quite tight. This is partly due to the bandages and partly due to the muscle tightening that is performed at the time of the surgery. As such even after the bandages are removed your face will still feel tight and will continue to feel so in the first few days, particularly as the swelling starts to set in. As a result of this tightening, you will also feel that you cannot open or close your mouth properly(even though you actually can!) You will initially look in the mirror and probably be shocked that you do not look anything like the fresher better face you were hoping to achieve with the facelift!  In fact you will probably feel you look hideous, swollen, distorted and uneven. During this time, many patients actually hate both themselves and their surgeon for having done this. This is NORMAL!  It will however settle in the next 2-3 weeks and you will once again start to like your surgeon and be pleased with yourself for doing it!
After the bandages are removed, your hair will be carefully washed and you may then return home. Over the next few days your hair should be washed daily with a gentle shampoo, obviously exercising care in the suture area.  As mentioned above all the stitches are dissolving and will not need to be removed. We normally see patients at about 6-7 days afterwards to assess your progress. You will be provided with full postoperative care instructions, which you are kindly asked to follow.

Post Operative Instructions

As mentioned above, following surgery you will experience obvious swelling, lumpiness and bruising of the face to varying degrees, which will last up to 3 weeks.  After this initial traumatic phase, you will continue to have some degree(although much less than before) of lumpiness and swelling in your cheeks and neck area for a somewhat longer period. Occasionally, isolated bruised and hardened areas can take up to four  months to resolve. The appearance of tiny thread veins on the cheeks can rarely occur.  Swelling may produce some temporary lag in the normal motion of the facial muscles but this should gradually subside without permanent change.

You will also experience a feeling of numbness and tension in the neck and cheek areas as well as around the ear. This is a result of the small sensory nerve fibres in the skin being
separated during the operation. Sensation usually returns to normal but may take anytime up to 9-12 months.

Mr. Karidis has modified his technique so that no hair elevation occurs with his facelifts. In men however the beard may be repositioned underneath and behind the ear, as a result of the skin being lifted, necessitating some adjustment of shaving in these areas.

A scar will obviously form at the incision sites. This is always red and slightly lumpy in the first few months following surgery. Of course light makeup applied over the scars in the early phase will help hide them. One must remember of course, it is always impossible to ultimately predict how any individual's scar will appear. However sometimes behind the ears, and rarely in front of them, scars of certain skin types can stretch. These skin types cannot be identified prior to surgery. Often, these can easily be hidden by longer hairstyles but may become visible if the hair is cut short or lifted. Very occasionally a small bald strip can develop adjacent to the scar that is situated above the ear in the temple area.

Although as mentioned scars are unpredictable, the vast majority of patients operated by Mr. Karidis do not experience problems with their scars. As a result of careful planning and meticulous technique, Mr. Karidis aim is to preserve your ability and right to be able to put your hair up comfortably without worrying about your scars in front or behind your ears being visible.

You will experience a tight feeling around your face following surgery as a result of the bandages used. This will be present more so in the first 10 days as a result of the initial swelling which makes the face feel tighter. However it is safe to say that the majority of patients experience a suprisingly small amount of actual pain following a facelift. In fact most patients experience a numb sensation once the bandages are removed. This of course improves with time.

All surgery carries some uncertainty and risk. When a Facelift is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still,
individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Conditions such as high blood pressure, bleeding disorders and smoking increase the chances of complications and therefore will be discussed in greater detail at the consultation.

Complications that can occur with a facelift include a haematoma (a collection of blood under the skin that must be drained by the surgeon), injury to the nerves that control facial muscles (usually temporary and less than 1% chance), infection(less than 1%), delayed wound healing, skin lumpiness, necrosis(skin loss), occasional hair loss in the temple region along the scar or distortion (usually temporary).

Risks such as leg and lung blood clots are rare. Early mobilisation by moving around as soon after the surgery as possible reduces this considerably. Mr. Karidis regularly deploys anti-clotting measures such as special stockings (TEDS) and compression devices (Flowtron)  during surgery to minimise this.

You can reduce your risks by closely following Mr. Karidis's advice both before and after surgery.

In accordance with the National Healthcare commission guidelines, according to the last five years of annual audit figures submitted to the Hospital of St. John and St. Elizabeth in London, Mr. Karidis performed on average  120 facelift procedures  per year. In the last 10 years he has performed over 900 facelift procedures.

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin
may be both tender and numb, and may not respond normally at first. Avoid strenuous activity, including sex, and heavy housework, for at least two weeks. Mild stretching and walking are fine. Above all, get plenty of rest and allow your body to spend its energy on healing.

Remember, at the beginning your face will look and feel rather strange. Your features will be distorted from the swelling, and your facial movements may be slightly stiff and you'll probably be self-conscious about your scars and bruising. It's not surprising therefore that most patients are disappointed and depressed in the first couple of weeks. However you must try to stay positive and understand that things WILL get better! The operation will be worth it!!

From about two weeks after the surgery you can probably get out and about without scaring anybody, however you won't fool anyone either about what you have had done. From the third and fourth week things get decidedly better, with most of the signs of surgery, i.e. bruising and swelling mostly gone. You can therefore start to get around without most people knowing that you've had some surgery. From this point onwards, you'll look and feel much better. You must remember however that for all the swelling to entirely disappear and for you to look entirely 100% normal will take up to six or even nine months. For all intents and purposes however most patients are back to work from about the third week after surgery. Every week that goes by will be slightly better.  If you need it, camouflage makeup can mask any residual bruising that remains. However depending on everyones individual sensitivities some people might feel more comfortable about returning to work after 4 or even five weeks. Remember we are all different and heal differently. Have some flexibility within your anticipated return to work schedule.

The chances are excellent that you'll be happy with your facelift, especially if you realise that the results will not be immediately apparent. In the properly selected individual it is very likely to boost ones self-confidence and self-image.

The results of any properly carried out facelift should be lasting but remember the procedure cannot halt the ageing process. The clock can be turned back but you cannot stop it ticking. However, it is reasonable to say that the reversal in ageing made available to the average facelift patient is undoubtedly successful enough to be recommended as a solution to many of the ageing signs that some individuals find objectionable.