Dr.Shehab Beg

Facelift

A facelift is the most comprehensive approach to treating facial wrinkles and sagging caused by aging. The surgery varies in range from minimally invasive ‘lunchtime lifts’ to more extensive, sophisticated surgery. A facelift removes excess skin, tightens underlying tissues and muscle and redrapes skin on the face and neck. It can correct midface sagging, marionette lines, jowls and a double chin, maintaining its reputation as the ‘gold standard’ for facial rejuvenation. Every year, thousands of people undergo successful facelift surgery and are pleased with the results.

WHAT DOES IT TRY TO ACCOMPLISH

Makes the face and neck look younger by removing jowls, wrinkles and spare skin. Can be combined with blepharoplasty and dermabrasion to the lips.

HOW IS IT DONE

The skin of the face and neck is pulled upwards and backwards. At the same time fatty deposits under the chin and along the jaw line can be removed and the muscles tightened. If indicated the cheeks can be filled out to give a more round and youthful look.

HOW LONG DOES THE OPERATION TAKE

Two to three hours.

HOW LONG IS THE STAY IN THE CLINIC

Maximum of three nights

TYPE OF STITCHES

Thin plastic stitches in front of the ears and silk stitches in the scalp

HOW LONG ARE THEY LEFT\ IN

The ones in the front of the ears come out at three days, the others are removed at two weeks, usually at your post-op appointment.

TYPE OF DRESSING

Bulky padded bandages

HOW LONG IS IT LEFT ON

Two days

BRUISING

Can be very severe, but usually is not

SWELLING

Very variable, but there is nearly always swelling below and in front of the ears

PAIN

Not usually painful, but there is a tight feeling at the back of the neck and neuralgic sensations in the neck are common

WHERE ARE THE SCARS AND HOW BAD ARE THEY

Mainly hidden in the temporal scalp and behind the ear, but there will be a fine line in front of the ears. The hairline will be a little further back after the operation.

HOW LONG DOES IT TAKE TO RECOVER

Two or three weeks

WHEN IS THE FINAL RESULT

Six weeks

HOW LONG DOES IT LAST

Permanent, but aging continues and therefore the wrinkles will form again with time

COMMON COMPLICATIONS

If bleeding occurs post-operatively the bruising and swelling will be much worse than usual. The wound behind the ear can take some time to heal, a problem encountered more often in smokers. The skin in front of the ears will be numb in most cases and this lasts for several months.

Your surgeon must be properly qualified to do the operation and he will advise you what can and what cannot be achieved in your case. Do take that advice. Dr. Mirza Shehab Afzal Beg is a British trained plastic surgeon possessing the highest qualification of Plastic surgery in UK i.e. FRCS (Plast) which no other surgeon currently practicing in Pakistan has. He has also worked as a Consultant in Plastic Surgery in UK. On his return from UK he is based at Liaquat National Hospital and is also a honorary consultant at Aga Khan Hospital. He has his cosmetic surgery and hair transplant set up at Clifton, Karachi.

Problems of the aging face (Face Lift)

As part of the ageing process, which happens to us all sooner or later, our skin progressively loses its elasticity and our muscles tend to slacken. The effect of this process on the face is to cause the folds in the smile lines to deepen, the corners of the mouth to droop, the jaw-line to sag and skin of the neck to fall into loose folds. Around the eyes, the eyebrows droop and skin in the eyelids gathers in loose folds. In the skin itself, fine wrinkles develop especially on the lips and lines of expression such as frown lines and forehead creases deepen. The rate at which this happens varies from one person to another and is probably determined by our genes. Whilst most people accept these changes in appearance, some people, for various reasons become self-conscious of them and, as a result begin to lose self-confidence.

Substantial weight loss in people who have been excessively over-weight can produce similar changes in facial appearance to those of the ageing process.

What can be done?

There are several operations that can be done to rejuvenate the ageing face. This fact sheet deals with the operation called FACELIFT (or RHITIDECTOMY) which is designed to correct the loose skin of the neck, the sagging jaw-line, the drooping corners of the mouth and the deeper smile lines. For further information on other operations you should read the other factsheets e.g “THE WRINKLES ON MY FACE AND LIPS” which deals with chemical peeling, dermabrasion and filler injections.

“MY FROWN LINES AND FOREHEAD CREASES” which deals with the operation called Brow Lift and Botox injections, “MY EYELIDS LOOK BAGGY” which deals with the operation called Blepharoplasty.

One or more of these operations can be combined with a facelift and Dr Shehab Beg will be able to discuss with you which combination of operations is best for your own individual problem.

In the FACELIFT operation, the skin is cut on each side of the head starting above the ears well behind the hairline, running down to the top of the ear, then in front of the ear where it joins the cheek, then round its lobe and up in the groove behind the ear and then backwards into the hairy scalp. The approximate course of this incision is illustrated in can be described to you by Dr. Shehab Beg. -The skin of the temples, cheeks and neck is freed like a sheet from the muscle-like tissue which lies underneath so that it can be tightened upwards and backwards. Surplus skin is cut away so that the tightened skin fits precisely to the shape of the original incision to which it is then stitched. Quite often, the layer of muscle-like tissue which lies underneath the skin is also treated in a similar way to give a more lasting result. If there is a problem of excess fat underneath the chin it can usually be cut away or sucked out during the operation.

What are the consequences?

This is a good operation to eliminate the ageing features which are caused by loose and inelastic skin. It lasts well in contrast to the so-called “minilift” in which a pleat of skin only is removed with the result that the sag usually returns within a matter of months. After face lift procedure one is left with scars which are mostly hidden within your hairline above and behind your ears. Where the scar lies in front of your ears, it is fine and, once it has lost its initial pinkness, it is usually hardly visible. Because hairless skin of the face and neck moves upwards, you will find that your hairline starts higher up after the operation both in front of your ear and behind your ear. If you are a man, your bearded skin will lie closer to your ear and extend backwards below your earlobes. You will have temporary bruising which should fade completely within 2-3 weeks. You will also find that your cheeks and neck feel rather numb and stiff for several weeks.

What are the limitations?

A face lift has no effect on fine creasing of the lips which, if a problem, would need treatment by either chemical peeling, dermabrasion or filler injections (see above).

Obviously, the rejuvenating effects of a facelift will not last forever. The ageing process will continue after the operation and your skin will continue to lose its elasticity. The operation will not make this process worse and you will always look younger than your real age. However, if your ageing features return sooner rather than later, for example if you put on a lot of weight and then lose it, the facelift operation can usually be repeated.

What are the risks?

Generally speaking, this is a safe operation and the risk of complications is low. But you should.

take notes of the following:

BLEEDING from a broken blood vessel is rare and may require you to go back to theatre to block the. Small leakages of blood occur more frequently and show up as slight THICKENING under the skin.

They usually absorb naturally but occasionally need to be drained.

INFECTION is extremely rare and is treatable with antibiotics.

Very rarely a NERVE which is responsible for moving part of the face can be damaged to cause paralysis of the affected muscle.

When this happens, the nerve usually recovers over a period of months

It is possible for some of the skin to die off if its CIRCULATION is impaired by the tension of the lift. It usually heals but leaves a wider scar and possible a bald patch if the hairy skin of the temple is affected. This can however be corrected very easily.

PATIENTS WHO SMOKE CIGARETTES ARE PARTICULARLY AT RISK FROM THIS COMPLICATION

Some patients have an inborn tendency for scars to stretch and some people form scars which stay thick, red and irritable for a long time. The risk of poor scarring on the face is small. There may be a narrow strip of hair loss along the line of the scars in the scalp.

What you should do before your operation?

If you are overweight and you intend to lose it, you should do so before your operation. Preferably, patients should be some 4lbs below their normal weight at the time of surgery since this allows the surgeon to remove more skin and thereby achieve a more pleasing result. It is wise to stop taking the contraceptive pill six weeks before and use an alternative method in order to reduce the risk of thrombosis in your leg veins. The same applies to Aspirin and Asprin-containing tablets which increase the risk of bleeding. If you smoke, you should stop now and it is wise to cut down on your alcohol consumption.

Have your hair permed and tinted if you wish before your operation as fresh scars are sensitive to these chemicals. The night before your operation you should thorougly shampoo your hair.

What you should expect at the time of your operation?

You will need to be in hospital for one or two days. The operation may be done either under general anesthetic or local anesthetic with sedation. It is not a painful operation; more uncomfortable due to the tightness of the .dressings and than effects of the operation. The. _ dressings are usually removed after 2-3 days.

What you should do after your operation?

You should remember to keep your head upright and sleep propped up in bed for the first few days. You should also try and avoid moving your head too suddenly from side to side so that you do not put unnecessary strain on your stitches.

On the 3rd or 4th day after your operation you can start washing your hair with a mild shampoo and blow-dry it very gently. This will make you feel better and make it easier for you to have your stitches removed between 4-10 days after your operation.

When shampooing, avoid hanging your head down. You should be able to visit your hairdresser after three weeks and there is no reason why you should not have your hair tinted at that time provided the scars are completely healed.

You can wear make-up on your face after four days in order to hide any discolouration or bruising but you MUST keep it away from your stitches. It is advisable for you to take two weeks off work. This will also ensure that bruising and swelling will have disappeared before you resume your normal lifestyle.

Making up your mind?

There is no “best age” to have a facelift. If you are self-conscious of a sagging appearance to your face or you dislike the untidiness of loose skin in your neck and you are prepared to have an operation, then certainly you should visit and discuss the question further with Dr. Shehab Beg whatever your age. Do remember however that we are talking about an operation which takes 2-3 hours to do.

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