Facelift

With ageing the elasticity and strength of the connective tissue and skin diminishes making the skin loose and wrinkled. Some individual properties and habits, like smoking, drink abuses and heavy sun exposure might accelerate this process of ageing.
A face-lift change the "coating" of the skin like the tailor changes clothes to fit. Excesses are removed but the quality of the "fabric" stays the same. The predisposing characteristics of the face do not change, which means, a face-lift cannot make someone beautiful unless they were so before. A tired appearance, however, can change to a less tired look.

Purposes of the operation: The purpose is to eliminate skin redundancy, stretch muscles and connective tissue and attenuate wrinkles. The quality of the skin can be improved by means of skin-rejuvenating procedures rather than with a face-lift. As the ageing process continues and as the causes of the deformity are multifold, one can never estimate the longevity of the beneficial effect of the face-lift. The operation does on the other hand not accelerate the process of ageing.

Technique: With the endoscopic technique, " button-hole-surgery", different procedures are available depending on the wanted achievements.

Brow lift

When the distance between the eyebrows and the upper eyelashes is short, with or without heavy upper eyelids and when frownlines are marked, a foreheadlift is suitable to raise the eyebrows. Other local operations can of course also achieve this.
The surgery can be done either with endoscopic technique or with the traditional brow lift where an incision is done a few centimetres behind the hairline from ear to ear. If the hairline already is high positioned, the incision is done before it in order not to pull the hairline higher up. With the endoscopic technique 5-6 incisions are made just behind the hairline. The hairline will always be pulled upwards.

Differences between the endoscopic and traditional forehead lift: The lifting effect of the traditional forehead lift is more effective and more stable.

Specific post operative events after a forehead lift: Transient numbness of the scalp. This can be permanent.

Mid face and neck

The endoscopic technique has not yet convincingly made it possible to stretch redundant skin without causing visible scars. The traditional face-lift with a combination of detachment and lifting of the soft tissues of the midface through incisions in the mouth or other combinations is the only alternative for tightening the skin of the face and neck.

Technique: The incisions runs from the temple into natural wrinkles in front of the ear, sometimes turning into the ear-canal, rounding the earlobe going in the crease behind the ear upwards and finally turned into the hair in the neck. The hair is not shaved or cut. The skin is widely undermined over the face and neck and cut, allowing a smooth, firm redraping after repositioning of the sagged tissues in the deeper layers. In cases of fat accumulation, the fat is reduced by suctioning and in many cases, a correction must be directed to visible musclebands on the neck through an incision under the chin. A firm dressing is applied and kept for 24 - 48 hours.

Anaesthetic: Conscious sedation and local tumescent anaesthesia, which is comparable to general anaesthesia.

Operating time: 2-5 hours depending of the complexity of the procedure.

What happens afterwards? (All lifting procedures):

• When the anaesthetic effect subsides there will be a short period with pain for about 40-45 minutes.Otherwise the pains are minimal and only mild painkillers are needed. The bandage can press around the ears.
• The face will swell and the swelling reaches its maximum on the 2nd or 3rd day. It subsides gradually during 7-10 days. Bruises can take a little longer to disappear.
• To accelerate the absorption of the swelling, you should sleep on the back with an elevated head (2-3 pillows) for 14 days.
• Sudden or intense movements with the head should be avoided during the first week.
• You should eat soft food during the first 3 days.
• Car driving is forbidden during the first week.
• The first stitches are removed after 4-5 days and the rest after 8-10 days.
• You can usually return to normal social activities after 10-14 days.
• You can return to physical training after 4-6 weeks.
• Hair dyeing and permanent should be avoided during the first 4-6 weeks.
• The face feels tense for about 4-5 weeks (face-lift).
• The face is numb for about 4-8 weeks (face-lift).
• The hairline is pulled up backwards according to the tightening of the skin.

Complications

Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. As a patient this must be considered before a decision for plastic surgery is set.

Bleeding: Postoperative bleeding can occur after every operation. If there is a significant bleeding the wound has to be opened again. These risks increase by the intake of painkillers or Vitamin E. These medications should be avoided during 2 weeks prior to operation. Smaller bleedings cause bruising and minor scars in the subcutaneous tissues, which will feel like lumps. These will gradually disappear.

Infection: All operations can cause infection, which will need antibiotic treatment.

Nerve Injury: The facial nerve and its branches run in the area but normally in a deeper level. The nerve to the frontal region crosses the zygomatic arch close to the periosteum, which will be elevated during an endoscopic lifting. The proximity increases the risk for damage. Even a totally cut nerve can regain its functions spontaneously after a couple of months.

Skin loss: If blood circulation is impaired (smoking, bleeding, infection, pressure) the blood supply to the thin, loosened skin can be disturbed and cause local necrosis.

Scars: Scars are normally very discrete. Even in persons with a tendency to get hypertrophic scarring on other parts of the body, usually get discrete scarring in the face. The scars behind the ears have a tendency to get somewhat elevated in the beginning. All scars are red for 3-4 months and bleaches gradually. The scars should be protected against sunlight and solarium for half a year.

Hair loss: Hair bearing skin that is elevated will usually have transient thinning of the hair growth. The hairlines are pulled up, backwards according to the stretching of the skin. This is unavoidable.

Smoking: Smoking depravities the blood circulation and has a negative impact on the wound healing. Smoking should therefore be avoided at least 2 weeks prior to the planned procedure and during the healing phase.