Face lift surgery
Ageing of the face is inevitable and driven by genetics, sun exposure, personal habits and the pull of gravity. Over time, the skin and retaining ligaments begin to loosen, and fat pads start to sag on the face and neck. Crow’s feet appear at the corners of the eyes, fine forehead lines become deeper creases and folds, the jaw line softens into jowls, and vertical folds appear at the front of the neck. Face lift surgery aims to improve the visible signs of ageing and create a more youthful facial appearance. Dr Sydney Ch'ng is Sydney's leading face and neck surgeon, who conducts face lift surgery for both aesthetic and functional purposes.
What does a face lift involve?
A facelift is also known as a Rhytidetomy or Meloplasty, and is a cosmetic procedure, specifically designed to rejuvenate and reduce signs of ageing. Dr Sydney Ch’ng regularly performs facelift surgery in Sydney.
The exact face lift procedure will vary for each person but generally,
the deeper layers of the face is lifted
soft tissue including fat is sculpted or redistributed from the face, jowls and neck
occasionally, a large submandibular gland and/or parotid gland is partially resected to improve the jawline
excess skin is removed.
Regardless of the approach to surgery, incisions will need to be made. These will be inconspicuous over time, they are concealed along or within the hairline, and in the natural creases of the face and ear. An incision under the chin, hidden in a skin crease may also be necessary to remove platysmal bands (thin layer of muscle underlying the neck skin) to further improve the appearance of the ageing neck.
A facelift is commonly performed at the same time as a neck lift and blepharoplasty (eyelid surgery). Non-surgical facial rejuvenation treatments are often recommended before or after facelift for best effects.
You need to disclose any past history of facial fillers and threads honestly. Dr Ch'ng will arrange for facial fillers to be dissolved prior to facelift surgery. Facial fillers can cause unpredictable and prolonged swelling and irregularities following surgery.
What to expect following a face lift
Dr Ch’ng performs deep plane facelift surgery, under general anaesthetic in a fully accredited hospital in Sydney. Depending on the complexity and extent of facial rejuvenation undertaken, surgery can take between four and ten hours. Following surgery, a haemostat net (to prevent bleeding) may be used.
Sutures are removed in stages, generally staggered at week 1 and 2. Vigorous activity is discouraged for six weeks. We do NOT use a face lift garment routinely.
Patients may notice some tightness or numbness on the face or neck, which resolves over time. Dr Ch’ng performs facelift and cosmetic procedures in Sydney, to help individuals achieve both cosmetic and reconstructive results. For more information on after care, results, and the procedure itself, get in touch with our friendly team today.
WHEN IS A FACE LIFT PERFORMED?
Facelift For Loose Saggy Skin
A face lift is to rejuvenate and alleviate the inevitable signs of ageing, such as deepening of nasolabial folds, jowls, platysmal bands and blunting of the cervicomental angle. As we age, there is a natural gravitational effect on soft tissues, skin laxity, and bony resorption. These effects can contribute to classic signs of ageing in the temple, cheek, jowl and neck areas.
In the case of ageing or loose skin, a facelift is specifically performed to achieve a more youthful and harmonious appearance. The procedure aims to lift the saggy soft tissue, and reduce the amount of excess skin present, resulting in tighter, firmer, and more toned facial skin. The face shape often becomes less elongated and more heart-shaped.
Facelift After Weight Loss
A facelift may be performed to help remove or redistribute soft tissue from the face, neck, and jowl area, improving overall facial contours. Weight loss can contribute to facial features becoming more gaunt, in combination with loose and excess skin. A facelift (often combined with micro fat grafting) can help to restore a more harmonious facial contour by repositioning tissue.
Facelift for Facial Reconstruction
Dr Sydney Ch’ng may also provide a facelift procedure to restore relative symmetry to the two sides of the face. It may be indicated following facial asymmetry from e.g., Bell’s palsy, cancer resection, previous surgery or trauma.
THE DIFFERENT TYPES OF FACE LIFTS
Deep Plane Face Lift
A deep plane face lift will involve lifting the skin, and superficial musculoaponeurotic system (SMAS) as one composite layer, promoting a lift towards the top of the ear. The technique aims to provide more dramatic and long-lasting results, while also ensuring that the tightening and smoothing of the skin is natural. On the strength of her experience with facial nerve anatomy having performed hundreds of cases of parotid surgery, Dr Ch’ng is very confident with the deep plane face lift technique, and this is her default facelift technique.
SMAS Face Lift or MACS
Lesser and more targeted face lift could be SMAS or MACS face lift.
The superficial musculoaponeurotic system (SMAS) refers to the muscular layers of your face; a SMAS face lift is carried out at a more superficial plane and poses less risk to injuring the facial nerve branches. A minimal access caudal suspicion (MACS) facelift is another lesser variation of face lift, considered to be minimally invasive. Dr Ch’ng can offer these techniques too in select cases.
SMAS Facelift vs Deep Plane Facelift - What's the Difference?
Both SMAS and Deep Plane Facelifts are effective and can reduce signs of ageing – however, they are different procedures and provide different results.
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A facelift is a cosmetic surgical procedure designed to tighten and lift the face and neck skin to create a tighter, smoother and more youthful appearance. People often speak of a facelift procedure being either a SMAS facelift or a deep plane facelift.
While both options can be effective in achieving the desired outcome of reducing signs of ageing, they are different procedures.
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Simplistically, the SMAS is a layer of fibrous tissue that covers the deeper facial structures and plays a key role in facial contour and shape, and facial expressions. With age, this layer naturally loses elasticity and sags with the overlying facial skin and fat. In a SMAS facelift, the facial skin and fat are separated from the SMAS. The SMAS is first tightened, then the skin and fat draped over the tightened SMAS.
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A deep plane face lift is technically more challenging as surgery takes place deep to the SMAS layer, between the SMAS and the muscles that effect facial expression. For the most part, a deep plane facelift does not separate the SMAS from the overlying facial skin and fat. This composite layer – facial skin, fat and SMAS – is dissected off the deeper facial structures, tightened and suspended as a single unit. A key component of the deep plane facelift is the release and re-positioning of the dense ligaments that span between the facial bone and the skin over the cheek prominence and along the jawline. This manoeuvre aims to suspend the facial soft tissue that has naturally sagged from the lower face to the mid face, as well as to create a more defined, clean-cut jawline.
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While a SMAS face lift and a deep plane face lift both aim to make the face appear tighter and more youthful, there are key differences between the procedures.
Technique and Outcome
A SMAS face lift treats the facial skin and fat, and SMAS layer as two separate units, whereas a deep plane facelift lifts the skin and SMAS layer together as one unit. The deep plane facelift procedure takes place in a deeper layer therefore requires a surgeon who is confident with facial nerve anatomy. In Dr Ch’ng’s hands, the deep plane face lift offers more effective (yet natural) and durable results. It is therefore her much preferred technique. It will be very specific circumstances for Dr Ch’ng to agree to a SMAS face lift.
Recovery period
Both procedures require individuals to rest and avoid strenuous activity in the six weeks following surgery. Individuals recovering from deep plane face lifts are required to take at least three to four weeks off from work or social events. A SMAS facelift recovery, depending on the circumstances, can be shorter.
Facelift Recovery: What's Involved?
Most patients return to work at four to six weeks following surgery but the final results from facelifts can take up to nine months to become apparent.
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A facelift procedure is a major surgery; one that requires an experienced surgeon to ensure the surgery is both free from serious complications and achieves the desired results. However, to achieve these results, post-surgery recovery and aftercare is important.
Recovering from a facelift surgery is a process that can take a few weeks for stitch marks, swelling and bruising to subside, and up to six to nine months for the final effects to be apparent. Most patients return to work and social events after three to four weeks. For a major social event, e.g., wedding of a family member/friend, it is advisable to schedule surgery at least three months out. There are steps to take that can make the process of recovery both smooth and efficient. To effectively recover from facelift surgery, it’s important to understand what is involved in the procedure, what to expect during facelift recovery, and how to ensure the best aftercare.
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Of course, recovery from facelift surgery is a continuum, but can be thought of conceptually as different phases/ stages. Waking up from facelift surgery, you may feel groggy and unsteady. Within the first few days following surgery, you will likely feel discomfort (tightness) or pain from the haemostatic net applied to the outer aspect of your cheeks, under the chin and jawline. The haemostatic net keeps the skin exactly where it is intended to be and reduces the risk of haematoma (bleeding). The haemostatic net is generally removed on day 6. A drain is usually not required. Facelift patients generally stay overnight in hospital. It is important to have someone drive you home the next day.
Dr Ch’ng will review you in Recover after surgery and the next morning in the ward to assess pain, incisions, and any swelling. Once discharged on Day 1, you should do light movements around the house. At the Day 3 and Day 4 mark, swelling and bruising may be at their height, however, you should start to feel better. You won't be able to wash your face or hair until Day 6 when the haemostat net is removed. Use facial wipes and moisturiser around the Micropore tape placed in the operating room. Use cooling eye mask 5-6 times per day in the first week to help swelling subside. Sleep on your back on a U-shaped pillow propped up on another pillow. The Micropore tape will be removed when the haemostatic net is removed on Day 6. Following removal of the haemostatic net, you should apply moisturiser over the haemostatic net suture marks. We do NOT routinely advise wearing of a facelift garment.
The first week of facelift recovery primarily involves rest. By day six, you can expect swelling to be significantly reduced, and you will be able to reduce pain medication. You will need someone to assist with home chores in the first week.
You should be on a soft diet for 4-6 weeks after surgery and drink lots of fluid.
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While some swelling and bruising may occur in the face and neck, it will begin to fade after the first week following surgery. During this time, you may feel tingling, numb, or tight sensations in the face which is common and not a cause for concern. The temporary redness and marks from the haemostatic net will start to fade as well but can take up to six weeks to resolve.
At two weeks following surgery, you should begin to feel more energy. You can wash your face and hair in the second week but you should be careful not to over-extend your neck . During your follow-up appointment, your surgeon will ensure you can return to some light exercises, like walking. Most mums feel confident doing school drop-offs and pick-ups in the second week.
As a general rule, the sutures are removed around day 14 (notwithstanding the haemostatic net which is usually removed on day 6). You should start applying silicone gel to the haemostatic net sutures marks and incisions (following suture removal) from Day 14.
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While you may still have some swelling and tight sensations in the face, you will begin to see improvements in your facial contour.
By the fourth week, you should be getting ready to return to work. In saying this, it’s important to be cautious about your incisions and avoid strenuous exercise that may impact recovery. At four weeks, minor swelling, tightness, and numbness may still be present, but should not get in the way of daily life.
During this time, it’s important to be mindful of the incision sites and practice sun protective measures, like avoiding direct sunlight and wearing sunscreen and a hat when outdoors.
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Although most patients can return to their normal activities at four to six weeks with a rejuvenated appearance, it can take up to 9 months to completely recover from facelift surgery. At 9 months, the patient will have approached the final results without swelling, clear incision marks, and unusual sensations, like tightness.
Within the first year of surgery (usually at Week 1, 2, 4 and 6; and 3, 6, 9 and 12 Month), individuals will have follow-up appointments with their surgeon to assess the recovery process and address any concerns or queries. It is not uncommon for Dr Ch’ng to recommend repeating certain minor procedures, like microfat grafting, if there are any minor irregularities.
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To ensure a smooth (and fast) recovery, there are a few steps you can implement after facelift surgery.
Follow surgeon’s instructions and attend follow-up appointments
Dr Ch’ng will provide personalised instructions specific to your procedure, and tailored to your individual circumstances.
Attending post-surgery appointments will allow Dr Ch’ng to assess how things are healing, adjust recovery instructions as needed, and answer any questions or concerns you may have. In addition to your appointments with Dr Ch’ng, you will also have appointments with Dr Ch’ng’s nurse who will clean wounds, remove sutures and report to Dr Ch’ng as required. Follow-up photos will be taken at each appointment so that objective assessment can be made. Dr Ch’ng review (often with the patient) all progress photos closely.
Manage swelling and bruising
Swelling and bruising are common after any surgical operation, including a facelift procedure. Significant swelling and bruising are however not common after facelift. Isolated areas of swelling can be due to obstruction of lymphatic flow especially if there is a past history of filler injection. To keep swelling and bruising down, some measures include sleeping on two pillows (a U-shaped pillow propped up on another pillow is commonly recommended by Dr Ch’ng), using a facial roller on any puffy areas as instructed by Dr Ch’ng, avoiding lifting heavy objects and bumping the face. If a blepharoplasty has been performed with the face lift, Dr Ch’ng will advise applying a cooling eye mask regularly throughout the day to hasten swelling resolution. If you experience any pain in conjunction with the swelling and bruising, take prescribed pain medication.
Get plenty of rest
A significant part of the body’s healing process happens during sleep and rest. Getting optimal sleep each night, resting throughout the day, avoiding strenuous activities, and doing light activity to improve circulation, like walking, can speed up the recovery process. When outdoor, however, take care to avoid sun exposure.
Sleep with head elevated
When sleeping and resting in the first six weeks, it is important to keep your head slightly elevated. This helps to reduce facial swelling and takes pressure off the sutures. Elevate the head with two pillows under the head or sleep on a reclined chair. Dr Ch’ng commonly recommend a U-shaped pillow to stabilise the head and neck when asleep.
Avoid smoking and alcohol
Smoking and drinking alcohol are proven to hinder the body’s healing process. Smoking slows the wound healing process, even increase the risk of skin necrosis. Alcohol can cause dehydration and inflammation in the body.
Stay hydrated and eating a healthy diet
Soft diet is advisable for 6 weeks. Staying hydrated and eating a diet rich in fruits and vegetables help wounds heal by reducing inflammation, increasing blood flow, and delivering nutrients to the operated areas.
Protect incisions from the sun
The sun can make incision scars darker. So, it is important to use sun protection, like sunscreen and hats, and avoid direct sunlight for a minimum of six weeks following surgery. However, practising SunSmart behaviour is generally advisable in order to age well, not only following surgery.
Get in touch
If you’d like to know more about our head and neck, plastic or skin cancer surgical services, or if you have a question for Dr Ch’ng, we’d love to hear from you.
