The Modern facelift
For decades, plastic surgeons have been reversing the effects of ageing with facelift surgery. Greater understanding of how the ageing process affects facial structures, combined with technological advances, has led to increasingly refined techniques, providing women with several lesser invasive options for turning back the clock.
We are all familiar with the 'turkey neck' appearance which arises as a result of the ageing process, when skin loses its natural taught, elastic property, gravity takes hold and loose skin pulled is downwards.
Neck lift surgery can be performed independently of facelift surgery and is sought by both women and men wishing to turn back the clock and tighten their jawline.
English proverb: "Eyes are the windows to the soul" (and sadly the first and most noticeable part of the body to show signs of ageing).
Upper eyelid drooping
During the ageing process, collagen losses leave skin unable to "bounce back" and, unfortunately, the skin on the eyelids is no exception.
Hooded upper eyelids can be hereditary, but drooping eyelids will affect us all at some time during our lives, some more than others, as lid heaviness can actually cause peripheral vision losses with surgery being the only option for correction.
In the main however, upper blepharoplasty is most commonly an aesthetic, cosmetic procedure sought by those wishing to turn back the clock on ageing.
This is the medical name for surgical rejuvenation of the eyes. The eyelift procedure involves removal of excess skin, smoothing the underlying muscle, tightening the underlying structures and removal, plus re-draping of any excess fat bulging through the protective membrane that covers the eye socket.
During consultation Angelica will discuss the option of having the procedure under local, "twilight" or general anaesthetic. The local is a popular choice, as recovery on the day is much faster, without the risks associated with full anaesthetic.
Facial fullness depletes with ageing, and replacement of these fat pockets are at the core of successful modern day facial rejuvenation, but avoiding 'pillow face' effects due to overfilling is also key!
Gentle, natural replacement of fat pockets with your own fat makes sense and, with the aid of the BodyJet system, surgeons are now able to offer patients predictable, longer lasting cheek and facial enhancing.
Balance and harmony is at the core of most cosmetic facial surgery, in the case of cheek augmentation this might involve boosting the definition of congenitally "flat" cheek bones or replacing the volume lost during the ageing process.
Silicone cheek implants are safe and durable, enhancing your appearance and bolstering your self esteem for a lifetime.
Younger patients may seek implants to bring better balance to their features, whilst the more mature person may choose to have an implant placed in conjunction with another cosmetic procedure. For example, during a facelift, a patient may wish to have implants placed over the cheekbones to help restore a fuller, youthful appearance.
Facial proportions have a significant bearing on the aesthetics. A small chin can make the person feel that they have a large nose, because the profile is unbalanced. Similarly a chin of excessive size can look pointy and unsightly.
One of the main considerations in rebalancing the chin shape is to understand whether the dental occlusion (the way the teeth meet) is in harmony. If the occlusion is also problematic, most of the times it is necessary to take the route of orthognathic surgery which requires careful orthodontic preparation and evaluation that often spans over one to two years.
Most of the times though, the occlusion is good to satisfactory, and the disproportion related to the chin can be dealt individually, or as is often the case in combination with a nose reshaping.
The chin can be increased in size either by repositioning the lowermost part of the mandible (jawbone) which is known as sliding genioplasty.
The other option is to use an implant which can be either silicone or a semirigid material. In our practice we prefer to use the Medpor™ material for reasons that will be discussed in detail at the consultation. For more information regarding these products, please visit the manufacturer's website at www.porex.com.
Reduction in the size of the chin can be done either through reshaping the bone with a burr or via a sliding genioplasty where the bone is pushed back and fixed in position.
The operation is normally carried out under a general anaesthetic, but as a day case.
Expect the bruising and swelling to settle for the most in 7 to 10 days.
Nose reshaping (Rhinoplasty)
As the most prominent facial feature, the size and shape of the nose is an important factor when considering facial balance or symmetry.
During your consultation, Angelica will spend time discussing what you don't like about your nose and the ways to improve upon it. Nasal length, tip projection and rotation, alar base width and nose to mouth angle will be considered.
By using state of the art 2D computer imaging, both you and Angelica can communicate clearly (although it is important to remember the result on the screen can never be 100% accurate).
Nose reshaping can involve one or all parts of the nose's anatomy:
- the tip of the nose
- the bridge of the nose
- the septum (septorhinoplasty)
- base width of the nose (alar base)
Surgical ear pinning is a relatively simple procedure that can offer a great deal of comfort to people suffering from "bat ears", especially younger patients who might be experiencing bullying amongst their peers.
Rejuvenation of the forehead and eyebrows is known as brow lift procedure. It aims to compensate for the gradual lowering in the brow position that occurs with ageing, in men and women.
The pattern of ageing is somewhat different depending on hereditary characteristics, but also different between men and women.
The aim of the brow lift procedure is to restore a more youthful brow shape and position.
Traditionally the technique involved a long cut across the scalp, behind the hairline (open brow lift) but this method is now less common but used in selected cases.
The latest and most used procedure used today is an endoscopic forehead lift. This requires several small incisions hidden in the hair, behind the hairline. The dissection is assisted with use of an endoscope, hence the name.
At the time of the surgery the frown muscles can weaken slightly. A more limited degree of brow lifting can be also achieved through the incisions made for an upper lid blepharoplasty, as well as through the upper part of the facelift incisions.
The brow lift procedure is carried out under general anaesthetic and most commonly involves an overnight stay. It is frequently combined with a facelift or eyelid operation.
After the Operation
Expect some bruising around the forehead and possible headaches for the first few days.
It is wise to limit the activity levels in order to keep the bruising under control. The position of the eyebrows starts a little higher than the end-result, but will usually settle within the first few months.
The main risks related to brow lift are decreased sensation in the forehead which is most commonly temporary and reduction in hair density around the incision lines. This is more common in someone with finer hair type and can be improved by a scar revision.
Almost everyone gets dark circles under their eyes from time to time. Dark circles under eyes usually are temporary and not a medical concern but don't be despondent if you are a sufferer as we can now offer a remedy for this often distressing problem.
What causes dark circles?
The cause is really unknown and you'll find that everyone you talk to has their own theory but here are some thoughts:
- Those with a high nasal bridge and deep-set eyes will naturally have darker eye circles.
- Can be a hereditary trait.
- People who suffer from long period of insomnia, lack of adequate rest and sleep.
- Hyper–pigmentation after childbirth or due to side effects of some drugs.
- Small micro clots form under the skin giving a dark appearance.
- Nasal congestion. When your nose is congested, veins that usually drain from your eyes into your nose become widened (dilated) and darker. The skin under the eye is very thin which means that the blood vessels under the eye can be more noticeable.
What we do know for a fact is that the skin in question is very thin and will show all sorts of imperfections. It therefore makes sense to 'thicken' this skin so it's not so reflective.
Tear trough correction
Hollow and dark circles under the eyes can make you look exhausted all the time and are caused by lack of 'padding' under the eyes. Injection of hyaluronic acid to the 'tear trough' area adds substance between the upper layer of skin and underlying tissues reducing the dark appearance.
This is a simple concept but in the right hands can produce dramatic and pleasing results.
What are the side effects?
You might be unlucky and sustain a bruise but generally there are no side effects or down time with this treatment.
Full, luscious lips are associated with youth and sadly, they are one of the first areas to lose volume during the ageing process. The most common solution for thinning lips involves injecting one of many types of filler available on the market, however the effect of these wear off after about 6 - 9 months, when treatment needs to be repeated.
Permalip, the permanent solution for thinning lips gives gentle definition to the body of the lip and also helps to plump out the smoker's lines associated with ageing.
Avoid the knowing glances with the 21st century minimal scarring facelift for those looking for a little invisible nip and tuck, the Short Scar Facelift.
Once past 40 both women and men can experience slight 'jowling' of the lower face and the beginnings of scraggy neck. The short scar facelift is the perfect remedy for those looking for a little help as it defines the jawline, lifts the midface and tightens the upper neck. With scars hidden in the hairline, around the back of and inside the ear, no one need ever know.
Angelica: "Thank goodness the Hollywood wind tunnel effect facelift is now a thing of the past. Surgical facial rejuvenation has become an art with surgeons trying to disguise their work as much as possible whilst leaving their patients looking fresher and younger but not changed. The short scar facelift can also be combined with an endoscopic brow lift to raise a heavy brow and give the eyebrows an even, natural arch."
The current philosophy surrounding facial rejuvenation is to adapt the type of surgical lift to each individual, using their underlying bone structure as a template so when the tissues are redraped, the face 'sits' naturally and is not pulled tight in unnatural fashion. It is also possible to undergo correction of eye bags (see notes regarding blepharoplasty) as well as other procedures at the same time as the short scar facelift. Free fat transfer from other parts of the body is sometimes used to restore the lost volumes of the central part of the face.
Methods have been polished and modified to defy gravity in a more effective way. Instead of only lifting one area surgeons now prefer a combination of lifts to give a balanced result. It is important that the underlying muscles (S.M.A.S.) are tightened for a longer lasting result.
It is important to remember however, that although a short scar facelift can wind the clock back by reversing the effects of gravity, it will not erase permanent creases, particularly around the lips. Further procedures like laser resurfacing or chemical peels can improve those lines and can be carried out in conjunction with a facelift.
At your consultation you should provide Angelica with a general medical history, together with details of any previous facial surgery. By gently lifting the facial skin, the surgeon is able to assess what could be expected post operatively. It is advisable to bring with you at the consultation photos from the time you felt you looked your best.