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Classical facelift separates the skin from the underlying tissue and pulls this skin upwards and backwards removing the excess. During the 1980s it became popular to go into a deeper layer and tighten the underlying muscle of the face, the SMAS or platysmal layer, This muscle is close to the skin and is the same muscle used by horses and other animals to twitch the skin.
In the 1990s some surgeons felt that going even deeper, into the layer adjacent to the bone, would be more effective and performed a tightening of all the layers of the face.
Today most surgeons perform a modification of these procedures and tailor the surgery to the need of the patient.
The incisions placed in a similar location for most patients. It begins just above the ear and then comes along the creases in front of the ear. In many cases, especially in women, the incision is taken inside the middle third of the ear behind the protruding cartilage called the tragus.
This serves to hide the incision and make it less noticeable. It is less common to do this in men because it can bring the hair bearing beard skin on to the ear. The incision then continues just below the earlobe and up and behind the ear. Some surgeons continue the incision horizontally into the scalp while others prefer to go along the hairline of the neck.
The skin of the face, or the skin and muscle, are then separated from the deep tissue.
The amount of dissection and separation depends on the needs of the patient. It is common to extend the dissection within an inch (2.5cm) of the corner of the mouth. Some surgeons perform liposuction of the cheek, nasolabial fold or chin. The underlying muscle is then tightened as a separate later or in conjunction with the skin.
The excess tissue is then redrapped in its new position and the excess removed. The skin is closed with stitches and some surgeons use staples in the scalp area. Drains are sometimes used especially if there has been a significant bleeding.
Surgeons vary in whether or not they use bandages. These days it is common for no bandages to be used but some surgeons apply compression bandages for several days.
The operation is done under either local anaesthetic or general anaesthetic. It is often combined with other operations including eyelid tightening and forehead lifting.
Complications
After all operations there is bruising and swelling. These last about two weeks but can continue for a month or more. Remember that the human body is asymmetrical and that even after surgery both sides of the body will look different. All surgery requires an incision and therefore will leave a scar. In most patients the scar heals well, but in a small number of peopled the scar remains thick and heavy, especially behind the ear. At the time of surgery the small nerves that supply feeling to the skin are damaged. This may cause changes in sensation including numbness. Although uncommon, bleeding and infection are risks and can be serious. You will have pain and discomfort after this surgery. The pain usually only last for a few days. One per cent of all operations lead to major complications. Weigh up the pros and cons, it is for you to decide. This is a surgical procedure and as such potentially serious complications such as a blood clot or embolus or an unexpected response to drugs or anaesthetics can occur. Beside the complications that can develop after any surgery, there are problems that are special for your surgery. These include damage to the nerves that provide feeling and movement to the face.
Liposuction to the neck alone or fat dissolving injections can produce a significant lift to the neck area.
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