FAQ – Facelift Surgery

Read more about Face Lift Surgery

Facelift surgery is recommended for people who are in good health. Those with certain conditions, such as blood clotting problems, uncontrolled high blood pressure, and the tendency to form large scars, should check with their plastic surgeons before considering a facelift.

Facelift surgery rejuvenates and enhances the face and neck by reversing the changes that have occurred with ageing. Facelifts used to be considered something for those in their late 50’s or 60’s or later, but now with the wide variety of subtle minimal access lifts available, people as young as in their 40’s are seeking surgery, which Dr Ayham Al-Ayoubi does not recommend as a Facial Plastic Surgeon. Also different people age at different rates and people seek facelift surgery for a variety of reasons.

Dr Ayham Al-Ayoubi explains that Genetics, exposure to extrem sunshine without using sun protoction, smoking and life style are the most important factors that affect the ageing process. This leads to loss of tone in the skin and ligaments of the face resulting in the appearance of jowls, loose neck, and deepening nose to mouth lines and droopiness of eye brows and eyelids. In addition, as we grow older we lose fat and our skin becomes thinner and more fragile.Altough with time the facial skin develops wrinkles and lines due to damage caused by environmental factors.

Facelift surgery, also known as rhytidectomy, which literally means “surgical removal of wrinkles” is a cosmetic procedure which gives the patient a more youthful appearance.

Dr Ayham Al-Ayoubi explains:

What makes our faces change as we get old?

While in youthful face a particular set of skeletal proportions are ideal for their soft tissue envelope, forces of gravity, soft tissue maturation, skeletal remodeling, muscular facial activity and solar changes act together changing these proportions and thus giving the appearance of an aged face. For example, as we age our eye sockets (orbits) increase in size while our upper jaw decreases in size. The space available for the overlying tissue will be less, resulting in inferior displacement of the cheek fat pad and skin with deepening skin folds.

Gravity and our genes influence the location and shape of our facial wrinkles, but chronic solar exposure is the major environmental insult that contributes to changes attributed to aging skin. Substantial weight loss can produce similar changes in facial appearance to those of the ageing process.

What happens to the skin of our face?

As we age, our skin becomes progressively thinner, drier, and less elastic. The loss of inherent elasticity results in skin that is more lax, with dependent draping that is prone to wrinkling from gravitational effects. Not only wrinkles appear, but other changes also occur. Dermal atrophy causes thinning of the skin, changes in organization of collagen make the skin less stretchable and blood vessels thinning results in thinning hair and the pallor often associated with elderly skin. Furthermore, this results in a reduction in skin surface temperature. As water-binding capacity and sebaceous gland activity decrease with age, the skin becomes drier. Hypertrophy of the sebaceous glands results in the visible coarseness.

How do folds appear?

Forceful contraction of facial muscles induces folds in corresponding parts of the face. These include the crow’s feet, the vertical frown lines above the nose, the transverse wrinkles over the bridge of the nose, the horizontal forehead creases, the fold between the cheek and upper lip,  and the prominent crease between the lower lip and the chin.

What happens to our eyes and cheeks?

With age, the eyebrow position steadily descends down. The fat in the eye sockets herniates creating bags in eyelid skin. The angle between the brow and nose becomes more sharpens and the furrows appear in the forehead and above the nose.

Cheek fat falls down, leaving behind a cheek depression. Orbital fat creates an irregular contour with appearance of a deeper eye sockets.

What happens to our noses?

As a consequence of aging, the middle portion of the forehead becomes flattened and the tip of the nose falls progressively. This combined with resorption of the upper jaw, the appearance of false hump on the nose and the descent of the chin pad contributes to the illusion of increased projection and length of the nose.

What happens to our chins and necks?

The downward pull of the surface muscle of the neck (Platysma), creates jowls, with loss of definition of chin and jaw line. The skin of the neck can become lax developing horizontal wrinkles. Anterior edges of the surface muscle in the neck separate and lose tone, thus creating anterior banding called “turkey neck” deformity. Furthermore, the larynx gradually descends with age, making the apple of Adam (larynx) appear more prominent. It is the combination of these changes that results in loss or blunting of the angle between the jaw and neck.

What can we do about facial aging?

While anti-ageing treatments are available and offer some help, their effect doesn’t make a real difference and is short living. On the other hand, face lift in certain to make people look younger. The aim of face lift is to smooth out the wrinkles on the face and the tighten the tissue underneath, creating the appearance of a younger face, which is more firm. The overall effect is that of removing the signs of aging. Surgeons will remove the excess skin on the face, cheeks and neck.

Our faces are the signature of our beauty. We all like to stay young all lifelong. It is possible now with an advanced facelift surgery to enhance but preserve our natural facial beauty. Both men and women can benefit from face lift. Without showing obviously that he or she has had a face lift.

Choosing to undergo a face lift procedure usually entails different desires for men and women in terms of facial contours, definition, and the extent of the surgery. Also expectation of results is different between men and women.

As we age, the skin on our face starts to lose its elasticity and begins to sag. Creases can become deeper and the jaw and neckline start to droop. The fat on the face, which makes it look plump and irons wrinkles, is absorbed as the years go by, and the face appears more gaunt.

At the London Medical and Aesthetic Clinic, our patients enjoy the most advanced techniques for facelift surgery London has to offer.  We offer a wide variety of treatment options for improving the appearance and age of the face. Among them are eye bag removal treatments and traditional facelift surgery.

In addition, we are proud to offer the cutting-edge FAMI (Fat Grafting) technique. Another option available to patients who want to avoid the small amount of discrete scarring of traditional surgery is the new non-surgical injectable face lift technique ( Sculptra ), which provide long lasting results with minimal recuperation time.

Before opting for any type of facelift surgery, our patients will have the opportunity to sit down with one of our consultants plastic surgeons and discuss their individual case in detail. After careful assessment, patients will be given expert advice on which procedure will provide maximum benefit for them.

Face lifts involve smoothing out the wrinkles on the face and the tightening of the tissue underneath, creating the appearance of a younger face, which is more firm. The overall effect is that of removing the signs of aging. Surgeons will remove the excess skin on the face, cheeks and neck.

There are a number of methods to carrying out Face lift, all with their own benefits and differences, these include:

• Traditional face lift
• Endoscopic – Keyhole Face lift surgery
• Minimal-access cranial suspension Face lift (MACS)

Face lift Keyhole involves the placement of an endoscope through an incision and carrying out the procedure via a television monitor, whereas Face lift MACS involves the removal of excess fat amongst other things.

Face lift is one of the cosmetic procedures that has attained growing popularity in recent years and is no longer a treatment exclusive to the likes of Hollywood stars. Studies have shown that the Face lift procedure is becoming more and more standard in the catalogue of choices people have in going about everyday life.

As the skin ages it loses its natural bounce and elasticity. As a result the look of the facial skin can become increasingly saggy and dull. Most people also start to notice the visible signs of ageing, such as fine lines and wrinkles, and these tend to be most prominent around the eyes, nose and mouth. A face lift is an effective means of smoothing out lines and wrinkles and creating a fresher, younger complexion.

Anti-ageing treatments are widely available, but their effectiveness is often brought into question. The effects of a face lift are undeniable and it is certain that people look younger after treatment.Face lifts involve smoothing out the wrinkles on the face and the tightening of the tissue underneath, creating the appearance of a younger face, which is more firm. The overall effect is that of removing the signs of aging. Surgeons will remove the excess skin on the face, cheeks and neck.

Elegance in facial features is important to all, but there are considerable differences in what we expect to see in the appearance of men and women.
Such differences encompass not only the clarity of the skin, the complexion, shadows and highlights, but also the actual shape of the bone structure in the face.

Choosing to undergo a face lift procedure usually entails different desires for men and women in terms of facial contours, definition, and the extent of the surgery.
It is important that patients and surgeons work together to clearly identify areas considered a Face lift priority for rejuvenation, beautification, and maintenance as well as to explore personal perceptions of beauty and health.

An aesthetic balance of the face however is more than the sum of maximising each possible change, and the primary target for the result of Face lift surgery is an elegant and age appropriate outcome and Face lift surgeries should achieve a natural look.

Planning a face lift is a collaborative effort between patient and surgeon, taking into account the patients’ personal perceptions of beauty and the abilities and techniques available to achieve the most desirable appearance.

The careful preparation for the Face lift surgery, discussing openly with the plastic surgeon the points of strong of concerns, and understanding the tipping point towards the face lift surgery are important components of the successful outcome of facelift surgery.

The popularity of the Face lift surgery could be attributed to a number of factors including the desire for people to look younger. Some people will often have wrinkles on their skin, but still have some elasticity so it can be stretched out. They will often have loose skin that needs removing so that the skin left over can be tightened. Of note is that it is not just women who undergo the treatment, with men being strong candidates as well.

Dr Ayham Al-Ayoubi’s belief is that every single patient is unique. His team of surgeons and nurses at our clinic provide an environment dedicated to giving every patient the particular results that they want with implementing our Motto “Enhancing but preserving our natural beauty “.

Dr Ayham Al-Ayoubi explains that the best candidates for facelifts are people who are experiencing severe wrinkling and sagging in the skin of their face and neck, but whose skin still has some elasticity. The procedure works best on people in their late 50s- 60s, but it still can be effective on patients into their 80s.

Reconstructive surgery techniques were being carried out in India by 800 BC. Sushruta, the father of Surgery made important contributions to the field of plastic and cataract surgery in 6th century BC. The medical works of both Sushruta and Charak originally in Sanskrit were translated into Arabic language during the Abbasid Caliphate in 750 AD. The Arabic translations made their way into Europe via intermediaries In Italy the Branca family of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.

British physicians traveled to India to see rhinoplasties being performed by native methods. Reports on Indian rhinoplasty performed by a Kumhar vaidya were published in the Gentleman’s Magazine by 1794. Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods. Carpue was able to perform the first major surgery in the Western world by 1815. Instruments described in the Sushruta Samhita were further modified in the Western world.

Aulus Cornelius Celsus, who lived in the first century AD, described plastic surgery of the face, using skin from other parts of the body.

The ancient Egyptians and Romans also performed plastic cosmetic surgery. The Romans were able to perform simple techniques, such as repairing damaged ears from around the 1st century BC. For religious reasons, they did not dissect either human beings or animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding, Aulus Cornelius Celsus left some surprisingly accurate anatomical descriptions, [ some of which – for instance, his studies on the genitalia and the skeleton – are of special interest to plastic surgery.

In 1465, Sabuncuoglu’s book, description, and classification of hypospadias were more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia.[ In mid-15th century Europe, Heinrich von Pfolspeundt described a process “to make a new nose for one who lacks it entirely, and the dogs have devoured it” by removing skin from the back of the arm and suturing it in place.

However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became common.

Up until the techniques of anaesthesia became established, surgeries involving healthy tissues involved great pain. Infection from surgery was reduced by the introduction of sterile techniques and disinfectants. The invention and use of antibiotics, beginning with sulfa drugs and penicillin, was another step in making elective surgery possible.

In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap.

The first American plastic surgeon was John Peter Mettauer, who, in 1827, performed the first cleft palate operation with instruments that he designed himself. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose.

In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and in 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.

20th century

In World War I, a New Zealand otolaryngologist working in London, Harold Gillies, developed many of the techniques of modern plastic surgery in caring for soldiers suffering from disfiguring facial injuries. Gillies was from England but volunteered in France with the Red Cross. During that time, he learned about plastic surgery. He became particularly successful in the field and was well known for his work. Kazanjian and Blair, two men hired for plastic surgery by the United States army, learned from Gillies in England. His work was expanded upon during World War II by his cousin and former student Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe’s radical, experimental treatments, led to the formation of the Guinea Pig Club. In 1946, Gillies carried out the first female-to-male sex reassignment surgery.

Plastic surgery, as a specialty, evolved remarkably during the 20th century in the United States. One of the founders of the speciality, Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on Reconstructive Surgery of the Face set the standard for craniofacial reconstruction

Types of Face Lift Surgery

Many types of face lift, know medically as Rytidectomy, are available. The type of face lift should be tailored to each patient need.  In our clinic we offer a complete variety of procedures:

1)- Traditional face lift: this operation is more invasive. It entails making a large hidden skin incision behind the hair line, separating the skin, repositioning certain facial fat, tightening facial muscles, pulling the skin eliminating the wrinkles, cutting excess skin and suturing the skin in a new position. There will be bandages and drain for few days.

2)- Minimal-access cranial suspension (MACS): this is a lesser version of the procedure, with smaller incision made at chosen sites to perform muscle tightening and fat re-positioning in less sever cases.

3)- Keyhole surgery: the surgical endoscope is inserted through small incision under the skin to tighten chosen muscles and remove excess fat. Keyhole surgery is most commonly used for brow lifts and upper face lifts and offers a short recovery time with less scarring. It is very good for appropriate patients.

4)- In addition, we are proud to offer the cutting-edge FAMI (Fresh Autologous Mesenchymal Integration) technique. FAMI consists of injecting your own Adipose (Adult) stem cells into the muscles and under the periosteum of bone surfaces for rejuvenation and slowing down of aging process.

5)- Another option available to patients who want to avoid the small amount of discrete scarring of traditional surgery is the new Non-surgical Injectable Face Lift Technique using a dermal filler (Sculptra), which provide long lasting results with minimal recovery time.

It is very important to discuss your options with your surgeon. Before opting for any type of facelift surgery, our patients will have the opportunity to sit down with one of our consultants plastic surgeons and discuss their individual case in detail. After careful assessment, patients will be given expert advice on which procedure will provide maximum benefit for them. It is important that patients and surgeons work together to clearly identify areas considered a Face lift priority for rejuvenation, beautification, and maintenance as well as to explore personal perceptions of beauty and health.

Where do I start?

You can contact our clinic to book a consultation and discuss the benefits face lift can offer you. Our consultants are there to welcome you and discuss all options with you and decide what is optimal for you own face. Not only will you pleases with the friendly atmosphere, but you will also pleased, most certainly, with the results you will see. Your face will be young, natural and very beautiful. Your loved one will love it.

Step by step Face Lift Surgery

Dr Ayham Al-Ayoubi explains that since each face has a unique shape and contour, the surgery will be slightly different for each patient.

Before the procedure, the patient’s skin will be evaluated for consistency and the surgery explained to them. People who smoke will be asked to stop at least a week or two before the surgery and and for a couple of weeks after the surgery, because smoking inhibits blood flow to the skin and can interfere with healing. Patients are also asked to avoid aspirin and other medications that can increase bleeding.

During a traditional facelift, an incision is made that typically begins around the hairline from the temple and curves around the earlobe, ending at the bottom of the hairline. A small incision under the chin to specifically tighten the skin of the neck may also be made.

Dr Ayham Al Ayoubi explains that the surgeon first separates the skin from the fat and muscle underneath. They may suction out or trim excess fat to give the face a sleeker look.

Underneath the skin is a layer of tissue called the SMAS (superficial musculoaponeurotic system)? This is tightened by folding it — pulling it back over itself. Tightening the SMAS layer lifts the cheeks, gives the jaw line more definition, and firms the neck.

Finally, the skin is pulled back up over the area and removes any excess skin with a knife or laser, similar to the way that you would pull a carpet to tighten it over the floor and trim the excess.

The incision is closed with stitches, sutures, or tissue glue. The stitches are usually placed within the hairline so they are hidden by the hair.

Recovery after a Face Lift

After your facelift surgery, you will go home with gauze bandages over your incisions. It is normal to see some pinkish or even red drainage on the gauze. If the dressing is getting soaked through with red blood, call your doctor. If you had any work done on your neck or under your chin, you will probably also has elastic bandaged that wraps around to the top of your head to keep gently pressure under your chin and prevent bleeding or swelling.

Sometimes this bandage can feel like it’s choking you. If this is the case, your surgeon can make a little adjustment by loosening the bandage or cutting into the elastic a little bit. Do not do this by yourself because relaxing it too much will defeat the purpose of wearing it, putting you at risk for complications. Do not be surprised if you come out of surgery looking like a mummy.

Your hair will be matted down under the bandage and covered with surgical soap, ointment, blood, and sometimes even KY Jelly (used to keep your hair off your face during surgery). Dr Ayham Al Ayoubi explains that you may be allowed a shower the first or second day after surgery, while some ask you to wait for up to 2 weeks.

This is to prevent bleeding and protect the stitches from being disrupted. If you color your hair, hopefully, you’ve done this before surgery since it may be 4 to 8 weeks before your okay for colouring again.

Dr Ayham Al Ayoubi explains that after facial surgery, it may difficult to open your mouth. A baby toothbrush and mouthwash can come in handy for clean teeth and fresh breath. You should wait at least 4 weeks before scheduling any dental work.

During your facelift recovery, you will start with a liquid diet, and then progress to soft foods, before moving on to a more substantial meal. Especially if you have had incisions in your mouth, your doctor may not want you to chew anything for up to a week. Juice, soup broth, jelly and yogurt are all good starter foods.

(Yogurt is especially helpful to balance the natural bacteria in your gut that will be wiped out from the antibiotics). Crackers, bread, toast, or rice are good to munch on before taking your medications to minimise the chance of nausea from the drugs.

Dr Ayham Al Ayoubi recommendations to rest is an order, not a suggestion. For your own sake you must take it easy. Too much activity too soon into your face lift recovery period will only cause problems and delay healing, unnecessarily worrying both you and your surgeon. No exercise, no sex, no lifting, no driving, no cleaning the closets, no playing with the dogs, no shopping, etc. until your surgeon says it’s okay. Engaging in too much activity or getting bumped in the surgical site can cause blood or fluid accumulation, ripped stitches, infection, and even tissue death. You’ve made a big investment in your appearance. Minimising your activity will help protect that investment.

You may have very little swelling or, on the other hand, you may be so swollen for the first few days that you hardly recognize the face in the mirror. Especially if you have swelling around the eyes, this can be shocking. The swelling will usually get worse before it gets better. Usually the first 3 days are increasingly swollen and bruised due to the natural healing response. Dr Ayham Al Ayoubi suggests ice packs (20 minutes on, 20 minutes off while you’re awake) can keep the swelling down and soothe your discomfort. Do not put ice directly on your face because numbness can prevent you from sensing a freezer burn.

Keeping your head and shoulders elevated during your face lift recovery will also help reduce swelling. Once you get up and move around more after your first few days, there is a tendency for some swelling to return as your blood pressure increases.

You may notice an area of firmness in the cheek or under the chin from a pocket of swelling. Do not worry, it will likely go away. If it’s turning purple or enlarging, contact your surgeon immediately to be sure it’s not a hematoma (blood collecting under the skin). The natural course of bruising during a facelift recovery will take you from red to blue to purple to green to yellow before the bruise is gone. (Some lucky patients skip the rainbow and go straight to yellow!) Dr Ayham Al Ayoubi recommends Arnica tablets to help reduce bruising and swelling.

Due to the natural force of gravity, the blood will drain downward through the planes of tissue. For facelift surgery, this commonly means that your neck and chest can become bruised in a matter of days. (Many patients have been alarmed that the surgeon operated on unauthorized areas because of noticeable bruises on the upper chest). The bruising will usually be increasingly noticeable over the first few days as the blood is pushed from deeper layers to the more superficial layers of the skin. Bruising and swelling will dissipate in 1 to 2 weeks at which time you should really start to like what you see in the mirror. At 4-6 weeks you’ll be very pleased with your new look, although some swelling can persist for months.

Some stitches by your ear will be removed after 5 days. Stitches or staples in the hair can stay in longer and help to provide additional support without risking visible scarring from the sutures. The scalp can keep stitches up to 10 or even 14 days since any scarring will be less visible beneath hair. The facelift incision is pretty well healed after 2 weeks, but the scar will remain pink for months. Once the incision is healed and any scab has fallen off, the face lift incision can be covered with camouflage makeup and of course, with strategically styled hair. Now is the time to watch for hypertrophic scarring. It’s easier to treat it in its early stages, rather than wait until it’s very thick, raised, and itchy.

After a face lift, you will have some areas of numbness on your cheeks. This will gradually return in the weeks and months following surgery. Be careful as decreased nerve sensation puts you at risk for burns from cold packs, curling irons, and hair dryers. Many people experience discomfort or ringing in the ears.

It is possible that some blood travelled into your ear during surgery and needs to be cleaned out. Sometimes, irritation of a nerve on the cheek that goes to the ear (the greater auricular nerve) can cause uncomfortable sensations after surgery. This will almost always resolve over time. Specially designed pillows with a hole cut out for the ear can help you sleep more comfortably once your surgeon gives you permission to sleep on your side. As the nerve sensation returns, you may feel itching, shooting pains, or shock like sensations. This is normal, and can sometimes be minimised simply with aspirin.

Recovering from facelift surgery is usually not very painful. Most people get by with some narcotic pain pills for a few days, and then Tylenol while many just use Tylenol without the narcotics. (If you’ve had facial implants or rhinoplasty at the same time you will experience more discomfort). The deeper facelifts (subperiosteal, deep plane and composite lifts) also do tend to create more discomfort because several layers of tissues have been manipulated including the muscle, and swelling is more pronounced.

Dr Ayham Al Ayoubi explains that the most common complaint after a facelift is discomfort, tightness, or pulling behind the ears. As your skin relaxes slightly, swelling subsides, and as you become used to the tightness, this discomfort will dissipate. If at any time you have significant pain, increasing pain, or pain that seems out of proportion to what you expected, call your surgeon.

Alternatives to Facelift surgery

Dr Ayham Al Ayoubi explains the alternatives to facelift surgery.

Other treatments may be used either as alternatives, or in combination with a facelift.

• Resurfacing techniques reduce surface wrinkles and can smooth the skin by removing damaged outer layers. Options include chemical peels and laser resurfacing.
• Pulsed light therapy stimulates the middle layer of the skin to produce more collagen, which plumps out fine lines and wrinkles.
• Tissue augmentation plumps out deep wrinkles with injections of collagen or other types of filler.
• Anti-Wrinkle Injections can flatten out wrinkles that appear in your skin when you smile or frown. This is particularly suitable for forehead lines and wrinkles around your eyes.
• Creams, gels and beauty treatments may help tighten your skin. However, there is no scientific proof that these work.

Sculptra is an alternative to Facelift surgery. It is a long lasting, clinically-proven, non-invasive, stimulating injectable treatment that is designed to smooth out and soften lines and wrinkles, restore facial volume and contour the face in a natural way.

Unlike Facelift surgery, Sculptra can provide natural-looking results with a less traumatic treatment. Fantastic results normally start to become visible after around 4-6 weeks. Patients can achieve a full face lifting effect which usually lasts up to 3-5 years. As well as achieveing a facelift effect, Sculptra can help with loss of fat and soft tissue in the face, hollow cheeks and temples, nose to mouth lines and even those deeper lines and wrinkles.

As we age, sagging jowls, wrinkly chest and decolletage can be a problem for a lot of women, Sculptra can dramatically improve these conditions and provide fantastic results.