face-lifts

What is a facelift?

A facelift, or in German a face lift (medically also called rhytidectomy), is a surgical procedure in aesthetic and plastic surgery on the human face. The procedure allows the facial skin and the underlying connective tissue to be tightened, thus giving the facial skin more tension, which appears to the human eye as "smooth skin".

A doctor usually performs this operation if the patient wants to look younger. Facelifts seem to be an ancient topic: confirmed documents from the 20th century report on this and documents from the ancient Egyptians also show that they were already involved in cosmetic surgery at that time.

How exactly does a facelift work?

A facelift is usually limited to the deep subcutaneous tissue. In exceptional cases, for example, a cheek lift can penetrate as far as the periosteum below the cheekbone. In the neck area and for long-term effects, deeper structures are also used; for example, when tightening the neck tissue, the platysma (a thin muscle in the neck) is tightened.

In order to tighten a specific area, these areas are tightened using sutures, which can be either absorbable or non-absorbable, and re-anchored to solid structures, with the tightening of different areas also taking place in different directions. The lifting usually results in excess skin, which is removed before the skin is sewn back together inconspicuously and without tension.

The facelift can be performed endoscopically using a camera or via several smaller incisions. The latter technique is usually used in the forehead area because there is often no excess skin here. There are also surgical options that do not require incisions. Thread lifting with gold or plastic threads using a barb means that no incisions are required, but excess skin cannot be removed here, so its use is limited to young patients.

Face lift operations

SMAS lift
In order to achieve long-lasting and effective results, it has been discovered that a certain layer of tissue must be tightened. This layer is the Superficial Muscular Aponeurosis System (SMAS). There are currently many methods and techniques for preparing, reducing, repositioning, doubling and ultimately tightening this layer of tissue again with sutures. The surgical preparation and re-attachment is individually adapted depending on the desired effect, especially the individual adjustment of the direction of the tissue in which the layer is attached.

First described by Passot in 1917, a method based on the SMAS lift, called the S-lift, is carried out as follows: The surgeon gains access via an S-shaped upper arch in the hairline in front of the ear, then runs partially in a straight line in front of the ear, and then finally disappears again in a lower arch behind the ear. The S-Lift can be further modified by different modifications of the holding sutures and access incisions via the Fogli-Lift, Soft-Lift or MACS-Lift (Minimal Access Cranial Suspension Lift).

Mini-Lift
In a mini-lift, only the skin is tightened in a small surgical procedure. The operation is quite simple and straightforward, but the results of the tightening do not last very long.

Liquid lifting
Liquid lifting is a procedure in which liquid injection materials are used. They act as placeholders and refill the lost volume in order to minimize the optical wrinkles of the large static facial wrinkles (marionette lines, nasolabial folds, etc.). The biocompatibility of these fillers has not yet been fully clarified. The underfill material has its own volume that is able to store water in order to increase the volume even further.

The solutions used for injection are mostly collagen, hyaluronic acid, autologous fats and calcium hydroxylapatite. Although these substances are all more or less reabsorbable and are broken down by the body after a while, histological studies have shown that the treated tissue differs significantly from untreated tissue. The liquid lift technique does not last as long as surgical lifting methods because the tissue is only filled and not tightened surgically. On the other hand, this technique can be used to tighten areas that cannot be tightened by surgical procedures, such as the perioral zone or the temple area.

Botulinum toxin A, also known by its trade name BoTox, is also often used. The toxin is injected into the tissue of the facial muscles to paralyze them and thus reduce the formation of wrinkles. BoTox is usually broken down by the body after about six months, so the effect is not very long-lasting either.

The face can also be “remodeled” with the help of silicone-like implants. This technique is used, for example, when there is a lack of projection in the cheekbone, the angle of the lower jaw or when there is a receding chin.

Thread lifting
Developed in Korea, this technique, which originally comes from acupuncture, uses polydioxanone threads (PDO threads) to place these threads under the skin in order to minimize wrinkles and sagging of the skin. The procedure takes place without an incision and the threads are brought into position using small micro-needles. The special thing about PDO threads is that they dissolve in the body over time and have been used as suture material for a long time. They are also intended to stimulate the body to promote collagen production and cell regeneration. The thread lifting has an effect lasting up to one year and three months, after which a further treatment may be required.

In many cases, the upper and lower eyelids are also tightened as part of a facelift in order to further reduce the aging process. Liposuction in the neck area in combination with facelifts also contributes to this in order to intensify the rejuvenating effect. Cosmetic treatments such as dermabrasion, peelings and laser treatments are often carried out after facelifts in order to keep the result as optimal as possible.

Facelifts are usually carried out under local anesthesia in combination with or without total anesthesia. Local anesthesia is used in combination with general anesthesia to ensure safe and easy handling of the tissue layers during the operation and to avoid perioperative pain. The anesthesia, which is between 15 ml and 50 ml, is absorbed and broken down by the body during and immediately after the operation, so that the muscles can be used again quickly after the treatment.

How long does a facelift take to heal?

The healing time for facelifts is as individual as the various lifting methods themselves. Depending on which method was used and how large and complicated the surgical area was, the postoperative healing phase ranges from one week to eight weeks. Most of the limitations are postoperative swelling and redness caused by trauma to the tissue during the operation.

Risks of a facelift operation
As with any other operation, complications can also occur with a facelift. General risks can include swelling, redness, post-operative bleeding, infections and impaired wound healing with a prolonged healing phase. Scars can also form. For people who tend to form hypertrophic scars, postoperative treatment with scar ointment can help.

Special risks with a facelift include the elimination or intensification of asymmetries in the face. Every face has some asymmetries that can be emphasized or reduced after a facelift, which can have a negative impact on the natural facial expression overall. It is up to the surgeon and his experience as well as his careful approach to the extent to which he can minimize or even avoid this risk.

Nerve damage
The branches of the facial nerve can also be damaged during the operation. The branches of the facial nerve are normally responsible for the motor skills and expressions of the facial muscles. They branch out in large numbers in the face and their terminal branches can be injured. As a rule, if the small branches are slightly irritated or injured, the nerve branches will regenerate after six months of restricted movement of the affected facial areas. In some cases, however, the nerves may be so badly damaged that they can no longer resume their original function. The face distorts, especially when smiling, due to a lack of motor activity.

Apart from the motor nerve branches, the sensitive branches of the trigeminal nerve, which is largely responsible for the facial sensation, can also be severed or traumatized by hematomas, swelling and tension caused by the stitches to such an extent that their function is limited. This typically leads to numbness in the affected area, which can be temporary or permanent depending on the extent and location of the damage.

Bonn University Hospital doctors and clinics are facelift specialists in Germany.

Facial surgery can be performed by plastic surgeons, maxillofacial surgeons, dermatologists, ENT doctors and ophthalmologists. Since the performance of such an operation is not attributed to a specialist title, there are no German medical standards. Accordingly, the search for a competent, trustworthy surgeon is usually difficult.