Cosmetic Surgery & Beauty Magazine #70



Today there

are many nonsurgical


for wrinkles and

volume loss, but

sometimes only

surgery will

suffice in lifting

sagging skin –

and creating

truly age-defying

results. aimÉe

surtenich reports.


First performed more than 100 years ago, surgical facelift techniques have

continued to evolve and today can enhance virtually any part of the ageing face.

Predominantly used by women to restore the contours of youth, a facelift, or

rhytidectomy, can correct sagging, loose skin and reposition fat and tissues to

add volume back to the face.

Over time, the effects of gravity, sun damage and the stresses of everyday life

appear on the face, altering the way people appear to the outside world. Deep

lines may appear around the eyes and mouth, sagging skin may fall from the

cheek, jawline and neck, and fat deposits that were once full and firm deplete,

leaving hollow and sunken areas of the face. As people are living increasingly

lengthy lives, a facelift is designed to address these age-related changes and

help both men and women look as young as they feel inside.

By repositioning both the skin and the layer of muscle and tissue beneath

(known as the superficial musculoaponeurotic system, or SMAS), the modern

approach to facelifting restores facial elements to a more desirable position to

create a younger looking appearance while avoiding the tell-tale signs of surgery.

While the modern approach to facelifting predominantly addresses volume

replacement and vectors of lift, the procedure also helps smooth lines and folds.

A facelift does not, however, address overall skin texture, skin thickness, or

wrinkling and creases around the nose and mouth.

Facelifts can be divided into full, lower and mid-facelifts. Typically, a full facelift

will begin with incisions made and concealed within the hairline. From here, the

skin is separated from the muscles and tissue beneath, and the SMAS layer is

then tightened in the mid and lower face, as well as the neck. The skin is then

pulled back, reducing lines and wrinkles. Excess skin and fat is removed, and

the incisions are closed.

A lower facelift addresses the appearance of ageing features in the lower

part of the face. It is common for a single incision to be made within the hairline

extending down around the perimeter of the ear and into the hairline on the back

of the head. Through these incisions, the skin is lifted from the underlying tissue

of the lower face, jaw line and neck to expose the muscle and fibrous tissue

beneath. The SMAS is repositioned to elevate and tighten the underlying facial

structures and the skin is repositioned, with any excess being removed. A lower

facelift procedure typically takes three hours, depending on the extent of surgery.

A mid-facelift is concerned with tightening the underlying tissues and elevating

the fat pads to give improved shape and volume to the face. Although capable

of restoring a firmer, younger-looking appearance, a mid-facelift cannot correct

loose skin in the neck and jaw line.

A mid-facelift can be performed using a variety of different incisions and surgical

techniques. For example, when combined with eyelid surgery (blepharoplasty),

the surgeon may choose to make incisions in the lower eyelid. When performed

in conjunction with a lower facelift, the surgeon may make additional incisions

inside the mouth along the gum line to help release the mid-face tissues.

Another approach is the endoscopic technique, whereby small incisions are

usually made just above the hairline, above the ear or by the temple. Additional

incisions are made inside the mouth over the cheekbone. With the aid of an

endoscope, the surgeon can gently manipulate the facial tissues and lift them to

a more youthful position.

A mid-facelift procedure takes around one and a half hours, depending on the

extent of treatment. 47

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