As people age, facial changes takes place, these are forehead and glabellar creases, ptosis of lateral eyebrow, redundant upper eyelid skin, hollowing of upper orbit, Lower eyelid laxity and wrinkles, lower eyelid bags, deepening of nasojugal grooves, Ptosis of malar tissues, Generalised skin laxity, deepening of the nasolabial folds, perioral wrinkles, downturn of the oral commisures, deepening of labiomental crease, jowls, loss of neck definition and excess fat in neck, platysmal band. Most of these changes benefit by Either Facelift alone or in combination with other adjunctive surgeries ( Blepharoplasty, Neck lift, Fat injection/ Liposuction etc). The term Facelift in simple terms means a cosmetic surgery procedure, done to tighten the laxity that occurs with facial ageing.
PREOPERATIVE WORKUP -- Specific inqiry is made regarding medications, allergies, medical problems, previous surgery, smoking and drinking habbits. History of patient’s history of hypertension and medications that affect clotting is very important to prevent post operative bleeding. Surgery is not performed until patient is off of Aspirin for 2 weeks. Facelifting is containdicated for patients on warfarin or clopidrogel. Hypertension is probably the single most important factor that most closely corelates with postoperative haematomas, thus blood pressure must be under strict control. Smoking increases the risk of wound healing and patients have to quit smoking permanently before surgery. A preoperative photograph of the patient is important for assistance in preoperative planning & intreoperative decision making. The patients are instructed to shower and wash their hair on the night before the surgery. On the morning of the surgery another shower and shampoo are desirable. At a minimum the face is thoroughly washed. Although the patients are not allowed to eat anything after midnight,they are instructed to brush their teeth and rinse their mouth with mouthwash.
MAIN PRINCIPLES/ STEPS OF FACELIFT SURGERY -- The surgery is done mostly under general Anaesthesia although regardless of the type of sedation/ anaesthesia chosen, the face is also injected with local anaesthetic solution prior to dissection. There are many technical approaches to face lifting. Most of the modern facelift procedures involve 2 layer SMAS type face lift ie facelift is done by addressing the 2 main component of face – Skin Envelop & SMAS layer underneath, separately but in a complimentary way. The primary advantage of the two layer SMAS type facelift, in which skin undermining is performed separately from SMAS dissection, is that it allows these 2 layers to be redraped along vectors that are independent of one another. The incision in skin is made in such a manner that after wound healing, the scars are inconspicuous. After raising the skin flap and mobilising it sufficiently, the underlying SMAs layer is dealt by either by Plication or SMASectomy.
MACS LIFT - The Minimal Access Cranial Suspension (MACS) lift is one of the most modern techniques of face lift surgery invented by DR Patrick Tonnard, of Belgium; which employs purse string sutures in the SMAS structure and malar fat pad with vertical suspension. The vertical nature of this lift requires an incision along the anterior sideburn and anterior temporal hair line. The procedure can be performed in combination with midline platysmaplasty to improve the results in the neck.
POSTOPERATIVE CARE & COMPLICATIONS --- Pressure dressing are not used. The head of the bed is elevated at all times, but flexon of the patient’s neck is avoided because this may compromise circulation to the cervical flap. Appropriate pain and sleep medications are given; narcotics are rarely required.The patient may go to the bathroom with assistance on the first postoperative day and as desired thereafter. The first dressing can be changed after 24 hours & usually all dressings are removed after 48 hours. All sutures are removed by the 8th day. Antibiotics are routinely used preoperatively and for 5-7 days postoperatively. If crusty or oozing, wounds are cleaned with hydrogen peroxide and coated with a topical antibiotic ointment. Swelling and bruising are variable. Depending on the ancillary procedures performed most patients look reasonably acceptable within 1-2 weeks and able to attend social functions by 1 month. Haematoma can occur, specially if a patient has uncontrolled blood pressure. Infection and Scarring are rare complications.
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