Our face distinguishes us from one another- its structure, appearance and expressions gives us an identity and conveys to the world how we are feeling. As such, age-related changes that can alter the appearance of the face may make an individual feel as if their identity has changed over time. Changes can occur in the upper, mid, and lower portions of the face; however, changes to the lower third of the face are often the most readily apparent.
These changes may include the development of deep lines in the cheeks and around the mouth, loose, excess skin in the cheeks, jaw line, and neck, and banding around the neck. Most often performed on individuals ranging from forty five to fifty five years of age, a lower facelift can help to reduce the appearance of deep facial wrinkles.
Before you understand how a facelift works, it is important to understand the underlying structure of the face and how the aging process causes it to change over time. The face is composed of layers of skin, muscle, and fat which lie above the facial bones. Much like a rubber band that has been over stretched, the tissues within your face weaken over time, losing their resiliency and ability to maintain a firm, youthful position. Facial aging occurs for many reasons. In response to sun damage and other factors, your skin's support network of collagen and elastin breaks down. As a result, your skin loses some of its structure and elasticity and becomes lax. Additionally, facial muscles weaken and stretch, and fat deposits, which normally give the face a soft, rounded appearance, migrate downward and are depleted, creating hollow areas. In combination, these changes create deep
How Does a Lower Facelift Work?
There are several different types of facelift each specialised to treat different regions of the face. For example, the lower facelift is usually performed to rejuvenate the lower portion of the face. Age-related changes in the upper and middle region of the face are usually corrected with a forehead lift and mid facelift, respectively. During a lower facelift, the underlying connective and muscle tissues, known as the SMAS, are lifted, facial skin is tightened, and excess skin is removed. It is important to realise that a lower facelift cannot correct signs of aging in the forehead or around your eyes, nor can it address fine lines or uneven skin tone and texture. Dr Miroshnik will help you determine which procedure is best for you, and whether an additional procedure such as eyelid surgery or skin resurfacing would produce more global facial rejuvenation. Most of the operations
A lower facelift procedure lasts approximately three to five hours depending on the extent of treatment. Prior to the start of your procedure, the treatment area will be cleansed and anaesthesia will be administered. The procedure will most likely be performed under general anesthesia in which you are asleep. However, Dr Miroshnik may choose to administer local anaesthesia with a sedative, in which the face and surrounding areas are numb and you are in a relaxed state. Prior to making the incisions, Dr Miroshnik may part your hair along the incision area and apply an antibiotic ointment, which will help to hold it in place. Once the incision area is exposed, he will carefully draw the incision lines so that the resulting scars will be as inconspicuous as possible.
A lower facelift can be performed using a variety of different incisions. The standard full facelift involves a single incision which is made within the hairline and extends downward around the border of the ear and into the hair on the backside of the head.
However, with a short scar facelift such as the 'MACS' lift, the incision is much shorter. It usually starts in the hairline of the sideburn and ends at the earlobe without extending behind the ear. Dr Miroshnik will discuss all the various facelift options that are available to you at the time of consultation.
Working through the incision along the hairline, Dr Miroshnik will use a series of surgical instruments to carefully elevate the skin away from the underlying tissues of the lower portion of the face, jaw line, and neck. In doing so, Dr Miroshnik exposes what is known as the 'SMAS', or 'Superficial Muscular Aponeurotic System'.
Lifting the SMAS
The SMAS is a tough layer of tissue composed of muscle and fibrous connective tissue. Repositioning or 'lifting' this layer is the key to modern facelift surgery. In this way, there is no tension on the overlying skin, making the results look natural.
There are a variety of methods that Dr Miroshnik can use to lift the SMAS. When performing a 'SMAS-ectomy' type facelift, a portion of the SMAS layer is excised and the leading edges sutured together to create a lifting effect. Alternatively, when performing a 'MACS' or 'Plication' type facelift, the SMAS layer is lifted using suture plication alone. Although the techniques may differ, they all work to lift and tighten the underlying structures of the face.
Lifting the Neck
If a neck lift is being performed in conjunction with your facelift, Dr Miroshnik may make a small incision on the underside of the chin. Often some fat is removed in this region by liposuction or direct excision to sculpt the area, increasing the definition of the jaw line. In some cases, Dr Miroshnik will manipulate the muscles in the neck, which are known as the platysma muscles. They are analogous to the SMAS layer in the face. He may choose to plicate these neck muscles or remove a portion of them in order to reduce the appearance of skin laxity and banding around the neck.
Once Dr Miroshnik has finished making the necessary adjustments to the underlying structures, the skin will be repositioned over the face. In some cases, he may choose to place a surgical drain beneath the skin to prevent fluid build up as you heal.Dr Miroshnik will stretch the skin flap in order to determine how much excess skin should be removed. He may place pilot cuts and sutures at different points along the incision to establish the proper amount of tension. He will then remove the excess skin around the natural contours of the face, and close the remainder of the incision with additional sutures.
A loose-fitting wrap or a compression garment may be used to facilitate healing. A compression garment is tight-fitting, and will help to reduce swelling by preventing fluid build up, as well as provide comfort and support as you heal. Although loose bandages may be removed in several days, compression garments are often worn for some time longer. As with any surgical procedure, you will likely experience some pain, bruising, and swelling, most of which will subside within a few weeks. If a surgical drain was used, it will usually be removed within a day following surgery, and non-absorbable sutures may be removed in seven to ten days. You will feel well enough to return to work in one to two weeks; however, you should avoid strenuous activity such as heavy lifting or exercise for up to three weeks to allow your body sufficient time to heal.
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You will typically start to notice the results very soon after your procedure. They will become even more evident in two to three weeks, as the bruising and swelling continue to fade. As all individuals heal at different rates, the final results may continue to evolve for several months. Although a facelift will not stop the aging process, it can significantly reduce the appearance of loose, sagging skin in the face and neck, restoring a youthful appearance for many years to come.