Four pillars of facial aging
Aging is not just Sagging!
Facial aging is related to changes in the skin, and there are at least four different pathways that make our skin look older, over the years. Therefore any type of facial rejuvenation planning should address each and every aspect of facial aging.
SAGGING – With age, the skin’s ability to remain taut and firm declines due to reduced production of collagen, elastin, and hyaluronic acid. Combined with gravitational forces, this loss of skin laxity leads to drooping features, such as jowls, nasolabial folds, and marionette lines. The decreased skin turgor also impairs the skin’s ability to recover from mechanical stress.
Treatment – Skin tightening devices, Facelift
SOFT TISSUE ATROPHY – As we age, the subcutaneous fat in the face decreases and redistributes, contributing to the hollowing of the cheeks, temples, and periorbital areas. This loss of volume results in sagging skin, deeper wrinkles, and an aged appearance. Additionally, bone resorption in the facial skeleton exacerbates the loss of structural support, further intensifying soft tissue atrophy.
Treatment – Fillers, Fat Injection,
MIMIC LINES – Repetitive movements of facial mimic muscles, such as frowning, smiling, and squinting, contribute to the development of dynamic wrinkles. Over time, these wrinkles become static, remaining visible even when the muscles are at rest. Common examples include crow’s feet around the eyes and forehead lines.
Treatment – Botulinum Toxins, Surgical ablation
SUN DAMAGE – UV radiation is a major external factor in skin aging, often referred to as photoaging. Prolonged UV exposure damages collagen and elastin fibers in the dermis, leading to the formation of wrinkles, uneven pigmentation, and a rough skin texture. UV-induced oxidative stress accelerates the breakdown of structural proteins, diminishing the skin’s resilience and elasticity over time.
Treatment – Skin care, Skin Resurfacing
Highlights of facial rejuvenation
Facial aging starts almost right after the puberty, however, we become aware of the changes in our early thirties. Facial rejuvenation is a strategic, step-wise approach to fight with facial aging. It should start as early as thirties and evolves over the decades.
Third Decade (30s): Prevention and Early Correction
- Use broad-spectrum sunscreen (SPF 30+).
- Incorporate antioxidants like Vitamin C or E serums to combat free radicals.
- Start using a gentle retinoid or retinol to promote collagen production and cell turnover.
- Hydrate with hyaluronic acid-based moisturizers.
- Chemical Peels: To enhance skin texture and even out pigmentation.
- Microneedling: Stimulates collagen with minimal downtime.
- Light Therapy: Prevents pigmentation and boosts skin health.
- Adopt a healthy diet rich in omega-3 fatty acids, antioxidants, and water.
- Prioritize sleep and stress management to reduce cortisol levels.
- Minimize fine lines caused by repetitive muscle movement, especially on the forehead and around the eyes.
Fourth Decade (40s): Targeted Rejuvenation
- Upgrade to medical-grade retinoids.
- Introduce peptides and growth factor serums for advanced repair.
- Use alpha-hydroxy acids (AHAs) for enhanced exfoliation.
- Dermal Fillers: Restore lost volume in areas like the cheeks and under-eye hollows.
- Botulinum Toxin (Botox): Address dynamic wrinkles on the forehead, glabella, and crow’s feet.
- Laser Resurfacing: Treat deeper pigmentation and improve skin texture.
- PRP (Platelet Rich Plasma) Injections: Improves skin quality with growth factors
- Radiofrequency (RF) or Ultrasound Therapy: Stimulate deeper collagen production for skin tightening.
- Quarterly treatments like HydraFacials or chemical peels for ongoing rejuvenation.
- Upper eyelid surgery is usually the first aesthetic operation for face in some individuals
- Temporal lift or endoscopic brow lift may be indicated in some cases.
- Liposuction for the neck, sometimes with laser if tigtening is also required.
Fifth Decade (50s): Comprehensive Restoration
- Intensify hydration with ceramide-rich creams and hyaluronic acid serums.
- Incorporate niacinamide to strengthen the skin barrier.
- Dermal Fillers and Botox: Maintain volume and smooth wrinkles.
- Thread Lifting: A minimally invasive option to reposition sagging tissues.
- Fractional CO₂ lasers or ablative treatments to correct deeper wrinkles and sun damage.
- Deeper skin peels like TCA for better correction of wrinkles and pigmentations
- PRP may be combined to CO2 laser treatments
- Ultrasound Therapy for maximal lift and firming.
- Radiofrequency skin tightening
- Subcutaneous laser treatment for dermal tightening.
- Hormonal changes during this decade can impact skin health. Consult a healthcare provider for hormone balancing if needed.
- Upper and lower blepharoplasty
- Endoscopic brow or forehead lift
- Mini facelift
- Deep plane facelift
- Neck lipo or neck lift
- Fat injections sometimes with stem cells
Facelift types
Facelift surgery is an evolving surgical technique in tandem with our understanding of facial anatomy. There are several facelift techniques, each addressing a different range of problems occurring at different age periods. They also differ in the scar location and length they leave.
Some facelift techniques with different names are actually overlapping in what they do and how they do it.
Facelift Techniques for Younger Patients:
Facelifts, traditionally associated with older patients, are increasingly sought after by younger individuals in their 30s and 40s who aim for subtle enhancements or early intervention to maintain a youthful appearance. The focus of these procedures is preventing aging signs or addressing early issues like minor sagging and reduced skin elasticity.
They are typically do not require skin excision thus they can be performed through small incisions and less invasive. Here’s an overview:
Temporal lift and endoscopic brow lift are two different operations but they use a similar incision and aim the same thing: an elevation of the lateral eyebrow. Procedures named as fox eyes or cat eyes can be easily added to these procedures, if required.
If performed as a singular procedure,they are indicated between 30-45 years of age. They can be combined to any other lifting or technique at any age.
Facelift Techniques for Middle Aged Patients:
Facelift procedures for middle-aged patients (typically in their 40s to 50s) aim to address more pronounced signs of aging, such as deeper wrinkles, moderate to significant sagging, and volume loss.
The techniques used are generally more comprehensive than those for younger patients, often focusing on lifting larger parts of the face, sometimes involving small skin excisions or deep tissue plications/suspensions with internal sutures. They may be also combined with adjunct treatments to address skin quality (peelings/resurfacings), volume loss (fat or filler injections), or additional surgical procedures for specific areas like the neck (lipo/laser lipo) or eyes (blepharoplasty). Here’s an overview of common procedures:
Endoscopic forehead and midface lift use a same incisions with the forehead lift, but the dissection goes down the cheeks and includes a cheek lift with special dissolvable pulling plates that grabs and elevates the cheecks towards the temples. It is indicated in cases in which there are no prominent jawls and no need for a skin excision.
Short scar facelift uses an incision just in front of the ear and a very limited skin only dissection in the cheeks. It is indicated for minimal to little laxity in the cheeks, only. A few deep sutures are placed to plicate the SMAS layer and 1-2 cmof skin may be excised. It has a minimal downtime so sometimes names as mini facelift, weekend lift, etc.
There are other full facelift techniques that address the same areas such as high SMAS technique, classical SMAS plication facelift, however, recently the deep plane technique became more popular among both surgeons and patients as it gives more efficient and natural looking results.
WHEN You Need WHICH Facelift?
“You need a professional view”
There are quite a few type of facelift procedures, each aiming a somewhat different solution to common aging problems in the face and neck. Moreover, there is a wide array of non-invasive and semi-invasive procedures available for facial rejuvenation, some of which are advertised as equivalent procedures to surgery, for instance liquid facelift.
Even worse, non-surgeon physicians may push the boundries of these alternative procedures to such extend that you may end up with a completely changed facial identity, or with wasting your time and money with unyielding interventions. Therefore, it is important to have the opinion of an expert surgeon in making your decision about your facial rejuvenation choices.
Procedures that can be Combined with Facelift
Let’s have a synergistic effect!
A facelift is a highly effective procedure to address facial sagging, wrinkles, and signs of aging. However, combining it with complementary surgical procedures can achieve more harmonious and rejuvenating results, addressing a broader spectrum of aesthetic concerns in a single session. This approach not only optimizes outcomes but can also reduce overall recovery time compared to undergoing separate surgeries.
Common Procedures Combined with a Facelift
1. Eyelid Surgery (Blepharoplasty)
This procedure targets drooping eyelids and under-eye bags, which are often not addressed by a facelift. Combining a facelift with blepharoplasty can rejuvenate the upper and lower face, creating a more youthful and rested appearance.
2. Fat Transfer
Age-related volume loss can make the face appear hollow. Facelift, by itself may not be able to restore this soft tissue deficiency. Fat transfer involves harvesting fat from other areas of the body and injecting it into areas like the cheeks, under-eye hollows, temples or nasolabial folds, enhancing the facelift results.
3. Chin Augmentation
A retruded, weak chin does not only undermine the facial proportions, but negatively affect the neck contour, indirectly. Therefore a chin augmentation with an implant may restore the facial profile and help dramatically to enhance the neck and jaw definition.
4. Lip Lift
Some individuals may have a long upper lift, constitutionally, however, it may appear as a sign of aging and loss of perioral soft tissue support. Combining a lift lip procedure to a facelift will make the upper lip appear fuller and more youthful.
5. Fox Eyes Surgery – Cat Eyes Lift – Almond Eyes Lift
Creating an elongated, almond-shaped appearance to the eyes has become a popular aesthetic trend. It aims to lift the outer corners of the eyes and create a more slanted, “fox-like” appearance, which may well fit to certain individuals. Combining this procedure to a temporal lift is quite feasible.
6. Corrugator Muscle Excision
The corrugator supercilii muscles, which are small muscles located above the eyebrows, are primarily responsible for creating vertical frown lines between the eyebrows (commonly referred to as “11 lines”) by pulling the eyebrows downward and inward. The middle part of these muscles may be approached from above during an endoscopic facelift and resected, in order to prevent frowning permanently
7. Forehead Reduction
This procedure is also known as hairline lowering surgery, and it is a cosmetic procedure designed to reduce the size of a high or disproportionately large forehead. This is achieved by advancing the hairline downward to create a more balanced and aesthetically pleasing facial appearance. This can be easily combined to any forehead lifting procedures.
8. Neck Liposuction
A full, fatty neck requires a liposuction prior to any neck lift.
9. Skin Resurfacing
Skin resurfacing procedures can complement a facelift by addressing skin texture, tone, and surface imperfections that the facelift alone does not correct. Combining these procedures helps achieve a more youthful and rejuvenated appearance. This can be performed with CO2 laser ablation, deep skin peeling (phenol or TCA) or dermabrasion.
Preparation for a Facelift
“It should not be a last minute decision”
Preparing for a facelift operation involves several steps to ensure a safe procedure, optimal results, and a smoother recovery.
- Quit smoking 4 weeks prior to your surgery
- Quit blood thinning medications and supplements prior to surgery
- Control your blood pressure with medications if it is high
- Disclose your full medical history, including chronic conditions (e.g., diabetes, high blood pressure) and past surgeries.
- Inform your surgeon about any allergies or adverse reactions to medications or anesthesia.
- Provide a list of all medications, vitamins, and supplements you are taking.
- Blood work and possibly an EKG (electrocardiogram) or imaging to assess overall health.
- Stop blood-thinning medications (e.g., aspirin, ibuprofen) and supplements like vitamin E, fish oil, or ginkgo biloba at least 2 weeks before surgery to reduce bleeding risks.If on prescribed anticoagulants, consult your doctor for safe discontinuation. Oral contraceptives should be quitted prior to surgery as they increase blood coagulability. If you are on angiotensin converting enzyme blockers (a type of anti-hypertensive medication) it should be replaced by an another type of medication.
- Quit Smoking and Alcohol: Avoid smoking for at least 4-6 weeks before and after surgery to promote better healing and minimize complications. Smoking decrease skin circulation and may lead to skin loss after surgery. Limit or avoid alcohol in the weeks leading up to surgery.
- Your surgeon may recommend starting antibiotics or antiviral medications to prevent infections or cold sores if you’re prone to them.
- Skin Care Routine: Follow a pre-surgery skincare regimen, often involving gentle cleansers and moisturizers. Use any prescribed topical products (e.g., retinoids) if recommended by your surgeon. Avoid sun exposure, and protect your skin with sunscreen and avoid excessive sun exposure to minimize damage before the procedure.
- Arrange Post-Operative Care: Have someone available to stay with you after you are discharged fromm the hospital. Arrange at least 2 weeks of leave for a proper convalescence period.
- Stock Up on Supplies: Cold compresses or ice packs for swelling. Arnica or bromelain supplements (if approved by your surgeon) to reduce bruising.
- Set Realistic Expectations: Understand the procedure, recovery timeline, and potential results.Discuss any concerns with your surgeon to address expectations and alleviate anxiety.
- Clothing: Wear loose, comfortable clothing on surgery day, preferably with a front-opening top to avoid pulling clothing over your head.
- Hair and Makeup: Wash your hair and face thoroughly the night before surgery. Avoid wearing makeup, lotions, or jewelry on the day of the procedure.
- Strenuous Exercise: Avoid vigorous physical activities for at least a week before surgery to minimize risks of bruising or swelling.
- Hair Treatments: Refrain from coloring or treating your hair within a week of the surgery to avoid irritating the scalp.
Recovery period in facelift
“It depends on the type of facelift”
The recovery period following facelift surgery, varies from person to person based on factors such as the extent of the procedure, the patient’s overall health, and the techniques used by the surgeon.
In general facial swelling is the main complaint, which starts on the first day any reaches its peak at the third postoperative day. Recovery from swelling differs according to the type and extend of the facelift surgery, ranging from 1 week to 4 weeks. Another significant problem is the somewhat weird look due to this swelling and bruises, that lasts about 1-2 weeks.
Below is an outline of what can you expect during the recovery process:
You will stay for 1 or 2 nights at the hospital. There may be drains or a web of external sutures in the face, to prevent blood accumulation under the skin. They will be removed in 2-3 days. Your face will be in bandages and progressive swelling may create a feeling of tightness and pressure in the head. To mitigate swelling and bruising, cold compression will be applied. Steroids and edema preventing herbal products like arnica and bromolein pills may be used. Pain is usually not a prominent complaint.
Early Recovery (1-2 Weeks):
- Swelling and Bruising: These are most noticeable during the first week and typically begin to subside by the end of the second week.
- Stitches and Bandages: Some of the visible sutures and staples are usually removed within 5-10 days, depending on the surgical approach.
- Physical Activity: You should avoid strenuous activities, heavy lifting, and bending over. Light walking is encouraged to promote circulation.
- Appearance: Visible bruising may still be present, but makeup can often be used after the first week to conceal discoloration.
Mid-Recovery (2-4 Weeks):
- Improved Comfort: Most swelling and bruising continue to diminish. You often feel more comfortable resuming light activities. You may resume sleeping on your side.
- Numbness or Tightness: Some residual numbness, tingling, or skin tightness may persist but is generally temporary.
- Return to Work: You may feel comfortable returning to work or public activities by weeks 2-3, depending on the physical demands and visibility of your job.
Long-Term Recovery (4 Weeks and Beyond):
- Final Results: Swelling can take several months to fully subside, revealing the final contours of the facelift.
- Scar Maturation: Scars will initially appear pink or red but gradually fade over 6-12 months, becoming less noticeable. Scar healing is usually very good in the face region.
- Lifestyle Resumption: Normal activities, including exercise and other physical activities, are typically safe to resume after 4-6 weeks with your surgeon’s approval.
Tips for a Smooth Recovery
- Follow Post-Op Instructions: Adhere to the surgeon’s guidelines for wound care, medications, and activity restrictions. Your blood pressure should be monitored and valsalva type movements should be avoided as they may cause late bleedings.
- Elevate the Head: Keeping the head elevated while sleeping reduces swelling.
- Avoid Smoking and Alcohol: These can impede healing and increase the risk of complications.
- Protect the Skin: Use sunscreen and avoid prolonged sun exposure to protect healing skin and scars.
- Scar Management: Use silicone gel cream over the scars to minimize redness and elevation. If a bad scarring pattern arises, CO2 laser treatments will be very beneficial starting 4 weeks after the surgery.
Longevity of facelift procedures
“Facelift is a very durable operation”
Facelift is a long lasting operation on contrary to other less invasive or non-invasive methods of facial tightening such as tread lifts or energy based devices. However, it cannot stop the natural aging process as the time continues to run, so you may consider this operation as a set back of the clock for about 10 to 15 years.
LONGEVITY:
Deep plane facelift – 10 to 15 years
Mid facelift – 5 to 7 years
Mini facelift – 3 to 5 years
- Age at the Time of Surgery: Patients in their 40s or early 50s often see longer-lasting results because their skin has better elasticity and regenerative capacity. Older patients may benefit greatly but might see results diminish more quickly due to reduced skin resilience.
- Skin Quality: Factors like collagen levels, skin elasticity, and thickness significantly impact how long results will last.
- Lifestyle Choices: Smoking, excessive sun exposure, poor diet, and stress can accelerate aging and diminish facelift longevity.
- Weight Fluctuations: Significant weight changes can lead to sagging skin, affecting the appearance of the facelift over time.
- Genetics: Hereditary factors play a role in skin aging and overall facelift results.
- Surgical Technique: Advanced techniques like the deep plane facelift offer more durable results compared to superficial procedures. Techniques that lift SMAS layer have a much longer durability when compared to skin only lifts.
- Maintenance and Enhancements: Using high-quality skincare products, including moisturizers, retinoids, and sunscreen, helps maintain results by protecting and rejuvenating the skin.
Frequently asked questions
Frequently Asked Questions in Facelift
Is a facelift procedure right for me?
Will a facelift give me a stretched look?
The older facelift techniques have had that problem, but the newer techniques such as “high SMAS” or “deep plane” facelifts have very natural results, taking you back to your earlier ages. Some recent brow lift techniques like fox eyes/cat eyes may have an bit accentuated appearance but this is actually what these patients want.
Are skin tightening devices an alternative to a facelift procedure?
Are some people better candidates for a facelift?
Your facial bone structure is an extremely important factor affecting the outcome of your facelift procedure. A prominent jawline, high cheek bones, a long neck, a strong chin create a good foundation for a better result. On the contrary, heavy cheeks, thick skin, weak facial bones, a short neck are unfavourable characteristics.
What is the best age for a facelift?
How many times can I get a facelift?
You may have a second facelift after 10-15 years. A third one may be possible but will be more risky and less efficient.
What are the risks of facelift?
What is the cost of a facelift?
Depending on the hospital you choose and the type of facelift operation, it may cost 6000-10000 euros, including hospital, surgeon and anesthesia fees.
