Natural Facelift & Neck Lift Surger  FAQs

Facial ageing is characterised by the laxity of the skin, loss of facial volume and descent of soft tissues with gravity. In the lower face, this results in a saggy appearance to the neck with loss of the natural neck angle and descent of soft tissue below the jaw that gives rise to the jowls. Face and neck lift cosmetic surgery rejuvenates the soft tissue descent to its site above the jawline and tightens the lax skin. In the neck, there is a loss of elasticity and thinning of the skin that results in increased folds and sagging. In addition, the platysma muscle that underlies the skin in the neck can be seen as a pair of vertical bands. Dr De Silva uses a precision technique in neck surgery to double stitch the platysma muscle that restores a natural curvature to the neck that is both youthful and more effective than commonly utilised single stitch techniques. Double stitch imbrication technique evens out irregularities in the neck contours and recreates a long-lasting rejuvenated neck angle.

Non-surgical facelift techniques use a variety of volume fillers and tissue stitching while avoiding opening of the tissues with surgery. These techniques do have an effect in rejuvenating the face by resorting facial deflation. Facial ageing is a combination of skin, soft tissues and underlying skeletal changes. Although non-surgical lifts can aid some of the signs of facial ageing, they will only give a temporary effect. Patients that are prepared to have non-surgical facelift treatments should understand the effects are modest and are limited in that they are focused on adding volume.

To rejuvenate weathering of the skin, counteract facial descent with gravity, and skin laxity remains challenging to treat with non-surgical treatments. Over the past 5-years many non-surgical treatments have evolved including radiofrequency (Morpheus8, Secret PRO RF, Thermage, FaceTite), cooling therapy (Cooltherapy, ultrasound (Ulthera) and heat therapy, all of the focus on tightening of the skin. They tighten millimetres, often with ageing beyond 40s there is more than 1 cm of loose skin which means the effect of these non-surgical facelift techniques is minimal. Realistic expectations is key to success with these treatments and some patients will benefit more from a mini-facelift technique that will truly rejuvenate the face by lifting the soft tissues that have descended and removing lose skin.

Threads lifting has been heavily marketed over the past 5-years, these do have a role in lifting the face however they are of short duration and generally last 6 months before additional intervention is required.

 Dr De Silva provides advice and guidance on any of the latest cosmetic technological innovations; he only utilises techniques that give patients both natural-looking result and longevity. Many new devices over the past 5-years have promised incredible results without surgery; often, they are heavily marketed and unproven. Most are only available for a short period of time, after which the devices are found to be less effective. Good advice is if something sounds too good to be true, it generally is. For legal reasons, specific devices cannot be discussed on a public website. Dr De Silva understands the difficult choices that patients have in deciding what to believe, and will only use treatments that he knows are effective and appropriate for use on his family members and friends. Dr De Silva served as the clinical representative of the Ethics Committee at St. Mary’s Hospital from 2002-2006.

Facial ageing is a combination of genetic and environmental factors. Particularly, sun exposure on the skin causes cumulative damage to the skin resulting in dark spots, fine lines and wrinkling that appear on facial movement and deeper lines on the face. Our understanding of facial ageing has changed over the past 5-years. Prior to that, facial ageing was considered to be secondary to gravity and drooping of the face and neck. The major leap in our understanding of facial ageing over the past few years has been the concept of fat compartments of the fact that not only descend with gravity, In addition, but also lose volume termed “deflation”. Why does this matter? Although isolated treatment of facial soft tissue droop or restoration of facial volume will have an effect, facial beauty is about symmetry, balance and harmony all of the multiple factors. What leads to a great natural-looking result is a simultaneous rejuvenation of the skin, soft tissues and underlying skeletal changes. Volumetric fillers that have revolutionised the non-surgical approach to facial rejuvenation in the past few years will restore lost facial volume, soften deep facial lines and youthful appearance of the cheeks. However, in isolation, they can lead to the “over-filled” or “puff or pillow-face” appearance that is characterised by some actors and actresses in the media. The artistry in giving patients a natural result requires a harmonious approach that both restores volume and treatment of facial decent. Different faces will age in a unique manner; Dr De Silva tailors his treatment of every patient on an individual basis. Some faces will require greater restoration of volume, and others will require greater rejuvenation of soft tissue descent.

A facelift will have the effect of rejuvenating the face, taking years off a persons’ appearance by restoring features of the face to a more youthful time. Society places value on youth and beauty, through more successful jobs, more attractive partners and inner confidence and self-belief. Although cosmetic surgery was once considered a premium luxury, it is now considered an investment in oneself, and an opportunity to revitalise and recapture a youthful external appearance that a person feels on the inside. Commonly Dr De Silva patients describe feeling many years younger than they look, a facelift is a way of lifting a patient’s esteem and restoring a balance between these factors. Dr De Silva advises all his patients that successful rejuvenation of the face is about looking better, a complete absence of lines and wrinkles is not a desirable goal, as this looks fake. Dr De Silva considers success when friends comment on how great you look after surgery without knowing that you have had surgery, a natural rejuvenation. Patients seeking a facelift are often looking for a more youthful appearance that can help with job prospects or in finding a partner, and the confidence that comes from a more youthful appearance. Dr De Silva utilises the most advanced treatments from the US; the surgery is completed as a day-case procedure which means that all patients go home on the same day of surgery. There is no requirement to stay in hospital overnight; hospitals are associated with increased risk of infections. In the UK, some hospitals still keep patients overnight, as hospital inpatient stays is the old way in which cosmetic surgery was practised. Patients usually take 2-3 weeks off work and social engagements, although after a couple of days, patients can do most non-strenuous activities. Dr De Silva usually recommends the use of one of his overnight team to care for you over the first night. After 3-weeks, patients can return to all normal activities.

A facelift will typically last for between 5-10 years. Different surgical techniques will impact the longevity of effect. Dr De Silva believes that a patient who is undergoing cosmetic surgery is investing in their appearance and uses a modified deep plane SMAS facelift to give patients a more durable and longer-lasting result. There are patient factors, including genetic makeup and exposure to the elements such as the sun that will influence the duration of a facelift. Dr De Silva advises all his patients on lifestyle changes that maintain the results of their facelift and may suggest referral to one of his specialist colleagues. Patients are frequently attending for 2^nd, 3^rd and even 4^th facelifts. Other areas of the face age differently to the lower face and neck.

Cost is tailored to an individual patient needs and is based on whether it is a full facelift, neck lift and if there are associated procedures to enhance the result. Additional techniques that include volume augmentation, skin resurfacing and specialised eyelid contouring techniques. A good long-lasting result that is free of problems is worth its weight, the quality of your care and outcome is most crucial Lower cost surgery may result in compromises in quality of the result and safety. For an accurate assessment of price, a consultation is required. If you decide to have surgery, the consultation fee will be deducted from your surgical fee.

The aim of a facelift is to rejuvenate the face by restoring drooping soft tissues of the face (malar cheeks, jowls at the jawline), remove excess skin that has become lax, restore the youthful curvature of the neck and jaw-neck angle. A good facelift is one that is natural-looking, by this avoids a fake wind-swept appearance that has been characterised by some cosmetic patients in the media. Dr De Silva is known for creating a natural look, to do this, he uses specific techniques including a double-layered tightening, modified deep plane technique, hidden incisions and complementary techniques such as facial volume replacement. “My objective is for friends and family to notice you looked freshened up and rejuvenated, however not know that you have undergone surgery.”

For the first couple of weeks after surgery, there will be a degree of bruising and swelling. For the first week, it is best to take things easy and generally keep a low profile. After one week, the residual bruising can be camouflaged with cosmetics, most patients will have some swelling, and can return to some more social activities if they like. Dr De Silva generally recommends patients leave 1-2 weeks for recovery, and from 2-weeks patients can return to regular social activities.

A bandage is placed around your head from the top of your head to under the chin, this gives support to the face and reduces swelling. Dr De Silva uses micro-drains for some patients to reducing swelling and enhance recovery. By the use of meticulous techniques, patients are able to leave the surgical centre and go home after 1-2 hours. Most patients have little or no pain; however, they should take things relatively easy and avoid all forms of exercise. Dr De Silva will see all of his patients the day after surgery and provide you with contact details so he may be reached 24-hours a day. The following day you are able to have a shower and wash your hair. From 5-7 days, Dr De Silva will remove facial stitches, and by 2-weeks most of the swelling will have resolved. The scars are hidden behind the ear and in the hair, the remainder fade over a period of months.

Facelift and neck lift surgery is a common cosmetic, and as with any surgery, there are potential risks and complications that may occur.

Complications in face and neck lift surgery may occur because of several reasons. One of the most important factors responsible for the success of surgery is the surgeon. The surgeon must have complete knowledge of how the surgery has to be performed. Facelift and neck lift surgery is demanding, and requires in-depth knowledge of the anatomy, experience attention to detail.

Complications can be defined as any unforeseen occurrence during or after the surgery. The complications that can occur during or after blepharoplasty and can be divided into four categories; intra-operative, immediate postoperative, early and later postoperative.

Intra-operative complications occur during the surgery. For example, these can occur due to a reaction to some medication or due to the local or general anaesthesia given and are managed by the surgical team at the time of surgery.

Immediate postoperative complications occur immediately after the surgery when the patient is in the initial recovery stage and may include bleeding or medication. These complications need to be handled immediately by the surgeon who performed the operation.

Early postoperative complications in facelift and neck lift surgery occur once the patient has been discharged. These appear almost immediately after the person returns to a normal routine. They can include bleeding or a haematoma (collection of blood), a reaction to a medication, infection and can be corrected by contacting the doctor immediately.

Late postoperative complications associated with facelift and neck lift surgery may occur when the patient fails to take proper care after the surgery, the surgical technique used, or the patient’s healing process. These complications include those of asymmetry, scarring, hollowing, numbness and facial muscle weakness, delayed healing and hair loss. Most of these complications are minor and can be easily corrected.

The commonest complications are bleeding and haematomas, all of which are treatable. The most serious complication of face or neck lift surgery is permanent damage to a branch of the facial nerve resulting in reduced facial expressions following surgery; this is an extremely rare complication. Face and neck lift surgery is generally a popular surgery with high patient satisfaction and low risk of complications.

All patients have a degree of bruising and swelling, that resolves over a period of weeks, 90% over the first two weeks. Patients who smoke have delayed healing as a consequence of smoking, Dr De Silva will not perform facelifts on patients who smoke, because of the risk of delayed healing, safety must come first.

A facelift restores drooping of the soft tissues of the face and the sagging skin of the neck. A facelift will not treat volume loss, termed deflation, in patients with volume loss, Dr De Silva advises volume replacement with fat augmentation or filler that will enhance the facelift result. A facelift will not rejuvenate the skin, fine lines, dark spots and wrinkles. Dr De Silva will advise a combined facelift and skin-resurfacing technique to enhance the results. Commonly a CO2 laser is used to resurface the skin, in some patient of darker skin tones, it is advisable to use an alternative skin resurfacing technique.

A good candidate for a facelift is facial ageing with symptoms of sagging of the skin and soft tissues of the face, deepening of the nasolabial folds (a line between nose and mouth) and loose skin below the neck with loss of the angle between the chin and neck. The patient should be in good health, and a non-smoker with have realistic goals of rejuvenating their face.

In the UK, most facelift surgery is completed under general anaesthesia; an alternative is a type of sedation used in conjunction with local anaesthesia. Sedation is also known as “twilight anaesthesia” or MAC (Monitored anaesthesia care). Twilight anaesthesia means that your body is sleepy and relaxed; you are still conscious and able to respond to questions and instructions, unlike general anaesthesia where you are unconscious, and the recovery after surgery is longer. Typically, you won’t remember the procedure or the short period of time following it, though you will feel a little euphoric. The benefits of sedation are that it relieves your anxiety around surgery and the recovery after surgery is faster.

The one-hour facelift is the name of a procedure that suggests it will be fast to complete, with local anaesthesia and fast recovery. Unfortunately, any short cuts with the surgical technique are reflected with both limited effectiveness and short-lived results.

The risk of a one-hour facelift is a fast technique that results in a small improvement that lasts for a short period of months. A surgical technique that is so fast to be completed in one hour can only be superficial beneath the skin, not lifting the deeper facial tissues and hence only lasts a short period.

Facelift techniques vary from mini facelifts, to complete face and neck lifting techniques, and take from 3 to 6 hours. More extensive techniques are usually required as a result of further ageing. True facelift techniques require general anaesthesia or sedation anaesthesia; the results take several hours to complete and last for a period of years.

Often patients require additional procedures such as fat transfer, blepharoplasty or skin resurfacing to get the best possible results. In addition, to give fine or hidden scars takes meticulous time and consideration and would take more than one hour just to close the incisions.

In recent years there have been a large number of advertised techniques that promise a great deal, there are no techniques that get something for nothing, and many patients are disappointed by their results. The reality is that as with many things in life, there are few short cuts, quick to complete, and quick to wear off. Considering a small 2cm cut in the skin requires five or more stitches to repair effectively, the lower part of your face cannot be supported effectively by a single stitch. The techniques required to give long-term effectiveness and natural-looking results are meticulous and take both time and expertise to complete.

Sedation is also known as “twilight anaesthesia” or MAC (Monitored anaesthesia care). Twilight anaesthesia means that your body is sleepy and relaxed; you are still conscious and able to respond to questions and instructions, unlike general anaesthesia where you are unconscious, and the recovery after surgery is longer. Typically, you won’t remember the procedure or the short period of time following it, though you will feel a little euphoric. The benefits of sedation are that it relieves your anxiety around surgery and the recovery after surgery is faster.

Video of sedation anaesthesia experience for facelift & neck lift surgery

A pulled look from a facelift is the result of an unsatisfactory aesthetic that is an unnatural rejuvenation of the face. A natural rejuvenation is one that restores parts of the face to their original position taking into account both individual facial ageing utilising specialised surgical techniques that respect the natural contours of the face.

For a natural-looking facelift and rejuvenation, Dr De Silva believes there are several facial plastic surgery factors that are of key importance:

• Elevation of the deeper layers of the face (including the SMAS, superficial musculoaponeurotic system) this requires specialised surgical techniques and hours of surgery to complete. Fast techniques that are superficial, principally lift the skin resulting in stretching of the skin and a pulled look.
• Meticulous attention to detail is required, to ensure that scarring is limited to a fine line and lifting does not alter natural hairlines. With meticulous techniques, these issues can be avoided. Excessive pulling of the skin can result in distortion of the ears and wide scars that are hallmarks of unnaturalsurgery, with meticulous surgical technique these can be avoided.
• Browlift procedures were once fashionable to elevate the position of the brow. Many people have a naturally low position of eyebrows even in youth, and brow lifts are less commonly indicated and need to be conservative. Over lifting of the eyebrows results in a surprised and unnatural appearance.
• Artistry, every surgeon has a different aesthetic, and by looking at a surgeon’s before and after photographs, it will give an indication of this aesthetic.
• Often natural-looking rejuvenation requires additional treatments to give the best possible result. Common additional procedures include fat transfer, skin resurfacing and blepharoplasty.

The weekend facelift is the name of a procedure that suggests it will be fast to complete under local anaesthesia and with a fast recovery. Unfortunately, any short cuts with facelift surgical technique are reflected with both limited effectiveness and short-lived results of the technique.

The risk of a weekend or one-hour facelift is a fast technique that results in a small improvement that lasts for a short period of months. A surgical technique that is completed very quickly in less than two hours can only be superficial beneath the skin, not lifting the deeper facial tissues and hence only lasts a short period. There is an increased risk of a pulled and unnatural appearance with a fast skin lifting technique.

The reason why patients chose these mini facelifts is often related to price. Often, they are economically favourable on consideration of comparison of price alone. However, they are less favourable once taking into account their short period of effectiveness, as they may last for only a period of months, usually less than one year, and the cost of further surgery.

Facelift techniques vary from mini facelifts, to complete face and neck lifting techniques, and take from 3 to 6 hours. More extensive techniques are usually required as a result of further ageing. True facelift techniques require general anaesthesia or sedation anaesthesia; the results take several hours to complete and last for a period of years. To result in a fine or hidden scar takes meticulous time and consideration and would take more than one hour just to close the incisions alone. In recent years there have been a growing number of advertised techniques that promise a great deal, there are no techniques that get something for nothing, and many patients are disappointed by their results.

For the reasons above, Dr De Silva does not recommend the weekend facelift. Often patients require additional procedures such as fat transfer, blepharoplasty or skin resurfacing to get the best possible results.

A facelift procedure rejuvenates the face by lifting soft tissues of the face that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, volume loss. Facelift surgery is effective to treat facial characteristics, including:

• Deep Nasolabial linesthat run from the nose towards the outside corners of the lips
• Jowls, soft tissue that has descended below the jawline resulting in loss of a smooth jawline
• Excess skinor vertical bands in the neck (secondary to laxity in the platysma muscle)
• Marionette linesfrom the corner of the mouth to the chin region

The facial ageing changes usually occur present from the forties, however, are dependent on environmental factors (including smoking, sun exposure, poor nutrition and stress) and genetic factors. Often to give the best result from a facelift, the surgery needs to be combined with additional procedures, including fat transfer to treat facial volume loss and skin resurfacing to restore sun-damaged skin.

Non-surgical treatments, including the use of wrinkle injection and hyaluronic acid fillers, have been substantial innovations in the past 10-years that have advanced cosmetic surgery. Patients with early signs and symptoms of facial ageing including dynamic wrinkles (wrinkles on facial expression) and early volume loss around the cheeks, below the eyes (termed tear trough depression) are effectively treated with non-surgical treatments.

The changes described above, including deep nasolabial lines, jowls and excess skin in the neck are not effectively treated with non-surgical methods and require facelift surgery to give a natural-looking rejuvenation.

How long a facelift procedure lasts is dependent on several factors: The facelift technique, Additional procedures, Environmental factors and Genetics.

• acelift techniquesvary from mini facelifts, to complete face and neck lifting techniques, and most surgeons will use different surgical techniques dependent on the patient and their individual ageing. More extensive techniques are usually required as a result of further ageing. True facelift techniques take several hours to complete, and last for a period of years, usually between 5-8 years. Dr De Silva’s preference is to use deep plane facelift techniques in suitable patients who are considered to last for a longer period of time. Thread-lifts, mini-lifts, 1-hour facelifts and other similar procedures often have a much shorter duration of between 6months andone1 year. Dr De Silva does not advise patients to have these quick techniques as they do not give good long-term results or reach patient expectations.
• Additional proceduresused in conjunction with facelift surgery will enhance the effectiveness and longevity of the surgery. Fat transfer to restore volume loss and skin resurfacing to restore sun-damaged skin are two common procedures that will enhance the facelift procedure
• Environmental factors that will speed up facial ageing and reduce the longevity of a facelift include smoking, sun exposure, poor nutrition and stress.
• Genetic and ethnicityboth influence facial ageing and longevity of a facelift, a useful indicator for genetics is looking at how your parents have aged relative to their peers.

A facelift procedure rejuvenates the face by lifting facial soft tissues that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, and facial volume loss with facial ageing.

The indications for a facelift are to treat characteristics of the face include, Deep Nasolabial lines (from the nose towards the outside corners of the lips), Jowls (the soft tissue that has descended below the jawline resulting in loss of a smooth jawline), Excess skin or vertical bands in the neck (secondary to laxity in the platysma muscle) & Marionette lines (from the corner of the mouth to the chin region)

The facial ageing changes above that are suitable for facelift surgery usually present from the forties onwards; however, they are dependent on environmental factors (including smoking, sun exposure, poor nutrition and stress) and genetic factors.

How long a facelift procedure lasts is dependent on several factors: The facelift technique, Additional procedures, Environmental factors and Genetics.

• Facelift techniquesvary from mini facelifts, to complete face and neck lifting techniques and most surgeons will use different surgical techniques dependent on the patient and their individual ageing. More extensive techniques are usually required as a result of further ageing. True facelift techniques take several hours to complete and last for a period of years, usually between 5-8 years. Dr De Silva’s preference is to use deep plane facelift techniques in suitable patients who are considered to last for a longer period of time. Thread-lifts, mini-lifts, 1-hour facelifts and other similar procedures often have a much shorter duration of between 6months and one year.
• Additional proceduresused in conjunction with facelift surgery will enhance the effectiveness and longevity of the surgery. Fat transfer to restore volume loss and skin resurfacing to restore sun-damaged skin are two common procedures that will enhance the facelift procedure
• Environmental factors that will speed up facial ageing and reduce the longevity of a facelift include smoking, sun exposure, poor nutrition and stress.
• Genetic and ethnicityboth influence facial ageing and longevity of a facelift, a useful indicator for genetics is looking at how your parents have aged relative to their peers.
• Non-surgical treatments, including the use of wrinkle injection and hyaluronic acid fillers, have been substantial innovations in the past decade that have advance cosmetic surgery. To maintain the effectiveness of a facelift does require maintenance with non-surgical treatments to give the best long-term results.

Facelift surgery generally lasts for 5-8 years, depending on the factors above. A person who has undergone a facelift will always look younger than that if they had not had a facelift, however with time to maintain that look a further facelift may be required. Patients working in professions where appearance is key to career prospects commonly undergo multiple facelift procedures to maintain their appearance over multiple decades.

The facial ageing usually presents the from the forties, however, are dependent on environmental factors (including smoking, sun exposure, poor nutrition and stress) and genetic factors.

The indications for a facelift are to treat characteristics of the face include, Deep Nasolabial lines (from the nose towards the outside corners of the lips), Jowls the (soft tissue that has descended below the jawline resulting in loss of a smooth jawline), Excess skin or vertical bands in the neck (secondary to laxity in the platysma muscle) & Marionette lines (from the corner of the mouth to the chin region)

Often to give the best result from a facelift, the surgery needs to be combined with additional procedures, including fat transfer to treat facial volume loss and skin resurfacing to sun-damaged.

Non-surgical treatments, including the use of wrinkle injection and hyaluronic acid fillers, have been substantial innovations in the past decade that have advance cosmetic surgery. Patients with early signs and symptoms of facial ageing including dynamic wrinkles (wrinkles on facial expression) and early volume loss around the cheeks, below the eyes (termed tear trough depression) are effectively treated with non-surgical treatments.

The changes described above, including deep nasolabial lines, jowls and excess skin in the neck are not effectively treated with non-surgical methods and require facelift surgery to give a natural-looking rejuvenation. Age itself is not an accurate indicator for facelift surgery. Most 40-year olds would not have the indications for facelift surgery as described above (jowls, deep nasolabial lines and vertical bands in the neck). However, as a consequence of genetic and environmental factors if these symptoms and signs are present in a facelift may be the most suitable facial rejuvenation.

A facelift procedure rejuvenates the face by lifting soft tissues of the face that have descended with facial ageing as a consequence of descent of soft tissues, laxity in soft tissues of face and skin, volume loss. By your 70s there will be most if not all of the changes above which will be effectively rejuvenated with a Facelift. There are several further considerations.

• Safetyis of paramount importance. If you are fit and healthy with few medical conditions, then having a facelift is both safe, associated with a fast recovery and good results. If you have medical conditions, it is important that you have the necessary medical assessment to ensure the medical conditions are controlled, and you are fit for surgery.
• Assessmentfor my patients includes blood tests, heart tracing (ECG or EKG), chest x-ray, amongst other tests.
• Medicationsthat you are taking may affect bruising, swelling and healing in general. It is key to discuss these with your surgeon.
• General fitnessis important, and with regular exercise, this improves your recovery and healing.
• Additional proceduresused in conjunction with facelift surgery will enhance the effectiveness of the surgery. Fat transfer to restore volume loss and skin resurfacing to restore sun-damaged skin are two common procedures that will enhance the facelift procedure.
• Surgical technique for facelift surgery in older patients requires meticulous surgery as the tissues lose some of the strength and elasticity with age, resulting in finer and more delicate facial tissues.

Overall there is not a specific age that is good or too old for facelift surgery more significant is your general health and level of fitness. Dr De Silva find from his experience, taking into account the steps above, patients in their 70s and 80s can have a excellent rejuvenation from facelift & neck lift surgery.

When completing facelift surgery, many surgeons will insert a fine tube into the soft tissues at the end of the surgery (termed a drain) on both the right and left side to continue to drain fluid after the surgery these are then usually removed between 1 day to 14 days  after surgery.

In a small proportion of cases, after surgery, as a consequence of further bleeding, a collection of blood can occur that needs to be removed. Some surgeons believe that the use of a drain may reduce the chance of this complication. However, the drains are often uncomfortable for patients and cause discomfort on removal.

Dr De Silva does not use drains, using meticulous fine stitch technique to avoid the use of drains. There are other interventional techniques that can be used to minimise the risk of bleeding, including the use of fibrin tissue glue and post-surgery medications.

The salivary glands are located under your jawline (termed submandibular and submaxillary salivary glands) and are usually hidden behind your natural jaw and soft tissue of your neck. In some people the glands can be lower down and create bulging in the neck, this can create a more bulbous or irregular shape and contour of your neck. Most people who undergo facial rejuvenation with face and neck lift surgery do not require surgery on their salivary glands. In some people, as a consequence of their natural anatomy and facial ageing, the position of the glands could affect the final surgical result. In these patient’s partial removal of the salivary glands as part of the face and neck lift surgery may be beneficial and improve the result of the surgery. The anatomy of the salivary glands includes a very powerful blood supply. Hence surgery on the glands needs to be both cautious and reserved for when necessary to avoid the unnecessary issue from surgery. If your salivary glands are more prominent in your neck, then partial removal of the salivary glands at the same time as facial rejuvenation surgery may improve the results of your surgery, an assessment is required to determine your individual needs and suitability for this surgery.

A mini facelift procedure is a technique that benefits a person with relatively early features of facial ageing, including facial sagginess with deep facial lines (termed nasolabial folds) with or without early jowls (softening of the smooth jawline) and some skin laxity in the cheeks and lower face. Key for suitability for a mini-facelift is relatively good skin elasticity and relatively mild changes in the lower third of your face and neck. The advantages of a mini facelift are a small incision and hidden scar with rapid recovery after surgery.
There are circumstances where a mini-facelift procedure is not adequate. If you have is substantial skin laxity, marked jowls, droopiness in the neck including vertical bands (termed platysmal bands). With these features usually from your 50s, a full facelift is required to provide a natural rejuvenation. A full facelift requires a larger incision as more surgery is required to lift and rejuvenate the face. The incision is longer as it needs to extend behind the ear into the hairline principally to treat the increased skin laxity. At the same time, the incisions can be largely hidden in natural creases and contours to avoid visible scars after surgery. The recovery from a full facelift is approximately 2-weeks, although the final result is 6-12 months later.

Key to a natural rejuvenation in both mini-facelift and full-facelift techniques include meticulous attention to detail, lifting beneath the skin including the SMAS and deep soft tissue layers (to avoid a wind-swept appearance) and multi-layered closure (to avoid visible scars). Both techniques are effective at rejuvenating your face depending on your clinical needs, and an assessment is required to determine your individual needs and suitability for this facial surgery. Both techniques may be completed with other facial techniques, including blepharoplasty (eyelid lift), fat transfer (volume rejuvenation), and CO2 laser resurfacing to augment the natural results.

Facelift Technique, Dr De Silva’s Mini Vertical Deep Plane facelift, from Dr De Silva Textbook on Facelift & Neck Lift Surgery 

Surgeons use a variety of different techniques for closing the incisions after surgery. If your surgeon only uses superficial stitches, all of these may be removed between 1-2 weeks after surgery. Dr De Silva utilises three layers of deep stitches in closing the incisions to ensure no tension on the wound, with the intention of leaving the finest possible scar. These specific stitches dissolve as much as 6-months after the surgery, ensuring that the soft tissues are held in place during the healing period. On occasion, as the swelling resolves the very edges of theses stitches can be felt along the incision line, these stitches are difficult to see as they are clear in colour. If they are irritating or uncomfortable, they can be removed. However, they are not causing any issues they can be otherwise left as they will naturally dissolve between 3 to 6 months after the surgery. There are deep stitches beneath the skin that dissolve between 3-6month; these are important as the support the face during healing and reduce scarring. Sometimes as the swelling goes down, you can feel an edge of a stitch. The stitch will dissolve, if it is uncomfortable, Dr De Silva can take it out for you.

During face and neck lift surgery, the face is rejuvenated by lifting the soft tissues that have dropped with facial ageing and restoring them to their natural position. As part of the surgery, the excess and floppy skin that has become lax with time is partly removed. As part of the face and neck lift surgery, it is completely normal to have a degree of numbness around the face and neck during the healing period. The sensory nerves that provide sensation gradually improve after surgery between 6 weeks to 6 months. Numbness during this period gradually improves as the sensory nerves recover. It is rare for the numbness to persist after 12months, however in the same way every person has relatively unique facial characteristics, very rarely numbness can be long-lasting. Patients who have difficulty adapting to this change may also find some tightness in their neck during the healing period. For these patients, MLD, manual lymphatic drainage a specific type of neck massage may be effective in improving their symptoms and reducing their recovery time.

Accusculpt technology uses a laser to reduce fat and in principle is similar to liposuction. The treatment reduces fat in the neck, which may be useful for reducing fat and neck in younger patients. The technology does not benefit facial ageing that has resulted in effects of gravity or skin laxity, i.e. patients with jowls or loose skin, are not treated. Accusculpt is marketed as a form of a facelift; however, it is not a true facelift. A true facelift involves lifting the layers beneath the skin, where gravity has resulted in jowls or deep lines in the face and removing the remaining loose skin. Every few years there is a new non-surgical technology that promises results that avoid the need for surgery, although these techniques have a role for some patients there are limitations and cannot be used for all patients.

The risk of an Accusculpt facelift is a fast technique that results in a small improvement that lasts for a short period of months. A surgical technique that is so fast to be completed relatively quickly can only be superficial beneath the skin, not lifting the deeper facial tissues and hence only lasts a short period.

Facelift techniques vary from mini facelifts, to complete face and neck lifting techniques, and take from 3 to 6 hours. More extensive techniques are usually required as a result of further ageing True facelift techniques require general anaesthesia or sedation anaesthesia, the results take several hours to complete, and last for a period of years.

The length of a neck lift will depend on the complexity of the surgery, the degree of laxity and facial ageing and patient ethnicity and sex. On average a neck lift will take from 1 and a half to 3 hours, less than 90 minutes is a short length of time. There is a great deal of individual variation in the neck, and good surgery requires a meticulous attention to detail, including measurements and time. It is important that your surgeon takes adequate time to complete the surgery cautiously and without rushing. Combined face and neck lift takes on average 4 to 6 hours.

Dr De Silva allows a minimum of 3-hours for most neck lift procedures and allows additional time to ensure the best possible result. For more complex revision neck lifting and combination treatments including facelift, fat transfer and blepharoplasty additional time may be required up to 7-8 hours. Dr De Silva generally limits neck lift to 4-hours as, after this time, there can be increased swelling that can affect the appearance of the neck.

A 30 minute facelift, simply put is not a true facelift. Non-Surgical facelift which can use a combination of fillers and temporary threads to lift the face. 

Is not even a minimally invasive facelift, it can be better described as a facial contouring procedure, which accentuates the cheekbones, under eye area, defines the jawline and lifts the upper neck.

London, New York, Los Angeles, South Korea, and Brazil stand out as top destinations for those seeking a youthful and rejuvenated appearance through facelift & neck lift surgery. Caution is required in hospital tourism as some countries package lower cost surgery with poor regulation and clinical safety standards. There have been an alarming number of tragedies from British and American citizens travelling overseas to have low cost procedures in countries including Turkey, South America and Thailand. Safety is an important consideration when undergoing a procedure.

During the Procedure: Patients are typically under general anaesthesia or deep sedation, so they do not experience pain during the surgery.

Post-Procedure first night: Mild to moderate pain and tightness are common.

Post-Procedure first three days: Mild pain and discomfort are common. This can be managed with prescribed pain medications. More than 50% of our patients do not require analgesia. 

Swelling and Bruising: Swelling and bruising can contribute to discomfort. Measures such as keeping your head elevated and applying cold compresses can help reduce these symptoms.

Tightness: Some tightness and pulling sensation, especially around the incision areas, are normal and usually subside within a few weeks.

There are measure that can be taken to improve Comfort and Results:

Follow Post-Op Instructions: Adhering strictly to your surgeon’s post-operative care instructions is crucial.

Pain Management: Take prescribed pain medications as directed. Over-the-counter pain relievers like paracetamol can also be used, but avoid NSAIDs like ibuprofen which can increase bleeding and bruising.

Hydration and Nutrition: Stay hydrated and eat a balanced diet rich in vitamins and minerals to support healing.

Rest: Ensure adequate rest and avoid strenuous activities for the first three weeks.

Follow-Up Appointments: Attend all scheduled follow-up appointments to monitor your healing progress.

Dr De Silva gives his patients detailed support during the recovery period to ensure a fast and smooth recovery. Reassurance and a supportive team are available 24-7 to provide help and support as needed. In addition Dr De Silva utilises modern innovations to enhance recovery including oxygen therapy, lymphatic drainage and regenerative medicine.

A customised mini facelift typically requires less invasive anaesthesia compared to a full facelift.  :

• General Anesthesia: Historically most mini-facelift surgery was completed with general anaesthesia may be used, particularly if combined with other procedures.
• Local Anesthesia with Sedation: Mini facelifts can be performed under local anaesthesia combined with sedation. Sedation anaesthesia can mean different levels of sedation, it can mean you are awake and relaxed OR it can mean your are sleeping deeply under the sedation.

Dr. Julian De Silva’s pioneered the use of sedation anaesthesia in the UK, patented a unique formulation of Twilight Sedation for his patients. Our advanced sedation technique in the UK delivers a state of deep relaxation and comfort without the full effects or risks associated of general anaesthesia. 

There are measures that you can take to help ensure both Comfort and Safety:

• Pre-Surgery Consultation: Discuss anaesthesia options with your surgeon to determine the best approach for your comfort and safety.
• Qualified Anesthesiologist: Ensure that the anaesthesia is administered by a qualified professional with experience in sedation anaesthesia. 
• Post-Surgery Care: Follow all post-operative care instructions to manage any discomfort and support a smooth recovery.

The duration of a facelift procedure can vary depending on the extent of the surgery and additional procedures being performed. Typically:

• Mini Facelift: Approximately 2 to 3 hours.
• SMAS Facelift: Approximately 2 to 3 hours.
• Deep Plane Facelift: Approximately 4 to 5 hours.
• Vertical Deep Plane Facelift: Approximately 4.5 to 6 hours.
• Extended Procedures: If combined with other surgeries such as neck lift, brow lift, or eyelid surgery, it can take up to 8 hours or more.

There are measures to you can take improve your result:

• Pre-Surgery Preparation: Follow all pre-surgical instructions, such as fasting and medication guidelines, to ensure you are in optimal condition for surgery.
• Choose an experienced Surgeon in facelift and neck lift surgery to perform the procedure efficiently and safely.
• Post-Surgery Care: Adhere to post-operative care guidelines to promote healing and achieve the best results.

Dr De Silva completes a customised vertical deep plane facelift that requires more skill and understanding of the anatomy that a conventional SMAS facelift. The result is a more natural and longer lasting result, lifting the areas that drop with gravity it delivers a natural rejuvenation of the face and can give a patients a 10-20 year rejuvenation. Facelift & neck lift surgery has evolved as a technique and a vertical deep plane facelift is the most natural innovation in facelift surgery in the past decade.

The most natural-looking facelift is one that focuses on subtle rejuvenation without giving the appearance of having “work done.” The Vertical Deep Plane Facelift, performed by Dr. Julian De Silva, is highly regarded for its natural results.

Key Features of a Natural-Looking Facelift:

• Vertical Lifting: Lifting the deeper layers of the face vertically to mimic natural anatomical structures.
• Minimal Tension on Skin: Avoiding excessive tension on the skin to prevent a “pulled” look.
• Volume Restoration: Combining facelift with volume enhancement techniques like fat transfer to restore youthful fullness.

Measures to Achieve Natural Results:

• Experienced Surgeon: Ensure your surgeon specialises in natural-looking facelifts and has a track record of successful results.
• Customised Approach: Tailor the surgery to your unique facial structure and ageing patterns.
• Post-Operative Care: Follow all recovery instructions to support natural healing and minimise visible signs of surgery.

The best age to have a facelift varies depending on individual factors, but most patients consider it between 45 and 75 years old. However, earlier or later interventions can be appropriate based on specific ageing concerns.

Considerations for Timing:

• Early Signs of Aging: Some individuals in their late 30s to early 40s opt for a mini facelift to address early signs of ageing. Dr De Silva often finds that younger patients have genetic factors such as hypermobility or early menopause. 
• Moderate to Advanced Aging: Patients in their 50s and 60s often seek full facelifts to address more significant sagging and wrinkles.
• In good health 70-80s: If in good health there is no age limitation for surgery. It is estimated that 50% people who are born after 2000, will live to 100!
• Overall Health: Ensure you are in good overall health to undergo surgery at any age.

Measures to Determine Timing:

• Detailed Consultation: Have a detailed consultation with your surgeon to assess your skin condition, ageing pattern, and objectives from surgery.
• Non-Surgical Alternatives: Explore non-surgical treatments if you have minimal ageing signs, delaying the need for surgery.
• Maintenance Procedures: Regular maintenance treatments, such as fillers or skin resurfacing, can prolong the youthful appearance and potentially delay the need for a facelift.

The Vertical Deep Plane Facelift is known for its long-lasting results, often maintaining improvements for 10-15 years. Dr De Silva developed this customised technique after 10 years experience in facial surgery to deliver the very best results to his patients. 

Key Features for Longevity:

• Deep Tissue Lifting: Repositions the deeper facial tissues, not just the skin, for a more enduring lift.
• Natural Anatomy Respect: Mimics the natural anatomy, reducing the risk of relapse.
• Volume Restoration: Addressing volume loss with fat transfer or fillers to complement the lift.

Measures to Prolong Results:

• Skilled Surgeon: Choose a surgeon with extensive experience in performing deep plane facelifts.
• Healthy Lifestyle: Maintain a healthy lifestyle with a balanced diet, regular exercise, and avoiding smoking.
• Skincare Regimen: Follow a rigorous skincare routine with products that support collagen production and skin health.
• Regular Maintenance: Consider periodic non-surgical treatments to maintain and enhance the surgical results.

When completing facelift surgery, many surgeons will insert a fine tube into the soft tissues at the end of the surgery (termed a drain) on both the right and left side to continue to drain fluid after the surgery these are then usually removed between 1 day to 14 days  after surgery.

In a small proportion of cases, after surgery, as a consequence of further bleeding, a collection of blood can occur that needs to be removed. Some surgeons believe that the use of a drain may reduce the chance of this complication. However, the drains are often uncomfortable for patients and cause discomfort on removal.

Dr De Silva does not use drains, using meticulous fine stitch technique to avoid the use of drains. There are other interventional techniques that can be used to minimise the risk of bleeding, including the use of fibrin tissue glue and post-surgery medications.

Typically patients will go home on the day of surgery. There is a support bandage that applies pressure to the face and neck for the first day. There is usually only mild discomfort that is relieved by oral analgesia; neck lift surgery usually results in feelings of tightness after the surgery. Dr De Silva advises his patients to apply ice packs to their face for the first 2-days as this speeds up recovery and reduces swelling. Patients often feel good after a few days, and the face is usually swollen and bruised for two weeks. Occasionally patients can feel really drained for the first couple of weeks. After 1-week patients may return to most normal activities, although strenuous activity should be avoided for 3-4 weeks. Most of the stitches are removed between 1-2 weeks. Dr De Silva avoids the use of staples as these promote scar formation through tracks. In addition, Dr De Silva takes steps to minimise leading, with meticulous techniques and fibrin tissue glue and drains in the face to enhance recovery after surgery. Dr De Silva follows his patients very carefully after their surgery and is readily accessible 24-7, he also advises patients on minimising scarring and may use medications that facilitate hidden incisions with the use of creams or local treatments.

How long a facelift procedure lasts is dependent on several factors: The facelift technique, Additional procedures, Environmental factors and Genetics.

• Facelift techniques vary from mini facelifts, to complete face and neck lifting techniques, and most surgeons will use different surgical techniques dependent on the patient and their individual ageing. More extensive techniques are usually required as a result of further ageing. True facelift techniques take several hours to complete, and last for a period of years, usually between 5-8 years. Dr De Silva’s preference is to use deep plane facelift techniques in suitable patients who are considered to last for a longer period of time. Thread-lifts, mini-lifts, 1-hour facelifts and other similar procedures often have a much shorter duration of between 6months andone1 year. Dr De Silva does not advise patients to have these quick techniques as they do not give good long-term results or reach patient expectations.
• Additional procedures used in conjunction with facelift surgery will enhance the effectiveness and longevity of the surgery. Fat transfer to restore volume loss and skin resurfacing to restore sun-damaged skin are two common procedures that will enhance the facelift procedure
• Environmental factors that will speed up facial ageing and reduce the longevity of a facelift include smoking, sun exposure, poor nutrition and stress.
• Genetic and ethnicity both influence facial ageing and longevity of a facelift, a useful indicator for genetics is looking at how your parents have aged relative to their peers.

The best UK surgeons in 2024 according to Rate MD

1. Dr Julian De Silval. Plastic/ Cosmetic Surgeon

23 Harley Street, London, London, ENG, W1G 9QN

2. Dr Riccardo Frati. Plastic/ Cosmetic Surgeon
3. Dr. Ayham Al-Ayoubi. 

Milner House, 14 Manchester Square, London, ENG, W1U3PP

When considering cosmetic or plastic surgery it is essential to complete some due diligence on your potential surgeon

1. Right Credentials. Specialist Board Certification, Fellowship training, publications and awards. There are general Plastic surgeons (completing breast & body surgery, members of BAAPS), Oculo-facial Plastic Surgeons (Specialising in surgery around eyes), ENT surgeon (specialising in ears, nose and throat surgery, FPS) and Maxillary-Facial surgeon specialising in teeth). 
2. Extensive Experience. Check the surgeon you are considering is completing that procedure on a daily basis. A surgeon specialising in facial surgery, completes facelift, blepharoplasty etc every day. A surgeon specialising in body surgery is likely to be completing more breast and body surgery. Medicine and surgery has become increasingly specialised over the past decade with technological advancements in all areas of medicine. Commonly general plastic surgeons completed a SMAS facelift which could be completed in 3 hours or less meaning that surgeons would complete 2 or more procedures a day. With technological advancement the most natural and longer lasting facelift surgery is completed with deep plane facelift. 
3. Artistry. No single technique will be suitable for all patients. Natural facelift and neck lift surgery needs to be tailored to the individual. Look at before and after photographs of the surgeon you are considering, to they have aesthetic that you like and fit your expectations from the procedure.
4. Detail oriented & Revision Surgery. Facial surgery is intricate as the detail is millimetres, body surgery is detail in centimetres. 20-30% of the surgery Dr De Silva complets is revision facelift & neck lift, who have had underwent facelift or neck lift surgery elsewhere and were unsatisfied with the results from their previous surgeon. There can be many reasons for this, not adequate improvement, recurrence, lose skin and puffiness remains, short longevity, visible scars.
5. Many patient reviews. A good indicator of your experience is looking at other patients experiences. You want to have a surgeon who will be there for you and support you on the recovery as well as deliver on the results that you expect from surgery. 
6. Safety. One of the most important aspects of surgery is safety. In the UK there is much regulation that is detailed and meticulously assessed to ensure patients safety and high quality of care. The CQC maintains this regulation in clinics across the country. Be cautious about going overseas for cheaper surgery, there have been many fatal and disastrous consequences of patients going to Eastern Europe (Turkey), Asian and South America. 
7. Facility. To undergo an aesthetic procedure, it would be preferred to have a procedure in a specialist aesthetic centre. Many private hospitals provide both functional (e.g. cancer, tumour procedures) and cosmetic procedures, this is not ideal. Specialise surgical centre will provide a better patient experience for the aesthetic patient. . 
8. Discrete Scars. Key to World Class facelift & neck lift surgery is discrete and virtually  invisible scars. There are many important factors to consider including, natural skin position, asymmetry, ethnicity, skin laxity, skin quality and other diagnoses. The skin incision is closed using a combination of interrupted and continuous non-dissolving fine stitches. Non-dissolving stitches are preferred as they avoid scarring and stitch lines. Dissolvable sutures although saves time for surgeons as they dont need to be removed, these can create additional scarring.
9. Use of Technology & Management of Complications. Ask about the use of technology to enhance recovery and speed up healing. Ask about the management of complications, although the chance of complications can be reduced with meticulous preoperative and postoperative care, there is no way to complete prevent all complications. Ask about these and how they would be managed.
10. Type of Anaesthetic. General anaesthetic (GA)has long been used as the anaesthesia for facelift and neck lift surgery. GA does carry a small risk of a deep vein thrombosis (DVT in the legs) or reaction to inhaled anaesthetic. Although these complications are rare with GA they are very serious. In addition after a few hours of GA, most patients recovery quite slowly and it is common to have symptoms of nausea or sickness, and to feel slight washed out. Other GA issues include shock hair loss, haematomas and longer recovery. Sedation Anaesthesia aka twilight anaesthesia offers a lower risk form of anaesthesia, and faster recovery without the risks associated with GA. 

 Dr De Silva specialises in Face Surgery Only and Facelift & Neck lift is the #1 Procedure he completes for his patients every day. Dr De Silva customises facelift and neck lift surgery for each individual patient and often combines with other procedures including blepharoplasty, chin implants, buccal fat reshaping, fat transfer, laser resurfacing. Dr Julian De Silva travelled world-wide with fellowship in the USA and spent time working in some the best Cosmetic centres in the World before setting up his practice over 10 years ago. This included London, UCLA Jules Stein Eye Institute in Los Angeles and Montefiore Medical Center, Albert Einstein College of Medicine in New York. Dr De Silva wrote an extensive book that includes everything each patient needs to know regarding facelift and neck lift surgery. Dr De Silva uses specialised state-of-the-art technology to improve the natural results or enhance recovery or longevity of the procedure including oxygen therapy and regenerative medicine. In addition Dr Julian De Silva has pioneered the use of sedation anaesthesia in the UK, and has been awarded a Patent for his innovation. Dr De Silva has always taken pride and constantly innovated on improving natural results, faster recovery with over 1000 5* reviews was voted the best in facelift and neck lift surgeon in the UK on an independent review site.

Link to video: How to choose the best facelift & neck lift surgeon for you?

The most advanced facelift technique currently available is the Vertical Deep Plane Facelift.

Key Features:

• Deep Tissue Lifting: Unlike traditional facelifts that only lift the skin, the Vertical Deep Plane Facelift repositions the deeper layers of facial tissue. This approach ensures a more natural and longer-lasting result.
• Vertical Lift: Lifting the facial tissues vertically rather than horizontally maintains the natural contours and avoids the “windswept” look.
• Comprehensive Rejuvenation: This technique can be combined with volume enhancement procedures like fat transfer and skin resurfacing treatments for a complete rejuvenation.

Measures to Achieve Best Results:

• Experienced Surgeon: Ensure the procedure is performed by a highly skilled and experienced surgeon like Dr. Julian De Silva, who has perfected this technique.
• Personalised Approach: The surgeon should customise the procedure to your unique facial structure and ageing patterns.
• Post-Operative Care: Follow all post-surgical care instructions to support healing and enhance the longevity of the results.

The deep plane facelift is the most advanced technique practiced today. It is a great option for patients with significant jowling and lower face sagging and creates very natural-looking and long-lasting results.

The best surgical hospital in the UK for facial cosmetic surgery is often regarded as 23 Harley Street Clinic in London.

Key Features:

• State-of-the-Art Facilities: Equipped with the latest medical technology and facilities custom build for facelift & neck lift surgery.
• Reputation: Renowned for its excellence in patient care and surgical outcomes.
• Expert Surgeons: Home to many of the UK’s leading cosmetic surgeons, including Dr. Julian De Silva.

Measures to Ensure Best Experience:

• Research: Verify the hospital’s accreditation and reviews from other patients.
• Surgeon Affiliation: Ensure your chosen surgeon is affiliated with a top hospital like Harley Street Clinic, which guarantees a high standard of care.
• Visit the Facility: If possible, visit the hospital beforehand to see the facilities and meet the staff.

Dr. Julian De Silva is often recognized as a leading celebrity plastic surgeon in the UK.

Key Attributes:

• Expertise: Specialises exclusively in facial surgery with over 20 years of experience.
• Media Coverage: Frequently featured in media outlets like Sky News, BBC, and various lifestyle magazines.
• Celebrity Clients: Known for treating high-profile clients and celebrities who seek the best in facial rejuvenation.
• Dr De Silva provides all his clients with complete anonymity, he has provided surgery for many celebrities, actors, singers and performers. Dr De Silva enjoys helping all patients and has treated patients of all professions and international patients from all continents of the world (not including antarctica!). 

Measures to Ensure Best Results:

• Consultation: Schedule a consultation with Dr. De Silva to discuss your goals and understand his approach.
• Portfolio Review: Review his extensive portfolio of before-and-after photos to see the quality and naturalness of his work.
• Testimonials: Read testimonials from celebrity and high-profile patients to gain insights into their satisfaction with the results.

When completing facelift surgery, many surgeons will insert a fine tube into the soft tissues at the end of the surgery (termed a drain) on both the right and left side to continue to drain fluid after the surgery these are then usually removed between 1 day to 14 days  after surgery.

In a small proportion of cases, after surgery, as a consequence of further bleeding, a collection of blood can occur that needs to be removed. Some surgeons believe that the use of a drain may reduce the chance of this complication. However, the drains are often uncomfortable for patients and cause discomfort on removal.

Dr De Silva does not use drains, using meticulous fine stitch technique to avoid the use of drains. There are other interventional techniques that can be used to minimise the risk of bleeding, including the use of fibrin tissue glue and post-surgery medications.