Facelift in London – for Natural, Youthful Results

Cost is tailored to an individual patient’s needs and is based on whether it is a full facelift, or neck lift and if there are associated procedures to enhance the result. Additional techniques 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 the 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.

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 patients of darker skin tones, it is advisable to use an alternative skin resurfacing technique.

In the UK, most facelift surgery is completed under general anaesthesia. Dr De Silva does generally use an alternative type of sedation used in conjunction with local anaesthesia. This 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.

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) 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 unnatural surgery, 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.

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.

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. The key to 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 that it allows for a small incision and a hidden scar with rapid recovery after surgery.

There are circumstances where a mini-facelift procedure is not adequate. If you have substantial skin laxity, marked jowls and droopiness in the neck include vertical bands (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.

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.

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% of 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.