Face Lift

Face Lift
The word "tight" usually has a negative connotation: the situation is tight, the neck is tight, the people are tight, and also – the muscles are tight. In all of these, the word "tight" describes a fragile state, sometimes dangerous, almost always on the verge of explosion.

Until we reach the skin. Here the word "tight" suddenly becomes an ideal: tight skin, tight abdomen, tight neck, they are all within the realms of fantasy, and the only sort of explosion or heat accompanying these dreams is a form of flattery ("She looks hot !"). *
What is a facelift?
In English, this type of surgery is called a "face lift". In Hebrew it is rather called "face stretching" or "face tightening". The exact term is probably a combination of both concepts.

Up until five years ago, most surgeons tended to stretch the skin towards the ears. In recent years, the tendency is to combine between lifting the skin towards the temples and stretching it towards the ears, as needed.
The customary definition for face lift is "stretching and lifting the lower half of the face and neck". Please note: the eyelids and forehead do not belong to this definition. So it's true you can decide in advance on a combined surgery which includes a facelift, eyelid surgery, and lifting of the eyebrows and the forehead, but this is a combined operation and not a regular facelift.

At what age can I begin?
Usually from the age of 40 and onward. However and as a matter of fact, at any age in which facial skin sagging is apparent (and we can only hope it happens long after the age of 40).
 
How long will the results remain?
Usually for 6-10 years, depending on the skin's type and its elasticity. On the other hand, even 15 years after surgery most likely you will look much better than you would have, were it not for the surgery you underwent.

Surgery types:
1. In a classic facelift, a long incision is made from the sideburn along the ear, behind the ear and into the hair. It is particularly effective for facial and neck skin excess treatments (sometimes a second incision under the chin may be necessary as well).
2. A short incision face lift, a method which spares the scar behind the ear, where the subcutaneous tissue is pulled by 3 loop-shaped stitches, hence the scar at the back portion of the ear is contracted.
3. In a mini-facelift, a very short incision is performed, a very limited skin separation of about 2-3cm and then a strong stretching of the skin and sub-skin. The advantage: a short healing period, yet the lifting effect is not maintained over time, and sometimes the orientation of the lift is not ideal.

Where is the incision performed?
The incision begins at the temple. From there is descends along the front of the ear, enters it, exits and encircles the ear butt, ascends behind the ear up to half its height and then reenters the hair behind the ear. A similar incision is performed of course next to the other ear as well. Sometimes a shorter incision is satisfactory, one which does not ascend behind the ear and enters the hairline. Its advantage is that it spares the segment between the ear and the nape hair, which is specifically the area that heals and doesn't look as good.
Sometimes a small incision emerging from the ear's front towards the cheek's sideburn and then slightly slanting upwards (at a length of about 3.5cm) along the hairline is added. In most cases, another small incision is required (about 3-4cm) in the area beneath the chin. This, in order to reach the muscles and fat located at the intermediate portion of the neck.

What is done during surgery?
Firstly, the facial and neck skin is separated. Through the incisions we can reach the fold separating the cheek from the upper lip (those expression lines) as well as the folds forming between both sides of the lower lip and the chin. Only after the skin has been separated, surgery may begin.

During the first step of surgery, the neck's appearance is improved. Through this incision it is possible to reach the whole width of the neck, to remove excess fats and tighten the neck's muscle to the intermediate line of the neck. In cases where the neck cords are very prominent, it is necessary to perform incisions at the neck's muscle. These incisions release the muscle and loosen it, thus eliminating the cords typical for an aging neck. Following the stretching and tightening of the neck's muscles, the facial subcutaneous tissue, which is actually a continuation of the neck's muscle, is about to be stretched. This tissue is also stretched sideways and upward and the excess tissue created is then removed or folded.

This is the stage where, if necessary, the central part of the face is stretched (the cheeks area). This stretching action should be performed via the incision by the ear. Using stitches, the subcutaneous tissues in this area are affixed towards the forehead, thus obtaining the appearance of a higher fuller cheek.
Now comes the turn of excess skin. The importance of this stage is measured not only by the amount of excess skin removed but also by its removal direction.
It is imperative to tighten the skin in such a way that most of the tension is in areas which are able to absorb it, however doing so without causing distortion or expansion of the scars in visible areas. For example, it is preferable to augment the stretch towards the back portion of the ear (which can absorb the tension) than towards the front portion of the ear (where the scars are visible).
The removal of the excess skin terminates when the skin appears tight, without any folds, and with a notable improved appearance of the neck, the jaw line and the fold connecting between the nose and the lip.  
Towards the end of surgery, we try to repair and maintain the hairline in those areas where incisions were performed. That is, keep an aesthetic look of the cheek's sideburns and the hairline behind the ear.
At the end of surgery, the incisions are gently stitched using very thin nylon threads, while in the hair areas and in other hidden areas, the incisions are closed using metals pins.

Combinations
It is possible to combine facial operations and to perform facial and neck lifts, eyelid, forehead (Full Face Lift) and even a light or a limited peeling. Nowadays, when it became clear that some of the aging process is the depletion of the face and reduced skin quality, we use self fat injections that are performed during surgery. The fat is harvested out of areas which contain excess fat such as: the abdomen, thighs and hips. It goes through a cleaning process using a centrifuge and those portions rich in stem cells are injected into sunken or depleted areas in the face. The purpose of this injection is filling and improving the quality and texture of the skin using stem cells.
PRP: Blood platelet-rich plasma (thrombocytes). During surgery, 60 cc of blood is taken from the patient. The blood platelets are separated by a centrifuge and these are sprayed beneath the skin's surface, even before the incisions are stitched. The goal of this action is to reduce the frequency of bleeding and to hasten the healing process of the surgery.

Is it possible to stretch even a little more?
Endless stretching is impossible. The stretch limit is associated with the blood supply capability of the skin. An excessively stretched skin will be unable to receive blood supply and it will decompose. Therefore, a good stretch is a compromise between the desire for stretched skin and the body's ability to withstand our aesthetic crazes. In this matter regarding the skin's stretching limits, there's another item of data that must be taken in consideration - the more elastic the skin is, the better is the result (stretch) obtained. In order to understand the term elastic, try to imagine rubber. What happens when it is stretched? Rubber, which is an elastic substance, maintains the tension that has been created within it and remains tense. This is exactly what happens when elastic skin is stretched: it stretches, and remains stretched. And what about the skin that has lost its elasticity? Its features are already more similar to plasticine. That is, when it is stretched it indeed stretches, but unlike the elastic rubber, it does not remain tight and stable. Just the same happens with the facial skin: you can stretch a non-elastic skin (such skin that when gently pinched, it does not return immediately to its previous state), but after several months it will lose some of this tension and the facial skin will look as if it needs another small stretch. What do we do? Discuss this with your doctor and take into account – in advance – that in cases where the skin is more plastic than elastic, a corrective surgery will be required and it can be performed a few months after the first surgery. It is worthwhile thinking about this operation, which is diminutive compared to the first one, as being another part of the same issue. Not an error, not a foul-up, but a second stage known in advance.

How is the anesthesia performed?
Facelift surgeries are performed under general or local anesthesia with intravenous sedation. In both cases, the operation is performed in the presence of an anesthesiologist. Why? Because this is a relatively long procedure, because of the large amount of anesthetic injections and since the average age of the patients is relatively high and usually they belong to a less healthy population group.
In case of local anesthesia, the anesthetic injections are administered only after intravenous sedatives have begun to affect, The injections are given along the planned incision line as well as in areas in which skin and fat are separated: in the neck, the chin and the cheeks. Does it hurt? Yes. A little. How much is a little? Like an injection administered by a dentist and even less. The sedatives that were given earlier ease the administration of these injections.
Currently, there is a clear preference for performing facelifts under general anesthesia because of the ability to maintain and preserve the airways during surgery.

Does a facelift require hospitalization?
Requires? No, since in principle the patient may go home after 6 hours. Nevertheless, it is advisable to be hospitalized for one night. Why? So that for the first hours following sedation, you are under supervision and monitored.

How long does the surgery last?
Between two to four and a half hours.

More regarding Facelifts:
A comprehensive guide by Dr. Haim Kaplan regarding Facelifts can be found at www.bello.co.il.
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