Open letter to Facelift Patients

Mr Kalus has written an open letter to patients considering a facelift, to help them through the decision process.

Dear Patient,

Each year we see many people, both men and women, who have become concerned about their facial signs of ageing. You may be aware of facial lines, sagging of your cheeks or a bagginess of your eyelids. Sometimes friends or family have also noticed the changes and this can lead to self-consciousness. The changes that occur in your eyelids can make you always look tired even when you feel bright and alert. Looseness and wrinkling skin of the neck may make you feel embarrassed and feel the need to “cover up” with a scarf or high necked clothes.

These changes all occur due to the loss of elasticity of the skin which comes with increasing age. In addition, the fat which is naturally present in the face tends to absorb as we age and this leads to thinning of the lips and deepening of the cheek furrows.

The texture and pigmentation of the skin also changes, especially if there has been a lot of exposure to the sun.

Because every person’s concerns are different, I think it is important for you to try to prioritize your concerns – in other words to list your concerns in order of importance. During the examination, I find it very helpful for you to look down into a mirror. This allows the skin to sag to its full extent and gives us a “window” into the future – showing us how you will look in years to come. The next step is to hold the mirror above your head and look up into the mirror. This gives an excellent indication of the likely improvement that will be obtained from a facelift!

Indeed a facelift is the corner stone of facial rejuvenation surgery. By lifting the skin and underlying muscle (called the superficial musculoaponeurotic system) we are correcting for the loss of elasticity of the skin and the stretching of the muscle. Of course it is critical that scarring be kept to a minimum and be invisible where possible. Therefore the procedure is performed through incisions in front of and behind the ear and extending slightly into the hairline. The extent of the procedure varies according to individual need but basically is designed to remove the excess skin and lift the underlying muscle which is then fixed in place.

If there has been some loss of facial fat with thinning of the lips and prominent cheek grooves then transferring some fat into these areas greatly improves the result. There have been great improvements in the technique of fat transfer over recent years and I much prefer the use of your own fat to artificial substances such as dermal fillers. The fat is taken from the abdomen, thigh or buttock, prepared by centrifugation and then injected with a special blunt cannula so as to cause minimal trauma. The fat becomes incorporated into the tissues and restores the fullness which has been lost due to the ageing process. More fat than is needed is transferred to allow for some absorption to take place and the area is therefore a little swollen for 1-2 weeks.

For some people the ageing process seems to begin first in the eyelids. The upper eyelids, the lower eyelids or both may be affected. In the case of the upper eyelids, a fold of skin forms which hangs down over the eyelid, occasionally even covering the eye lashes. The upper eyelid feels heavy and the upper part of the visual field may even become obstructed. The natural reaction is to try to hold up the upper eyelid by raising the eyebrows and this causes multiple creases in the forehead. The best way to treat the upper eyelid is to remove the fold of excess ski.. In some cases the eyebrows have also descended and a brow lift may be required. This can be performed through a small incision within the hairline.

The lower lids also may sag due to stretching of the skin and underlying muscle. In addition, the lower lids may bulge due to fat, which is normally situated behind the eye, herniating forwards. The lower lid is best treated by removal or rearrangement of the excess prolapsed fat and tightening of the skin and muscle.

For the last 20 years we have been performing facial rejuvenation surgery as Day Surgery. This means that you can have your operation in the morning and go home in the afternoon. Because you will have had an anesthetic, it is necessary that someone pick you up and look after you on that first night. The operation takes between 1 and 3 hours depending on what is done. Of course an option to stay overnight is available.

A number of steps are taken during the surgery to prevent post-operative complications. In this way bruising and swelling are minimized and the recovery period is shortened. A special dressing including a firm bandage is placed around the face as a further measure to reduce bruising and swelling. You will be given antibiotics before and after the operation in order to prevent post-operative infection. Although you will be asleep during the operation, a long acting local anesthetic called Marcaine is injected into the facial skin during the surgery so that when you wake up you will feel no pain. A light pressure dressing is usually applied to the eyelids following the surgery, again to minimize bruising and swelling and this is removed about an hour after you wake up. At this stage an ice pack is applied to the eyelids to reduce the swelling .Once you are able to eat or drink, usually after one or two hours, you will be given tablets such as Celebrex, Panadol or Panadeine to reduce inflammation and to prevent discomfort. High blood pressure is a common cause of post-operative swelling and bruising and if there is any sign of your blood pressure being high after the anesthetic then you will be given special medication to keep the blood pressure normal over the next few days. Once you arrive home we suggest that you go to bed and get a good night’s rest. Taking Panadol or Panadeine every 4 hours is good insurance against discomfort the following morning.

When you leave our hospital, you will be given an appointment to return the following morning for your first post-operative dressing. A light dressing is then applied to the facial skin and worn for the next few days to reduce swelling. It is unusual for pain to be present but Panadol or Panadeine can always be taken if required.

The stitches are removed after seven days as we aim to have you substantially healed by the seventh post-operative day – although a little bruising and swelling may persist at this time and it’s probably wise to arrange to have two weeks away from work or other important social engagements. Once the sutures have been removed, the incision lines continue to mature and are usually red for several weeks or months. They usually resolve into fine white scars that are barely visible, although sometimes thickening of the scars can occur especially behind the ears where most of the tension has been applied. These thickened areas usually settle with a little extra time. There is a large variation in the healing process amongst individuals.

Having read this letter you will be better informed regarding the surgical options available for facial rejuvenation. Of course there are also a number of non-surgical options available such as dermal fillers, anti-wrinkle injections, thread lifts and various dermal and laser therapies. Your initial consultation is the most important step for the development of a treatment plan that best suits your needs.

Should surgery be required our aim is to perform the procedure safely, effectively and with minimal discomfort and disruption to your lifestyle. My staff and I will be very happy to assist you in arriving at the best decision. Please do not hesitate to contact us if we can help in any way. We do hundreds of these procedures every year and realize that facial rejuvenation is more about improving your self-confidence and happiness than just tightening the skin. This is precision surgery that requires expert knowledge and technique, so that you will look relaxed and refreshed with scars that are barely visible.

Allan Kalus

For more information about Facelift surgery at Avenue Aesthetic Surgery click here.