Ever thought about going under the knife? The thought of having a facelift is both terrifying and exciting. It's a big decision that can help improve your confidence and give you back an appearance that better represents how you feel on the inside. But it's not a decision to take lightly.
We spoke to Mr James Murphy from Spire Manchester Hospital to find out exactly what happens during a facelift procedure. Taking us through from the consultation stage to post operative care, here is what everyone considering a facelift needs to know.
Before the operation
Q. What happens at the consultation stage?
A. There are usually at least two consultations before undergoing a facelift. The first consultation is to assess the problem as the patient sees it and to discuss the various surgical and non-surgical options for dealing with this problem. This first consultation is a very general discussion. The patient is made aware of the potential benefits but also some of the common risks and complications.
The second consultation is more detailed. I use a 3D imaging system to assess the problem more accurately and fine tune the surgical plan to suit their individual needs.
Q. What steps happen between the consultation and deciding to have the surgical procedure?
A. After the first consultation the patient has as much time as they need to think about whether they wish to go ahead. This should be at least 14 days though, if somebody wants to proceed as quickly as possible, they can book a date for surgery after the first consultation, as long as it is at least two weeks later. In practice, patients often take several weeks and sometimes months to decide to go ahead, at which point they can arrange a date for their surgery and for the second preoperative planning consultation.
Q. What preparation do you have to go through before the operation? In the days/weeks before?
A. The main thing is for patients to be healthy, well-nourished and well rested. Alcohol intake should be kept to a minimum and I prefer it if patients do not take dietary supplements as these can occasionally contain substances that may have an adverse effect on the surgery.
At the second planning consultation, I will occasionally request blood tests and investigations but these are generally not necessary if the patient is fit and well. Starvation instructions are also given at the second consultation so that a patient is fully prepared for the surgery.
On the day
Q. What happens before the surgery?
A. The patient arrives at the hospital and is admitted onto the ward. This involves a nurse taking a medical history and recording their observations (blood pressure, temperature, height and weight etc). I will see the patient in their room once they have been admitted and will discuss some of the minor details of the surgery with them again.
More often than not, several markings are needed whilst the patient is awake and these are done in the patient’s room before they are taken to theatre. The patient changes in to a gown and is asked to put on compression stockings to help with the circulation in the legs. Once they are ready for theatre, they are usually walked down to the anaesthetic room. They will have met the anaesthetist in their room and he will be in the anaesthetic room to administer the general anaesthetic.
Q. What should you bring with you on the day?
A. I advise patients to bring some creature comforts with them. They are often going to spend a night or two in hospital and it is nice for them to make the room their own. This can include electronic devices to help pass the time (kindle, laptop, tablet etc) but I am more than happy for people to bring in pictures of loved ones and articles of clothing that make them feel more at home. Toiletries can be brought in as necessary depending on the length of stay.
Q. Where is the anesthesia administered? How long does it take to work?
A. The anaesthetic is administered in the anaesthetic room which sits next to the operating theatre. It is generally done by an intravenous injection in the back of the hand though occasionally gas induction is used. Before the main injection, a small syringe of short acting pain killer is often given which relaxes the patient and makes them more prepared for their general anaesthetic. Once the general anaesthetic has been administered, it often takes no more than five to 10 seconds before it starts to work. The next thing the patient knows is that the operation is over and they are in the recovery room.
Q How long does the operation last for?
A. A facelift is not a single operation. A straightforward short scar facelift (often used on younger patients) may only take two or so hours to perform but more complicated lifts with ancillary procedures such as eyelid surgery, fat grafting, brow lift, liposuction and more complex procedures in the neck can take anything up to five or six hours.
Q. What happens during the operation?
A. The surgery is too complex to go into every single surgical detail but the incision is made in the skin around the temple, ear and behind the ear are initially made to gain access to the face, neck and sometimes the forehead. The lift itself takes place by manipulating, tightening or repositioning what is known as the SMAS layer within the face which contains strong fascia, ligamentous support structures and the muscles of facial expression.
Occasionally liposuction is performed to certain areas to help with the reshaping and once the lift has been performed the skin is closed without tension to prevent a windswept look. The details of how the lifting takes place and which areas are to be treated is something that is discussed on a case by case basis with individual patients at their consultations.
Q. How are the incisions closed?
A. Each surgeon has his or her own different way of doing this. The important point is that they are closed without tension. If the skin is pulled tight the wounds will not heal as well, the scars may become stretched and the face may look too tight. A combination of absorbable on non-absorbable sutures are used and generally stay in for around one week postoperatively.
Q. How is the area bandaged?
A. A gentle support garment is placed around the head and under the chin. There is a layer of cotton wool padding underneath this which helps control selling and bruising. This should be comfortable rather than overly tight and is usually removed or changed the following day.
Q. How is infection prevented?
A. A single dose of intravenous antibiotic is given at the time of the surgery. It is not routine to give postoperative antibiotics as there is no evidence this reduces infection rates.
Q. What pain killers are used post op?
A. Regular tablets are taken including Paracetamol, anti-inflammatory medicines such as ibuprofen and, occasionally, Codeine.
Post surgery
Q. How long do you stay in the hospital/clinic for?
A. Almost every facelift has a single overnight stay in my practice. Occasionally, with more complicated ancillary procedures (eyes, brow, neck) a second night in hospital is advisable as patients are more likely to rest during this period and recover much more quickly.
Q. When can you remove the dressings?
A. The dressings are changed whilst the patient is in hospital but they tend to go home with a light support garment on to help with swelling in the neck in particular. This stays in place for the first week until they are seen in the clinic for a wound check and removal of sutures as necessary.
Q. How often do you have to change the dressings?
A. My patients do not have to change dressings when they are at home. The support garment is removable for washing hair etc. but is best to be worn as much as possible in between.
Q. What sort of pain can you expect post op?
A. A facelift is not a particularly painful operation though some patients report a spasm and tightness in the chewing muscles of the jaw. The face certainly feels tight, looks over corrected and the swelling is mildly uncomfortable but, if the head is kept elevated, the level of pain is relatively low.
Q. How long is the downtime after a facelift procedure?
A. The recovery is something that happens in stages. For the first week, a patient will not want to venture outside the house. They will be well enough to move around the house freely but will feel self-conscious if they were to step outside the door.
Once they have been for their one week visit, they are often quite comfortable being seen out in public, though not necessarily by people who know them. Most people take three weeks off work and then feel ready to face their friends and colleagues at that point. Full recovery takes many more weeks. If somebody is having a facelift as they have a big event coming up (wedding, birthday or holiday) I would advise them to do it at least three months ahead.
Q. What activities should you avoid post op?
A. Anything that puts your blood pressure up. This includes lifting, straining or any form of exercise. The greatest risk in the first few days after surgery is of bleeding and patients need to rest as much as possible.
Q. What can you wear to support the area post operation?
A. Patients will be given a support garment which sits underneath the chin and is wrapped around the head. This is removable but is best left in place for the first week at least.
Q. What kind of symptoms are normal and abnormal post op?
A. It is normal to feel a sense of tightness and occasionally pain in the chewing muscles but generally each day is better than the one before. Any changes in how the face feels where the symptoms have become worse are concerning and should be discussed with the surgeon or his or her team. Infection is very unusual and certainly not likely during the first week but an increase in swelling, particularly on one side, could signify bleeding which would need to be investigated.
The patients face is often stiff in the early stages following surgery but they should have full and normal movement of the facial muscles almost immediately. Any weakness or asymmetry in this regard should be discussed with the surgeon. It is entirely normal for the skin in front of the ear and side of the neck to become numb after the surgery. This can take several months to return. Bruising in the skin is unfortunate but normal. Any fluid collections under the skin are not normal and should be treated.
Q. What advice would you give about the procedure to anyone considering facelift surgery?
A. The best advice I can give a patient who is considering a facelift is to have reasonable, realistic expectations. A facelift cannot correct all the features of aging but can give the impression of youthfulness. Patients should therefore focus on the ‘big picture’ rather than become overly focused on individual lines or areas of the face. In selecting your surgeon, you should only choose a surgeon who is performing significant numbers of facelifts on a regular basis.
It is highly specialised surgery that requires extensive training to produce satisfactory results. It is also extremely useful for prospective patients to talk to previous patients who have been treated by the surgeon. Whilst these patients will have been handpicked, it is reassuring to hear the experiences of other people and to ensure that the surgeon or clinic that you are speaking to is set up to carry out this complex surgery safely and elegantly.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional
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