The face-lift

Each face is unique, has its own character and expresses emotions and feelings, giving and individual their personality.

Cosmetic facial surgery must completely preserve this identity, which gives everyone their individual charm. The aim is not to transform a face so that it looks more beautiful or younger, which would result in an appearance conrform to the standard norms of beauty. On the contrary, an individual’s identity should be emphasized, highlighting the strong points that give them their charm. The overall harmony should look natural and not show any signs of surgical intervention.

Advances in cosmetic surgery and medicine have completely transformed the use of facial and neck rejuvenation techniques. Large lifts with scalp incisions and areas of skin detachment that had significant consequences have been mainly replaced by lifts that leave only small scars: the Minilift (Soft Lift, French Touch, Macs Lift, Natural Lift...), which are used with lighter techniques (the curl-lift, hyaluronic acid or botox injections, chemical and laser peels) for a harmonious result across the entire face.

A complete face and neck lift involves 5 areas:

• The brow lift, which covers all the eyebrows and forehead.

• The temple lift, which concerns the outer part of the eyebrow, the upper eyelid and any crow's feet.

• The mid-face lift, which focuses on the cheekbones and malar bags, which are swellings located under the fatty pockets of the lower eyelid.

• The jugal facelift, which deals with the cheeks and jowls.

• The cervical lift allows redefinition of the cervico-facial angle by correcting saggy skin around the neck and any double chin.

The cervico-facial lift comprises the mid-face, jugal and cervical techniques. It can be used to correct sagginess in the entire cheek and neck areas and is the most popular technique because it does not affect facial expressions, which give you your identity. It restores, in particular, the oval of the face to what it was a few years before.

For the upper part of the face, conventional frontal and temporal lifting lead to extensive scarring in the hair and excisions in the scalp, which can cause a decrease in hair density in the detached areas and a retreating hair implantation line. For this reason, I no longer practice this technique. For these two regions, I prefer to use the Curl-lift (tension threads) technique, which uses tension threads to support loose parts on the face with only 2mm incisions hidden in the hair and no scalp excision. This prevents the loss of hair density and does not affect hair implantation.

Each person comes to me asking for a particular defect to be corrected when they find this particularly troublesome. The objective of the operation will be to correct this defect as a priority by assessing whether it may be appropriate to correct other associated defects for a well-balanced, natural result that meets your expectations.

So, depending on the insights gained during the first consultation, the operation may be combined with another operation to improve the overall harmony of the face. Indeed, correcting a particular defect sometimes risks bringing out another defect, which was less visible before. This can be carried out during the same procedure or at another time.

The cervico-facial lift can frequently be combined with:

• Eyelid plastic surgery,
• A frontal, temporal or malar curl-lift (tension threads),
• Lipomodelling by liposuction, removing fat deposits (double chin, jowls, fatty cheek pads), and/or by lipofilling (injections of your fatty tissue) to correct wrinkles and restore volume to saggy areas,
• Hyaluronic acid or Botox injections to reduce wrinkles,
• Chemical peels or laser treatment.

During the first consultation, it is essential that you openly express what bothers you and what you would like to improve. Do not be afraid to ask any questions, including expressing your fears and expectations. Everyone has a different body shape, psychology and expectations, which are not the same and there is no standard to apply.

After you have explained your motivations, I will examine you and offer one or more solutions, taking into account your expectations, your anatomy and respecting your identity and the natural aspect of your appearance.

In order for you to visualize the desired result, using a mirror, I will manually recreate the effect the recommended treatments will have on your skin; then, I will show you photos of surgical results of cases similar to yours so you can understand the objective of the procedure.

It is essential that you and I have a good understanding when deciding to operate and to determine the technique to use among those I can offer.

I will then give you all the information on the techniques proposed along with the information sheets from the Société Française de Chirurgie Plastique Reconstructrice et Esthétique (French Society of Plastic, Reconstructive and Cosmetic Surgery) as well as a detailed estimate of the costs for the options chosen. You will then be able to move your project forwards and get ready for a second consultation when you will be able to ask any additional questions to help you make a decision and prepare for the operation.

Depending on the type of anaesthetic (local or general), a full or partial blood test should be carried out.

For general anaesthetics, you will need a consultation with the anaesthesiologist in the weeks leading up to the operation and at least 48 hours beforehand.

For people using hair dyes, ideally, you should dye your hair the week before the operation, because a new dye can only be applied 3 weeks after the operation.

No medications containing aspirin or anti-inflammatories can be taken within 10 days of the procedure.

For general anaesthetics, you will have to fast strictly for 6 hours before the operation (do not eat anything, chew gum, eat sweets or smoke). However, for local anaesthetic, you can drink and eat lightly at normal mealtimes.

Tobacco consumption should be stopped or reduced as much as possible during the month before and the month after the procedure. Tobacco can cause scarring problems.

A stay in hospital is usually limited to the night after the operation. Same-day discharge is also possible after a few hours of monitoring following the operation. During the night, painkillers and analgesics are given by drip infusion if you are in hospital or can be taken in tablet form at home. Leaving the following day means you can go home without any bandages.

The duration of the operation is about 2 hours.

Local, deep local (neuroleptanalgesia) or general, according to your preferences.

Before you go to the operating theatre, in your room, I will go over the precise goals with you as we agreed during the consultations. You can then always make recommendations and ask any questions. I will then draw the lines and marks on your skin to guide the operation and the lines of the incisions.

Incisions are made around the ear, starting under the sideburns to hide them and then along the curves that contour the ear, finishing behind the ear. This means the path is not straight and the scars are hidden as far as possible.

I do not make any incisions in the hair and there is no scalp excision, which can lead to a decrease in hair density in the detached areas and a retreating hair implantation line. This is good for anyone with little hair. This incision pattern means the original site for hair implantation can be completely preserved and, in particular, prevents rising sideburns.

The incisions and detached skin give access to the anatomical structures that need reshaping: muscles and aponeurotic structures are repositioned, tightened and set in the right position, any excess fat is removed by micro liposuction, then the skin is replaced without stretching it over these newly-created embedded structures. Any excess skin is removed along the line of the incisions and sewn together with intradermal stitches, which are placed inside the thick part of the skin, making them invisible. The stitches dissolve and do not need to be removed.

The cervico-facial lifting technique is important because it repositions the tissues and this is ensured by re-tensioning the deep tissues and not by creating tension on the skin, which would lead to a fixed appearance and a very temporary result.

At the end of the operation, a bandage is placed around the head, leaving the eyelids uncovered, which is particularly good for anyone who suffers from claustrophobia.

During the night following the operation, you may feel a sensation of painful tension in the cervical area, accentuated by the compression bandage around your head. This pain is moderate in a resting position and can be treated with painkillers and analgesics, which are given by drip if you are in hospital or can be taken as tablets at home.

The next morning, the bandage can be completely removed; you can then have a shower and wash your hair at the clinic. Your hair can be blow dried using a hair dryer on a moderate heat setting. You can also get a specialist hairdresser to assist.

Returning home, you will not need a bandage as protection but only a simple pair of sunglasses and a scarf around your face to keep drafts away from the area that was operated on.

If you wish to leave the same day, you can go home with a bandage around your head, which you can remove yourself the next morning at home or return to see me to have it removed.

Swelling (oedema) and bruising in the cervico-facial region are usually very moderate. These take about ten days to almost completely disappear. You can hide them with suitable make-up designed for post-operative use the day after the operation. However, you can only use these products on the scars themselves after 5 days.

You will need to take 8 days out from work and social activities in the majority of cases. In case of significant bruising and oedema, which is rare (5% of cases), you may need to have up to 3 weeks off. 

The stitches used will dissolve and do not need to be removed. They are placed internally under the skin’s thickness (intradermal sutures) and are invisible.

Scars should be cleaned daily with an antiseptic.

You should make a follow-up appointment 3 days after the procedure, then after 15 days, 1 month, 3 months, 6 months, and 1 year.

• Exposure to the sun: no direct exposure for 1 month, then exposure is allowed with sunblock using a maximum sun protection factor.

• Make-up: the bruises can be hidden with a cover cream the day after the operation and you can apply your usual make-up over this. The products you use must be designed and suited for post-operative use. They will be prescribed to you on a post-operative prescription. However, you cannot apply any make-up directly to the scar before the 5th day.

The procedure reshapes the oval of the face and neck, correcting tissue sagging. The improvement is immediately visible despite oedema (swelling) and any bruising that prevents us from fully judging the final result. After about ten days, your initial recovery will allow us to appreciate the result, even if full recovery takes 1 to 3 months.

In the long term, this permanently corrects tissue sagging; the majority of patients do not need another operation. In some patients, the ageing process means that a new operation may be beneficial, but rarely before about fifteen years.

However, to delay the aging process, you can carry out maintenance through lighter treatments such as hyaluronic acid or Botox injections or chemical and laser peels.
 
The result is a relaxed, rejuvenated, expressive and natural face. Your circle of friends will see a change and an improvement but without being able to tell this it is because you have had a procedure.

In addition to a cosmetic improvement, this operation has a beneficial impact on the patient’s personal well-being and development.