Facelift

More and more doctors are offering the type of facelift that uses outdated techniques and can be performed by less experienced surgeons. The problem with soft, bio, S facelifts etc. is that the effects are very temporary because the only or main cosmetic factor contributing to a younger look is tightening of the skin layers. Because skin is very resilient, it does not take long for stretched skin to slacken and assume its original look. Stretched skin also leads to an unnatural facial expression, making it obvious that it has been altered cosmetically.

A technique which guarantees long-term natural-looking results is the extended or super extended facelift. In addition to a extensive amount of skin undermining, the procedure involves lifting of the SMAS muscle layer. This allows the skin to be placed over the newly contoured face without tension, to create a perfect chin-neck angle and retain a normal, natural-looking facial expression.

The operation begins with an injection of tumescence (also see Tumescence). Then, if necessary, liposuction is performed in selected areas using a very fine cannula. The advantage of this procedure is that it also allows the facial skin layer to be separated from the muscle layer without bleeding. With this technique, the subsequent process of separating the skin layer from the face and neck is not only much quicker, but involves less risk and is achieved with nearly no bleeding. An additional, secondary advantage of the technique is that it results in more effectively tightened skin, particularly around the neck area. Next, fine incisions are made close to the ears or in front of the hair line and the facial and neck skin is carefully separated from interfering ligaments (i.e. ligaments causing retraction). Then the muscle layer is tightened (SMAS technique), which is the key step of the operation. SMAS tightening has a long-lasting effect, as the layer tightened becomes much firmer and does not slacken as quickly as with older operation techniques limited to removal and stretching of the skin layer. With the modern method, after the SMAS layer is tightened, the skin layer is draped back with little or no stretching and the excess skin is removed. Thanks to this procedure, facelifts no longer result in a mask-like look. Last, the most time-consuming step is completed: the finely stitched suture, which has a major influence on the appearance of later scarring.

According to the latest insights, facelifts do not always require dressing, and if at all, only for the first few hours after surgery. Because bandages tend to cause stasis instead of preventing hematomas and swelling, they are in fact contra productive. It is, however, important, to cool the face consistently the evening following the operation or starting the first postoperative day.

The procedure is usually carried out under general anaesthesia and sometimes even in twilight sleep, and takes approx. three to four hours. On the first day after surgery, following a check-up, it is recommended that you continue to cool the wound regularly, but to refrain from cooling if it causes pain and not to cool single areas for an extended period of time. In order to prevent the delicate facelift suture from softening, the wound must be kept dry. As early as day two following surgery, directly before you are released from the hospital, you may wash your hair with the assistance of a nurse.

For the next eight days, it is necessary to rest and refrain from physical exertion. Except for taking frequent short walks, most of the day should be spent in bed in an upright position. During this period, it is advised to sleep on your back only. You should also avoid laughing, making exaggerated facial expressions and vigorous chewing in order to aid healing of the skin. Minor hematomas during this period are normal. With major hematomas, which are more likely to occur during the first 24 hours, a physician must be consulted, as drainage may be necessary.

When the bandages have been removed the suture is treated with suture ointment using a clean Q-tip. Ten to twelve days after surgery, the stitches are removed. At this stage, there will still be discoloration from hematomas and swelling. Patients from outside Berlin are now allowed to return home, but it is recommended that all patients take at least three to four weeks off from work to recuperate. The ultimate aim of the operation is for you to resume your normal social and working life without visible signs of surgery and to reap compliments on your youthful appearance.

Reddening of the suture, numbness, swelling and occasional pain may continue for months after this major operation. If this occurs at all, it generally subsides without treatment. It is recommended the patient wait at least one year before undergoing a further corrective operation.
Again, it is important to avoid sun exposure and intense warming (sauna, sun) of the face, particularly of the suture area. Patients with corrective lenses should not wear glasses for two to three weeks as to prevent irritation of the suture line behind the ears. The patient is also advised to refrain from wearing earrings during the first four postoperative weeks.

Light sports activities such as golf should not be engaged in for four weeks following surgery; more strenuous activities such as squash, tennis or soccer should be put on hold for the next two to three months. You are also advised to avoid sauna bathing and exposure to the sun as to prevent skin discoloration.
In order to reduce swelling more quickly and to speed healing, it is recommended that lymph drainages be performed starting day four and make-up be applied by a professional cosmetician.

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