Stay on top of the ageing game with the most popular surgeries for all areas of the face and neck.
The face and neck are some of the fastest and most obvious areas of the body to reveal the signs of ageing. It’s no wonder that the facial anti-ageing marketplace is very much alive and kicking with skin treatments, fillers and wrinkle treatments to fix a whole myriad of concerns.
There’s a limit, however, to what fillers, wrinkle injections and skin treatments can do. Not every non-surgical treatment out there is going to address every problem, and while many techniques will show improvement, they may not garner the same result – or longevity – as those achieved with surgery.
For example, when it comes to lifting a severely sagging and deflated face, hooded eyelids or fixing a hooked nose, most times surgery is still your best bet. Surgery these days is a far cry from yesteryear – as techniques continue to evolve, procedures have become more customisable, leading to very natural-looking results and more manageable downtime.
There’s a wide range of cosmetic surgery options to target specific areas of the face, such as sagging jowls or droopy eyelids. Today’s approach to cosmetic surgery involves tailoring a procedure or combination of procedures to your individual requirements and goals. In the right hands of a skilled and experienced surgeon, you could look 10 or more years younger; still looking like “you”, just a younger, fresher version.
Facelift
The ultimate anti-ager
There’s no getting away from the fact that over time the effects of gravity, sun damage and the stresses of everyday life appear on your face. Deep lines may appear around your eyes and mouth, sagging skin may fall from your cheek, jawline and neck, and fat deposits that were once full and firm become depleted, leaving hollow and sunken areas of your face.
A facelift, or medically termed ‘rhytidectomy’, is used to restore the contours of the face, correcting sagging, loose skin and repositioning fat and tissues to add volume back to the face.
By repositioning both the skin and the layer of muscle and tissue beneath (known as the superficial musculoaponeurotic system, or SMAS), the modern approach to facelifting addresses volume replacement and vectors of lift to create a younger looking appearance while avoiding the telltale signs of surgery.
Recovery from modern facelifts is typically much less extensive and lengthy compared with facelifts of the past, with less swelling, bruising, pain and recovery time. There are also different procedures, such as mini-lifts, which use smaller and fewer incisions, offering less recovery and down time.
Types of facelifts
Advances in surgical procedures and technology mean there are several different facelift types and techniques available today. They are designed to address your individual needs more specifically, helping to ensure optimal and natural-looking results.
SMAS lift
The SMAS (Superficial Musculoaponeurotic System) technique concentrates on the thin underlying connective tissue and muscle layer called the superficial musculoaponeurotic system, as well as repositioning and removing excess skin. Tightening this foundational tissue gives a smoother and improved shape without noticeable tension in the skin. This type of facelift is generally considered to be the gold standard in facelift surgery today.
Extended SMAS lift
An extended SMAS lift separates the SMAS from the underlying facial structures more extensively towards the nose and upper lip compared with the SMAS lift. This can address age-related changes in the nasolabial area (around the nose and mouth) more than the traditional SMAS lift; however increasing the amount of SMAS lifted also increases the risks of complications, such as skin necrosis.
Deep plane lift
A deep plane facelift is designed to reshape the entire face, including the upper and lower eyelids, the brow and the neck, by lifting facial tissues, fat, muscle and skin in one continuous section. Because the dissection is deep, the flap is thicker than in the SMAS method. This procedure is more invasive than other methods and may require a longer recovery period.
Subperiosteal lift
Commonly performed with the aid of an endoscope, the subperiosteal lift is designed to reposition skin, fat and muscle simultaneously since the tissues tend to sag together, not individually. This type of facelift releases tissues off the bony layer, separating the bone from all of the tissues covering it. There is more swelling with the subperiosteal lift than with more superficial lifts, due to the depth of the dissection. It also usually causes more swelling and takes longer to recover.
Composite lift
The composite facelift is similar to a deep plane lift, with the addition of an extra step to include the muscle around the lower eyelid. The orbicularis oculi muscle (around the eye) is separated from its attachment to the cheekbone through an incision in the lower eyelid and then lifted and sutured into place. The composite facelift essentially involves elevation and resection of the SMAS layer, orbicularis muscle and cheek fat pad. There is typically more swelling with the composite lift than with more superficial lifts.
S-lift
The S-Lift is a type of facelift named after the S-shaped incision made in the hairline at the temple and in front of the ear. The SMAS and attaching skin is usually elevated as one unit and only excess skin is removed. The best candidates for an S-Lift are those who do not have significant skin laxity of the neck and jowls. It is most suited to patients beginning to show signs of facial ageing and want some tightening of the lower face without longer incisions.
Mini-lift
This type of facelift typically refers to any limited-incision facelift, usually with a quicker recovery time compared with other more invasive techniques. Also referred to as a MACS Lift (Minimal Access Cranial Suspension) and the shortscar facelift, it is typically suited for patients with early signs of ageing, usually aged in their 30s and 40s, to achieve a natural-looking facial rejuvenation. During a mini-lift, the surgeon usually makes a short incision on the front side of the ear. Via this incision, deep plicating sutures lift the deep tissues and the extra skin is then removed. Due to its less invasive approach, this type of facelift typically offers less recovery time and a lower risk of complications.
Thread lift
A minimally invasive alternative to a surgical facelift is the thread lift. Thread lifting elevates the soft tissues of the face using specially designed internal sutures and can deliver subtle yet effective results for the right candidate. The procedure involves the use of multiple fine biocompatible threads to lift and support sagging skin on the face and neck. Tiny ‘nicks’ are made to the skin, which are hidden in the sideburn area. Threads are then looped to the sagging soft tissues that support the face and neck, lifting and anchoring the facial tissue to an elevated, more youthful position.
Once in position, the body generates new collagen that surrounds each thread to maintain the lifting effect. The threads dissolve within nine to 12 months, while maintaining the revitalising and lifting effect for several years to come. The procedure is typically performed under local anaesthetic and usually takes around one hour to perform. Patients can usually return home within one to two hours after the procedure.
Eyelift
There are many processes at play that contribute to the appearance of ageing eyes – from skin laxity and thinning to fat depletion and descent. The muscle layer beneath the skin starts to lose its tone with age; the fat of the eyelid bulges forward to cause a dark shadow; the cheeks begin to shrink, leaving a groove-like valley known as the tear trough; and the brows descend. These changes often lead people to mention that you look tired when you are not, and make you look like your parents long before you thought you would.
Eyelid surgery, or blepharoplasty, is designed to combat these signs of ageing.
Surgeons will typically consider the aesthetics and function of both the upper and lower eyelid, and consider whether altering one or both is the appropriate surgical approach. Skin quality, ethnic features, as well as unique facial anatomy, will also dictate the ideal approach for each patient. Often an upper eyelid blepharoplasty is sufficient in rejuvenating the appearance of younger patients, whereas a lower lid blepharoplasty may be needed to remove redundant skin and bags in older patients. In others, a brow lift may be the best option to address specific concerns.
The results of eyelid surgery become apparent gradually, with swelling and bruising usually subsiding after around two weeks to reveal a smoother, better defined eye region and a more alert and rejuvenated appearance. Results typically last around seven to 10 years. Some patients may also elect to have their eyelid surgery combined with a facelift or brow lift to maximise the rejuvenating effect and further enhance results.
Upper blepharoplasty
Upper eyelid surgery is well suited to those with excess skin that creates a hooded effect over the eyes. The procedure involves surgically removing this excess skin to create a more ‘open’ appearance in the eye area, revealing the contour of the brow and inner eyelid crease. Upper eyelid surgery is usually approached from the skin crease in the outer surface of the eyelid. The incision is typically made in the lid crease and is performed with either a scalpel or CO2 laser that seals the blood vessels as it incises. Skin and muscle are removed to reduce hooding in the upper eyelid. This is typically a minimally invasive procedure which can yield dramatic anti-ageing results.
Lower blepharoplasty
Lower eyelid surgery is typically more complex than upper eyelid surgery and can require a combination of surgery, filler and laser to give the best result. Incisions for the lower lid blepharoplasty can be made either inside the eyelid or just below the lower lash line. Excess skin in the lower eyelids is removed through these incisions to correct under-eye bags or sagging.
This type of blepharoplasty involves making an incision on the inside of the lower eyelid to access the tissues of the eyelid. The orbital fat can be repositioned or removed from this approach. When the fat is repositioned, it is moved into the area of the orbital rim depression to reduce the fullness of the lid and the depth of the orbital rim groove. This technique improves the appearance of the dark circle around the eye, with minimal effect on the shape of the eye while maintaining a natural looking appearance.
Brow lift
The effects of sun damage and the natural ageing process contribute to a gradual descent of the brow, giving a ‘heavy’ or ‘hooded’ look to the upper face, which can make a person appear angry, sad or older than their years.
Also known as a forehead lift, a brow lift elevates a low or sagging brow to a more youthful position, minimises the creases and wrinkles that develop across the forehead, and improves frown lines that develop high on the bridge of the nose. It can also rejuvenate the upper eye area, reducing heaviness and sagging over the eyelid and at the outer edges of the eye.
In endoscopic brow lifts, small incisions are made in the hairline, allowing the tissue and muscle beneath the skin to be repositioned or removed, correcting visible creases and furrows in the forehead. Swelling and bruising normally subside after two to six weeks.
Rhinoplasty
Rhinoplasty improves the appearance of the nose to balance it with the other facial features. Nasal surgery can also correct impaired breathing caused by structural abnormalities. As a person gets older, the nose tends to elongate and droop and the skin becomes thicker and less elastic. The hallmark of nasal ageing is the loss of support for the lower one-third of the nose. The major and minor tip support mechanisms weaken with age, which can lead to a dorsal hump as a result of decreased tip projection and a longer nose as a result of tip ptosis, or droopiness.
A rhinoplasty procedure can create a more youthful appearance to the entire face by reversing the signs of an ageing nose and can be an effective adjunct to other facial rejuvenation surgeries.
Nose surgery is typically performed either using: a closed procedure, where incisions are hidden inside the nose; or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils. The soft tissues that cover the nose are lifted, allowing access to reshape the structure of the nose.
Most people take around seven to 10 days off work to allow swelling and bruising to subside. Results are permanent and it may take up to a year for the new nasal contour to fully refine.
Neck and chin lift
Two of the defining features of a youthful face are a well-defined jaw line and a pleasing angle where the neck and chin meet. Chin and neck ‘fullness’ or a poorly defined jaw line can create the appearance of excess weight and premature ageing. Facial liposuction is a relatively minimally invasive surgical procedure and is best suited to patients presenting with excess fatty tissue but minimal excess neck skin.
Through several tiny incisions, the fatty tissue is removed via a specialised suction device. Swelling and bruising should typically subside in around seven to 10 days, after which most patients can return to normal everyday activities. Final results can take several months to become evident.
For severe skin laxity of the neck, a lift may be more suitable to reduce excess skin and fatty tissue of the neck and correct poor definition of the chin/neck angle and jaw line. The technique used will depend on several factors, such as the degree of excess skin, the level of skin laxity and the presence of fatty tissue. During a typical neck lift procedure, the platysma muscles of the neck, which weaken and separate with age, are tightened and sewn back together in the centre. Tissue and skin can also be elevated to a more youthful position during the procedure. An additional small incision under the chin may be made to tighten the platysma muscles.
Other techniques may involve an incision only inside the hairline at the back of the neck (known as a posterior neck lift) or behind the ear only (for some suspension techniques), depending on the techniques used and the degree of lifting required.
Facial implants
Facial implants are designed to achieve more defined and harmonious facial contours and create structural balance in the face. Cheek implants are used to correct sunken cheeks or create the look of prominent cheekbones; a chin implant can build up a receding or weak chin; and a jaw implant can create a more defined and chiseled jaw line.
The implants themselves are specially formed solid, biocompatible materials designed to augment the physical structures of the face and create more structured contours and angles.
Incisions for cheek implants are made through the hairline or lower eyelids, while a chin or jaw implant incision is usually hidden in the mouth. The incisions are normally closed with absorbable sutures that dissolve over the next seven to 10 days.
