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The passing of time leads to multiple changes in our facial features. Whilst ‘ aging gracefully’ is often a term used to assuage this natural process, it often leads to a tired, dull appearance, which can be undesirable to many.
Features of the aging face happen in all layers, from the skin to the bone. Starting from the outside in, our skin loses its suppleness, begins to sag, and develops patchy pigmentation, both as a result of aging as well as cumulative damage from environmental factors such as UV rays. Beneath the skin, the fat compartments of the face shrink, leading to a hollowed appearance in areas such as the temples, upper eyelids and cheeks. Deeper down, the ligaments, otherwise known as the support structures of the face, start to relax, leading to the drooping of the overlying fat and skin layers. Finally, the bony support structure recedes at the forehead, cheeks and jaw, leading to a flattened upper face, cheek retrusion and squaring of the jaw.
Much of modern aesthetic medicine and plastic surgery is focused on slowing or reversing the aging process of the face. Minimally invasive methods include skin care, laser therapy and other energy devices, fillers, botulinum toxin and more recently, implantable threads. However, for a more significant improvement and reversal of the features of aging, surgical methods such as facelift surgery and fat grafting need to be employed. Also, from about the age of 50 onwards, there are many features of aging that can only be addressed through more powerful lifting techniques such as facelift surgery.
To understand a facelift, one must first understand the basic layers of the face, some of which are the target of pulling and lifting during the surgical procedure. Again from the outside in, you have 1) the skin, 2) the connective tissue and fat compartments, 3) the muscle and its fascia (otherwise known as the SMAS or superficial Musculo-aponeurotic system), 4) the loose connective layer or ‘spaces’ of the face, and 5) the fibrous covering of the facial bone.
Furthermore, the face can be regionally divided into the upper, middle, lower face, and neck, each or all of which can be targeted during a facelift procedure. The upper face consists of the temples and the area from the hairline to the brow, the middle face consists of the area from the brow to the bottom of the nose, and the lower face consists of the area from the bottom of the nose to the chin. The neck can be subdivided into the area under the chin (the submentum), and the lower neck.
Modern skincare and minimally invasive lifting treatments for the face, such as those offered by plastic surgeons and aesthetic clinics in Singapore, can be options to slow down or delay the aging process. However, as mentioned previously, facelift surgery performed by plastic surgeons leads to the most significant and lasting results. Furthermore, procedures have evolved to minimize and mask any visible scars.
Starting with the upper face, options for lifting include open as well as endoscopic techniques. Open techniques involve making an incision at the hairline and allow for full rejuvenation of the forehead with the removal of excess skin. Care must be taken to minimize the scar, which can usually be hidden by allowing the hair at the hairline to grow through the scar. Endoscopic techniques utilize small incisions within the hair-bearing area and a telescopic camera to dissect and lift the brow. This technique does not leave any visible scars, but no skin is removed and is not suitable for individuals with higher foreheads. A good compromise is the temporal browlift, which involves a limited incision at the temporal part of the brow, allowing for a lasting lift of the brow peak.
The middle and lower parts of the face can be approached through incisions at the lower eyelash margin and just in front of the ear. More traditional techniques involved the dissection and removal of skin only, but this was found to be associated with less longevity and often left a ‘wind-swept’ appearance. More modern techniques focus on lifting the muscular fascia or SMAS layer, which result in a more lasting and natural appearance. For Asians in particular, more powerful techniques have to be utilized as Asian skin and soft tissue tends to be heavier and more difficult to lift.
The most significant lift can be derived from the deep-plane facelift, which directly lifts the anterior part of the face and mobilizes the SMAS layer over the spaces by releasing and repositioning the ligaments of the face. This brings the tissues of the face back to the original position of youth, and restores the natural contours of the face. The neck is approached in a similar manner via incisions extending to the hairline behind the ear, and sometimes requiring a small incision at the area under the chin. Quite often, these can be avoided if the lower neck is not too lax, as is common in Asian patients, and the facelift surgery can be performed as a ‘short-scar facelift’. This is the best compromise between scar and lifting ability, and restores the youth of the lower face and submentum. Performed well, a good facelift can last at least 10 years.
For all forms of facelift surgery, the performing plastic surgeon has to be familiar with the underlying facial anatomy to minimize complications including bleeding, loss of sensation as well as nerve and muscle paralysis. For more assurance, you should approach a fully-certified plastic surgeon in Singapore who performs facelifts regularly.
Facelift surgery can be performed under local anaesthesia (LA), but for increased patient comfort sedation or general anaesthesia can be utilized alongside the LA. This makes the procedure very comfortable and pain free. For smokers, it is imperative that smoking is stopped for the 2 weeks before and after the facelift surgery to minimize any surgical complications. This is because smoking can impair the blood supply to the facial skin.
The procedure itself can be performed as a day surgery procedure, and there is usually no need to stay in a hospital overnight. You will be kept very comfortable during the surgery, and no shaving of hair is required. After the facelift surgery, there may be small drains left which help to reduce post-surgical fluid or blood collections. These are removed within the first 1-2 days after surgery.
In recent years, fat grafting has become a popular adjunct, allowing for the natural restoration of volume loss in the face in addition to the facelift. Your plastic surgeon may recommend this in addition to the facelift surgery.
Costs for facelift surgery in Singapore depend on the type and extent of facelift performed, and can begin from about $5000 upwards. It is best to have an open discussion with your plastic surgeon about which procedure suits you best.
After the procedure, you may be put into a facial pressure garment which helps to reduce swelling and bruising for the first 1-2 weeks. Placing cold compresses on the face also help with this. The stitches are usually removed at 1 week post-operatively, and almost all the bruising will be gone by the end of the 2nd week after the procedure. Swelling due to the procedure usually peaks in the first week, and by 2-4 weeks 80-90% of the swelling is gone.
Performed well, a good facelift can last at least 10 years. If patients desire further lifting after this period and are still in good health, repeat facelifts can be performed if required.
Learn more about Dr Adrian Ooi, Dr Pek Chong Han and the team