Face Lift Surgery

Definition and Scope

Facelift surgery (facial ritidectomy)is a surgical procedure performed with the aim of removing sagging and wrinkles that occur on the face and neck with aging. Over time, as a result of gravity, sun damage, stress and the natural effects of aging, the skin of the face loses its elasticity; the cheeks descend downward, sagging in the jaw line (jawline) and loosening under the neck, called “tickles”, appear. Facelift surgery aims to achieve a younger and more dynamic facial profile by rounding up these sagging areas in the cheeks, chin line and upper neck area. During this operation, usually the deep tissues of the face (facial muscle membranes known as the SMAS layer) are also tightened, so that not only does the skin stretch, but also ensures that the results are more natural and lasting. The facelift usually covers the lower face and neck area; when deemed necessary, it can be combined with additional procedures such as eyelid aesthetics, forehead lift or neck lift. After surgery, the patient's facial contours are more pronounced, the jaw-neck angle is sharper, and the overall facial expression becomes more relaxed. The main thing is to be targeted with a facelift not completely change the faceis to reveal a younger version... a younger version without disturbing the natural appearance of the person.

How Is Surgery Done?

Facelift surgery can be performed with full-scale (classic) or more limited (mini facelift) techniques. A full facelift usually involves the mid-lower face and neck, while a mini facelift is a method made with shorter incisions to correct lighter sagging. The surgery is performed under general anesthesia in sterile operating room conditions (or under sedation + local anesthesia in some mini-facelifts) and is typically 3-5 hours can last.

In facelift surgery, the surgeon plans the incisions from the hairline in the temple area so that they extend from the front of the ear line to around the ear and behind the ear to the hairy skin. In this way, the scars coincide with the natural folds around the ears and into the hair, reducing their visibility. During surgery, the skin is carefully separated from the underlying tissues. Deep tissue layer, which subsequently leads to sagging of the face (SMAS - musculo-aponeurotic system of the face) is strained by the surgeon and hung upwards. This procedure forms the basis of facelift surgery because it alone regenerates the underlying structures rather than stretching the skin, allowing a more lasting and natural result to be achieved.

After the deep tissues are tightened, the excess amount of skin is determined by measurement, and excess sagging skin is removed from the edges. The remaining skin is adapted to the incisions with fine stitches in the new taut position. During this time, because most of the tension is given to the underlying SMAS layer, an artificial “tense face” expression is not formed on the skin; the facial expressions are preserved. If there is a pronounced “tickle” deformity in the neck area, the neck muscles (platysma) can be intervened and tightened with a small incision under the chin. At the end of surgery, a drain may be placed behind the ear or under the chin to remove blood and fluid that may accumulate under the skin.

Skin incisions are usually closed with aesthetic sutures and thin bandages are applied over them. A special facial corset (bandage) is worn on the operated areas of the face in order to reduce the edema that may occur after surgery and ensure proper fusion of the skin and underlying tissues. When the patient is awakened and taken to his room, there will be a slight feeling of tension and bandages on his face. It is aimed at minimizing swelling and bruising with measures such as cold application on the first day, keeping the head elevated.

Who is it suitable for?

Facelift surgery is preferred by individuals of middle age and older, usually with significant sagging of the skin of the face and neck. Typical characteristics for candidates are:

• Sagging Lower Face and Neck: People with pronounced skin sagging on the chin line, low cheeks, loose skin in the neck area (the appearance of a “turkey neck”).
  
  
• Skin that has lost its elasticity: Individuals whose skin shows fine wrinkles and sagging, facial contours have lost their expressiveness, usually found in their late 40s and later. However, the condition of the skin is as important as biological age; some people may have tight skin even in their 50s, while others may experience severe sagging in their early 40s.
  
  
• Those Who Want a Younger Look and Don't Benefit from Other Methods: Non-invasive methods such as facial fillers, botox, rope suspenders, or skin lifting devices may be inadequate in advanced sagging. Facelift surgery in this case is the most effective option for patients who want a lasting and noticeable result.
  
  
• Good General Health Status: People who have chronic conditions such as high blood pressure, diabetes, heart disease under control or who do not constitute an obstacle to this surgery, can remove the anesthesia required by the surgery. Careful evaluation should be carried out in patients with blood clotting disorders, serious lung problems or similar high-risk cases.
  
  
• Those who do not smoke or are ready to quit: Smoking affects the fine vessels in the face, disrupting postoperative skin circulation and increases the risk of serious complications (e.g. skin loss, bad scar). Therefore, the ideal candidates are non-smokers, while smokers are required to quit at least a few weeks before surgery and not to drink until recovery is complete.
  
  
• Those with realistic expectations: A facelift does not stop the aging process, but it takes the hands of the clock back. Candidates should know that they will get a younger appearance after surgery, but they will not magically achieve flawless, completely wrinkle-free skin. In addition, the natural features of the face will be preserved, only a more strict and rested look will be provided.
  
  

The surgeon determines whether he is suitable for this surgery by assessing the candidate's facial structure, skin quality and expectations in the preoperative examination. If skin elasticity is still good and sagging is minimal, alternative methods may be recommended instead of surgery.

Possible Risks and Complications

Facelift surgery is a surgery with a low complication rate when performed on experienced hands, but each surgical intervention carries some risks, such as:

• Hematoma (Blood Accumulation): It is the most common complication of facelift. In the first 24-48 hours after surgery, there may be a buildup of blood under the skin (hematoma). In this case, sudden swelling, stiffness and pain appear in the affected area. If large hematomas form, the patient is taken back to the operating room and the accumulated blood is drained and the bleeding point is checked. The risk of hematoma is somewhat higher in male patients and those with high blood pressure, which is why blood pressure control after surgery is important.
  
  
• Infection: Infection rarely occurs, as blood circulation in the facial area is very good. But if it occurs, it can give signs of redness, increased temperature and purulent discharge. At an early stage, it is treated with antibiotics. If necessary, part of the seams is opened and the infected material is cleaned. With wound care, the problem is usually solved.
  
  
• Nerve Damage: During a facelift, the branches of the facial nerve that provide facial expressions can be stretched or very rarely injured. As a result, temporary muscle weakness can be observed in certain areas of the face (for example, inability to lift an eyebrow, difficulty moving the corner of the lip). Most of these conditions are accompanied by edema and healing of tissues It recovers on its own in 3-6 months. The probability of permanent nerve damage is extremely low, but not completely impossible. Since experienced surgeons know the anatomical structures well, this risk is minimized.
  
  
• Skin Loss and Wound Problems: Especially in patients who smoke, skin loss (necrosis) can occur in small areas by causing circulatory problems at the edge of the skin in front of the ear or behind the ear. In this case, these small wounds are left to heal on their own by caring for them with dressings or, if necessary, corrected with local small interventions. In addition, some patients may have enlargement or poor scarring at the edges of the wound. These scars may appear red-hard in the first months, usually fade and soften within 6-12 months. If deemed necessary, massage of the scar area, application of silicone tape or revision procedures can be carried out in the future.
  
  
• Hair Loss on Scaly Skin: Temporary hair loss can sometimes occur in areas of the hairy skin where the incisions pass. This stress-related condition mostly resolves within months and the hair comes out again. Very rarely, permanent hairline change or thinning may occur in the area of the upper ear temple; a small hair transplant or revision of the wound site may be considered for correction.
  
  
• Sensory Changes: Numbness or change of sensation in the area around the ears and cheeks after surgery is quite common. Since the nerve endings are in the process of healing, this feeling of numbness subsides within a few weeks and usually returns to normal completely in a few months.
  
  
• Unsatisfactory Cosmetic Result: Rarely, the patient may notice a less noticeable change than expected, or one side of the face may look slightly different than the other. It is necessary to wait for this period, since the final result of the operation is usually fully seated after 3-6 months. If after this period a pronounced asymmetry or defect is present, a second minor correction surgery (revision) can be planned.
  
  

Although all of these risks are unlikely to occur, they should be explained in detail by your surgeon before the facelift surgery. It is important to pay attention to the symptoms in the postoperative period, especially in the event of excessive swelling or pain in the first days to immediately consult a doctor. The vast majority of complications can be resolved with early intervention without leaving a permanent problem.

Healing Process

The healing process after facelift surgery is relatively comfortable compared to many other surgeries, but includes temporary changes such as pronounced bruising and swelling. It is often preferable to stay in the hospital the first night after surgery. Thanks to this, doctors monitor the patient for the possible development of a hematoma and monitor the amount of fluid coming from the drains. Drains are usually removed when the condition stabilizes at the end of the first 24 hours. Bandages on the face are lightened or removed, and the patient is discharged with a suitable facial corset.

First Week: For the first few days, it is normal to have noticeable swelling and bruising on the face and neck. Bruises under the eyes, cheeks and neck area are most intense during this period. The application of cold compresses, lying down with the head held high (with an extra pillow) and edematous medications given by the doctor help the swelling to go down more quickly. The pain is usually mild and controlled with painkillers. By the end of the first week, the face is still swollen, but the color of the bruises begins to turn yellow. During this period, most of the stitches are removed (stitches around the ear and inside the hair can be removed on the 5-7th day; some surgeons may also use a self-melting suture). The patient should refrain from heavy activity during the first week, do not make sudden head movements.

Week 2: Most of the bruises noticeably subside in the second week. The swelling on the face also continues to gradually descend. Patients will be able to return to their social life around 10-14 days, covering the slight bruises left with the help of makeup. Especially the return to office-style work is possible after about 2 weeks. But still strenuous exercises, heavy lifting and movements that will strain the face should be avoided. During this period, the feeling of numbness in the face may persist, which is normal, and it is necessary to wait patiently for nerve healing.

Week 3-6: From the third week, the vast majority of patients can return to all their daily activities. Lightly paced walking, low-intensity exercises can be performed. Around week 4, more intense exercises can also be started if the doctor allows it. However, contact sports or activities with a risk of impact on the face area should be avoided for the first 6 weeks. In the process, there may still be a slight residue of edema on the face, a feeling of slight swelling is normal, especially when tired in the evening. Scars retain their pink color but can often be hidden with makeup. Hair can be re-washed, styled; it is only necessary to treat the treated areas gently.

Long Term: The full results of facelift surgery are usually 3-6 months then comes out. By the end of this process, the swelling has completely passed, the tissue sensation has returned to normal, and the scars have matured and become indistinct. The complete fading of the marks can last up to a year; protection from direct sunlight (using sunscreen) in the process improves the quality of the trail. Patients usually regain their “final” appearance 6 months after surgery and retain this younger appearance for many years. Of course, the aging process will continue, but the patient will have turned back the clock by several years with surgery. In the later years, with skin care, a healthy lifestyle and sun protection, the results can be maintained for the longest time.

Face Lift at Central Hospital Istanbul

Central Hospital Istanbul gives its patients confidence in face lift operations with its plastic surgeons specialized in face and neck aesthetics and modern technical infrastructure. Before surgery, our patients undergo a detailed consultation process. In these interviews, the anatomical structure of the face is analyzed, possible changes are discussed on the photographs, and the patient's expectations are listened to. Our surgeons create a personalized surgical plan based on each patient's facial structure and needs. When deemed necessary, complementary procedures such as eyelid aesthetics, oil injection (to give volume to the face) or neck lift are also planned in the same session, ensuring a holistic rejuvenation.

In face lift surgeries in our hospital, SMAS Lifting Current techniques are used, including subtissues, such as subtissues. In this way, the results obtained look more natural and retain their permanence for many years. Our surgeons are highly versed in the anatomy of facial nerves and vessels and perform the surgery with great care. All measures are taken to minimize the risks that may occur during and after the operation; for example, special devices are used to control bleeding during the operation, and after surgery, our patients are closely monitored for the risk of hematomas in special rooms.

Central Hospital Istanbul's postoperative care team offers attentive care to our patients who have undergone face lifts. Our experienced nurses and patient carers plan every detail from the position of our patient on the first night to the application of cold. After discharge, our patients are trained on how to use the facial corset and how to carry out wound care. In addition, information is provided about normal conditions (such as swelling, drowsiness) and alarm signs that they may encounter during the recovery process.

Our patients are called for regular check-ups after facelift surgery. In the first week, first month, third month and sixth month check-ups, our surgeons follow the course of recovery, making additional recommendations if necessary. In these checks, if necessary, the condition of the scars can be assessed and intervention planned or supportive practices such as facial massage and skin care can be recommended.

At Central Hospital Istanbul, the goal is not only to give our patients a rejuvenated appearance with facelift surgery, but also to increase the patient's self-confidence and improve the quality of life. Our team of experts in the field and friendly staff are there for our patients at every stage, from pre-surgery to their final inspection. After all, it is our greatest reward that our patients feel fresher, more dynamic and happy when they look in the mirror.