Facelift surgery refers to any procedure that changes the appearance of the face, especially the cheeks, neck and jowls, the lower part of the cheeks that displays signs of sagging skin. That’s why a lot of patients opt for a facelift to restore their youthful appearance and eliminate the most pronounced signs of aging. A mini or full facelift are both great options for restoring skin elasticity and correcting aging skin’s droopy appearance as surgery is a longer-lasting solution compared to non-surgical treatments such as fillers.
Our facelift clinic in Toronto is dedicated to fixing the elasticity of aging skin because as we age, skin sags, facial muscles lose their tone, and gravity pulls down weakened skin even more. If you’re considering a full or even mini facelift surgery, here’s what you should consider:
- Having loose skin or excessive fat in the chin, cheek and neck area
- Having sagging skin in the upper cheeks
- Having a sad, exhausted look as a result of skin drooping
- Displacement of fat or skin on face
Facelifts work to do three things for the skin:
- They target wrinkles that result from loose skin. They tighten loose and sagging skin by removing excess skin and stretching the remaining skin to appear firmer.
- They tighten muscles and tissue in the face to help eliminate wrinkles and signs of aging.
- They re-position fatty tissue as a means of contouring the face to a more desirable appearance.
During facelift surgery at our Toronto clinic, patients are given either a local or general anaesthesia, along with sedation and numbing. The exact type of anaesthesia to be used will depend on the type of facelift being done. More information can be given to patients during a consultation with a surgeon. Small incisions are made in front of and behind the ears and along the hairline at the temples. Fatty tissue is addressed first through liposuction and fat grafting, if necessary. Excess skin is then trimmed and the remaining skin is tightened. The incisions are then stitched. A dressing is applied to the area. It is common for discolouration, bruising and swelling to occur after surgery, but these symptoms will go away after a week. Medication for pain will be administered to patients. It is best that patients avoid strenuous activity for up to three weeks after surgery. It is also important that each patient keep his or her head elevated in order to ensure a safe and fast recovery. Scars are small and barely noticeable as they are generally made in discreet areas. Facelifts are intended to create natural looking and long lasting results.
Facelifts can include fat grafting. Facial fat grafting is the process of using liposuction to remove fat from other areas of the body, purifying it and then injecting it into the facial structures. Fat in the cheeks, lips and under the eyes can be lost over time due to aging and the pull of gravity. This creates a weak and sagging look in the face. Adding fat to areas of the face can help to reverse this appearance. As the fat in fat grafting surgery is taken from the patient’s body, grafting results in a more natural and youthful appearance in the cheeks, chin, lips, jawline and mid-face. Furthermore, body contouring in other areas, such as the back, is also done, meaning that patients will reap two benefits from one surgery. Patients may also seek facial fat grafting if they generally have a thin face, flatness in areas of the face and facial asymmetry.
Typical facelift surgeries can take between 2-4 hours at our clinic in Toronto. However, some clinics may take 6-8 hours if surgeons use the deep plane facelift technique. The long-term results of a facelift are dependent on the maintenance of health and diet that naturally help skin to look healthy. However, aging of the skin is inevitable.
There are several techniques used to perform facelift surgery and each has their benefits and disadvantages. Also, they each yield slightly different results because they are performed on different areas of the face. At our cosmetic surgery clinic in Toronto, we pride ourselves on open communication with our patients. This includes sitting down with each patient and mutually setting goals and expectations for their facelift surgery, as well as ensuring a clean bill of health so that the surgeon can decide on the best technique to use for a facelift.
This type of facelift is minimally invasive as the procedure includes small incisions and is done to lift the cheeks, jowls and neck area. Mini facelifts can be done to improve the appearance of minor concerns of the face or they can be done to retouch the results of a previous facelift. Typically middle-aged or younger patients who do not have severe sagging in the face are better suited for mini facelifts. Because mini facelifts are less invasive than regular facelifts, they result in less bruising and swelling and quicker recovery times. However, the changes of a mini facelift are less dramatic and the results last a shorter time because the patient will continue to age and changes to their skin will occur naturally.
During the procedure patients will be sedated with local anaesthesia. Incisions made are dependent on the structure of the face, but no incisions are made behind the ears. Skin is then separated from fat and muscle. Some excess fat may be trimmed, while muscles are tightened and skin is pulled back.
After surgery, a dressing is applied. During the first week of recovery some swelling and discoloration may occur around the face and neck. Exercise and strenuous activities should be avoided for up to three weeks and patients are required to keep their head elevated to encourage proper recovery. Any scars that occur as a result of the surgery will heal and fade over time. The placements of incisions also allow scars to be covered by hair and natural creases of the face.
As its name implies, skin only facelifts focus only on skin during a facelift surgery. Skin and fatty tissue are typically cut and sculpted to remove any signs of aging on the skin. However, though skin only facelifts can yield pleasing results as the skin in the face is being re-positioned, these results do not last as long as facelift surgeries that tighten muscles beneath the skin. Candidates for skin only facelifts should only try to target problems of excessive skin. It is best that patients for skin only facelifts have thinner faces, less fat in the face, a well-defined bone structure and even skin tone. Because the results of a skin only facelift are limited, they are less commonly used than Superficial MusculoAponeurotic System facelift surgeries.
The Superficial MusculoAponeurotic System (SMAS) refers to a layer of facial muscles under the skin. Any SMAS based surgery is considered a deep facelift because it targets muscles underneath facial skin. There are several types of SMAS facelift surgeries.
The least invasive type of SMAS facelift is a SMAS Plication. This procedure is almost skin only as it involves very little manipulation of muscle tissue in the SMAS. In this procedure, the SMAS is not cut into. Instead, the tissues are set to overlap each other. The most ideal candidates for this type of SMAS facelift surgery are those who do not have a well-defined, thick SMAS. This procedure can also be used for those who may have higher medical risks during surgeries.
A SMASectomy is another type of SMAS surgery similar to a SMAS Plication where the SMAS is not cut into and lifted. Instead, a round section of the SMAS is cut out. The risk of facial nerve damage is decreased with this procedure because there are no deep cuts. However, there is less of a dramatic lift in the results of this procedure. For both the SMAS Plication and SMASectomy the procedure times are shorter than other facelift surgeries.
This type of SMAS facelift focuses on the middle and lower sections of the face and is the most invasive as it works to tighten muscles deep under the skin. Before the surgery, patients are given general anaesthesia with sedation. Incisions are then made along the hairline, extending down to the ear. Next, the skin is lifted, allowing the surgeon to access the SMAS layer and the muscles underneath it. Attachments between the SMAS layer and surrounding muscles are loosened and the SMAS layer and skin are then re-positioned. As well, excess and loose skin are trimmed and then incisions are sewed back together. The deep plane lift offers patients long lasting results and is ideal for those with severely loose and sagging skin. The results of a deep plane facelift are usually dramatic. In order to be an appropriate candidate for a deep plane facelift, patients must be in good health to ensure a safe recovery. Patients should also have a degree of flexibility in their facial skin and have a well-defined bone structure under their skin to provide support for the changes made to their face.
The MACS lift is a type of SMAS facelift that targets mainly the mid-face, jawline and neck areas. During the procedure patients are given either local or general anaesthesia with sedation and incisions are made around the ears. Small incisions are made and the skin is then detached from the cheeks, corners of the jaw and the neck. Next, tissues and muscles under the SMAS layer are tightened and moved vertically, as opposed to horizontally in most other facelifts. This vertical re-positioning of tissues and muscles provides a more natural-looking result because all the tension from re-positioning is subcutaneous. In other words, the layers beneath the skin hold up the skin rather than the skin itself being pulled. Finally, the incisions are stitched to close.
The S-Lift is a type of facelift that focuses on the lower face and neck, including the jowls and chin. Before the surgery, patients are given either local anaesthesia with sedation or general anaesthesia. This procedure is called an ‘S-Lift’ because the incision made for the procedure is in the shape of an S. The incision is made closely in front of the ear and the S-shaped section of skin is lifted. (If major improvements to the neck are to be done, a small incision will be made under the chin). Next, the muscles and tissues are tightened and excess fat is trimmed. Finally, the incision is sewed back together. The entire procedure can take up to two hours. It is common for mild bruising, swelling and numbness to occur after the surgery in the area being enhanced. However, usually patients return to work one week after the surgery. It is best that strenuous activity be avoided for at least a month after the procedure.
The High SMAS facelift is a type of facelift that focuses on elevating the SMAS tissues higher than they are lifted in other SMAS surgeries. Usually, SMAS tissues are lifted up to the cheekbones. However, lifting these tissues to the outer part of the cheek pad allows for a more enhanced look. Before the procedure, patients are given a general anaesthetic or sedation. Incisions are made along the hairline. During the procedure SMAS tissue and muscles are tightened and fatty tissue is redistributed to a higher level of the cheek. Any excess fat or loose skin will be trimmed. Finally, the incisions are stitched back together. Bruising, swelling or numbness may occur for up to two weeks after the procedure. Strenuous activity should also be avoided during the recovery process.
An extended high SMAS facelift involves making an incision higher into the cheek– at or above the cheekbone. This higher incision allows surgeons to elevate the tissues in the cheek much higher than a regular SMAS facelift. This technique can be used to enhance the middle and upper cheek level. One concern with this procedure is that since it is done so high in the cheek, there is a greater risk for facial nerve injury.
Endoscopic facelift procedures use a tube-like probe with a very small camera attached to it, called an endoscope, to capture video images of the internal facial structures and transmit them to a TV screen in the operating room. Before the surgery, patients are given a local or general anaesthesia. Next, incisions are made along the hairline and the endoscope is inserted into the facial structure through these incisions. The facial muscles and tissue are reshaped and positioned and excess fat and skin are removed. Finally, the incisions are sewed back together. This type of facelift focuses mainly on the cheek area. This procedure cannot be done on the neck. The most ideal candidates for an endoscopic facelift are younger patients with excessive fatty tissue and skin and muscles that have just begun to loosen. Endoscopic facelift surgeries usually result in shorter recovery times and less bleeding and swelling.
The two-layered facelift procedure is a facelift technique that raises the skin and SMAS separately. This allows surgeons to re-position and reshape each layer of facial skin, fat and muscle individually.
The composite facelift is a type of facelift procedure that allows surgeons to access deeper layers of tissue than a deep plane facelift. It is called composite because the subcutaneous layers under the skin are lifted as one unit, as opposed to being lifted in layers or tissue by tissue. The composite facelift is most praised for leaving patients with results that look more natural than other facelifts. These results occur because the SMAS layer is moved vertically, rather than horizontally, preventing the skin from looking stretched. Unlike other procedures, fat under the eyes are not removed. Instead, it is re-positioned because fat helps to give a more youthful appearance.
The mid facelift is a facelift that focuses on the middle of the face or top part of the cheeks and underneath the eyes. Ideal candidates for a mid facelift are those who have wrinkles under their eyes or have flattened cheeks. Mid facelifts are great for making cheeks look fuller and more youthful. Many times, traditional facelifts focus solely on the lower part of the cheeks and neck, so getting a mid facelift along with a traditional one will allow for a smoother and tighter look throughout the entire cheek and neck area and below the eyes. During a mid facelift procedure, patients are put under anaesthesia and incisions are made around the hairline at the temples. The fatty areas of the cheek are then lifted and skin is tightened. The incisions are then stitched. The entire procedure takes no more than two hours. The recovery process for a mid facelift is usually less than a traditional facelift because mid facelifts are less invasive. A dressing is done on the incisions after they are stitched in order to prevent bleeding. It is normal for bruising and swelling to occur and last for several days after the procedure. Although strenuous activity should be avoided for at least two weeks after the procedure, patients should be able to return to their normal routines 3-4 days after surgery. Scars are typically unnoticeable because they are on the hairline and incisions are small.
Some patients may only want to make surgical enhancements to the lower portion of their face if they have no concerns about their cheeks. For such cases, a lower facelift surgery may be considered. Lower facelifts remove excess skin and tissue in the lower part of the face and help to reverse dropping mouth corners. A lower facelift surgery focuses only on skin around the jawline and neck, making it less invasive than a traditional facelift. Sometimes patients who have had a full facelift in the past, but need additional tightening in their lower face may undergo a lower facelift. During the procedure, patients are given either local or general anaesthesia and small incisions are then made in front of and behind the ears. Excess skin is removed and the remaining skin is tightened. The incisions are then stitched. The procedure can last up to two hours. A bandage and dressing is done on the area to prevent bleeding. It is common for bruising and swelling to occur for a few days after the surgery, but patients are usually able to return to their regular routines three days after the procedure. Scars are usually barely noticeable as they can be covered by hair on the hairline and/or are behind the ears.
This type of facelift targets the weak and sagging skin in the neck area. Neck lifts are most suitable for those who lack confidence because they feel the skin around their neck is too loose and wrinkled, making them look older. It is most common for older patients to receive this type of surgery because skin in the neck wrinkles and sags due to age. However, younger patients with weaker neck muscles can also undergo a neck lift in order to create a youthful and slimmer appearance of the neck.
Patients are usually given a local or general anaesthetic at the time of surgery. During this procedure incisions are made behind the ears or under the chin. The skin is pulled and excess fatty tissue from the neck is removed. After the fatty tissue and skin are removed and pulled, the remaining skin is stitched to close. The entire procedure takes a maximum of 3 hours. This procedure results in minimal scarring as the incisions are small and are slightly hidden behind the ears or beneath the chin. It is common for swelling and bruising to occur after a neck lift for up to a month. Instructions on how to use a compression device to manage bruising and swelling will be given by a surgeon. The most soreness will occur during the first week after the procedure, but medicine to relieve pain will be given. Patients should be able to return to work and normal activity after two weeks.
Some patients may confuse neck lifts with neck liposuction. Neck liposuction focuses on fatty tissue, so those who have excess fat in their chin and neck are most suited for neck liposuction. Anyone considering liposuction will also need to have elastic skin so that skin can return to its normal form after the procedure. Those who mainly have loose and sagging skin are better candidates for neck lifts.
Eye surgery is called blepharoplasty. As people age, the skin around their eyes looses elasticity and wrinkles and bags may form. In other cases, some may have too much fat underneath their eyes. These symptoms can create an appearance of tiredness. Eye surgery can either remove excess skin or redistribute fat to result in a more youthful and rejuvenated look. Blepharoplasties can be done either specifically on the upper or lower parts of the eye. Upper blepharoplasty focuses on removing excess skin on the eyelid that causes wrinkling.
During the procedure, patients are given a local or general anaesthesia. Then incisions are made in the creases of the upper eyelid, excess skin and fat are trimmed and the incision is stitched back together. Lower eyelid surgery concentrates on removing or redistributing fat and skin beneath the eye, just below the bottom eyelashes. During the procedure an incision is made right under the lower lashes and excess skin and fat are removed. Next, the incisions are closed.
Another type of lower eyelid surgery is called transconjunctional surgery where the incisions are made inside the lower eyelid. This type of incision allows surgeons to correct issues where the lower eyelid is too lax and need tightening. Since the incision is made under the eyelid there are no visible scars. Doing both upper and lower blepharoplasty procedures together take no longer than two hours. After the surgery, the recovery process is usually fast. An ointment and bandage are placed on the areas, along with a cold compress to relieve bruising and swelling. If dryness occurs, eye drops are recommended. Surgeons advise patients to use ice to reduce swelling, avoid contact lenses for the first week, keep their head elevated and avoid strenuous activity. Bruising and swelling can last up to 3 weeks after the procedure.
Some patients, especially those of Asian descent, do not have a natural upper eyelid crease. Double eyelid surgery can help to create a crease in the eyelid. There are three techniques to create an eyelid crease:
- Closed thread technique- The closed thread technique uses sutures, or stitches, to create a crease in the eyelid. The skin on the eyelid is surgically attached to structures in the eyelid to make a crease.
- Open incision technique- In the open incision technique the skin on the eyelid is cut and reattached to deeper structures of the eyelid to create a crease.
- Double sutures and twisting technique- The double sutures and twisting technique creates a crease by pinching the underside of the eyelid skin and stitching it together.
The results of eyelid surgery are intended to be permanent. Scars from eyelid surgery are usually minimal and/or do not show when eyes are open.
It is common for eyebrow lifts to be done with eyelid surgeries. Eyebrow lifts can be done to reduce forehead creases or raise low eyebrows. There are four types of incisions made to do eyebrow lifts: open brown lift, browpexy, direct brow lift, and endoscopic lift.
- Open Brow Lift- This type of eyebrow lift uses one, long incision that begins at the ear and goes along the hairline.
- Browpexy- This type of eyebrow lift focuses on re-positioning the eyebrows through an eyelid incision.
- Direct Brow Lift- The direct brow lift uses incisions directly above each eyebrow and helps to remove wrinkles in the forehead.
- Endoscopic Lift- This type of eyebrow lift is the least invasive because it uses small incisions in the scalp, which hide scars.
It may take several weeks before the final results of an eyebrow lift show completely. Recovery usually takes up to two weeks.
Otoplasty is surgery to enhance the ears. Some patients may feel that their ears are too large, or are disproportionate to their head and face. Others may have ears that protrude and an otoplasty can help to correct this by re-positioning the ears closer to the head. Some ear cartilage may need to be removed during this surgery, but no changes are made to the inner ear so there is no risk for damage to hearing.
Before the surgery, measurements of the ears will be taken so surgeons can give each patient precise results. During the surgery, patients are given a local anaesthesia. An incision is made the behind the ears very close to where the ears are attached to the head. Cartilage in the ear gives the ear its shape and structure, therefore, this cartilage has to be reshaped and re-positioned to change the shape and position of the ear. Once this process is done, the ear is then carefully stitched back to the skull.
The procedure usually takes no more than two hours. In most cases, the only visible scar is a very faint line behind the ear. After the procedure, patients will be given a bandage that is wrapped around their head to protect their ears and apply pressure to prevent bleeding. As the stitches behind the ears are quite delicate, a replacement bandage will need to be worn for a week after surgery to help keep the surgically enhanced ears in place. This bandage cannot get wet. Instructions on how to properly shower and care for the new ears will be given by doctors. Furthermore, a headband to protect the ears during sleep will need to be worn at night for a month after surgery. Pain medication will be administered for any mild pain that may occur after surgery. Patients will be able to do light activities a day after their surgery, but will have to wait three weeks before returning to heavier activities.
A soft lift is a type of face lift done without surgery. Instead, it uses Juvederm (fillers) to help patients eliminate loose skin and wrinkles in the face. By using fillers alone, you can also achieve a full facelift without surgery.
During cosmetic surgeries, fillers are injected into the skin to remove wrinkles and fine lines by temporarily paralyzing facial muscles. There are certain risks to be aware of before considering treatments. Some patients may be allergic to the ingredients in fillers or may suffer serious side effects if they have any pre-existing muscle or nerve conditions. Some side effects of the injection are normal, such as discomfort on the area of the injection, while others such as shortness of breath and blurred vision need to be reported immediately. It is important that patients notify doctors of any medical conditions or medications they have taken or are taking so that medical emergencies are avoided.
Juvederm is a series of drugs or fillers used to fill in areas of the face that lack fatty tissue or have deep wrinkles and sagging skin. It is most common for cosmetic surgeons to use hyaluronic acid-based fillers, which is a natural substance derived from human skin. This substance helps to create volume in the skin because it bonds to water molecules. Filling in areas of the face that appear uneven can help to create a smoother, more youthful look. Juvederm is injected into the skin as a filler to temporarily correct facial wrinkles and folds. Although pain during Juvederm treatments is usually uncommon, sensitive areas of the face can be numbed with an anaesthetic. The entire process of injecting fillers can last from 10 minutes to an hour depending on how many areas of the face are being treated. It is common for some swelling, numbness or itchiness to occur, but these will dissipate in less than a week after a treatment.
Although the results of both fillers and Juvederm are almost immediate, they are also temporary. Results can last between 6-12 months, so treatments are ongoing. Fillers and Juvederm yield different results so it is important that patients are honest about their goals during consultations. Fillers specifically targets lines around the eyes and forehead. Juvederm corrects lines and flatness around the mouth, cheeks, chin, and eyes and plumps lips. As well, Juvederm helps to contour jaws and the middle and lower face for a fuller and more youthful appearance. Using both Fillers and Juvederm can help to create an overall more youthful look. The results of soft lift procedures are almost immediate. There is very little discomfort or pain during and after the procedure.
There are risks involved in any type of surgery. Specifically with facelift surgeries, risks are dependent on the type of facelift technique being used. Generally, possible risks include: bleeding, infection, blood clots, bruising and swelling. In even more unusual cases, it is possible for irregularities such as facial asymmetry to occur. There are more risks involved when undergoing deep plane facelifts because facial nerve tissue is exposed during the procedure. Smoking and certain medications can cause blood to thin, leading to complications during surgery. Therefore, patients who smoke should avoid smoking at least two weeks before any procedure. During consultation, surgeons will advise patients about any medications they should stop taking before the surgery or during the recovery process.
It is important to follow given instructions during recovery in order to ensure the fastest and most effective recovery. As is necessary for anyone undergoing any type of cosmetic surgery, patients must be in good health in order to ensure a proper recovery. As well, patients should always have realistic expectations about the outcome of their surgery and understand that every person has a differently-shaped head and face, but surgeons will work their hardest to make sure that results best meet their patients’ personal goals.