Facial Rejuvenation Surgery: Procedures, Risks and Alternatives
Facial rejuvenation surgery refers to a variety of operations designed to reduce the signs of aging on the face. These include facelift, brow lift and eyelid surgery. In addition, there are a number of additional procedures to deal with finer wrinkles such as dermabrasion, chemical peels, laser skin resurfacing, Botox injections and fat grafting. Other corrective procedures that are sometimes carried out at the same time as facial rejuvenation surgery include chin or cheekbone implants, lip enhancement, earlobe shortening and nose correction surgery.
Reasons for Having Facial Rejuvenation Surgery
The two reasons why people choose to have facial rejuvenation surgery are to reverse the effects of aging and for medical reasons. It goes without saying that the more common reason is to revive the face for cosmetic purposes by hiding the signs of aging, especially in older, sun-damaged skin or skin damaged by years of smoking.
As the years go by, gravity and aging of the skin are slowly changing the appearance of the face. Gravity affects all the layers of the face and causes the face to gradually drop. This produces effects such as brow lines and furrows, drooping of the eyebrows, upper eyelids and cheeks, bags under the lower eyelids, hollowing under the eyes, nose-to-mouth grooves, jowls (fat and skin hanging from the lower jaw) and double chins. Aging of the skin, on the other hand, shows up as fine wrinkles and irregular skin pigmentation.
On top of all of this are the effects of the sun which can trigger abnormal cell growth in the outermost layer of the skin and increase the risk of developing skin cancers. There is also a generalised speeding-up of the aging process in sun-damaged skin, while similar changes are also seen with prolonged and heavy smoking.
Facial rejuvenation surgery (i.e., facelift, brow lift and eyelid surgery) only addresses the effects of gravity. It is not a treatment for fine wrinkles or skin coloring. Different other techniques (mentioned later as alternatives to facial rejuvenation surgery) are used to treat wrinkles and pigmentation changes.
There are two rare medical conditions where facelifts are also performed, i.e., cutis laxa (deterioration of the elastic fibres in the skin) and pseudoxanthoma elasticum (infiltration of the skin by abnormal fibres). In both these very rare disorders the face looks abnormally old and surgery can help improve the appearance of the face.
Procedures Used as Part of Facial Rejuvenation Surgery
Facial rejuvenation surgery is no longer seen as being only for the rich and famous. It is becoming increasingly more affordable for millions of consumers, while recent advances in microsurgery techniques and computer simulation enable the surgeon to achieve extremely natural results. The three surgical procedures used for facial skin rejuvenation are:
A facelift (rhytidectomy) is performed by cutting the skin of the face and repositioning muscle and fat to remove wrinkles. This is often done within the hairline and within the natural creases around the ear. Layers of the face are then lifted from the structures below and pulled tight. Excess skin is trimmed off, while the deeper tissues beneath the skin can also be repositioned, then the layers are anchored into position and the skin is closed up with stitches.
The traditional brow lift operation (also forehead lift) is performed by making a cut in the scalp and removing some skin before it is stitched back together. In endoscopic brow lift, several smaller cuts are made and small anchors are used to secure the tissue. This technique produces minimal scarring.
A procedure called blepharoplasty is used to tighten excess eyelid skin on the upper and lower eyelids. In procedures for above the eye, a cut is made over the upper eyelid and excess skin, fat and muscle are removed before the cut is closed. When used for bags under the eyes, a cut is made just along the lower lash line or inside the lower eyelid. For more information on blepharoplasty read this article.
Potential Risks of Facial Rejuvenation Surgery
Although most people are very satisfied with the outcome of their surgery that is not to say that there are no risks. Complications, such as fever, swelling, extreme pain or tenderness, abnormal discharge (including pus) from the wound or stiches coming out before they are due to be removed, do occur. Other possible complications of face rejuvenation surgery include the following:
- Bruising and swelling – it is unavoidable
- Temporary and permanent numbness – temporary numbness is also unavoidable
- Hematoma – blood collects under the lifted layers. It is quite common and occurs more often in men than in women.
- Skin slough – small areas of skin lose their blood supply and die. It is up to twelve times more common in smokers than in non-smokers.
- Scars – some people produce bad scars which are very lumpy
- Temporary, partial hair loss – sometimes a bald patch develops around part of the scar
- Paralysis of facial muscles – damage to the nerves controlling facial movements. This is the most dreaded thing that can go wrong during a face-lift but it is very rare.
- Recurrence of the signs of aging. The benefits of facelift usually last for around ten years but this is highly variable.
- Temporary and permanent paralysis of forehead muscles. This problem is not uncommon and can result in a ‘flat’ forehead, which is almost always temporary.
- Hematoma – this risk is the same as for facelifts
- Lop-sided brow – there are unequal right and left eyebrow heights but the chances of this happening are small
- Abnormal and decreased sensation in scalp – it usually settles with time but in rare cases it can be permanent.
- Hair loss in scarred areas – it is the same as mentioned for facelifts
- Surprised look – caused by over-correction of the drooping brow. This can settle with time or may require another surgery
- Recurrence of drooping brow – it may be more marked on one side compared to the other
- Watering eyes – excessive correction can cause the eyelids to turn outwards and prevent them from closing properly. The eyes tend to water as a result, with tears constantly running down the cheek. It is probably the most common mistake in eyelid surgery.
- Gritty sensation in the eyes – another common complication but it usually settles quickly
- Incorrect skin removal – if too much skin is removed, it can result in more white showing in the eye, while if too little skin is removed, the original problem may not be fully resolved
- Excess lower fat removal – if too much fat is removed from the lower lid, it can leave a patient with a ‘hollow-eyed’ look
- Numbness in the eyelids – it is not uncommon and usually only temporary
- Retrobulbar hematoma – blood from the wounds accumulates behind the eyeball and causes an increase in pressure. Though severe, it is extremely rare.
Smoking is a very important issue when it comes to facial surgery. People must try not to smoke before or after facial surgery. This improves healing and reduces the chances of things going wrong.
Suitability for Facial Rejuvenation Surgery
The best candidates for facial rejuvenation surgery are in good general health and between 40 and 60 years old as the skin is still elastic and the bone structure is strong. A very crude test that anyone can perform on themselves is to pull up on the skin in front of their ears. If this makes a person look better they will probably benefit from a facelift. But, the most important thing that decides whether or not a person will benefit from surgery is their understanding of what can realistically be achieved.
However, there are certain rare conditions where facial rejuvenation surgery cannot be recommended. For example, in Ehlers-Danlos syndrome the skin is over-elastic and patients with this condition have a very poor ability to heal wounds. Another example is a condition called progeria where there is early or premature aging. People with this disorder have many other health problems so again surgery is best avoided.
Alternatives to Facial Rejuvenation Surgery
Facial rejuvenation surgery reverses the effects of gravity but does nothing for the condition of the skin itself. However, there are several ‘adjunctive’ procedures that can be performed to combat the effects of aging on the skin. Chemicals, lasers and scrapping the skin can be used to smoothen fine wrinkles, while fillers, neurotoxins and fat can be injected into areas of the face where augmentation is necessary. These procedures include:
- Chemical Peeling. This is a technique where a chemical preparation is applied to the skin to burn its top layers in a controlled way. It leaves a ‘fresh’ raw surface underneath that heals over the next few days producing a new younger looking skin surface. Chemicals used for peeling include alpha-hydroxy acids (AHAs) derived from various natural products such as fruits, sugar cane and milk, trichloroacetic acid (TCA), glycolic acid, Retin-A and phenol (not suitable for those with kidney, liver and heart disease).
- Laser skin resurfacing. This is an alternative to chemical peels and dermabrasion (see below). Laser skin resurfacing is more controlled and, therefore, more predictable. This technique uses the heat of the laser to vaporise superficial layers of the skin.
- Dermabrasion. The outer layer of the skin is scraped or scratched off. A diamond wheel or a wire brush are used.
- Dermal filers. These injectable substances are used to fill in wrinkles, add volume and alter the contours of the face.
- Botulinum toxins. Botox injections relax the muscle under a wrinkle and thus smoothen the wrinkles. They can also be used to balance facial asymmetry.
- Liposculpture and fat grafting. Fat is removed from one part of the body (e.g., the tummy or buttocks) using liposuction. The intact fat cells are then injected into the areas requiring treatment.
With the exception of injections, all of the above procedures are aimed at removing the outer skin layer, which makes the skin fragile for some time. In addition, there are a number of other possible complications including a risk of forming thick scars, skin colour changes (pale skin or skin darkening), infection with bacteria or viruses, temporary increase in acne, and over-tightening of the skin, which may, for example, pull on the eyelids leading to problems closing the eyes and result in over-watering of the eyes.
Where to Find Related Information: Smart Beauty Guide