(Face lifting)

Forehead lift

Thirty years ago circular face lift stopped to satisfy the biggest part of plastic surgeons’ clients. Its results didn’t stay too long. The clients had to retake it in some time. Nowadays it is unacceptable. To reach an evident aesthetic and continuous result multilevel and multidirectional lift of soft tissues of all the face zones is needed. The task of a professional is a sculptural face modelling not superficial skin tightening.

Aesthetic proportions (“the golden section”).

Conducting an aesthetic surgery, the surgeon is guided by the proportions of the human body. Proportions are the key concept of the plastic surgery. The analysis of the face proportions used nowadays is based on the studies, conducted by Leonardo Da Vinci many centuries ago.

The eyes of an adult person must be located in the middle of the face (the middle of the vertical height of the head). The top of the ear must be at the same level with the eyebrow. The distance between the under lip and the chin must be approximately in the middle between the end of the nose and the chin and at the same level with the angle of mandible:

The width of each eye (A) must be equal to the distance between the eyes (B) which is also equal to the width of the bottom of nose. The width of the mouth in relaxed state must be equal to the distance between irises:

A lot of face measurements comply with “the rule of thumb”. So the nose length must be approximately equal to 1/3 of the face height, and must be equal to the height (length) of ear, the distance between irises, the distance between ear and outer corner of the eye and must be approximately equal to the length of thumb:

Also the distance from ear to outer corner of the eye must be equal to the distance between this corner and a vertical line, drawn through the center of the face:

So, the wrinkles are a lot of the skin, and hanging-down and expansion are relief changes of all the face soft tissues.

When is the face lifting recommended?

The changes of the face tissues (as well as skin and more deep tissues) are divided into some periods in accordance with the age.

• 18-28 years- “the stage of plateau”. The skin is in the period of flourishing, the face is proportional, and there is no hanging-down of the soft tissues.
• 28-35 years – the initial stage of the withering of the face skin, but there are no evident signs of soft tissues’ hanging-down.
• 35-45 years – the appearance of the evident age-related wrinkles, initial manifestation of the soft issues’ hanging-down.
• 45-65 years – evident age-related changes of the face soft tissues. Now you should see a plastic surgeon.

The reasons of the age-related changes.

• Genetic - or implementation of the body self-destruction program - skin becomes thin and begins to cornify, the body proportions change, ears and nose are growing, eye sockets “are falling back” etc.
• Gravitational – conditional on the gravity force, which makes face mimic musculature, breast, stomach, buttocks and thighs sag;
• Atmospheric – “sun, air and water”, wind and chemically corrosive medium expose the skin to wind and hasten the aging;
• Behavioral – improper feeding and bad habits;

The signs of aging of neck and lower third of face.

1. The horizontal folds on neck.
2. The extension of the angle between the neck and lower jaw (“turkey’s chin”)
3. Vertical folds downwards to angles of mouth (“the marionette lines” or “the folds of grief”).
4. The distortion of the accurate face shape.

The signs of aging of the middle zone of face.

1. Lacrimal groove – the groove coming from the interior angle of the eye between the inferior eyelid and cheek.
2. Distension and hanging-down of the inferior eyelid. In profile it is a distance between the ciliary border and the lacrimal groove.
3. Malar bag – one more age-related relief a little bit lower and sideways from the lacrimal groove.
4. Nasolabial fold – an overhang of the skin of cheek aside from the nose and upper lip.

The signs of aging of the upper zone of face.

1. Downshift of the eyebrows.
2. Skin redundancy of the superior eyelid.
3. Ptosis (downshift) of external canthus downwards.
4. Cross folds of the forehead skin and longitudinal folds above the bridge of nose.

The division in conformity with age is rather relative and it depends on the inherited factors, external and internal influences, but in general at the age of 40-50 the cutaneous covering of face and neck are subjected to distension and sagging. Sometimes because of the individual peculiarities a serious modelling of appearance is needed even in the young age (premature aging at the age of 30-35). Certainly there is a non-surgical method of face lifting with the help of threads (see Thread lifting), but it works efficiently, when there is no use to remove large redundancy of skin. The face lifting makes it possible to influence soft tissues of face and neck, successfully removes any signs of age-related changes, even if they are evident.

Preoperative preparation of the patient.

1. Do not use medicine that can influence blood coagulation two weeks before the surgery.
2. Have a fasting day (light food in small portions) a day before the surgery.
3. Do not eat and drink in the morning of the day of surgery.

Anesthesia.

Circular lifting of face and neck is a long lasting surgery (4-5 hours), requiring general anesthesia. The lifting of certain zones of face, e.g. forehead or eyebrows may be conducted under local anesthesia or intravenous anesthesia.

How can the age-related relief changes be removed?

A serious face lifting (multilevel and multi-vector lifting of all zones) means not only work with skin, but also with soft tissues – muscles stretched in time and sag adipose tissue. The discharge and transfer of SMAS (Superficial Muscular Aponeurotic System) is obligatory. The mimic musculature is rearranging, and the adipose tissue is moving from the place where it is redundant to the place where it is missing. The face becomes almost the same as in youth. It is important that such rejuvenation is “harmonious”, i.e. the individual balance of features, which was peculiar to the person 10-15 years ago, is observed.

ПPostoperative period.

1. Hospital stay during 2-3 days.
2. The sutures in front of the auricles are removed on the 7th day after the surgery (to form a flat unnoticeable scar), on the scalp – on the 10th day after the surgery.
3. One week after the surgery the patient can use make-up.
4. 10-14 days after the surgery the patient is back to work.
5. During 1.5 a month it is forbidden to go in for sports.
6. One month after the surgery the patient can sunbathe and go to solarium.
7. 3-4 weeks after the surgery it is good to have a course of lymphatic drainage massage to achieve better results. Till that time face massage is contraindicative.

Results.

The result of the multilevel multi-vector lifting stays more than 8 years, the patients look much younger than their peers even 15-20 years after.