Facelifts

New names keep appearing: maxi or mini facelift, in two or three layers, hard or soft, superficial or deep. I will therefore try to shed some light by setting out a few simple principles.

By definition, a lift means raising something. Ageing causes the skin to stretch, the various structures of the face to sag, and often a build-up of fat. For a long time, only a skin lift was performed, by retightening the skin. Then, in the 1960s and 70s, surgeons began to tighten the muscles and fascia as well, and also to remove the fat accumulated in the neck and jowls.

Some surgeons tighten the skin and the muscles separately, others keep them together, hence the names one-, two- or even three-plane lifts. This mobilisation of the muscles and fat can also be carried out to a greater or lesser extent. Excess fat can be removed by suction or by direct excision, or a combination of both. A new dimension has appeared (as a spin-off from craniofacial surgery): the possibility of lifting all the soft tissues of the face, in front of the bone, which is called a “mask lift” or deep facelift.

This procedure, which can give spectacular results in very specific cases, corrects the sagging of the central part of the face but not the excess skin of the neck. Endoscopy is excellent for the forehead, can be used on the face to lift the cheekbones, and can sometimes help in the neck. All this is rather complicated, and highlights two important points:

• there is no such thing as “a facelift”, but multiple possible actions that the surgeon must know and choose from;
• this choice must be made after a precise study of the various problems to be solved and of each person’s anatomy; each time, a different operation will be performed, adapted to the particular case of each patient.

The extent of the operation is also a matter of debate between those who favour small successive touches and those who recommend a “total” procedure. It is a false debate. The situation must be assessed at the time of the request and the surgical approach adapted to each patient to obtain the best possible result. For me, as far as rejuvenation surgery is concerned, this means a natural appearance, with no visible traces of the operation and yet the most effective rejuvenation possible.
Ageing may be more or less uniform depending on the patient. Sometimes it shows mainly in the eyelids or the forehead. The neck may be mostly affected, or the cheeks. In these cases, only the affected part can be corrected.

More often, ageing is harmonious and affects the various parts of the face equally. In these cases, to obtain a correction that remains harmonious and natural, the various parts must be corrected at the same time.

Age is also a matter of controversy between those who favour an early facelift and those who prefer a later one. I believe it is preferable to intervene before the folds and wrinkles become deeply established, especially at the corners of the mouth and the jowls, and that a facelift at this stage not only rejuvenates but also slows down ageing.

However, one should not go too far and intervene too early: there must be clear sagging for a cervico-facial facelift to be reasonably considered.

Nevertheless, beyond the anatomical state, each patient’s particular situation (work, family, smoking, medical problems, psychological balance) will have to be taken into account in deciding the timing and nature of the planned procedure.