Gravity causes drooping of the soft tissues in the face and neck, leading to ptosis (drooping) of the brow and cheek and also the formation of jowls and loose folds of skin. In addition to this the full fat pads of youth shrink causing a hollowed appearance in some patients. Browlift, facelift and necklift are three procedures which may be performed individually or in harmony with one another to produce an aesthetic rejuvenation of the face. These ‘lifting’ operations are without doubt the most operator dependent procedures in plastic surgery. In other words the success of these operations are the most dependent on the skill of the surgeon. There are a variety of options available for facelifting which have evolved over the last century. These range from a simple skin only facelift (also known as a subcutaneous facelift or mini-lift), which provides a tightening of the jawline and superficial rhytids (wrinkles), through to subperiosteal procedures and SMAS (Superficial Musculo Aponeurotic System) lifts which provide a greater degree of longevity and tightening.
Face and Neck Procedures
Types of Blepharoplasty
As we age, most of us develop some laxity and excess skin in the upper eyelid area. This can usually be removed by excision of the skin in an upper blepharoplasty. Upper blepharoplasty involves removal of skin plus or minus muscle and sometimes reduction of the medial upper eyelid fat pocket. This is generally carried out under local anaesthetic.
A vital part of the upper blepharoplasty consultation is consideration of the brow height. A drooping brow can exacerbate upper eyelid skin excess and restoration of the brow shape and height can be achieved using brow/forehead lift. We undertake direct brow lift, endoscopic browlift, open bicoronal brow lift and open hairline-lowering foreheadplasty depending on preoperative status and desire for change.
The lower eyelid can start to age with prominence of the fat pocket, visible tear trough and the appearance of crows feet. This is often exacerbated by loss of volume in the (malar/submalar area). Descent of the midfacial tissues can also expose the anatomy of the orbital rim. Gestures to address ageing changes in the lower eyelid/cheek area include lower blepharoplasty (laser/conventional plus or minus canthopexy/canthoplasty). Restoration of volume in the mid face by fat transfer or the use of facial implants can be helpful. Significant support can be restored to the lower eyelid by elevation of the mid face with either a high SMAS or deep plane facelift or a mid face lift.
Fat is removed from the lower eyelid fat pockets via a hidden incision in the lower conjunctival fornix. The external skin is resurfaced and tightened using the CO2 laser in ablative mode.
A subciliary incision is made and the skin is undermined. Sometimes simple skin excision is adequate (pinch. Blepharoplasty) however in some cases reduction of fat pockets can be made from an incision through the underlying orbicularis oculi muscle.
Canthopexy and Canthoplasty
Canthopexy is a descriptive term for retightening of the lateral canthus of the eye by suturing the tendons here to the periosteum of the orbital rim.
Canthoplasty is a more aggressive version of canthopexy where the lateral canthal tendon is completely reconstructed.
Types of Browlift
Direct brow lift requires the precise excision of skin from the forehead either directly above the eyebrow or in a mid forehead skin crease
Endoscopic brow lift entails elevation of the deepest layers of the forehead away from he underlying fascia and bone. These are anchoring using absorbable fixation devices known as endotines.
Open bicoronal brow lift is an extremely effective long lasting rejuvenative gesture for the upper third of the face. An incision is made across the top of the head, the forehead is undermined often removing a strip of galea and excess scalp is excised.
Open Hairline-lowering Foreheadplasty
This procedure is well suited to patients with a. High forehead or a receding hairline. The hairline can be advanced forward by up to 2cm. An incision is made along the frontal hairline and both the forehead and the scalp are undermined. In this case, excess forehead skin is removed from the overlap at the hairline.
This is normally undertaken in a subperiostial plane protecting the infraorbital nerve. The soft tissues of the face are mobilised off the bone and elevated upwards with either sutures or the temporary absorbable endotine mid face device.
Fat can be harvested from areas of excess, refined and reinserted into areas of volume loss such as the mallar/submaler areas and the upper orbital rim. Not all of the fat graft survives and it is a procedure that often requires repeating to achieve optimal results.
Cheek implants may be inserted either through a lower eyelid incision, the facelift incision if a concurrent facelift is being undertaken, or transorally through the mouth. The provide an extremely predictable volume restoration and can be customised to correct asymmetries.