Facelift & Neck Lift

As we age, changes become apparent in our bodies. For most people, the changes that occur on their faces are the most bothersome. There are three zones of the face, namely the Periorbital Zone (the hairline to above the tip of the nose), the Perioral Zone (tip of the nose to the chin and mandible), and the Neck Zone (below the chin and mandible). Several factors contribute to aging in the face. These include some bony resorption on the bones of the face and weakening of cartilaginous support structures, atrophy of the different fat compartments in the cheeks, thinning out and drooping of the skin due to diminished elasticity and collagen formation, and disruption of the acid mantle on the skin making the skin dry.

These, in turn, appear as down turning of the tip of the nose and elongation of the ears, sunken cheeks and temples, prominent nasolabial lines, marionette lines, jowls, turkey neck, crow’s feet, dry skin, and sunspots. The three zones of the face do not necessarily show aging changes equally-some may have a prominent nasolabial line with a slightly more youthful eye and forehead, etc.

The treatment for some of these changes may be as simple as botox injections and volumization with either dermal fillers or autologous fats. However, for skin elasticity and drooping, treatment becomes a facelift, often coupled with a neck lift. Thus, since different faces age differently, the appropriate treatment strategy must be tailored to each patient, individualized and explained. The ultimate goal is to have harmonious rejuvenation across all three zones.

Your Consultation with Dr. Joel Nicdao

During the consultation, skin elasticity and volume loss are determined in the different zones. Physical maneuvers may be done to determine if the patient would benefit from a short scar surgery (mini or endoscopic) or a full, large scar procedure. There is no point in opting for a short scar if the concerned deeper structures cannot be accessed completely or if excess skin bunches at the edges of the said scar.
Some ancillary procedures may also be discussed at this time, such as liposuction of the chin and/or jowls, wattle excision, or fat transfer to sunken cheeks or nasojugal folds.

Ideal Candidates

Ideal candidates for face and neck lift surgery are those who are 50 years old and above (although some patients in as early as their forties may also qualify), have a fair amount of loose skin and underlying muscles at the jaw and neck, have jowls or sagging skin that produces the jowl appearance, volume loss at the cheeks and around the mouth, and static wrinkles around the nose and mouth. As in all surgeries, patients are generally healthy with no or controlled co-morbidities, nonsmokers, and have realistic expectations and are open to lifestyle modification in order to maintain their newly acquired youthful looks.

The Facelift & Neck Lift Procedure

Depending on the main surgery and ancillary procedures to be done, the patient may be done safely under local anesthesia with some sedation or under general anesthesia. Both will still require laboratory tests and a preoperative cardiopulmonary risk assessment.

Perioperatively, after determining the planes and extent of dissection and undermining, the most appropriate vectors (pull) for maximum and natural-looking lift are identified. Vertical vectors produce better rejuvenation compared to horizontal vectors, which may flatten natural contours making the face look unusual.

It is vital that the patient does not end up with a “done” look which may include overly stretched lips (wind tunnel look) and receded hairlines. When the desired lift has been achieved, the skin is redraped and any excess is excised.

It should be noted that some hair loss may be expected especially in the areas of the incision where hairs eventually fall out and no longer regrow. To counteract this, incisions are beveled in order to spare hair follicles so that they are left behind after the skin is redraped and excised.

Recovery

Patients are advised to stay for one night for monitoring by a private duty nurse to make sure that any possible early complications (hematoma) may be identified early and addressed promptly. As long as dressings are dry, the patient has no severe pain, hematoma or signs of dehydration, the patient may be sent home the next day. They will be advised to rest at home with antibiotics and pain relievers. They will follow up in one week to have the stitches removed.