Face and Neck Lift

I perform two types of facelifts according to the results you wish to achieve.

A one-stitch facelift: This is the less invasive of the two procedures.

The small scars are hidden in the hairline at the sideburn area and occasionally, there is a small incision under the earlobe. The incisions are closed with dissolvable sutures, which do not need to be removed. The procedure takes approximately 45 minutes to perform under local anaesthetic in clinic.

This method carries minimal risk, and the results should last for approximately 1 year, at which stage the procedure can be repeated if desired. It does not improve the appearance of the neck and is recommended for patients in their 30s and 40s, who only need moderate tightening.

You can return to work the next day, and the hair easily covers scars as they are healing.

MACS face and neck lift (minimal access craniofacial suspension): This type of facelift/neck lift involves more than just tightening the skin, as it extends below the skin to the deeper more fibrous layers. Tightening this deeper SMAS layer (superficial musculo-aponeurotic system) allows the underlying facial muscles to also be lifted. These muscles, just like the skin, droop with age.

During the same operation, I often perform fat grafting to improve the appearance of wrinkles, grooves and to replace any lost volume from areas as desired (such as lips or cheeks).

A small area of liposuction can also be performed to remove the fat pad at the chin.

In general, incisions are made inside the hairline at the temple, extending down along the natural crease in front of the ear, curve behind the ear under the earlobe and horizontally back into the hairline. In a less extensive lift, a shorter incision can sometimes be made. If surgery is required around the jaw line and neck, a small incision under the chin may be needed.

Once the deeper layers have been lifted, the skin is re-draped, carefully removing any surplus skin and tissue before closing the incisions. Dissolvable sutures are placed in the hairline, whilst the sutures used for the incisions around the ears, need to be removed after a period of approximately 6 days.

MACS facelift and neck lifts are mostly performed under a general anaesthetic (you will be fully unconscious). The operation takes between 3 to 5 hours to perform depending on the area(s) to be treated and whether any other procedures are carried out at the same time. You are likely to stay in hospital for one night, but it can be carried out as a day case if you prefer to go home on the same day.

Having cosmetic surgery should be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk, and it is important that you are aware of possible complications. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me. Decisions about cosmetic surgery should never be rushed.

These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

• Unintended intraoperative awareness, which is very rare.
• Dizziness and nausea.
• Sore throat.
• Damage to teeth or mouth.
• Nerve injury due to body positioning.
• Allergic reaction or anaphylaxis.
• Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: Facial scars to settle remarkably well and are barely perceptible. However, some patients heal with noticeable thickened, thin or stretched scars.

Bruising and swelling: This is very common on both the recipient and donor sites and the bruising may take a couple of weeks to settle.

Haematoma: This can happen if a bleed occurs under the skin, allowing a large blood clot to form. If a haematoma develops, it is likely to do so within 4 to 6 hours post-surgery. Any increase in swelling or pain should be reported immediately so that treatment can be given. Sometimes patients need to have this collection of blood removed with another short operation.

Infection: This is rare, as the face has good circulation. Infections sometimes require antibiotics or occasionally drainage of an abscess if the infection is deep.

Numbness, reduced sensation or oversensitivity: Injury to sensory nerves can occur, leaving areas of numbness; a common area being the earlobe. This gradually improves as the nerves recover but permanent numbness of the earlobe is possible.

Wound healing problems: This problem is rare but more likely to happen to smokers, as nicotine reduces the blood supply.

There is a risk that a patch of skin may form a black scab, which usually falls off after a few weeks, leaving behind an open wound. This should heal quickly but may result in a less than satisfactory scar, which requires revision. It is for this reason that you must stop smoking prior to your MACS face or neck lift for the optimum result.

It is very unlikely to occur in a one-stitch facelift, as the skin is not lifted beyond the area excised.

Seroma: Occasionally clear fluid can collect under the facial skin, giving the appearance of swelling. This can be aspirated with a needle if it feels tense, otherwise it normally resolves by itself in approximately 2 to 3 weeks after surgery.

Nerve injury (the facial nerve): Weakness in parts of the face can occur. This is normally temporary due to bruising of the nerve, which should return to normal in a few weeks.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. To reduce any risks of this, we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.

All the risks outlined above will be discussed in a lot more detail at your consultation with me. However, if you have further questions or concerns, please do not hesitate to ask.

If you have had a one-stitch facelift under local anaesthetic, you can go home straight after the procedure.

If you have a general anaesthetic procedure, you can go home the same day or stay in hospital overnight, depending on your preference.

You will have non-absorbable sutures applied, which require removal in approximately 5 to 7 days.

You will be able to have a shower and wash your hair once the sutures have been removed.

For optimal results, you will need to wear a medical support strap to help shape your chin and allow the tissue layers to heal. This should be worn for 2 weeks, although you can remove it to shower and apply cream to your incisions.

Before you leave the clinic, you will be given a follow up appointment to see the nurses at one week post-operatively to check your incisions and an appointment to see me in Clinic 2 weeks’ time.

Scar Advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

Recovery times vary from one person to another and depending on which procedure you have had.

A one-stitch facelift will routinely heal within 2 weeks, and you can return to work the next day.

Following a MACS face and neck lift you should take things easy for the first week. Most patients return to work after 2 weeks.

If you have any concerns during this recovery period, you must contact the clinic for early advice.

Remember that is important to wear a high factor sunscreen (ideally SPF100) over the scars for 12 months when you go outside. This prevents pigmentation of the scars.

For self-funding patients, surgical fees are a combination of the hospital costs, the surgeon, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.

Facelift Patient Information Guide

Face and Neck Lift - Nicotine and Surgery