Face ageing appears with a progression and a pace that may vary according to the individual, to his family predisposition, as well as to his life style. It displays on all the face elements: on skin, on subcutaneous fat, on in-depth muscles.
The cutaneous relaxation is mainly evident in correspondence with the nasolabial groove, the oblique line between nose and cheeks, as well as the creases next to the mouth or the wrinkles on the forehead. The face starts loosing its oval shape because the skin and the underlying fat slide downwards, on the sides of the mouth. Eyelids, too, follow the same destiny and they often relax, forming the so-called “bags” under one’s eyes. In the same way, the neck skin looses its tone, forming the so-called “double chin”.
Even the subcutaneous fat of the upper part of the face (temples, cheekbones) undergoes transformations with ageing, reducing itself, giving the face an “edgy”, sunken look. The fat tissue of the central and lower part of the face accumulates downwards, due to gravity, on the sides of the chin as well as under it. Even the face muscles modify: they loose their tone, they relax, following downwards the lines of gravity, worsening the sliding of all the face tissues.
The consequence of all this is that the overall aspect of the face modifies: the cheekbones are deprived of the soft tissues that were covering them and are highlighted in a different way. The bones surrounding the eyes, the ones of the temples, of the forehead and the jawbone become more evident. The forehead skin stretches, the eyelashes slide down towards the upper eyelid and the eye. In this new situation, the face takes on a serious, stern look, as if it were sulking.
The youthful expression of the face is lost, imperceptibly but progressively, year after year, so that the face assumes an aspect and an expression that are different when compared to the previous ones. Furthermore, with ageing, skin fines down, becoming thinner and more fragile. Obviously, these phenomena can appear more or less precociously in people who have lost weight or that are genetically inclined.
Face Lift Surgical Operation (Rhytidectomy):
In the light of the above-mentioned brief considerations, it is possible to understand how the modern face lift operation, compared to the surgery of a few years ago, does not only act on the skin, whose traction would provoke an unnatural result that does not last in time, but also on several deeper anatomic structures (adipose tissue, fasciae and muscles) that, in a slow but progressive way, have modified their correct position and, as a consequence, the position of the overlapping skin.
At present, the face lift technique is more accurate and enables the patient to obtain more natural and long-lasting results, when compared to previous techniques. The skin incision that is needed to perform a face lifting varies as for location and extension, according to each specific case. Usually it is hidden by the hair on the temples, then goes down towards the front part of the ear, disguised by the first skin wrinkle, then it turns around the earlobe, goes up again behind the ear and ends in the hair behind the ear. Through this access, it is possible to correct the SMAS (Superficial Muscular Aponeurotic System) muscular plan, recovering the right tone in the muscles that have relaxed. In order to better outline the neck features, excess fat is removed, especially on the double neck.
The skin is laid again on the face with the appropriate natural tension, without any undue traction, only removing what is superfluous, avoiding, in so doing, an unnatural look. The result that is obtained is a more tonic and youthful face. Sometimes it is necessary to perform a complete lifting of the whole face, but in many cases the surgeon will just correct one part of it (mini lift), without performing a complete surgery. Therefore, it is possible to choose to carry out a sectoral lift, improving the aspect of the lower portion of the face, of the neck, of the chin or the central portion, the one of the cheeks or the upper portion of the face, correcting eyelids, falling eyebrows or attenuating eyebrows wrinkles. The latter is called front lift. It can be performed both in a traditional way and with endoscopy (mini-invasive technique).
For the front face lift the endoscopic technique is the most modern, the most accurate and the less traumatic solution. Such a technique makes use of a very small camera, which is connected to an external television monitor that enables the surgeon to visualize the finest details of the structures to be corrected. The tools are inserted through small accesses in the scalp, as an alternative to the long scars of the old techniques.
In expert hands, major complications with face lifting seldom occur, but they are anyhow possible, due to the formation of haematomas, to the delay in the recovery of the skin behind the ears. Even the possible sensory or motory deficits are usually temporary. After a face lift, the tissue recovery is slower with smokers, who do not interrupt or drastically reduce smoking during the period immediately prior and following the surgery.
Both face lift as well as mini lift can be associated, when required, with other surgeries, such as blepharoplasty, neck liposuction, plastic surgery to increase cheekbones (malaroplasty) or to increase the chin size (chinplasty), rhinoplasty, the increase in the volume of lips (chieloplasty), etc. This surgery is performed in general anaesthesia, with one or two days of hospitalization.