This fact sheet was developed under the aegis of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as an addition to your initial consultation, to try to answer all the questions you can ask yourself if you plan to use surgery baldness. The purpose of this document is to provide you with all the necessary and essential elements of information to help you make your decision with full knowledge of the facts. Also you is it advisable to read with the greatest attention.

 

 

 

• DEFINITION OBJECTIVES AND PRINCIPLES

Many facelift techniques are described in the medical literature. They all aim to correct the disgraces caused by the aging of the face and neck.

The two most frequent types of facelift in the activity of a plastic surgeon are the classic cervicofacial lift and the centrofacial lift. These two techniques are not opposed, but respond to different aesthetic objectives. In some cases, they can be combined.

The cervico-facial lift acts on the neck and cheeks and finishes its action on the temples. This is described separately in another information sheet.

The centrofacial lift acts on the lower eyelids, the hollow of the dark circles and the cheekbones.

These sometimes major physical alterations, as well as the psychic suffering induced, give a therapeutic purpose to this restorative surgical procedure.

Under no circumstances can this aesthetic surgery be covered by health insurance.

This facelift is envisaged when the patient, in front of the mirror, corrects by a vertical traction upwards of the cheekbones, some of the disgraces linked to ageing.

This facelift is not suitable for all patients and the indication can only be chosen by the surgeon. This intervention can be associated with another facial aesthetic surgery procedure: facial lipostructure, neck lift and also be supplemented by medical and surgical therapies (dermabrasion, laser, peeling, botulinum toxin injection, injection of filling product such as hyaluronic acid).

This facelift does not aim to modify the features but to put the anatomical structures back in a younger position.

 

• BEFORE THE OPERATION

A routine pre-operative check-up is performed as prescribed. An anaesthetist will be seen in consultation no later than 48 hours before the operation.

No medication containing aspirin must be taken during the 10 days preceding the operation. Hair must be washed the day before the operation and make-up must be carefully removed on the day of the operation.

It is essential to fast (not eat or drink anything) 6 hours before the operation.

 

• TYPE OF ANESTHESIA AND CONDITIONS OF INTERVENTION

Type of anaesthesia: Centrofacial lift can be performed under general anaesthesia or under deep local anaesthesia with intravenous tranquilizers ("vigil" anaesthesia).

The preoperative consultation by the anaesthetist will have allowed to look for a possible contraindication.

Hospitalisation: This operation can be carried out either with a 24-hour hospitalisation or "outpatient", i.e. with a discharge the same day after a few hours of supervision.

 

• INTERVENTION

Two incisions are usually required to perform the surgical procedure. A first incision is located in the lower eyelid, just below the eyelashes and extends into the crow's feet, in order to remain discreet. A second incision is hidden in the hairy part of the temple area. These two incisions, made on each side, allow the surgeon to make a detachment of the deep subperiosteal plane (in contact with the bone).

Depending on the surgeon, the vertical suspension of the cheekbones will be carried out either by means of threads or by more sophisticated resorbable anchoring systems.

The excess lower eyelid is resected at the end of the operation.

The operation lasts one to two hours.

An absorbent dressing is put in place for the hours following the operation.

A slightly different strategy, proposed by other surgeons, makes it possible not to have recourse to a temporal incision. A single incision is made in the lower eyelid, just below the eyelashes and extending into the beginning of the crow's feet, in order to remain discreet.

The cheekbone detachment is made deep, in contact with the bone, as described above.

The re-draping of the skin, which is strictly vertical, does not continue towards the lateral part of the cheekbone, which makes it possible to dispense with the association with a temporal lift.

The suspension of the cheekbones is carried out as indicated above.

This technique, which avoids the approach of the temple area, has no effect on the temple.

AFTER THE INTERVENTION: THE OPERATING SUITES

 

The outing takes place the same evening or the next day, usually without a bandage.

Moisturizing eye drops may be prescribed. An analgesic and anti-inflammatory treatment is also prescribed.

The first few days, you should rest as much as possible and avoid any violent effort.

During these first days, the patient should not be surprised or worried:

of a hypercorrection,

Diffuse facial edema (swelling) that can increase rapidly (it is more marked on the second day than on the first). In some cases it can be asymmetrical.

bruising in the eyelid area (bruising)

a painless irritation of the eye (redness of the eye)

a cardboard sensation of the periorbital bone framework

 

Hypercorrection is necessary for the success of the intervention and disappears within the first 7 to 10 days. It is increased by edema.

 

The bruising and swelling usually disappears within the first 2 to 3 weeks. Some areas regress more slowly.

 

The cardboard sensation disappears within a few months.

 

Scars are usually hidden under the eyelashes and in the hair. The only scar that is slightly visible under the eyelashes and mainly in its external part, can, from the tenth day, be camouflaged by make-up. It will gradually fade away.

 

Schematically we are:

on the seventh day, presentable for the intimate ones,

around the fifteenth day, presentable for his friends (the sunglasses type "mask" are particularly suitable for convalescence),

but in order to appear in front of people whose surgery we want them to ignore, it is necessary to allow, in the absence of complications, 3 to 6 weeks..

 

• THE RESULT

After six to eight weeks, we can have a good idea of the final result. However, it only appears stable between the third and sixth month.

The scars under the ciliary gums are sometimes still pink for 3 months, but are easily camouflaged by make-up.

The temporal scar, even if red and indurated, is perfumed and can be hidden in the hair. It does not begin

 

sometimes it doesn't get better until you're six months old.

Thanks to the contribution of the centra-facial lift, the rejuvenating effect is appreciable with an aesthetic result that remains natural and harmonious.

This physical improvement is usually accompanied by psychological well-being.

 

In the long term, aging continues to do its work and the face continues to suffer the ravages of time.

A facial maintenance with specific treatments of the epidermis (laser, pulsed lamps...) and with injections of fillers and botulinum toxin helps to maintain the result longer.

A new intervention, often more moderate, may sometimes be necessary.

 

• FAULTS OF THE RESULT

It may be essentially:

oedema (swelling) that persists in certain areas beyond the third month and may require massage,

of partial tissue slackening.

excessively visible scars or hair loss in the temporal region (alopecia) that may require remote surgical re-treatment (six months to a year).

 

• POSSIBLE COMPLICATIONS

Although performed for essentially aesthetic reasons, a facelift is nonetheless a genuine surgical procedure, which implies the risks inherent in any medical procedure, however minimal it may be.

In particular, this procedure is subject to the risks associated with living tissue, the reactions of which are never entirely predictable.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

As far as anaesthesia is concerned, during the consultation, the anaesthetist will himself inform the patient of the anaesthetic risks. It should be noted that anaesthesia induces reactions in the body that are sometimes unpredictable and more or less easy to control: the fact of having recourse to a perfectly competent anaesthetist, working in a truly surgical context, means that the risks incurred have become statistically very low.

As far as the surgical procedure is concerned: by choosing a qualified and competent Plastic Surgeon, trained for this type of operation, you limit these risks as much as possible, without however completely eliminating them.

Fortunately, the after-effects of surgery are generally simple during a surgical procedure performed according to the rules, and real complications are rare.

In practice, the vast majority of operations are carried out without any problems and patients are satisfied with the results.

However, despite their rarity, you must be informed of possible complications:

A haematoma that may require rapid evacuation or a secondary puncture.

Localized skin necrosis, responsible for delayed healing. It can be promoted by smoking.

These two complications appear to be exceptional in a facelift, notably due to the deep nature of the detachment.

Infection is exceptional when the operation is performed without strict aseptic conditions.

An ectropion (retraction of the lower eyelid) is possible in this type of procedure. Its appearance, in the days following the operation or later in the first few days, can sometimes lead to a surgical resumption that can go as far as skin grafting. However, simple massages can often lead to a satisfactory slackening of the scar. This complication remains rare, however, but its adequate management is necessary in order to prevent any risk of ocular complications (irritation, inflammation, dryness). A tendency to round eye can also be observed.

Nervous lesions:

in particular a paralysis of the temporal branch of the nerffacial responsible for the elevation of the eyebrow. The result is an impossibility of eyebrow elevation with asymmetry on both sides. This asymmetry is most often temporary and the botulinum toxin injected into the other eyebrow makes it possible to obtain, if the patient so desires, a symmetry for the time of recovery. In some cases, however, it can be permanent.

The loss of sensitivity of an upper hemi-lip is sometimes observed. It is most often reversible.

Abnormal, hypertrophic or even keloid scars of unpredictable appearance and evolution can compromise the aesthetic aspect of the result and require specific local treatment, often long. But these anomalies are exceptional in the eyelids.r.

 

In total there should not overstate the risks, but just be aware that surgery, even seemingly simple, still a small share of hazards. The use of a qualified Plastic Surgeon ensures that it has the training and knowledge required to avoid these complications, or effectively treat if jurisdiction.

          

These are the pieces of information that we wanted to bring you in addition to the consultation. We recommend that you keep this document, read it again after the consultation and reflect "a clear head." This reflection may raise new questions for which you wait for additional information. We are available to talk during the next consultation, or by phone, or even on the day of surgery when we meet in any way before anesthesia.