History

No other operation is associated so strongly with aesthetic surgery as the facelift.

As early as in the beginning of the 20th century, surgeons performed aesthetic corrections to the face, removing skin from the cheeks and temples to smooth out wrinkles and eliminate excess skin.

In the 1970s, plastic surgeons came to realize that underlying structures such as the tendon sheets, fatty tissue and muscles needed to be tightened as well if more lasting results were to be achieved.

Even more drastic techniques in the 1980s involved detaching the tissues from the frontal bone and the cheekbones so that they could be shifted vertically in one go. This technique became popular in the nineties as the Masklift, which was used by Dr Tessier, Dr Krastinova, and later by Dr Cornette De Saint Cyr.
At the same time, the endoscopic forehead lift was pioneered, where the tissues of the forehead were detached by making small incisions in the hairline; the tissues were then raised and reattached to the skull bone without any skin being removed.

A recent trend is to follow the opposite procedure

• minor skin incisions at the front of the auricle
• limited dissection of the skin
• firm traction applied to the underlying muscles with sturdy sutures that are worked into the tissues
• traction in vertical direction
• skin is removed in vertical direction only, without leaving scars at the ears

This is essentially the MACS lift technique, developed by Dr Patrick Tonnard and Dr Alexis Verpaele.

Preparing for the facelift

Stimulate the circulation of the skin by applying vitamin A acid cream for six weeks.
Treat inflammations or active acne of the facial skin.
Take Arnica Montana 200K pellets for four days in advance to avoid bleeding and blue discoloration.
Stop taking aspirins, blood diluents and vitamin E 12 days before the operation.

Technique of the facelift

Incision: this varies according to the technique used and the extent of the lifts:

• an incision in the natural fold before the ear, in the central part sometimes on the front of the auditory duct
• an incision in the temple area, either vertically across the hairline, or following the hairline
• an incision at the back of the auricle, branching off to the hairline at the back of the head; this incision is necessary to remove excess skin in the neck

Detaching the skin

The extent of the skin dissection varies considerably according to the technique used and the degree of slackening of the skin.
In the MACS lift, only the skin of the cheek is detached over a width of up to 5 cm before the auricle.
If there is obvious excess skin in the neck, the skin is also detached up to the hairline behind the ear and in the neck up to the median line.

Treatment of the underlying structure

Excess fatty tissue in the neck is removed by suction or by removal directly from the underlying muscle.
Sagging tissues in the cheek are reinforced with rows of sutures, whether or not attached to a rigid structure such as the periosteum over the cheekbone or the temple muscle at the top of the ear.

Removal of excess skin

By detaching the skin and tightening the underlying muscle or tendon sheet, this excess skin can be removed and the skin lesion is subsequently closed under moderate tension using fine sutures on the skin or tissue glue.

Dressing and drainage

After surgery, a drain is put in place using a fine subcutaneous tube to avoid accumulation of fluid or blood under the skin. A dressing is applied around the ears and the chin, which gently presses the skin against the dermis and allows swifter adhesion.
Drain and dressing are removed the next morning.

Evolution and postoperative care

After surgery, swelling and blue discoloration occur, which may evolve for up to three or four days at the most.
The face usually does not hurt very much, although some tautness may be experienced and the detached skin may feel numb.
Sudden pain, swelling and blue discoloration may indicate hemorrhaging, in which case the surgeon should be notified.

Rest and sleep in a slightly seated position for the first few days.
Exercise regularly at home to promote the circulation in the legs.
Avoid strenuous effort, stooping deeply, bowing your head deeply, lifting heavy objects, and jogging for several weeks.
Wash your hair every day with a mild shampoo to remove any remaining blood in the hair and around the scars as quickly as possible.
Carefully soak off the scabs from the scars on the face and around the eyes by gently dabbing them with cotton buds.
If the skin around the scars is more darkly colored, you should apply the prescribed antibiotic ointment to that area of skin twice daily.
See your surgeon to have your sutures removed no later than eight days after the operation.
Makeup is allowed after eight days, hair dyeing after three weeks.
Apply a sun stick with high protection factor to the visible scars as long as they are still red.