Choosing the right facelift: An expert guide

In this informative guide, highly esteemed consultant plastic surgeon, Ms Monica Fawzy, offers expert insight on the factors involved in choosing the right cosmetic treatments for the face and sheds light on the way surgeons assess and plan the ideal facelift treatment for each patient.

The leading specialist also gives invaluable advice on how to ensure you choose a reputable practitioner and the key points to reflect on before your initial consultation.

Which factors are involved in choosing the best type of facelift for each patient?

Many patients will think of scar lengths as differentiating points, as ‘short-scar’ facelifts have received much media interest in the last ten years, but in fact, there are numerous decision- making options that your surgeon must plan for, to tailor the ideal facelift to your face, which include:

• The features you seek to correct.
• The extent and level that the ageing process has affected your face: with regards to your skin quality, extent of volume deflation and sagginess of the soft tissues, and specific ageing changes in the upper, middle, and lower thirds of your face.
• Your baseline facial anatomy, such as your bony and muscular structure, the location and shape of your hairline, the degree of skin pigmentation and thickness changes at the junction between your cheek and ear, your earlobe shape and position.
• A downtime that is acceptable to you.

Your surgeon’s assessment will result in options regarding:

• The location and length of the incision, and subsequent scar, which may extend from the hairline in your temple to the lower aspect of your earlobe in ‘short-scar lifts’, or continuing around your ear and to varying degrees in the hairline behind your ears in other techniques.
• The extent and levels of the dissection required, be it under the skin and fat, under the SMAS muscle layer, under the periosteum which is a layer covering the bone, or a combination.
• Management of the SMAS muscle layer, be it with folding of the layer on itself and tightening (plication or imbrication), resection, or a combination of this.
• Management of volume anomalies, with replacement of fat (if deflation and hollowing is present) or removal of fat (for example in those with a heavy neckline).
• Additional procedures that may augment the effect of the facelift, such as an upper lip lift in those with an elongated upper lip, or earlobe reduction or augmentation in those with aged earlobes- amongst others.
• Whether the facelift will also address any minor problems of the neckline, or whether a formal neck lift is also required (or consideration of a combined face/neck lift procedure such as an ‘R lift’) 

The advantages, disadvantages and limitations of the proposed technique should be fully discussed during your consultation.

When should I consider a facelift?

If you are medically, psychologically, and financially healthy, then a facelift may be a good option if you have developed sagginess of the facial skin and soft tissues that cannot be corrected by any other means.

Most patients will present with moderate to significant sagging of the skin and underlying soft tissues, that is improved if they simulate the general effect of a facelift by placing their fingertips in front of their ears and lifting the tissue upwards. Correction of this will require a facelift, as simply filling the face with the aim of correcting that level of sagginess will result in an unnatural and unattractive appearance, such as a ‘pillow face’ look.

Signs of deflation alone- but with good soft tissue tone (for example, simple hollowing of the temples, around the eyes, and cheeks), do not require a facelift and can be corrected with volume augmentation alone such as with fat, or fillers. Both procedures may be frequently combined in someone who has both sagging tissues and deflation.

Rather than deciding that you necessarily require a facelift, it may be best to consult a surgeon with the features that you seek to correct in order to determine your options, as another procedure may be more suitable. Your surgeon will ask you to bring old photos of your face to your consultation (especially the front and three-quarter views) as this will help them evaluate whether a particular feature of your face (such as a long upper lip, or any facial hollowing) is innate to you or whether this is because of ageing. If you are seeking to ‘turn the clock back’, then it is very useful to know what the starting point was.

What is the best age to get a facelift?

There isn’t an ideal age for any medical procedure, as your surgeon will assess you based on your physiological rather than chronological age, and the features that you wish to correct. Many patients present in their late 40s and 50s onwards, when the features of facial ageing become noticeable in many, but some present earlier- most commonly, after losing a significant amount of weight with consequent premature facial ageing.

If the features you are concerned about are relatively minor and can be addressed with less invasive procedures (if required at all), then you will be advised by your surgeon of that. As with any procedure, you will not be offered surgery unless you are medically and psychologically healthy, and your surgeon feels that the features you wish to correct can be addressed by that specific procedure, and the degree of the ‘anomaly’ merits the potential risks that would be undertaken.

How do I choose a facelift?

It is best to focus on the features you would like to correct in the first instance. The clearer you are in your own mind on what you want to achieve, the better. If you have more than one concern, it is useful to determine whether all are equally important to you, or whether one is most important, with other ‘secondary issues’.

At this point, it is worth consulting with a surgeon to determine your options. There isn’t an ‘ideal facelift’ that is best for all. Your surgeon will assess you and give you a tailored plan that is specific to you- with one or more options that would address your concerns, and with a discussion of the advantages and disadvantages of the option(s) offered.

How do I choose the right surgeon for me?

The advice I would give family members who may be considering any surgery is that, at the very least, the surgeon they choose is:

• Appropriately qualified - in the UK, this would be indicated by a General Medical Council Certificate of Completion of Training (CCT) in the relevant subspecialty, such as Plastic Surgery.
• A member of the relevant national association of surgeons, such as BAPRAS or BAAPS, if based in the UK.
• Open and honest, with a full discussion of all the risks involved and potential limitations of the procedure in question, the likely post-operative care to be expected and downtime required.
• Someone they feel comfortable with and trust, as they are likely to spend a significant amount of time with them both preoperatively, for at least two consultations before surgery and during several post-operative reviews.

Ms Monica Fawzy is one of the UK’s leading consultant plastic surgeons and is renowned for her expertise in facial cosmetic procedures.

If you are considering a facelift and wish to discuss your options further, you can schedule a consultation with Ms Fawzy by visiting her Top Doctors profile.