Enhancing facial aesthetics: understanding blepharoplasty, brow lift, and facelift procedures

As we age, our skin loosens and sags, due to a loss of elasticity and slowing collagen production. In this article, consultant oral and maxillofacial surgeon Mr Atul Kusanale explains how cosmetic surgical procedures like blepharoplasty, brow lifts, and facelifts can refresh the appearance and reduce the impact of time on our facial aesthetics.

Over time, the face begins to lose its plumpness and volume, leading to an appearance of skin that is droopy, thin, and wrinkly. As we live our lives, our environment and time will begin to weather the skin: UV rays from the sun will damage fibres in the skin called elastin which provides elasticity to the skin, and production of collagen – which is responsible for structure in the skin – gradually declines. These are the biggest factors to visibly ageing skin, but lifestyle choices like a history of smoking tobacco can also contribute.

To address and correct ageing skin, or to even modify the appearance to a patient’s liking, there are several treatments and procedures available at the moment. Treatments like dermal fillers and Botox are quite popular with effective results, but they only last a certain amount of time before they will need to be repeated in order to maintain these results. However, surgical treatments are more dramatic and long-lasting and can be combined for a powerful impact.

Blepharoplasty

Blepharoplasty is an eyelid surgery to improve the appearance around the eyes. It involves reducing the appearance of bagginess and dark circles by removing or repositioning excess skin as well as the muscles and fatty tissue beneath. It can be done on the lower eyelid, where the incision will be hidden just below the lash line, and in the upper eyelid, where the incision will be hidden in the eye’s natural crease. Most blepharoplasty procedures take around an hour (longer if both eyelids are being worked on). Patients should expect to have the stitches for a week or so, during which they need to be vigilant to avoid infection and be gentle when washing their face. The full recovery time is a few months, and during the first two weeks, the patients will have bruising and swelling around their eyes, but shouldn’t feel much beyond mild discomfort at the beginning of the healing process.

The possible risks of blepharoplasty include a loss of vision, dry eyes, scarring, an inability to fully close the eyes, and asymmetrical healing.

Brow lift

A brow lift, also known as a forehead lift, aims to reduce the appearance of wrinkles. The forehead is the main place on the face where wrinkles become the most prominent, becoming ‘worry’ or ‘frown’ lines between and above the brows, which creates the effect of looking sad or tired. The brow lift also helps to reduce the folding of skin over the eyes (similar to hooded eyes), to make patients look more alert and youthful. There are a few different techniques to perform a brow lift:

• The classic lift, also called an open brown lift, involves one continuous incision along the top of the head from ear to ear, likely hidden in the hairline. The surgeon will move the tissue around and remove excess muscles and skin.
• The endoscopic lift involves multiple shorter incisions in the scalp, through which an endoscope and other surgical instruments are inserted so that the surgeon can adjust the tissues and anchor them down with stitches or screws.
• A direct brow lift involves removing the excess skin right above the brows, and is best for patients with bushy brows. It is one of the shortest techniques to perform.
• A temporal brow lift involves the lift being done via small incisions in the hairline beyond the temples.

Surgical brow lifts generally take two hours, but there is also a faster non-surgical option using Botox injections to paralyse and relax the muscles between and outside the brows, but the results will not last as long as the surgical options. After the brow lift surgery, patients should expect swelling, tightness, and bruising around the incisions, which will be wrapped in padding and bandages to protect the stitches from infection and tearing.

The possible risks of a brow lift include visible scarring, limited mobility of the brows, scalp itchiness, asymmetry, and numbness.

Facelift

A facelift, also known as a rhytidectomy, describes a group of surgical procedures that reduces signs of ageing and tightens the face by removing and repositioning the skin, fatty tissues, and muscles of the face. Of the three procedures described thus far, this is by far the most dramatic and holistic in enhancing facial appearance. There are several techniques with which a facelift may be performed, such as:

• A traditional facelift, which involves incisions around the ears, hairline, and below the chin, from which the rest of the facial skin and muscles are pulled back and tightened by the surgeon, anchoring them to the supporting structures of the face and neck. The excess fatty tissues and skin are removed as needed.
• A superficial musculoaponeurotic system (SMAS) facelift, which targets the lower two-thirds of the face (the cheeks, lips, jaws, and chin). SMAS refers to the muscular layer of the face.
• A mid-facelift, which only targets the cheek area of the face, and involves the surgeon adjusting the fat and skin in the cheek area.
• A mini-facelift is best for younger patients with earlier signs of ageing and focuses on the lower thirds of the face. It is the shortest and least invasive type of facelift.

There are also non-surgical facelift options, such as platelet-rich plasma injections and dermal fillers.

This procedure typically lasts around three hours, and afterwards, the whole face will be wrapped in padding and bandages to protect the incision sites and help minimise the swelling and bruising, which will last for at least three weeks. The entire recovery process will take around three months, and strenuous activity should be avoided for the first few weeks.

The possible risks of a facelift include visible scarring, hyperpigmentation, haematoma, and facial nerve injury.

It is important to remember that ageing is inevitable and cannot be reversed permanently. These procedures are cosmetic and patients will continue to age regardless of how thorough the procedure they underwent. Results will last around 10 years, and patients can choose to have more surgery in the future. Always be sure to discuss with your surgeon about the best option for you and the results that you can expect.

If you are considering cosmetic surgery, consult with Mr Kusanale via his Top Doctors profile.