Facelift ABCs: how to know which one is right for you

Written by: Mr Giovanni Ferrando
Edited by: Sarah Sherlock

There is more to a facelift than what is portrayed in Hollywood. Some are minimal, and some involve more serious measures. Mr Giovanni Ferrando is an extremely experienced consultant plastic and reconstructive surgeon who clearly tells which facelifts are recommended and when.




What are the different types of facelifts?

There are lots of different types of facelifts, such as superficial facelift (aka lunchtime facelift), vertical facelift, and deep plane facelift. However, I'm against the superficial facelift because they don't last too long, just a few months. A good surgeon has to do a job that last years or more, and the patient has to enjoy the result for a long time.



How do patients know which type of facelift is right for them?

A good surgeon has to know exactly which kind of facelift is perfect for each patient. You need to understand that during the ageing process, all the structures on the face can drop, it's not only the skin. The skin is a superficial cover of the face. During the ageing process, the subcutaneous fat, the muscles, and the muscle mass that covers all the deepest portion of the face can also drop. For example, if you look at the picture of a very young girl, her cheeks are very full and the distance between the lower eyelid and the cheek is very short. If you see a picture of the same girl 20 years later, you will see the face has completely changed; the cheeks are smaller, the structure under the skin is sagging in this area, and the jawline has lost the definition. You can see no continuity in the jawline, and there is the same problem in the neck. But you need to go deep because the problem is not in the skin, it is in the muscle and in the subcutaneous fat. For this reason, if you want to do a correction of the ageing process, you need to move the deep structure of the face—putting the muscle and the subcutaneous fat in the same position they were in before.



How long do facelifts last and when should people get a refresh facelift?

A good facelift can last a very long time. If you compare, the superficial facelift lasts no more than a few months, as opposed to the deep facelift or the vertical facelift which can last 10 to 15 years because the surgeon works in the deep structures of the face and moves the deep structure up again. With this method, the skin would be completely tension free as the tension and the movement upwards of the deep structure sustains all the face and the skin. Consequently, the scar will be completely tension free. For this reason, if you compare the scar on the superficial facelift and the deep facelift, the deep facelift always has the better scar than the superficial facelift because the tension is in the tissue under the skin, not on the skin. Sometimes you need to do a refresh or another facelift after 15 years, but you can do a smaller procedure because some parts of the original result may last a very long time.



What are blepharoplasties?

Blepharoplasty is an operation that we do on the upper and lower eyelid. We can perform only upper or only lower blepharoplasty, or we can perform both together. It can be done under general anaesthesia or, more frequently, under local anaesthesia with sedation. We do the sedation with the anaesthetist because the operation may be more comfortable for the patient. During the blepharoplasty, the surgeon has to remove the excess skin on the upper eyelid and a small bag on the upper eyelid close to the roots of the nose. In the lower eyelid, the surgeon has to remove a very small amount of skin. The most important thing is to remove all the bad bags, which are like a hernia in the lower eyelid. There are three bags for each side: the middle, the centre, and the lateral bag. The most important to remove is the lateral bag, because you can see there's more amount of the lateral bag, usually seen in a second blepharoplasty. During the same operation, the surgeon can also perform a small canthopexy, which is a small procedure on the lateral contour of the eyes, raising the corner of the eyes a little bit.



How does blepharoplasty improve appearance?

The blepharoplasty can improve the eyes a lot because you can remove the excess skin on the upper eyelid and remove the bags from the lower eyelid. When you are speaking with somebody, the first thing that you look at are the other person’s eyes. When the eyes have excessive skin on the upper eyelid or bags on the lower eyelid, the person may appear tired and can appear older than the normal age. When you do the blepharoplasty, these parts improve massively. The patient can see this area appear younger and fresher immediately. Sometimes during the procedure, you can also move the corner of the eyes a little bit and give them a different shape.



Is it possible to have blepharoplasty and a facelift together?

It's quite common to have another minor procedure during the facelift. Sometimes we do the facelift and a blepharoplasty. Sometimes we do other procedures, like the reduction of the distance between the nose and the upper lip. This is because you can always see a longer distance between the nose and the upper lip, the angle between the nose and the upper lip, during the ageing process. It's quite common to do something more during the facelift. Additionally, you sometimes do a fat transfer during a facelift to improve some areas like the upper lip or the lower lip with a small amount of fat. Definitely, we can tell that the best and the most natural result for the facelift is the facelift with the work on the deep plane or vertical facelift. Always avoid the superficial and other very fake facelifts.



If you are considering getting a facelift or having a procedure done to correct ageing, you can go to Mr Ferrando's Top Doctors profile and schedule a consultation.

By Mr Giovanni Ferrando
Plastic surgery

Mr Giovanni Ferrando is a vastly experienced consultant plastic and reconstructive surgeon with private clinics in London and Italy. He is known for his innovative and pioneering work in designing and developing new techniques to be used in cosmetic and aesthetic surgery, and has a very keen attention to detail, always striving to achieve natural-looking results. He specialises in all kinds of aesthetic surgery, with special interest in rhinoplasty, blepharoplasty, facelift, breast augmentation, Botox injections on other less invasive aesthetic medicine treatments. 

When performing surgery on a patient, Mr Ferrando prefers to take time to study the proportions of the patient's face, and also gets to know the patient well to make a decision on what the best nose for the patient would be. He personally draws a portrait of the patient to see the desired results, and to use the same hand to craft the drawing that will perform the surgery. This part of the process is important to Mr Ferrando in ensuring the best results are achieved. 

Alongside his clinical practice, Mr Ferrando devotes time to giving talks about his profession, and is a regular contributor to the Aesthetic Plastic Surgery Journal, and is currently writing a book on rhinoplasty. 

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