| Facial
rejuvenation surgery is usually made up of a combination of different
procedures to produce the best and most natural result. As every face
is different, so is every surgery and in choosing the right procedures,
age, skin damage and expectations are taken into consideration.
“There’s a different emphasis for each age group,”
says Dr Hodgkinson. “The same procedure can’t be performed
for every age group and expect good results.”
As the face cannot be isolated into components but is a whole it is
quite usual for several procedures to be employed at once to gain a
natural appearance.
Facelift
As the face ages, fat accumulates and not only does the skin lose
its elasticity and start to droop, so do the muscles and tissues underneath
the skin. In the past 20 years facelifts have come a long way and have
now reached a point where a good facelift can be undetectable and provide
a natural, fresher appearance rather than an operated on “social
pages” type of appearance.
In a patient’s 40s, minimal surgery is usually desired to limit
the scarring and downtime. “This is where surgery such as the
S-lift comes into play,” says Dr Hodgkinson. “Usually just
some tightening up of the tissue underneath the skin is enough. Sometimes
liposuction will reduce the double chin.”
“For a person who has jowling or needs to “freshen up”
the appearance around the neck and jaw line, a mini-lift is beneficial,”
explains Dr Hodgkinson. “It involves less scarring but will not
correct signs of ageing in the mid-third of the face.”
The idea of waiting until aged 60 to have a one-off facelift is gone.
Patients are starting younger so they will have less procedures and
a more natural appearance.
In the late 1980s the Deep Plane Facelift was developed to address
the fact that the muscles of the face sag and lose their tone; fatty
deposits commonly develop in the jowl area and under the eyes. This
sagging and drooping causes the finite and existing amount of skin to
stretch and lose elasticity. It is with this stretching that the problem
may appear to be the skin.
“Without first tightening the underlying muscles and removing
the excess fat pads, the skin, if tightened, will still be placed under
pressure and not only will the patient have the ‘tight look’,
they will also be more likely to develop wide, visible and unattractive
scars,” says Dr Hodgkinson. “In the deep plane facelift,
after tightening and fixating sagging muscles and removing unnecessary
fat pads, skin is re-draped and sutured under no tension.”
Browlift
Ageing of the upper face can result in a drooping of the brow creating
a lowering of the eyebrows and a ‘heaviness’ of the eyes.
“Endoscopic brow lifting has become the procedure of choice in
lifting the brow,” explains Dr Hodgkinson.
Five small incisions (approximately 1cm) are hidden within the hair.
An endoscope (a small camera which can project an image of the underlying
tissue on to a television screen) and other instruments are inserted
to release the muscles of the brow. When the muscles are released a
gentle ascent of the brow is achieved resulting in relaxation of the
scowl.
“The eyes are also affected by this lifting of the brow,”
says Dr Hodgkinson. “But older patients, over 40, may have extra
lax skin around the eyes which a browlift alone will not address.”
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Eyelid Surgery
Lax skin around the eyes creating wrinkling and also bulging of fatty
tissue is best treated with blepharoplasty (eyelid surgery). This can
be divided into upper and lower blepharoplasty and these are not always
done in combination.
Upper eyelid surgery entails a small incision being made in the crease
of the eyelid. Any excess skin and fat is removed and the incision closed.
Lower eyelid surgery usually entails an incision placed along and hidden
in the lower lashes. However if no excess skin needs removing and only
fatty bulges are being addressed, access can be made through an incision
hidden inside the eyelid. “To reduce the hollowed out appearance,
it is now preferable to remove less fatty tissue than in the past,”
says Dr Hodgkinson. “Often the fatty tissue is not removed but
rather moved to a more appropriate position so the bulges are minimised.”
Nose Surgery
Rhinoplasty involves careful assessment of the skeletal, bony and
cartilaginous components of the nose that contribute to the shape of
the nose. “These components are changed in such a way that, when
the skin is redraped over the nasal structures, a new appearance is
produced,” says Dr Hodgkinson. Computer imaging is available and
is sometimes quite helpful to both patient and surgeon to provide the
patient with a realistic view of what might be achievable from nose
surgery. If there is nasal obstruction, the internal structures such
as the septum and turbinates are also operated upon to open up the nasal
passages.
Facial Implants
“Sunken cheeks can give a person’s face a melancholy,
sad or dejected appearance. Similarly a ‘weak” deficient
chin can spoil a profile, exaggerate the nose and make the neck appear
‘heavy’. Also what happens in the 60s is that the bones
are degenerating and the midface is getting smaller. It is imperative
in this age group to concentrate on bony shape and volume,” explains
Dr Hodgkinson.
Facial implants are used to augment the facial skeleton that is deficient
and negatively affecting the aesthetic balance of the facial features.
Cheek implants can be inserted through the same incisions as a lower
blepharoplasty or though the inside of the mouth leaving no visible
scars. Chin implants are inserted through the mouth or from under the
chin itself. “The appropriate implant, size and shape are chosen
by the surgeon in consultation and after consideration of the patients
aesthetic desires. The implants are inserted on to the bone, and require
very accurate and careful placement though small incisions,” says
Dr Hodgkinson. Facial implants are usually made from solid silicone
or Porex.
Liposuction
An accumulation of fat in the neck results in a double chin, which
in the younger age group can be corrected by liposuction alone. A very
small amount of fat is removed using fine cannulas, which leave imperceptible
scars. “In older patients accompanying laxity of the platysma
muscle means the results from liposuction are less satisfactory and
neck lifting procedures and possibly facelifting procedures will need
to be used in conjunction with liposuction,” explains Dr Hodgkinson. |
