Smokers are strongly advised to refrain for 6 weeks prior to surgery, as smoking has a higher risk of complications related to both anaesthesia and wound healing. Aspirin and related anti-inflammatory medication (ibuprofen, naproxen, diclofenac), vitamin E and certain other products should also be avoided during this time to reduce the risk of bleeding. Please ask if you have concerns about both prescribed and non-prescribed medication that you take. The contraceptive pill or HRT should be stopped for 4 weeks pre-operatively.
Most patients are admitted on the day of their operation. You are usually seen early for pre-operative nurse monitoring and to see the anaesthetist who checks on your overall fitness for surgery, and discuss aspects of your in-patient stay with us. You will be seen by Mr Adams again to discuss the procedure, take photographs as necessary, and to obtain consent. You should have obtained all the necessary detailed information about the procedure, length of stay, recovery, risks and expectations before your admission.
The facelift or neck lift procedure is performed under general anaesthetic and takes 4 hours depending on the nature, complexity or number of tasks required. The incisions are designed to minimise scarring in concealed areas (in the hair line and behind the ear) or in sites that leave barely perceptible scarring (such as in front of the ear or in the chin crease). The underlying facial or neck tissues are tightened in layers and the skin re-draped under little or no tension. Drains are occasionally inserted, but Mr Adams now uses special tissue glue that obviates the need for large drains and which helps distribute tension evenly under the skin. A mixture of metal staples and stitches are used to close the incision lines. The face and neck is bandaged for the first night and will be removed the following morning for inspection, prior to the application of a facial garment, which is to be worn during the first week. Antibiotics and a steroid are given during your stay to reduce infection risk and swelling respectively.
You are required to rest both during your stay and afterwards at home. Antibiotics are prescribed for five days at discharge, to be taken orally. Keeping your head elevated helps relieve swelling. Pain is not a significant feature, although you will be given standard painkillers on your discharge. You should not drive for five days following your surgery. Hair washing is possible at home after 24 hours. You should be off work for 2-3 weeks depending on the nature of your work. A full return to normal is expected at 6-8 weeks. A final assessment of your results cannot be expected for 3-6 months. You will notice that turning your neck can be restrictive for a number of weeks and that it feels “overly tight”. This feeling will pass over 4-6 weeks.
You will be seen at one week following surgery for assessment and stitch removal. A further dressings appointment is often made at two weeks too. An outpatient appointment will also be made for you to see Mr Adams at 6 weeks and 9 months.
Risks and Complications
As with any surgical procedure, complications can occur. Bleeding is a rare complication and if a problem, would manifest during your stay. This can result in a collection of blood called a haematoma. In such cases, a return to theatre for its removal may be necessary. This risk is reduced further by the use of the tissue glue technique employed by Mr Adams. Patients most at risk of haematoma are males, smokers and those with poorly controlled blood pressure.
Another rare complication concerns interference of branches to the facial nerve, which supplies the muscles for facial expression. Patients might notice that one side of their mouth or eyebrow might not move appropriately. Fortunately, and in most cases, this is a temporary phenomenon that resolves within a few days (or very rarely, a few weeks) after surgery.
Poor scarring is difficult to predict, but can be more of a problem in dark skin. Thickened (hypertrophic or rarely, keloid) scars are managed with steroid injections and occasionally can be revised surgically. Poor scarring can still be problematic in spite of treatment.
Hair loss is uncommon, yet may be noticed in the temple region. In most cases, hair will re grow after several months.
Numbness is a normal phenomenon in the cheek, jaw or neck areas, but in time this resolves spontaneously. A small patch of numbness can persist permanently.
Skin necrosis is possible in some cases and might occur at the edges of healing scars. Problems of this sort are related to poor blood supply or tension at the scars sites and are most susceptible in smokers.
Dissatisfaction with the outcome of surgery can occur for a number of reasons, such as unattainable expectations. Face lifting generally achieves good rejuvenating results but it must be remembered that you cannot expect ‘to be returned to your youth’, and the procedure does not ‘stop the clock’. Mr Adams spends time with his patients pre-operatively ensuring that both his, and your expectations are matched so as to avoid an ‘unfavourable result’. Repeating a face-lifting procedure is not an uncommon request as ageing persists, so providing a guarantee on longevity of face-lifting is simply not possible, despite what one reads!