Plastic Surgery | Dr. Enrique Etxeberria, Plastic Surgery in Bilbao

lift

Plastic Surgery - lift - Cervical Lift

Cervical Lift

  • Print
  • Send email
  • Download PDF

Often, a person’s identity depends principally on the face: its structure, general appearance and expressions. This is why it’s possible for age-related changes that can alter the appearance of the face to make a person feel as though their identity has changed with the passage of time. The changes can present on the upper, middle or lower part of the face. However, changes in the middle part of the face can often become obvious before changes in the lower part of the face. These changes can include the loss of volume and sagging of the cheeks, as well as the formation of deep wrinkles and sunken areas below the lower eyelids. With the frequency appropriate for those for in whom the lower part of the face has not yet drooped, a middle area facial rejuvenation can help to reduce these signs of ageing and reinstate a more firm and youthful appearance.

CERVICOFACIAL ANATOMY

Before understanding how facial rejuvenation works, it is important to know the underlying structure of the face and the manner in which it causes changes in this structure with the passage of time. The face is made up of layers of skin, muscle and fat resting upon the facial bones. Just like an elastic band that has been stretched too much, the tissues of the face weaken and lose their elasticity and capacity to maintain a firm and youthful disposition. Facial ageing occurs due to many reasons. Due to sun damage and other factors, the skin’s support network of collagen and elastin breaks down. As a consequence, the skin loses part of its structure and elasticity and becomes flaccid. In addition, the facial muscles weaken and stretch and the deposits of fat, which generally give the face a smooth and full appearance, move downwards and diminish. As a whole, these changes take place simultaneously and create sagging cheeks, sunken areas and deep wrinkles in the middle part of the face.

PRE-OPERATIVE RECOMMENDATIONS

As in all interventions, the initial medical examination is indispensable in order to detect any possible anomaly that may contraindicate the operation.

MIDFACIAL REJUVENATION

There are various types of different facial rejuvenation procedures, each of them specially designed to treat different areas of the face. For example, midfacial rejuvenation is normally performed to treat the middle part of the face. Age-related changes that appear on the upper and lower part of the face are corrected, generally, with a stretching of the forehead and facial rejuvenation of the lower part of the face, respectively. In addition, drooping and swollen eyelids can be treated with eyelid surgery. During a midfacial rejuvenation procedure, the underlying tissues are tightened and the fat pannicles that give the face shape and volume are moved upwards to reinstate a more firm and youthful appearance. It is important to know that a midfacial rejuvenation cannot correct the loose skin around the neck or the jawline, nor can it treat fine lines or irregularities in the tone and texture of the skin. The doctor will help you to determine the best procedure for your case, and if an additional procedure such as eyelid surgery or skin rejuvenation is also performed, it could produce a more comprehensive facial rejuvenation.

LOWER AND CERVICAL FACIAL REJUVENATION

There are various different types of facial rejuvenation, each of them designed to treat different areas of the face. For example, facial rejuvenation of the lower part of the face is normally performed to treat this part of the face. Age-related changes that appear on the upper and middle part of the face are corrected, generally, with a stretching of the forehead and a midfacial rejuvenation, respectively. During a rejuvenation of the lower part of the face, the underlying connective tissues and muscles known as the SMAS (Superficial Muscular Aponeurotic System) are stretched, the skin of the face is tightened and excess skin removed. It is important to know that a rejuvenation of the lower part of the face cannot correct signs of ageing on the forehead or around the eyes, nor can it treat fine lines or irregularities in the tone and texture of the skin. The doctor will help you to determine the best procedure for your case, and if an additional procedure such as eyelid surgery or skin rejuvenation is also performed, it could produce a more comprehensive facial rejuvenation.

PREPARATION FOR SURGERY

A procedure for the rejuvenation of the lower part of the face lasts approximately three hours, depending on the scope of the treatment. Prior to starting the procedure, the area to be treated will be cleaned and anaesthetic administered. It is very likely that the procedure will be performed with general anaesthetic, and therefore the patient is asleep. However, the doctor may opt to administer local anaesthetic with a sedative, thereby numbing the face and surrounding areas and the patient remains in a state of relaxation. Prior to making the incisions, the doctor may divide your hair along the area of incision and apply an antibiotic ointment, which will help to keep it in place. Once the incision area is duly exposed, the doctor will draw incision lines with utmost care, in such as way that the scars formed will be as invisible as possible.

INCISIONS

A rejuvenation of the lower part of the face can be performed employing different types of incisions. Generally, one sole incision is made within the hairline which moves downwards around the ear and towards the hairline at the back of the head. However, it is advisable to speak with your doctor about the different types of incisions.

S.M.A.S. LIFT

The SMAS is a layer of tissue made up of tissue and fibrous connective tissue. Despite the fact that not all doctors manipulate the SMAS during a facial rejuvenation, some of them will reposition it for the purposes of bringing the structures of the face into a more youthful position. There are diverse methods that can be used to stretch or lift the SMAS, such as plication or excision, whereby the tissue is increased and a more elevated position is achieved using sutures. Although the techniques may differ, they all fulfil the function of stretching and tightening the underlying structures of the face.

NECK LIFT

If a neck lift is performed in combination with a facial rejuvenation, the doctor will make a small incision in the lower part of the chin. In some cases, the doctor will manipulate the muscles in the neck, which are known as the platysma muscles. Just as with the SMAS, the doctor may opt it is advisable to speak with your doctor about the different treatment options.

CLOSURE OF THE INCISION

Once the doctor has finished making the necessary corrections to the underlying structures, the skin will be repositioned on the face. In some cases, the doctor may choose to place a surgical drain under the skin to avoid the accumulation of fluid during the cicatrisation period, although this does not tend to be necessary. The doctor will stretch the flap of skin to determine the amount of excess skin to remove. It is possible that guidance cuts and sutures will be undertaken along the length to establish the adequate tension. Then, the doctor will remove the excess skin around the natural outlines of the face and close the rest of the incision with additional sutures.

RECOVERY

While some doctors prefer not to use bandages, others may apply a comfortable wrap or compression bandage to facilitate cicatrisation. A compression bandage is fitted and will contribute towards the reduction of swelling by avoiding the accumulation of fluid and will provide comfort and support throughout the cicatrisation process. Although loose bandages can be removed after several days, the compression bandages are often used for some weeks. As with any surgical procedure, you will probably experience some pain, bruising and swelling, which for the most part will diminish over the course of a few weeks. Usually however, the post-operative period tends to be very comfortable, always providing the instructions of the surgeon are meticulously followed. If a surgical drain was used, this will be removed, generally, the day after the surgery, and non-dissolvable sutures can be removed between seven to ten days afterwards. You will probably feel well enough to return to work within one or two weeks; however, it is advisable to avoid strenuous activities such as lifting heavy objects or exercising during the first three weeks in order to to perform a plication of the neck muscles or remove a portion of them in order to reduce the appearance of lax and sagging skin around the neck. In other cases, the doctor may opt to remove the fat in order to shape the area even more. If you are concerned about the appearance of your neck, give your body time to heal.

RESULTS

Generally, you will begin to notice the results very shortly after the procedure. These will be more evident still after two to three weeks, as the bruises and the swelling continue to disappear. Given that everyone heals at a different rate, it is possible that the end results will only be seen after a number of months. It is important to know that the scars will be permanent: however, these are normally well hidden behind the hairline. Despite the fact that facial rejuvenation will not stop the ageing process, it can significantly reduce the appearance of loose and sagging skin on the face and neck, providing a youthful appearance for many years more.