Facelift (Rhytidectomy) & Necklift
Since Dr Kremer's arrival in London facelifts have been one of his most requested procedures. The facelift is a major surgical procedure whose purpose is to improve the appearance of the face, jaw area and neck. The improvement is achieved by tightening of the skin and facial muscles and, where needed, removal of fat. The degree of improvement varies from individual to individual, and is influenced by the physical traits of the skin, and the amount of sun damage, the underlying bone structure, and a variety of other factors. Prior to surgery, as part of your evaluation, photographs will be taken. Photographs are as important to the plastic surgeon as X-rays are to the physicians in other medical specialities. These photographs are part of your confidential medical record.
In a neck lift, excess fat is removed through a small incision under the chin, and the superficial neck muscle is tightened through a hidden incision behind the ear. In this lift, the incision is extended behind the ear to the ear lobe around in front of the ear and then behind the hairline of the temporal region. From this section of the facial skin is mobilized. The underlying tissue is tightened and then relaxed and the excess skin is removed. After closing the skin, your face will look much younger.
For strongly sunken cheeks and nasolabial folds, a strong lifting of the mid-face may be necessary. This lift will be cut above the gum or placed under the eyelid and is based on a new technique developed in Beverly Hills for mid-face lifting. In many cases, a superficial facelift for the patient is sufficient.
The positioning of the cuts is optimised so that the scars remain as invisible as possible, which is especially important for men in particular as they usually have a shorter hair cut and lighter hair growth. With my technique, we will be running the cut "in front of the ear" and partly hidden behind the ear cartilage (tragus).
If the wrinkles on your neck are not so pronounced, you can apply a gentle mini facelift. In this procedure, the incision is just in front of the ear and from here, cheeks are raised again to remove excess skin. The swelling after such a mini facelift is significantly less than after a full extensive facelift.
Men and facelift
As men grow older, the facial skin and the underlying fat and connective tissue can become loose, resulting in an increasing loss of elasticity of the skin with accompanying folds. The degree of wrinkling is individual and is influenced by various factors, such as UV radiation, nicotine consumption, weight fluctuations and also by genetics. The anti-wrinkle creams offered by the cosmetics industry are usually of little help.
Men are often disturbed by a limp neck sagging with the split neck muscle (platysma), and the low-hanging eyebrows with a strongly folded forehead and deeply entrenched nasolabial folds.
In this case, a neck and facelift surgery, will help to smooth wrinkles on the neck, face and forehead, resulting in a fresh, youthful look. A facelift is often combined with a correction of the upper and lower eyelids.
In a detailed consultation Dr Dirk Kremer will discuss what type of lifting is appropriate for you.
What risks are associated with a face lift?
Are you considering a facelift? If so you should ensure that the procedure is carried out by a qualified specialist in plastic and aesthetic surgery - such as Dr Dirk Kremer. In such a case, it is rare that complications occur, and the long lasting results are subtle with a natural aesthetic.
Possible complications of a facelift:
Bruising and swelling
As with any surgery, bruising and swelling will occur. The bruising usually heals by itself but wearing a compression mask for 1-2 days can significantly reduce the swelling.
Discuss with Dr Kremer whether the wearing of such a compression bandage is suitable for you and the facelift you are having.
Bleeding from a facelift is rare, but significant swelling and pain associated with surgery can cause it and must be stopped immediately.
Infection of the wound area is very rare due to the very good blood supply to the face. If an infection should occur an appropriate antibiotic therapy can heal this infection very rapidly.
Wound healing disorders
Wound healing disorders are also rare. As a rule, various risk factors play a role, and you will talk with your surgeon before surgery to discuss these in detail. These so-called risk factors include: delayed healing in diabetic patients, smokers and patients with bleeding disorders.
Numbness of the skin
Numbness of the skin at the surgical site can occur temporarily during a facelift, caused by the severing of the finest skin nerves during the preparation. Sensitivity usually returns during the healing process.
Operating in the scalp area can lead to scarring and possibly alopecia, or hair loss. This is very rare and can be corrected later.
Injury of the facial nerve
Injury of the facial nerve is extremely rare for a facelift. In the preparation of the facial skin, the nerve can be slightly damaged by tearing or bruising. This causes a temporary weakening of parts of the facial muscles, but which later re-forms with the healing and regeneration of the nerve branch again. Since the facial muscles stimulate numerous nerve branches, a complete paralysis of a part of the facial muscles would require a complete separation of all these nerve branches and is almost non-existent.
Overall, the face lift or facelift has a high degree of efficiency and safety.
What to consider before surgery?
As with any surgery, you should be well and in good health beforehand.
- Alcohol consumption should be reduced to a minimum.
- Smoking should be limited as much as possible, as nicotine reduces blood flow to the tissue.
- Heavy smokers should refrain completely preceding a facelift. Discuss with your surgeon, how long before and after surgery you should stop smoking.
- Aspirin and similar blood-thinning medications should for their inhibitory effect on blood clotting not be consumed for two weeks before and after surgery.
- It is advisable to plan for some recuperation time, up to seven days after surgery or after the facelift.
For questions and doubts before the surgery, please call your surgeon.
Where in London will the facelift take place?
A face lift can be carried out either in the clinic or outpatient basis but with a short stay in the hospital too. The individual time scale usually depends on the extent of the planned operation and will be carefully discussed with your surgeon (Dr. Dirk Kremer). Generally, you should plan for 1-2 days of hospitalisation, during which time post-operative care will be ensured by trained staff.
What kind of anaesthesia is used during facelift?
Facelifts are usually performed under general anaesthesia, which means that you sleep during the entire procedure. Details of the anaesthesia will be discussed pre-operatively by an anaesthesiologist, which clarifies your specific anaesthesia requirements. The anaesthetist will be present during the entire procedure and control the anaesthesia.
Alternatively, the so-called "standby-anaesthesia" is available. It is also controlled entirely by the anaesthetist, they will be calculated not intubated and ventilated. You fall into a deep, pain-free sleep.
Another alternative is the local anaesthesia with injection of local anaesthetic. With local anaesthesia, you will also receive a sedative (either as a tablet or by intravenous injection in the arm vein) which puts you in a kind of twilight sleep. You are awake, but relaxed and insensitive to pain. You get to witness the operation, and you may feel a pull or the like.
What to do after the facelift?
In the first 3-5 days after surgery, you will feel mild pain in the entire area of operation, and a feeling of tension. Thus your facial expression is restricted and your head movement is limited. In general, you are given pain medication to alleviate the pain.
During surgery drains are placed that can be drawn from on the first day after surgery and you may also use a compression mask is used which is removed after 1-3 days. You will need to keep quiet in the first days after the face lift and keep your head elevated in order to reduce the swelling.
After seven days, the first stitches are removed. The scalp needs a little longer to heal, so threads or brackets are left for a few days more.
You can resume your normal daily activities relatively quickly, usually after a couple of days. You should continue to plan time to rest in the first week after surgery and sport should be avoided, in consultation with your doctor, for at least six weeks. As explained above, smoking and alcohol consumption should be reduced to a minimum after surgery. Visits to the sauna and steam room should be avoided for several months.
At first your face will look unfamiliar to you: your features may be altered by some swelling, or you expression will often seem a little stiff. The initial pale red scars will fade more and more until you can only see narrow white lines and after 2 weeks you will usually be relaxed and recovered.
After 10-14 days, depending on the extent of the facelift, most patients can again resume their work. Any remaining scars still visible can be covered with camouflage make-up.
Can a facelift be repeated?
After 10 years, a facelift can be repeated easily, or minor adjustments can be made, such as a mini-lift or a cheek lift. Some people deliberately choose the option of repeated repairs at shorter intervals, to avoid a dramatic change and rejuvenation of the face. In the U.S. this is known as "maintenance".