Lower Facelift

Lower Facelift Introduction

An individual’s identity is often primarily determined by the face—its structure, overall appearance, and expressions. As such, age-related changes that can alter the appearance of the face may make an individual feel as if their identity has changed over time. Changes can occur in the upper, mid, and lower portions of the face; however, changes to the lower third of the face are often the most readily apparent. These changes may include the development of deep lines in the cheeks and around the mouth, loose, excess skin in the cheeks, jaw line, and neck, and banding around the neck. Most often performed on individuals ranging from forty five to fifty five years of age, a lower facelift can help to reduce the appearance of deep facial wrinkles, sagging jowls, and sagging and banding in the neck, restoring a firmer, more youthful appearance.

Facial Anatomy

Before you understand how a facelift works, it is important to understand the underlying structure of the face and how the aging process causes it to change over time. The face is composed of layers of skin, muscle, and fat which lie above the facial bones. Much like a rubber band that has been over stretched, the tissues within your face weaken over time, losing their resiliency and ability to maintain a firm, youthful position. Facial aging occurs for many reasons. In response to sun damage and other factors, your skin’s support network of collagen and elastin breaks down. As a result, your skin loses some of its structure and elasticity and becomes lax. Additionally, facial muscles weaken and stretch, and fat deposits, which normally give the face a soft, rounded appearance, migrate downward and are depleted, creating hollow areas. In combination, these changes create deep wrinkles, jowls, and loose skin in the lower portion of the face.

How Does a Lower Facelift Work?

There are several different types of facelift—each specialized to treat different regions of the face. For example, the lower facelift is usually performed to rejuvenate the lower portion of the face. Age-related changes in the upper and middle region of the face are usually corrected with a forehead lift and mid facelift, respectively. During a lower facelift, the underlying connective and muscle tissues known as the SMAS are lifted, facial skin is tightened, and excess skin is removed. It is important to realize that a lower facelift cannot correct signs of aging in the forehead or around your eyes, nor can it address fine lines or uneven skin tone and texture. Your physician will help you determine which procedure is best for you, and whether an additional procedure such as eyelid surgery or skin resurfacing would produce more global facial rejuvenation.

Surgery Preparation

A lower facelift procedure lasts approximately three hours depending on the extent of treatment. Prior to the start of your procedure, the treatment area will be cleansed and anesthesia will be administered. The procedure will most likely be performed under general anesthesia in which you are asleep. However, your physician may choose to administer local anesthesia with a sedative, in which the face and surrounding areas are numb and you are in a relaxed state. Prior to making the incisions, the physician may part your hair along the incision area and apply an antibiotic ointment, which will help to hold it in place. Once the incision area is exposed, the physician will carefully draw the incision lines so that the resulting scars will be as inconspicuous as possible.

Incisions

A lower facelift can be performed using different types of incisions. Commonly, a single incision is made within the hairline that extends downward around the perimeter of the ear and into the hairline on the backside of the head. However, you should discuss the different types of incisions with your physician.

Tissue Elevation

Working through the incision along the hairline, the physician will use a series of surgical instruments to carefully elevate the skin away from the underlying tissues of the lower portion of the face, jaw line, and neck. In doing so, the physician exposes what is known as the SMAS, which may be repositioned to achieve a more youthful appearance.

Lifting the SMAS

The SMAS is a layer of tissue composed of muscle and fibrous connective tissue. Although not all physicians will manipulate the SMAS during a facelift, some physicians will reposition it in order to lift the facial structures to a more youthful position. There are a variety of methods that can be used to lift the SMAS, such as plication or excision in which the tissue is augmented and suspended in a higher position with sutures. Although the techniques may differ, they all work to lift and tighten the underlying structures of the face.

Lifting the Neck

If a neck lift is being performed in conjunction with your facelift, the physician will make a small incision on the underside of the chin. In some cases, the physician will manipulate the muscles in the neck, which are known as the platysma muscles. Similar to the SMAS, the physician may choose to plicate the neck muscles or remove a portion of them in order to reduce the appearance of skin laxity and banding around the neck. In other instances, the physician may choose to remove fat to further sculpt the area. If you are concerned about the appearance of your neck, you should discuss the different treatment options with your physician.

Incision Closure

Once the physician has finished making the necessary adjustments to the underlying structures, the skin will be repositioned over the face. In some cases, the physician may choose to place a surgical drain beneath the skin to prevent fluid build up as you heal, although this is not usually necessary. The physician will stretch the skin flap in order to determine how much excess skin should be removed. They may place pilot cuts and sutures at different points along the incision to establish the proper amount of tension. The physician will then remove the excess skin around the natural contours of the face, and close the remainder of the incision with additional sutures.

Lower Facelift Recovery

While some physicians prefer not to use bandages, others may apply a loose-fitting wrap or a compression garment to facilitate healing. A compression garment is tight-fitting, and will help to reduce swelling by preventing fluid build up, as well as provide comfort and support as you heal. Although loose bandages may be removed in several days, compression garments are often worn for a few weeks. As with any surgical procedure, you will likely experience some pain, bruising, and swelling, most of which will subside within a few weeks. If a surgical drain was used, it will usually be removed within a day following surgery, and non-absorbable sutures may be removed in seven to ten days. You will likely feel well enough to return to work in one to two weeks; however you should avoid strenuous activity such as heavy lifting or exercise for up to three weeks to allow your body sufficient time to heal.

Lower Facelift Results

You will typically start to notice the results very soon after your procedure. They will become even more evident in two to three weeks, as the bruising and swelling continue to fade. As all individuals heal at different rates, the final results may continue to evolve for several months. It is important to realize that you will have permanent scars; however they are typically well hidden within the hairline. Although a facelift will not stop the aging process, it can significantly reduce the appearance of loose, sagging skin in the face and neck, restoring a youthful appearance for many years to come.
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