INTRODUCTION

Lifting is a surgical procedure to improve the visible signs of ageing in the face and neck. With ageing, the skin and the muscles of the face begin to lose tone. Lifting face cannot stop the ageing process, but it can improve the visible signs by treating deep structures, with readjustment of face and neck skin, removal of selected fat areas and filling where appropriate. Lifting can be made separately, or along with other procedures, like eyelid surgery.

To sum up rejuvenation is achieved not just by stretching, but by readapting, lifting tissues and filling.

ANAESTHESIA

Lifting can be made with general anaesthesia or local anaesthesia and sedation. The selection depends on the surgery to be performed and also on the patient's preferences. For example, it is possible to treat the fat excess of the eyelids, raise the eyebrows and get rid of the forehead's wrinkles to give a more youthful aspect to the glance with local anaesthesia altogether.

PROCEDURES

FRONTAL LIFTING

It has three main goals: to eliminate the wrinkles of the forehead, those of frowning and to raise the eyebrows. By means of this, the sad, tired or angry look are eliminated. Wrinkles occur by hyperactivity of the frontal and corrugator muscles (these are responsible for frowning). The technique consists of excising partially these muscles so that they are debilitated. At the same time forehead's skin is stretched to raise the tail of the eyebrows and to give a youthful aspect to the face. We perform this technique with ENDOSCOPY. Instead of the classic long incision that is placed in the hair and that goes from ear to ear, we make two small cuts of 1,5 cm., within the hair, and with the aid of endoscopy and instruments specially designed, we search for these muscles to be sectioned. Because of this, a great scar is avoided, the recovery is faster and the aesthetic result is very satisfactory. Recently we have introduced the corrugator section through the upper eyelids.

Other choice may deal with a restricted treatment on the eyebrow, raising it through a limited incision in the temporal area.

Furthermore, through this temporal incision we also reach the malar area and lift the soft tissues of this area to increase the lateral fullness of the face.

However, in selected cases when there are many frontal wrinkles, flaccidity or severe skin damage after sun exposure, the classic frontal lifting is indicated. The incision in these cases remains hidden within the hair.

CERVICOFACIAL LIFTING

Indicated to treat the flaccidity and wrinkles of both neck and face inferior third. The incisions are placed around the ears trying to keep them hidden as much as possible. Both skin of the face and the thin muscular layer underneath (the SMAS) are dissected and raised. The SMAS work-up reshapes the face, giving back the natural curves of youth. Through another small incision under the chin, we can slim down the neck and stretch the platysma muscle. The neck gets a more acute angle and definition on profile. Liposuction in the neck is indicated to those patients with no skin flaccidity, no muscular bands and with fat excess in the submental area.

When performing a lifting, we try to avoid stigmata such as earlobe distortion, hairline malposition or scar stretching. The tension applied is the necessary in order to get satisfactory results but not to have such unesthetic marks.

COMPLICATIONS

In addition to the general complications such as infection or haematoma, specific but fortunately exceptional complications are:

• Conspicuous and anaesthetic scars.
• Nervous injury: The accurate knowledge of the anatomy of this area makes injury to nerves very rare. Some sensitive and motor nerves can be damaged during the facial lifting's operation. Weakness or loss of facial movements may happen postoperatively. These injuries can improve with time. The injury of sensorial nerves of face, neck and ears can cause temporary or more rarely permanent thumbness. The painful healing of the nerve is very rare.
• Loss of hair. Loss of hair may occur in the area of the face where the skin is raised during surgery or more frequently in the scalp.
• Delay in healing: Odds for wound dehiscence or delayed healing do exist. Some facial zones cannot cure normally and take a long time in healing. Some areas of skin can die, which requires frequent changes of later bandage or the need of surgery for removing the noncured tissue. It has been proved that smokers have a greater risk of suffering from this skin loss and also from healing complications.