The Ageing Face <br>The passing of time leads to multiple changes in our facial features. Whilst ‘ aging gracefully’ is often a term used to assuage this natural process, it often leads to a tired, dull appearance, which can be undesirable to many. <br> <br>Features of the aging face happen in all layers, from the skin to the bone. Starting from the outside in, our skin loses its suppleness, begins to sag, and develops patchy pigmentation, both as a result of aging as well as cumulative damage from environmental factors such as UV rays. Beneath the skin, the fat compartments of the face shrink, leading to a hollowed appearance in areas such as the temples, upper eyelids and cheeks. Deeper down, the ligaments, otherwise known as the support structures of the face, start to relax, leading to the drooping of the overlying fat and skin layers. 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In cases where the lower neck does not need rejuvenation, the incision can be finished in a ‘short-scar’ fashion, whereby no incisions at the back of the ear are required. Once the SMAS layer is exposed, there are various descriptions of how it can be tightened, including plication, minimal-access cranial suspension (MACS), SMASectomy, and sub-SMAS procedures. Whichever technique is used, care must be taken to avoid injury to the facial nerve which can result in temporary or even permanent paralysis of the face. Once SMAS tightening is done, the excess skin is removed to enable tension free closure for more invisible scarring. <br> <br>For Asians in particular, more powerful techniques have to be utilized to lift as Asian skin and soft tissue tends to be heavier and more difficult to lift. The most significant lift can be derived from the deep-plane facelift, which directly lifts the anterior part of the face and mobilizes the SMAS layer over the spaces by releasing and repositioning the ligaments of the face through strong sutures. This brings the tissues of the face back to the original position of youth, and restores the natural contours of the face. <br> <br> The neck is approached via incisions extending to the hairline behind the ear, sometimes requiring a small incision at the area under the chin. Adjunctive procedures such as liposuction, buccal fat removal or fat grafting may be performed along with the facelift. <br> <br>facelift_chin_neck <br> <br>For all forms of facelift surgery, the performing plastic surgeon has to be familiar with the underlying facial anatomy to minimize complications including bleeding, loss of sensation as well as nerve and muscle paralysis. For more assurance, you should approach a fully-certified plastic surgeon in Singapore who performs facelifts regularly. Performed well, a good facelift can last at least 10 years. <br> <br>The Facelift Consult <br>During the consult with the plastic surgeon, a thorough history and physical examination will be taken. Your goals, motivations and desires for the procedure will be discussed, to enable a wholistic decision is made to ensure lasting satisfaction. A past medical and surgical history is also important to elucidate risk factors for the procedure. The physical examination is paramount to determine the areas of the face requiring rejuvenation, the existence of any pre-existing asymmetry, as well as the techniques required. Often, a lift for other parts of the face besides the region is question may be recommended to achieve a balanced outcome to the facelift. Benefits and risks of the different methods of facelifting should be discussed. Though uncommon, risks of facelifts include pain, bleeding, infection, nerve injury, wound breakdown and scarring. <br> <br>Preparing for a Facelift <br>Facelifts are commonly performed under sedation or general anaesthesia (GA). Occasionally, a patient may opt to have the procedure under pure local anaesthesia. However, this is not advisable as a full facelift can last up to 5-6 hours. Any medications or supplements that can increase bleeding and decrease wound healing such as aspirin, garlic and smoking should be stopped at least 1-2 weeks prior to the procedure. If sedation or GA is chosen, you will need to fast for at least 6 hours prior to the procedure. <br> <br>What to expect during the procedure <br>The facelift procedure itself can be performed as a day surgery procedure, and there is usually no need to stay in a hospital overnight. You will be kept very comfortable during the surgery, and almost always no shaving of hair is required. 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