Our face is the most basic reflection of our identity, emotions and social interactions. Over time, the loosening and wrinkles that occur in the skin tissue due to the aging process have increased the interest in facelift surgery (rhytidectomy) in many people. Just as an aging building requires renovation, facelift surgery aims to reduce these signs of aging and give a more vibrant and dynamic appearance. However, this is not just about "stretching and rejuvenating the skin".
A facelift, medically known as a "rhytidectomy", is a surgical procedure that aims to reduce the signs of aging on the face and neck. Today, a facelift is not just a simple surgery to cut away excess skin. Highly refined techniques are applied that also take into account the deep layers of the face.
It is possible to liken facelift surgery to strengthening a worn-out wall by going down to the foundation of the structure instead of scraping the paint and plastering it again. In particular, the arrangements made on the layer called "SMAS" (Superficial Musculoaponeurotic System) under the skin, which controls the movements of the face, provide longer-lasting and natural results. SMAS is a layer where the muscle layer that shapes our face with facial expressions is located. This layer loses its elasticity and sags over time; therefore, instead of only stretching the skin on top, it offers a more effective solution to recover this underlying muscular system.
Candidacy for facelift may vary from person to person. There are two main factors that are important here: general health status and the realism of the person's expectations.
General Health Status:
Surgical risk is increased if there are serious health problems such as cardiovascular disease, diabetes, uncontrolled hypertension or bleeding and clotting disorders.
In smokers, wound healing may be adversely affected because nicotine impairs circulation and reduces skin nutrition. For this reason, many surgeons recommend quitting smoking at least a few weeks before surgery.
Realistic Expectations and Psychological Preparation:
The person needs to understand that as a result of the surgery, he/she will look more vigorous and fresh, not transformed into a completely different person. The surgery does not stop the aging process; it only revitalizes facial features and gives a firmer appearance.
Some people are particularly bothered by sagging in the "double chin" area, while others complain of sunken cheeks. Facelift surgery is an effective option for revitalizing the jawline and cheeks.
Skin Elasticity and Bone Structure:
People with relatively elastic skin and prominent bone structure (e.g. prominent cheekbones) may have more pronounced and lasting results.
Successful results can also be obtained in thin, very sensitive or previously sun-damaged skin; however, these features are taken into account during the planning of the surgery.
Candidacy for facelift surgery is related to skin quality and signs of aging, not age. Some people have significant sagging in their 40s, while others may have minimal problems until their 60s. The most important point is a detailed evaluation with the surgeon.
The surgical process is usually carried out in a phased approach and is planned according to individual needs. There are roughly four basic steps:
Anesthesia:
Local or general anesthesia is applied so that you do not feel pain during the surgery. General anesthesia is usually preferred for more extensive facelift procedures.
Incision and Preparation:
The classic facelift incision starts from inside the hairline, goes around the front of the ear and extends behind the ear. In this way, the scars are concealed as much as possible at the end of the healing period.
In some techniques, the incision may be shorter or limited to the area around the ear (e.g. mini-facelift). This depends on the degree of sagging of the patient's skin and the extent of the surgery.
Regulation of the SMAS Layer:
The part that makes the real difference is to intervene in the SMAS layer, which houses the facial muscles. This layer is folded, tightened or excess tissue is removed when necessary. Afterwards, the facial contours are "deeply" supported.
Some surgeons perform this procedure with methods such as "SMAS Plication" (folding) or "SMAS Imbrication" (overlapping). The aim is to provide rejuvenation without excessive stretching of the skin.
Skin Stretching and Removal of Excess Tissue:
In the final stage, the skin is gently stretched to fit the new position of the SMAS and excess tissue is cut away. Thus, wrinkles are smoothed and facial contours become clearer.
Incision sites are closed with fine stitches or sometimes staples, bandages and protective dressings are applied.
Facelift surgery is not a single "package" procedure. Since each individual's facial structure, skin elasticity and needs are different, there are different methods. It is possible to summarize them in three main groups:
Classical (Above-Skin) Facelift:
It is the first technique that emerged historically. It is done by simply pulling the skin and removing the excess. However, the lower layers of the skin are not intervened.
The disadvantage is that the permanence of the results is limited and may leave a "tense" expression. Because the skin that is not supported underneath may sag again after a while.
SMAS Based Facelift:
Methods such as "SMAS Plication" or "SMAS-ectomy" fall into this group. At the heart of the surgery is the repair and reshaping of the SMAS layer under the skin.
The results are usually more natural and lasting. Since the facial contours are more deeply supported, there is less re-sagging in the long term.
Deep Plane Facelift (Deep Plane) and Sub-Variations:
In this technique, not only the SMAS but also the surrounding muscle and fat tissues are lifted together. In other words, the "infrastructure" of the face is moved up collectively.
It is an effective and permanent solution for people with significant sagging in the mid-face area (cheeks and cheekbones). However, it requires surgical experience and caution because it works more closely with the layers through which the facial nerves pass.
For some patients, more minimal interventions (e.g. "Mini-Facelift", "MACS Lift" or "S-Lift") may be preferred. In these methods, the incision is smaller, the operation time and recovery period are shorter; however, if the degree of sagging is high, classical or SMAS-based methods generally give better results.
The recovery period after facelift surgery may vary according to everyone's body reactions and the extent of the surgery; however, in general terms, similar stages are followed:
First Week (Early Period):
Swelling, bruising and mild pain on the face and neck are expected. Cold compresses and keeping the head elevated are effective in reducing this swelling.
In some cases, small drains are placed to prevent blood or fluid accumulation (hematoma or seroma). These drains are usually removed in the first 1-2 days.
Pain is controlled with painkillers. Rest is important, but light walks also promote healing by increasing blood circulation.
Second and Third Week (Intermediate Period):
Most patients feel well enough to return to their daily work and light physical activities after 2-3 weeks.
Removal of the stitches is usually completed in 5-10 days. Some doctors also use self-dissolving stitches.
Most of the facial edema will go away, but there may be slight stiffness or numbness, especially around the ears and jawline. This feeling decreases as the tissues continue to heal internally.
First Month and After (Late Period):
Surgical scars may initially be pink or red in color. Over time, especially after 2-3 months, they begin to fade and become closer to the skin color within months.
The exact final results are usually clear between 6 months and 1 year. This includes the adaptation of the tissues to the new location and the maturation of the scars.
Additional Applications and Care:
During the healing process, special creams or silicone gel sheets recommended by the doctor can help the scars to heal faster.
In some cases, gentle massage techniques or lymph drainage can help reduce edema.
High protection factor creams (SPF 30 and above) should be used to protect from the harmful UV rays of the sun. Protecting the surgical scars from the sun in the early period is important in terms of scar aesthetics in the long term.
In general, significant differences are seen in the first few weeks after facelift surgery, but you need to be patient to see the full "settled" results. The procedures require time as they require the healing process of deep tissues.
As with any surgical intervention, risks cannot be completely ignored in facelift surgery. The important thing is to be aware of these risks and take the necessary precautions.
Hematoma (Blood Accumulation):
It is one of the most common complications. Blood may accumulate under the incision line and in this case, pain, swelling and bruising increase in the area. If detected in the early period, it may need to be drained.
Facial Nerve Damage:
Some branches of the facial nerve, called "facial nerve", may be temporarily or, in rare cases, permanently affected. This may cause numbness, loss of sensation or facial asymmetry.
The possibility of nerve damage is low in facelift surgeries performed in expert hands. The surgeon takes care to protect the areas where the nerve passes with his/her knowledge of anatomy.
Infection
Although rare, infection may occur in the surgical incision area. It is controlled with early diagnosis and appropriate antibiotic treatment.
Skin Necrosis (Tissue Loss):
Especially in smokers, this risk increases as the nutrition of the skin may be impaired. In areas where blood circulation is not good, tissue loss may occur in small areas. Therefore, it is important to quit smoking before and after surgery.
Anesthesia Related Problems:
There are risks such as blood pressure fluctuations, allergic reactions and breathing problems. General health screening and review by an anesthesiologist help reduce these risks.
Scars and Hair Loss:
Scars are usually well hidden as the incisions are made around the ear. However, depending on individual wound healing characteristics, more prominent scars may remain.
Some patients may experience temporary hair loss around the ear or hairline, but most of the time it is not permanent.
Although the rate of complications is low, an experienced surgeon and the right patient selection further reduce this rate. At the same time, postoperative doctor controls make it possible for early detection and treatment of problems that may occur.
After a facelift surgery, the results are not expected to be "permanent for life". Aging is a natural process and it is not possible to stop this process completely with surgery. However, the surgery offers a younger and more vibrant facial expression for years to come.
Technique Differences:
Deep techniques, including the SMAS layer, can be longer lasting compared to skin lifting. Because it supports not only the skin but also the subcutaneous tissues.
Small interventions such as mini-facelift are suitable for patients with less sagging and the results usually remain satisfactory for 5-7 years.
Age and Lifestyle Influence:
Facelift surgery performed at a young age (e.g. mid-40s) may provide longer-term results as the skin elasticity is still in good condition.
Factors such as smoking, excessive sun exposure, malnutrition may shorten the duration of the result as they negatively affect skin quality.
Personal Anatomy and Genetics:
Every person ages at a different rate and in a different way. Features such as genetic heritage, bone structure, skin type also affect the permanence of the surgery.
In general, the effects of a good facelift surgery can be significantly preserved for 7-10 years. Afterwards, some loosening is natural with the body's natural aging process. However, a face that has undergone surgery still looks younger than without surgery.
After the facelift surgery is completed, various supportive applications can be used to maintain the effect of the operation and protect the health of the skin:
Medical Skin Treatments:
Doctor-approved professional skin treatments for surgical scars and the overall texture of the skin can accelerate regeneration by removing the dead skin layer.
Methods such as chemical peeling or microneedling can also help to make the surgical scars smoother (however, the timing of such procedures should be determined by the doctor).
Fillers and Botox Applications:
Facelift surgery eliminates sagging and loosening problems; however, botox or filler injections can offer additional support for fine wrinkles and mimic lines such as crow's feet.
It may be preferred to delay mild signs of aging, especially years after surgery.
Lifestyle Adjustments:
Regular exercise and a healthy diet support the production of collagen, which improves the skin's structure and improves the overall appearance.
Drinking plenty of water maintains the skin's moisture balance and provides a more radiant appearance.
Quality sleep supports the body's repair processes. Insufficient sleep can cause effects such as pallor and bagging of the skin.
Sun Protection:
The sun's harmful rays are an important factor in wrinkle formation. High-factor sunscreen (at least SPF 30) should be used regularly to both protect postoperative scars and slow down aging.
Especially in the first few months after surgery, avoiding direct sunlight as much as possible will positively affect the healing process.
Psychological Support and Social Interaction:
After surgery, some patients quickly adapt to the change in the mirror, while others get used to their new appearance over time. Emotional fluctuations are normal in this process.
Support from family and friends has a morale-boosting effect during the recovery process. If necessary, a short-term psychological counseling can alleviate the anxiety that may be experienced in the postoperative period.
All these supportive practices play an important role in maintaining the new facial appearance longer and increasing personal happiness.
Facelift surgery is a comprehensive surgical procedure that helps to achieve a more vigorous, fresh and confident appearance by reducing the signs of aging in the facial area. Good planning and due diligence both before and after surgery is the key to success and minimizes possible risks.
Preoperatively: It should be clarified whether you are a suitable candidate, which techniques will be used and what your expectations are.
During Surgery: Proper organization of deep tissues such as the SMAS layer is critical for long-term results.
Post-Surgery: The healing process should be carefully monitored and the doctor's recommendations should be followed exactly to reduce swelling and allow the tissues to heal easily.
Long Term Care: The effects of surgery can be maintained for a long time with regular skin care, sun protection and complementary aesthetic applications if necessary.
A facelift surgery can create a positive change in one's physical appearance and self-confidence; however, this procedure is not just an "elixir of youth". The aging process will continue, but it is possible to meet this process in a more advantageous position with the renewed appearance provided by surgery. Just as strengthening the foundations of an old house, repairing the walls and freshening the paint and whitewash offer a holistic improvement, facelift surgery similarly provides a comprehensive renewal of the external appearance and sub-tissues of the face.
For this reason, the best decision is made with a full understanding of one's own wishes and needs, health status and the realistic results of the surgery. A comprehensive preliminary consultation with an experienced and expert surgeon is the first step to achieve both healthy and pleasing results. A face that expresses itself better and offers a more vibrant and energetic reflection can positively affect the quality of life.
