At a certain point, non-surgical methods may no longer do the job. Sydney plastic surgeon Dr Darryl Hodgkinson shares his approach to surgical rejuvenation of the face. Before and after facelif...Continue Reading
Mid and Lower Facelift Surgery
Before & After Gallery Mid and Lower Facelift Surgery
About The Procedure
Anti-ageing facial surgery for the mid and lower regions of the face, such as the cheek area is relatively new, however, effective at achieving excellent results for patients.
This technique of giving the mid-face a lift has the primary goals of re-establishing an inverted cone aesthetic look for the face as opposed to a square appearance that sagging from age can cause.
A facelift procedure that focuses on the lower areas can also smooth nasolabial folds that have been affected by sagging as well. By elevating the cheeks, Dr. Hodgkinson is able to shorten the region between the lower eyelid and cheek. This creates the more youthful appearance that many patients desire.
Smoothing of the nasolabial fold
Facial rejuvenation has previously focused on improving the appearance of the neck. This is achieved by working with the submental fat pad along with the superficial musculoaponeurotic system SMAS. This process, however, did not alter the nasolabial folds. The other popular procedure, the brow lift, also failed to do much about the area between the eyes and the mouth.
Ageing causes the soft tissues from the cheek to fall, which creates deeper nasolabial folds which flattens the midface causing a square appearance. The facelift, while making vast improvements to a patient’s appearance, still left the midface with a fallen down look.
Facial implants were quite successful at filling and lifting the mid-third of the face, and this was improved even more when endoscopes were developed for cosmetic surgery purposes. This allowed for easy access to this area, making it easier to lift.
The mid and lower facelift process
The biggest issue with improvements to the middle and lower region of the face has always been a technical difficulty of moving from the upper third into the mid-third due to the facial nerves between the two. While the endoscope did not eliminate this issue, it did allow for smaller incisions to be made in the temporal area.
The current procedure involves an incision made inside the mouth to identify the structures from inside the mouth and cheek. Sutures are then directed up, suspended into the temporal region, reached through small incisions concealed in the hairline.
This creates a lift in the cheek area, deep underneath the skin. If required, a cheek implant can also be inserted during this process should the patient wish to have more volume.
No skin is removed, and over time, the tissues will attach to the bone, creating a permanent bond that cannot be seen or felt as they sit at bone level. This is a low-risk technique with the main complication being broken sutures. This risk is minimised however, by having the sutures held in place for 7-10 days with tape. These procedures also present a risk of partial damage to the facial nerves; however Dr. Hodgkinson is yet to see this occur despite performing thousands of facelifts over his career.
The goal of the facelift
Facelift surgery aims to elevate sagging tissues, readjusting the contours of an aging face. Fat accumulation and degeneration are two of the main contributors to the appearance of an aging face along with lax facial tissues of the skin, neck, and jowls.
To rectify the issues caused by sagging tissues, the facelift looks to re-suspend the platysma muscle, while tightening and anchoring the subcutaneous muscular aponeurotic system (SMAS). The SMAS is approached by the “deep plane” reducing skin dissection and improving the area around the mouth and cheeks.
Facelifts are most common in women aged 45-60 and men aged 50-60. Dr. Hodgkinson creates a restoration of a more youthful appearance by reviewing photographs of patients that have been taken in their early 30s to ensure a natural look. Any scars as a result of the procedure are hidden as much as possible within the hairline.
Dr. Hodgkinson’s experience with the facelift procedure
Dr. Hodgkinson has published several articles on his unique facelifting process, all of which he has presented to the worldwide plastic surgery literature while also lecturing internationally on his technique. By exhibiting at international cosmetic surgical gatherings, Dr. Hodgkinson is considered an expert in this field, particularly for his “total neck rejuvenation” technique.
Along with being recognized worldwide as an expert in cosmetic plastic surgery, Dr. Hodgkinson has more than thirty years of experience not only in cosmetic surgery, but also plastic/reconstructive surgery. He has performed thousands of variations of the facelift procedure on a wide range of patients, all with excellent results.
Dr. Hodgkinson performed his plastic surgical training at the prestigious Mayo Clinic in the United States. He is featured amongst an elite group of surgeons who hold two degrees in plastic surgery from American Board of Plastic as well as the Reconstructive Surgeons and the Royal College of Surgeons in Canada. He is well known for the relationships he builds with his patients, which for him, is a crucial step in the achievement of a successful surgery.
What will happen after the procedure?
Bruising and swelling are normal after facelifting, but the severity depends on the extent of the surgery and is minimised by bandaging and early ice application to prevent excessive swelling. Most people can go back to work after about two weeks, but the visible signs of surgery will still be evident for several weeks.
Before and 3 months after Mid Facelift and Necklift by Dr Hodgkinson
Feeling a bit depressed is quite common during the immediate postoperative period and is more related to the reality of the process rather than the outcome; in fact, as time goes by and your rejuvenated, more youthful appearance settles in, the happier you will feel about it.
Will this procedure rectify my sagging jowls?
Jowls are usually caused by ageing in the lower half of the face. While this is not always something that affects everyone as they age, it is a common situation we are presented with from patients. As we age, our skin loses elasticity and the underlying tissues and fat pats atrophy. This creates sagging or a loose appearance affecting the definition of the jawline and creating a laxity of the tissues under the chin (causing a double chin). The mid and lower facelift is the best procedure to treat sagging jowls as it will elevate the tissue. By focusing on this area, there is also the benefit of less scarring and down-time while still obtaining a long-lasting and natural result.
How long will the results last?
There are a number of factors that will determine how long the results of this surgery last. Genetics and lifestyle habits such as drinking and smoking will play a part, along with sun exposure and stress. It is essential to keep in mind that you will continue to age after surgery; however, the mid and lower facelift procedure can help set back the hands of time, on average lasting from 8 to 10 years.
Before and After a Facelift Procedure
Will this procedure help with my saggy neck?
The double chin or "turkey neck" can occur as early as the late teens due to the hereditary feature of a chubby neck. Unfortunately, diet and exercise won't always fix the problem. Prior to the age of 40, liposuction can be an effective way to target and remove these fatty accumulations. After 40, we must consider the laxity of skin and sagging muscles under the chin that begin to occur with age. To rectify this, the mini-lift is the treatment of choice as it will firm and provide tension to the underlying muscles of the upper neck. From the age of 45 onwards, fat and sagging skin combine, making the problem more severe. This is where the neck or a facelift procedure is a more effective option.
To obtain a definitive answer on the most suitable procedure for you, we recommend a consultation with Dr. Hodgkinson, who has extensive experience in facelifts, and can provide the most honest and valuable information for making an informed decision.
Before and 4 months post male facelift and blepharoplasty. Note the natural result
What should I consider before having this procedure?
As with any facelift procedure, it is important to time your surgery so that you have ample time off. We recommend a recovery period of at least a few weeks to fully heal before returning to the rigours of daily life, however, the targeted nature of the mid and lower facelift requires slightly less downtime than a full standard procedure. Winter is a popular time of year for a facelift procedure as it will reduce exposure to the sun, which can make the healing process a little more straightforward.
What risks should I be aware of?
The major risk with a facelift procedure is hematoma or blood collecting under the skin flaps of the face. To ensure this does not happen, a specialised clinic nurse stays with all of Dr. Hodgkinson's facelift patients in order to stabilise the patients' blood pressure and reduce anxiety or discomfort. The nurse stays in contact with Dr. Hodgkinson and the anaesthesiologist and can detect if a hematoma forms early on for immediate attention.