Facial Plastic and Cosmetic Surgery
When we are getting older, the skin, the connective tissue, the muscles and the adipose tissue of the face and the neck tend to sag progressively. This is caused by the combination of a series of factors, such as gravity, a loss of skin tautness due to a decrease of collagen production and a diminution of cutaneous elasticity. The evolution is accelerated by sunlight-exposure. Some conservative remedies - such as creams and massages - can slow down but not halt these processes, which are influenced by numerous factors as to their intensity.
A “face lift” aims to counter the alterations which the aging facial skin generally undergoes. It consists not only in the tightening of the facial skin, although this is an essential goal of the “face lift”. The treatment includes moreover the elevation of deeper tissue, in particular the muscle and adipose tissue. There are different procedures, depending on whether the forehead-eyebrow region, the mid-face region, the lower face region or the neck region is concerned. The nose and mouth region can also be subject to a special treatment.
One of the oldest face-lift techniques is the exclusive skin lifting (“Skin only facelift”). Compared to the platysma muscle technique, also called SMAS-facelift, the exclusive skin lifting is today rather seldom, yet, in some cases, it is indeed still performed.
Today, the ordinary face lift normally does not only include the elevation, the tightening and the partial resection of the facial skin by lateral incisions. The treatment involves rather different layers of the skin, such as the epidermis, dermis and further subcutaneous tissue layers.According to the requirements one or more of these skin layers are separately tightened or corrected. The “Superficial musculo-aponeurotic system” (SMAS) plays hereby an important role. The tightening of this subcutaneous tissue under the facial epidermis, promises longer-lasting results than the mere skin tightening.
Even by the most sophisticated face lift procedures not all facial wrinkles can be eliminated. Therefore additional techniques are used - in particular to correct fine superficial alterations of the skin - , such as the dermabrasion, the treatment with chemical substances (“Chemical peel”) and the laser treatment (“Laser skin resurfacing”) as well as the injection of dermal fillers, either autologous tissue from the patient or especially prepared synthetic materiel.
The choice of the technique depends largely on the expectations of the patient towards the surgery. Hence, a thorough discussion (or even repeated ones) with the patient is particularly important to establish an adequate treatment.
Face lift surgery can be performed under narcosis. Usually, the stay in hospital does not last longer than two days.
Forehead lift (Eyebrow lift)
The assessment of the eyelids must always take into consideration the eyebrows and the forehead. The forehead region, the superior facial section (among three equal horizontal sections) from the upper edge of the eyebrows to the hairline is on average about 7 cm high in males and about 5 cm in females. In the western civilisation the eyebrows are considered aesthetically ideal, if they correspond to the following criteria: the inner end of the eyebrows lies on the vertical line over the edge of the nostril and the inner corner of the eye (medial canthus); the outer end of the eyebrow lies approximately on the extension of the line between the outer nostril and the outer corner of the eye (lateral canthus). The male eyebrow is slightly less curved than the female one. The maximum elevation of the eyebrow is limited to 2.5 cm from the iris measured on the vertical line from the outer corner of the iris. All these criteria vary according to the age.
The elevation of the eyebrows can largely or entirely offset the redundant skin of the eyelids. A tired, sad or “grim” facial expression is often the cause for the wish to undergo cosmetic surgery, since generally it doesn’t reflect the real state of mind of the concerned person. Such an undesirable facial expression is rather due to drooping eyebrows than to redundant eyelid skin.
The older techniques designed to correct the eyebrows (eyebrow lift) consisted in the excision of skin either just above the eyebrow or behind the hairline. Given the development of endoscopic procedures with hidden incisions, the superficial excision of skin has become obsolete for most cases.
The forehead lift or eyebrow lift - the terms are tantamount - is a widespread surgical procedure for the facial rejuvenation. It is performed either isolated or in combination with other surgical interventions, for example a face lift or an eyelid correction (blepharoplasty). The eye area is the principal target region, since it often shows first signs of aging, including eyelid creases, extending beyond the eyelid to the temple region, “anger” furrows above the nasal bridge and horizontal forehead wrinkles as well as the sagging of the eyebrows. These alterations arise from a loss of elasticity in the tissue, a genetic predisposition and recurrent involuntary facial movements (for example frequent frowning, contraction of the eyelid muscle). Persons with lively facial movements may develop earlier wrinkles in the forehead region, in particular if they are frequently exposed to the sunlight.
Once an eyebrow ptosis has developed, many of the affected persons tend to use the forehead muscles to elevate their eyebrows to prevent a further sagging of the eyelids, although this is actually due to the eyebrow ptosis. This triggers a vicious cycle of involuntary activity of the forehead muscles to offset the sagging of the eyelids, since this reaction causes in turn ever deeper forehead wrinkles. The well-intended resection of the upper lid skin aiming to tighten the skin of the eyelid (blepharoplasty) unfortunately aggravates the eyebrow ptosis. The further sagging of the eyebrows after an eyelid correction can compromise - especially in women - the cosmetic result of the surgical procedure. Other techniques, however, designed to reduce the activity of the forehead muscles and to elevate the eyebrows in an adequate position, can help minimize undesirable wrinkles.
An excessive elevation of the eyebrows, notably in the central region, makes the face looking surprised or scared. Of course, such an effect has to be avoided. If the position of the eyebrows is correct, it can make sense to carry out a correction of the aging upper eyelid.
A facial paralysis (facial palsy) arises from a damaged or transected facial nerve (nervus facialis). In most of the cases this is due to inflammations or a tumour development in the path of the nerve, thus in the skull base, in the ear or in the parotid gland. The facial paralysis can also be due to injuries, for example a head trauma. However, the paralysis happens also to occur sometimes with no apparent cause.
For the affected patients the immobility of one half of the face is aesthetically extremely embarrassing and sometimes it is even an outright disfigurement. Yet, the functional disorders are also considerable: the eyes cannot be closed, the lips cannot accurately retain liquids and food in the mouth.
Without medical care the eyes can be affected by conjunctivitis and even vision problems can occur. In the early stage even minor surgical interventions may bring relief.
If the paralysis persists for a longer period, there are surgical procedures to counter even the lip paralysis. The range of techniques includes ligament tightening under the cheek skin as well as nerve and muscle transplantations.
All these surgical approaches help also improve the aesthetical appearance of the affected face.