As part of the aging process which happens to all of us sooneror late, our skin progressively loses its elasticity and our musclestend to slacken. The stresses of daily life, effects of gravity andexposure to sun can be seen on our faces. The folds and smilelines deepen, the corners of the mouth droop, the jaw line sagsand the skin of the neck becomes slack. Around the eyes, theeyebrows droop and the skin of the eyelids gathers in loose
folds. In the skin the first sign is fine wrinkles developing aroundthe lips, at the outer corners of the eye and lines of expression.
The rate at which this happens varies from one person toanother and is probably determined by our genes. Aging ofthe skin of the face does not necessarily reflect the rate thatthe rest of our body and mind is ageing and many people feelfrustrated that the face they see in the mirror is not the onethey feel should be there. Substantial weight loss can producesimilar changes in facial appearance to those of the aging
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Who will benefit from a facelift?
At the beginning your face will look a little puffy and may feel rather strange and stiff. The scars can bevery well hidden by women with their hair and disc shaped earrings so that they should be able to resume
The best candidate is one whose face and neck has begun to sag, but whose skin
A facelift is carried out in a hospital and most surgeons and patients prefer a general anaesthetic. It is
work and social activities within a couple of weeks. Camouflage make-up can be helpful in masking
still has some elasticity and whose bone structure is strong and well defined. Most
possible to carry out the procedure under local anaesthetic and intravenous sedation but the patient would
patients are in their 40's to 60's, but facelifts can be done successfully on people
still be advised to spend the night in hospital. The procedure, although long, can be combined with other
operations of all sorts. The most common however would be an endoscopic brow lift and an eyelid reduction.
Other extra procedures which can be used to enhance the face at the same time are malar (cheek bone)
Men find it more difficult to disguise the scars and will need to shave their beard closer to the ear in frontand also behind the ear where the skin has been lifted.
It should not be obvious that a patient has had a facelift, but instead they look
and chin augmentation and lip enhancement.
younger, more vital and cheerful. It is a procedure that technically works well but
The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound.
also increases morale and is well appreciated by the patient.
This is an extension of the forehead lift which is designed to tighten the skin of the upper half of the face,as opposed to the standard facelift which helps the lower half of the face. The Deep Facelift carried out
There may be some slight reduction in hair growth in the temples, but this is not usually a problem unless
endoscopically avoids the same ear to ear incision. It is usually carried out at a younger age than the
the hair is very thin and repeated facelifts are being carried out.
What a facelift does not do?
standard facelift. It tightens the skin of the mid-face and freshens the eyes, opening and lifting the outerangle and reducing the wrinkles of the crows feet. There will be swelling around and below the eyes which
How long does a facelift last?
gradually resolves in about a month. There will also be scars beneath the eyelashes of the lower eyelid and
A facelift works better for the lower half of the face and particularly the jaw line and
sometimes in the upper gum line. There is a slight risk of damage to the nerve which supplies the muscles
neck. If you have sagging eyebrows and wrinkles of the forehead then you should
A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to always
of the forehead. This weakness is usually partial and temporary, on rare occasions it may be permanent.
perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles, freckles
be there, in that you will not look as old as you would have done if it had not been carried out.
Incisions are made above the hair line at the temples and extend in a natural line down the front of the ear,
and rough areas will benefit more by chemical peel or laser resurfacing.
or just inside the cartilage at the front of the ear, and continue around behind the earlobe and up in thecrease behind the ear and off into the lower scalp. Occasionally it may be necessary to make a small
Choosing your surgeon
What should you do before the operation?
incision under the chin. Sometimes only the skin is lifted following separation from the underlying platysma
A facelift is a skilled procedure and we would recommend that you choose a surgeon who has undergone
If you are overweight and intend to lose it you should do so before the operation.
a full training programme for cosmetic surgery. These surgeons will be on the Specialist Register in Plastic
This allows the surgeon to remove more skin and therefore achieve a more pleasing
More usually however the platysma muscleand its fibrous attachments (S.M.A.S.) is dissected free and
Surgery at the General Medical Council. All members of the British Association of Aesthetic Plastic Surgeons
result. You should avoid taking tablets containing aspirin and non steroidal anti-
sutured tightly to the solid structures in front and behind the ear. At other times the skin and the S.M.A.S.
(BAAPS) are on the Specialist Register.
inflammatory drugs such as Voltarol and Indocid for at least two weeks before
layer are lifted together as a single layer, but will still be sutured separately. Fat along the jaw line and under
surgery as they increase the risk of bleeding.
the chin may be removed by liposuction or on occasion through an incision under the chin. The skin is
sutured so that it is lifted upwards and backwards, just as when one lifts the skin when looking in the mirror.
You should stop smoking at least two weeks before surgery as this is the main
Sometimes drains are inserted. Most surgeons will bandage the face to minimise bruising and swelling.
cause of reduced healing. It decreases circulation of the skinflaps, particularly
These bandages will stay for one or two days and the sutures are removed in 7 to 8 days.
After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend intothe neck. Discomfort is usually mild and can be controlled with Paracetamol. It is normal for there to be
Have your hair permed and tinted, if you wish, before your operation as fresh scars
some numbness of the skin of the cheeks and ears. This will usually disappear in a few weeks or months.
are sensitive to these chemicals for a few weeks.
It is better to keep the head elevated for a couple of days to reduce swelling. Drainage tubes will be removeda day or two after surgery. Avoid strenuous activity, saunas and massage for at least two weeks.
Scientific Oral Inflammation and Diabetes Advisory Panel Maria Emanuel Ryan, DDS, PhD, Department of Oral Biology and Pathology Stony Brook University School of Dental Medicine Ray Williams, DMDChair, Department of PeriodontologyDiabetes mellitus is a chronic metabolic disordercontributing to bacterial proliferation and oralaffecting carbohydrate, fat, and protein metabolism.
VALVEKENS'S PROTOCOL: A GUIDE TO HIGH EFFICIENCY (Department of Molecular Genetics, The Cambridge Laboratory, The John Innes Centre for Plant Science Research, Colney Lane, Norwich * The protocol described here is mainly intended as a guide for newcomers, but I hope that people with expertise in transformation will also benefit. I have tried to stress details, tips, and any pieces of informa