All the information on aesthetic surgery and the plastic surgeons in Chirurgiens Plasticiens.info, the specialist in aesthetic surgery.

ENDOSCOPIC FACELIFT

Aesthetic surgery:
This document has been conceived under the authority of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOFCPRE).

DEFINITIONS, AIMS AND PRINCIPLES

Endoscopy is a surgical technique used for many years in many specialties. It consists in a performing an operation without completely "open", but just by entering a mini-camera that will allow monitoring on a television screen the manoeuvres made with special instruments. This can often minimize the surgical trauma and especially significantly reduce scarring. This technique has been adapted to cosmetic surgery where it has found its best indication in the treatment of the upper face, from the forehead and temples to the level of the oral commissure. This is the "endoscopic lifting.

The procedure aims to correct the disgraces at this level, hereditary or due to age, only making a few small incisions of about 1 cm hidden in the scalp.

The principle is to detach the entire region, flush with the bone, then reposition the tissues and keep them in place by deep fixations.

It is thus possible to act on the middle level of the face, in the region of the cheek bone, the cheek and nasolabial folds (creases surrounding the nose and cheek).

An endoscopic face lifting can be done in isolation or be associated, if necessary, with other techniques on the face, such as blepharoplasty (aesthetic eyelid surgery), canthopexy (elevation of the corner of the eyes), face and neck lift, laser-abrasion or dermabrasion, peelings, Botox, etc…

An endoscopic facelift aims to correct the damage from the upper and middle third of face and replacing the aspect of "tired" or "severe" by a more fresh and relaxed, with more open eyes.

The disgraces most commonly referred are the following:

Decrease of the height of the lower eyelid,

Suspension of the cheek bones,

Filling the depression under the eyes, a veritable "valley of tears" and padding the cheekbone,

Crow’s feet wrinkles at the corner of eyes,

Attenuation of the naso labial folds and suspension of the cheeks.

When one combines an endoscopic brow lift, it will also work on:

The collapse of the forehead with horizontal wrinkles

Sagging eyebrows with excess skin on the upper eyelids

The frown lines between the eyebrows

The procedure, performed as well in women than in men, may be made from 40 years. However, it is sometimes done earlier, when the disgraces are constitutional (hereditary factors) and not related to aging.

This surgery for aesthetic reasons cannot be supported by health insurance.

BEFORE THE OPERATION

The motivations and demands of the patients have been analyzed.

A careful study of the upper facial region and its relations with the rest of the face has been made.

A preoperative assessment is normally conducted as required.

The anaesthesiologist will be seen in consultation at the latest 48 hours before surgery.

No medication containing aspirin should be taken within 10 days prior to surgery.

Smoking cessation is strongly recommended at least one month before and one month after surgery.

An antiseptic shampoo will be used the night before and / or in the morning.

It is essential to fast (not eat or drink) 6 hours before surgery.

TYPE OF ANAESTHESIA AND HOSPITAL STAY

Type of anaesthesia

Two methods are possible:

Local anaesthesia deepened by intravenous tranquilizers ("vigil" anaesthesia).

Classic general anaesthesia in which you sleep completely.

The choice between these different techniques will be the result of a discussion between you, the surgeon and the anaesthesiologist.

Hospital stay

Hospitalization is short. The admission is in the morning (or even the day before in the afternoon) and the discharge is permitted either in the evening or the day after the operation.

THE PROCEDURE

Each surgeon adopts his/her own technique that he/she adapts to each case in order to obtain the best results. However, we can retain some common basic principles:

Skin incisions: They are between 5 and 10 mm long, are three to five in number and are placed in the scalp, a few centimetres behind the forehead hairline.

One of them will allow the passage of the endoscope connected to a mini video camera, the other giving way to the different instruments specifically adapted to this endoscopic surgery.

The path of these incisions is of course the future location of scars, which are therefore virtually invisible since they are very short and hidden in the hair.

Detachment: includes the temples and facial bones, down to the buccal commissures, including the cheekbones and the upper cheeks.

Replacement: Loose tissue will be re-tightened to soften the crow's feet, move upward the tail of the eyebrows, and above all the cheekbones and fat under the eyes that had accumulated over the nasolabial folds. They will be held in position by deep fixations whose nature varies according to surgeons.

Sutures: the small incisions are closed, often with skin staples that are easily removed or with buried absorbable sutures.

Depending on the surgeon, the extent of improvements and the possible need for additional procedures, the intervention may take 2 to 3 hours

AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP

There is no real pain, but possibly some discomfort with a feeling of tension on the temples and cheek regions. The first days you need to rest up and avoid any exertion.

The postoperative course is mainly marked by the appearance of edema (swelling) and ecchymosis (bruisings) whose size and duration are highly variable from one individual to another.

The dressing will be removed between the 1st and 3rd day. Staples are removed between the 8th and 15th day.

The stigma of the intervention will diminish gradually, allowing the return to normal social and professional life after a few days (10-20 days depending on the magnitude of the surgery).

Some numbness of the operated area, possibly some itching on the skull, can be observed during the first weeks. They gradually disappear.

THE RESULT

A delay of 3 to 6 months is necessary to assess the final outcome. This is the time for all of the oedema to be reabsorbed and the tissue regain their flexibility.

In most cases, intervention has resulted in improving and a significant rejuvenating effect of the upper face, with an attenuation of nasolabial folds, padding the area under the eyes and cheek region (with disappearance of the “valley tears”) and a decrease of the lower eyelid height.

If you get associated a brow lift, also will get a correction of sagging of the forehead with an eyebrow better positioned, illuminating the eyes, a moderate re-tightening of the upper eyelids, smoothing of crow’s feet, and a net attenuation of forehead and glabellar (between the eyebrows) wrinkles.

The results are generally durable, although the aging process is not stopped by the intervention, the benefit of the facelift will be felt many years after.

The goal of this surgery is to bring improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction.

DISAPPOINTING RESULTS

These can result from a misunderstanding about what we can reasonably expect. This is so that wrinkles can be significantly reduced without disappearing completely, or excess skin on upper eyelids, which may require additional excision at their level to get an optimum result.

They can also occur because of unexpected tissue reactions or unusual scarring phenomena. It can sometimes be seen as swelling persisting for several months or as a small asymmetry in the look.

These imperfections, if they are poorly born, can possibly be corrected by a small "touch" that will usually be under local anaesthesia, from the 6th month after surgery.

POSSIBLE COMPLICATIONS

An endoscopic facelift, although carried out for aesthetic reasons, none the less a real surgery, which involves the risks associated with any medical procedure, however small it may be.

We must distinguish here between risks related to the anaesthesia and those related to the surgery.

For the anaesthesia, the anaesthesiologist will explain the risks during the preoperative consultation. You must be aware that anaesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anaesthesiologist, in a surgical context, means that the risks are statistically practically negligible. In fact techniques, products and monitoring methods have progressed considerably over the last twenty years, giving optimal safety, especially when the operation is not an emergency and the patient is in good general health.

Concerning surgery: by choosing a competent, qualified Plastic Surgeon, used to performing this procedure, you limit the risks, without however eliminating them completely.

Fortunately, real complications are rare following an endoscopic facelift that has been carried out correctly. In fact practically all the operations go well and patients are completely satisfied with the result.

In spite of the fact that complications are so rare you must be aware of the following possible problems:

Hematoma: mostly harmless, may need to be evacuated if it is too important.

Infection: unusual when the procedure is performed under normal conditions of asepsis.

Complications such as wound healing abnormalities or localized alopecia (hair loss) are more rare than in traditional face-lift because of the limited size of the incisions. However, smoking increases their risk.

Nerve damage: it may concern some sensory branches and then be responsible for certain insensitivity and itching of the forehead and scalp that eventually subside after a few months. A paralysis of the frontal branch is much more rare and, fortunately, is only temporary in most cases described.

All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.

You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.

These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.

Our advice is for you to keep this document and to read it and think it over carefully after your consultation.

Once you have done this you will perhaps have further queries, or require additional information.

We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.


"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).


This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.

The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.