MIDFACE LIFTING
Aesthetic surgery:
This document has been conceived under the authority of the French Society of Plastic, Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION
Many facelift techniques are described in the medical literature. They all intend to correct the disgraces caused by the aging of the face and neck.
The two more common types of facelift in the activity of a plastic surgeon are the classic face and neck lift and the midface lift. These two techniques are no opposites, but respond to different aesthetic goals. They may be associated in some cases.
The face and neck lift acts on the neck, cheeks and finished its work on the temples. It is being described separately in another document.
The midface lift acts on the lower eyelids, the bags and rings under the eyes and on the cheekbone.
In any case, this surgery being for aesthetic reasons cannot be covered by health insurance.
AIM
This facelift is discussed when the patient, before the mirror, correct by a vertical pull up on the cheeks some age-related disgraces.
This lifting is not suitable for all patients and only the surgeon can lay the indication.
This intervention may be associated with another technique of facial plastic surgery: lipostructure of the face, neck lift and can be completed by non surgical treatments (dermabrasion, laserpeel, botulinum toxin injection, injection of fillers like hyaluronic acid).
This midface lift does not aim to change the features but to replace the anatomical structures in a more young position.
BEFORE THE OPERATION
A usual preoperative assessment is normally conducted as required. An anaesthesiologist will be seen in consultation at the latest 48 hours before surgery. No medication containing aspirin should be taken within 10 days preceding the intervention. It is practical washing the hair the night before surgery and a thorough make-up cleansing the day of surgery. It is essential to fast (nothing to eat or drink) 6 hours before surgery.
TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia
Midface lift can be performed under general anaesthesia or under local anaesthesia deepened by intravenous tranquilizers ("vigil" anaesthesia).
The preoperative consultation by the anaesthesiologist will allow checking possible contraindications.
Hospital stay
This procedure can be performed either with a hospital stay of 24 hours or "ambulatory" that is to say with a same-day discharge after a few hours of surveillance.
THE PROCEDURE
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Two incisions are usually required to complete the surgery. A first incision is located at the lower eyelid, just below the eyelashes and extends into the crow’s feet, to remain discreet. A second incision is hidden in the hairy part of the region of the temple. These two incisions on each side, allow the surgeon to perform a detachment of the deep subperiosteal plane (in contact with the bone).
Depending on the surgeon, a vertical suspension of the cheeks will be conducted, either by sutures or by more sophisticated absorbable anchoring systems.
Excess lower eyelid is removed at the end of surgery.
The procedure lasts one to two hours.
An absorbent dressing is put in place for some hours following the operation.
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A somewhat different strategy, proposed by other surgeons, allows avoiding a temporal incision. A single incision is made at the level of the lower eyelid, just below the eyelashes and extends into the beginning of the crow’s feet, to stay inconspicuous.
The detachment of the cheekbone is done deeply, in contact with the bone, as indicated above.
The repositioning of the skin, strictly vertical, does not continue to the side of the cheekbone, which eliminates the need of associate a temporal lift.
The suspension of the cheekbones is performed as indicated above.
This technique avoids the access of the temple region and thus without action on it.
AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
The discharge takes place in the evening or the next morning, usually without dressings.
Moisturizing eye drops may be prescribed. Analgesic and anti-inflammatory treatment is prescribed.
The first days you need to rest up and avoid any exertion.
During these early days, the patient should not be surprised or worried of:
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overcorrection,
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a diffuse edema of the face (swelling) that may worsen quickly (it is more marked the second day than the first). It can sometimes be asymmetrical.
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ecchymosis (bruises) in the region of the eyelids
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a non-painful irritation of the eye (redness of the eye)
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a feeling of tightness under the periorbital bones
The overcorrection is necessary for a successful intervention and disappears in 7-10 days. It is increased by the edema.
The bruising and swelling usually disappear within 2-3 weeks. Some areas regress more slowly.
The tightness sensation disappears within a few months.
The scars are usually hidden under the eyelashes and hair. The only slightly visible scar below the lashes and mainly in the outer part, may, upon the tenth day be camouflaged by makeup. It will gradually fade.
Basically, patients will be:
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the seventh day, presentable to their innermost circle
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about the fifteenth day presentable for their friends (the sunglasses type "mask" are particularly suitable for convalescence)
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but to appear before the people you do not want them to know the operation, it is necessary to wait, in the absence of complications, 3-6 weeks.
THE RESULT
After six to eight weeks, you can have a good idea of the final result. It does however stabilize until the third and sixth month.
Sometimes the scars under the eyelashes are still pink for 3 months, but they are easily camouflaged by makeup.
The temporal scar, even red and indurated, is perfectly concealable by the hair. This scar sometimes starts to fade as early as six months.
Thanks to the contribution of the midface lift, the rejuvenation effect is significant with an aesthetic result which remains natural and harmonious.
The physical improvement is usually accompanied by a psychological well-being.
In the long term, aging continues to do his work and the face continues to suffer the ravages of time.
A maintenance care of the face with specific treatments for the skin (laser, pulsed lamps...) and with injections of fillers and botulinum toxin helps maintain the results longer.
A new intervention, often more moderate, may sometimes be necessary.
DISAPPOINTING RESULTS
It can be mainly:
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edema (swelling) persistent in some areas beyond the third month and could require massage,
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a partial relaxation of the tissues.
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scars too visible or loss of hair in the temporal region (alopecia) that may require further surgery later (six months to a year).
POSSIBLE COMPLICATIONS
The midface lift, although essentially carried out for aesthetic reasons, none the less is a real surgery, which involves the risks associated with any medical procedure however small it may be.
We must distinguish complications from anaesthesia from those associated with surgery.
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Regarding anaesthesia, during the consultation, the anaesthesiologist will inform the patient on the anaesthetics risks. You must know that anaesthesia-induced reactions in the body are sometimes unpredictable and more or less easy to control: the fact of using a fully qualified anaesthesiologist, practicing in a real surgical context, makes the risks become statistically almost negligible.
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Regarding the surgical procedure: in choosing a qualified competent plastic surgeon, trained for this type of intervention, you limit the risk at maximum, but not abolish them completely.
Fortunately, the postoperative course is generally simple after a surgical procedure performed according to the rules, and real complications are rare.
In practice, the vast majority of operations go without any problem and the patients are satisfied with the results.
However, despite their rarity, you still should know the possible complications:
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A hematoma, may require rapid evacuation or a secondary puncture.
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Localized skin necrosis, which causes delayed healing. It can be promoted by smoking.
These two complications are exceptional after a midface lift, mainly because of the profound nature of detachment.
especially a paralysis of the temporal branch of the facial nerve, responsible for the elevation of the eyebrow. This results in an inability to raise an eyebrow with asymmetry on both sides. This asymmetry is most often temporary and the injection of botulinum toxin into the other eyebrow can get, if the patient desires, symmetry during the recovery time. However, in some cases it may be permanent.
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the loss of sensitivity of half the upper lip is sometimes observed. It is most often reversible.
abnormal scars, hypertrophic or keloid, of unpredictable onset and changes, can compromise the aesthetic outcome and require specific local treatments, often long. But these anomalies are rare in the eyelids.
The infection is exceptional when the procedure is performed with strict aseptic conditions.
An ectropion (lower eyelid retraction) is possible after this type of intervention. Its appearance in the days after surgery or later in the first few weeks, can sometimes lead to surgical revision even skin grafts. However, simple massage can often get a satisfactory scar release. This complication remains uncommon but its proper management is necessary to prevent any risk of eye complications (irritation, inflammation, dryness). A tendency to round eye can also be observed.
Nerve lesions:
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.