THE FACELIFT
(Rhytidectomy)

the facts…………………..

Your Consultation

Cosmetic surgery patients can safely be split into two groups.  Those born with, or who as they grow, develop features they do not like.  For example: a large nose, large breasts or even undeveloped breasts, protruding ears, or indeed, any feature that may make them unhappy.  Then there are those who are unwilling, or unable to come to terms with the effects of ageing, pregnancy or trauma.  Both groups may be unhappy to the detriment of their self-esteem.

Today in the United Kingdom, there can be few unaware of the benefits of cosmetic surgery and many consider it to be the “ultimate voyage of self improvement”.  However, good cosmetic surgery is not an accident, or a miracle, it has to be planned.

Planning starts with your consultation…..

Consultations should only be given by one person, a highly experienced surgeon who is the only one capable of determining whether you are a suitable candidate for the surgery that you are asking for.  Counsellors, lay or nursing, irrespective of their experience are not licensed to operate and although they may assist with simple explanations, you should not allow yourself to be placed in a situation where they advise surgery.  Most lay counsellor’s work on a commission basis and it is therefore unlikely that your best interests will figure prominently in their thinking.

At the consultation you will not find lay counsellors.  All consultations are carried out by highly trained Surgeons.

The patient prepared to accept advice from an unqualified source should not be too surprised if the standard of surgery reflects this fact.  Competent professionals will not be found associating with this type of organisation.  It may be wise to bear this in mind.

No substitute exists for a Pre-Operative Consultation.  It may be inconvenient; you may feel it unnecessary believing that you know what you want.  The truth is different.  Consultation is an integral part of any treatment you may have carried out.  It cannot be bypassed.

 We do not charge for Consultations.  A very high degree of knowledge and skill is required for a well-balanced opinion about the necessity for the operation in which you may be interested.  You must appreciate that even when the advice is not in favour of surgery, it comes from a highly qualified person who has given his time, attention and experience to your problem, consulting, both pre and post-operatively accounts for over 50 per cent of surgeons times and good ones do not give this time away.  Neither will they tell you that you need surgery when you don’t.  Surgeons build reputation not only by the work they carry out, but the work they decline.

The Consultation is free of charge, but if you do not attend a consultation when booked and have not informed us that you are unable to attend then a fee becomes payable.

Appointments for consultation may be arranged by telephoning the Patient Information Service.

Do’s & Don’ts

Considering cosmetic surgery?  The following simple rules should ensure that you end up looking better, not worse………..

• Avoid any organisation where “counsellors” are employed.  The only person qualified to advise you on your surgical requirements is the surgeon who is to carry out your surgery.  Nurse counsellors should also be avoided.  They have no training, which makes their advice of no use to you.  Counsellor usually means sales, which usually means problems.

• Do nothing until such time as you have consulted a highly experienced Surgeon.  Experience without training is not much use to you.  Always insist on a highly experienced Surgeon.

• Do not accept shared, or worse still, mixed accommodation.  You need your own room and bathroom.  Good surgeons will not be found working where conditions such, as this exists.

• Ask to speak to some of your surgeon’s previous patients.  Particularly those who have undergone the same treatment in which you are interested.  All competent surgeons have patients prepared to give testament to their competence.   If you were told that this would not be ethical, it would probably be better if you found another surgeon.

• Exercise caution when offered photographs depicting patient’s pre and post operatively.  There are several things to consider here.  The first is whether or not they are the property of the person showing them to you.  All too often the same photographs keep turning up with different surgeons claiming to have carried out the operation.

The second thing to bear in mind is the simple face that these photographs will represent the very best a surgeon or organisation can produce.  They are not going to show bad photographs.  If what you are shown does not impress, you should remember that what you are looking at is probably their very best.  You may not do anywhere near as well.

• All responsible surgeons and organisations publish detailed facts with regard to the procedure in which your interests may lie.  Avoid those whose information consists of nothing more or less than trumpet blowing.  Pictures of smiling patients do not tell you what you need to know.  Look for detailed information and explanations about the procedure, which should include the disadvantages and risks as well as the advantages.

• Ensure that your levels of expectation are realistic.  Plastic Surgery is not going to turn you into a film star, nor much sought after employee, not is it going to mend marriages.  In fact, apart from improving some aspect of your appearance there is very little else you can justifiably expect from it.

If improvement of appearance is all you ask from your surgery, you will no doubt be delighted at the increase in self-confidence and rapid return of self-esteem.  However, as stated above, ensure that your expectations are realistic by discussing carefully with your surgeon just what can be achieved.

• Do not have surgery to please someone else.  This is a private solution to a personal problem and surgery carried out for this reason is rarely successful.  If you have surgery, have it because you want it, not for somebody else.

Considering Treatment?

Today it has become almost cultural to take vitamins and food supplements as an aid to maintaining health.  However, if you are considering aesthetic plastic surgery and regularly take food supplements please read the following very carefully.

Likewise, if you are taking any medication on a regular basis, the following information is of importance to you:

The following must not be taken two weeks prior to surgery being carried out and for the two weeks following:

Effamol G     Primrose Oil     Wheatgerm With Vitamin E      Evening Primrose Oil     Salmon Oil Capsules    Cod Liver Oil Capsules
Multi-Vitamins with E

No anti-inflammatory agents (mediations for the treatment of swelling, bruising, pains, etc) including:

 

No Naturopath preparations including:

 

Do not take medications containing salicylates including:

 

Or anything containing Aspirin.  You may take paracetamol.

Monoamine Oxidase Inhibitors (Moams), prescribed for depression must not be taken, nor any medication used to thin the blood.

Smoking may seriously affect the outcome of any surgery you may be contemplating but particularly in the case of:

 

You should stop smoking ideally from six weeks pre-operatively and for two weeks post-operatively.  If you can stop for this period of time why not stop permanently?

Please contact us if you require explanation or further information on the above.

The Facelift
(Rhytidectomy)

This booklet has been prepared to answer many of the frequently asked questions about Facelift (Rhytidectomy).  The information contained within is important to everyone thinking about Facelift (Rhytidectomy) treatment and we recommend that all sections be read carefully.

You must not use this Facelift (Rhytidectomy) information as something on which to base final decisions without the benefit of an individual examination.  Descriptions of the surgical details are in general terms and will not apply to everyone.  This Facelift (Rhytidectomy) information may, however, serve as a starting point for your enquiry.

The material contained within this Facelift (Rhytidectomy) booklet was designed to allow careful consideration at home of both the procedural and surgical details of the operation in which you are interested.  It is free of photographs, makes no recommendations for surgery and in no way should it be considered promotional material for the hospital.

If you consult a surgeon you do so in the knowledge that he endorses the basic concept of this Facelift (Rhytidectomy) booklet.  Wherever his ideas or methods differ from those described within, he will draw this to your attention and describe his own preferences and the reason for them.

Differing methods should not be considered as deviating from normal, or accepted procedures.  There are hundreds of variations for each surgical procedure carried out and your surgeon has a duty of care to ensure that he selects that, which is appropriate for you.

Why have Aesthetic Plastic Surgery? 

Examine your reasons – make sure that your expectations are realistic – have a positive attitude remember plastic surgery will not resolve your major life problems but should boost your confidence and self esteem.

Do not have surgery to please someone else, these are private solutions to personal problems and surgery for this reason is rarely successful.

When a reputable surgeon and anaesthetist carry out an aesthetic surgery operation, it is rare for severe complications to occur, but nothing can be guaranteed absolutely.

However, in very difficult cases it is conceivable that several procedures may be required before the ultimate end result will be achieved.  If this is the case, you will be advised of this fact before you are allowed to elect for surgery, and the price you are quoted will include the close of all surgery necessary.

Rarely is aesthetic plastic surgery covered by insurance policies.  Surgery required to correct poor attempts at cosmetic surgery may be covered by medical insurance if it can be shown that the correction of previous surgery is essential to the health or well being of the insured.

When surgery is carried out to correct the result of poor surgery carried out elsewhere, it is done so on the basis that more than one surgical procedure may be required and that such procedure(s) do not carry the guarantee applicable to surgery originating from this hospital.  This type of surgery is usually difficult and unpredictable and may require several procedures.  If you hold medical insurance, it may well be that the cost, either in full, or part, will be met by your insurers.  The Hospital will assist with the necessary forms.  An ever-increasing amount of surgery carried out at this Hospital is for corrective purposes.

Everyone is different and the same operation will have different results.  Some take longer to heal than others, some skins produce raised scars and other, hardly any at all.  This is due to differing natural healing responses, which cannot be evaluated prior to surgery.  You must remember this.  Minor revision surgery may be required because in major or complex procedures it is more likely that all the factors of shaping and healing, will fail to give a perfect result first time.  Some revision surgery becomes necessary, because a patient fails to transmit his or her true requirements to the surgeon.  If you have a passive personality (absolutely nothing wrong with that) and during your consultation say, you contribute little, you are most likely to end up with the surgical result which reflects your surgeons aesthetic tastes as opposed to your own.  As previously mentioned, if your requirements are specific in any way, they must be made known to your surgeon during consultation.  During your consultation, your surgeon will listen carefully to what you say, noting down your requirements in your personal records.  These notes will be of great value to him, both when planning your treatment and carrying it out.  If you are accepted for treatment, please do not make a definite appointment for your surgery to be carried out unless you are sure you can keep it.  The Nottingham Center for Cosmetic Surgery required a fee equivalent to 10% of the total fee payable before booking a surgical appointment and this fee is non-refundable in most circumstances.  Please discuss this point with administration.

Anaesthetics

Wherever possible, we avoid the use of general anaesthetics, preferring instead to use sedation therapy, Twilight, as it is sometimes known is a natural method of anaesthesia, which allows you to sleep naturally throughout your operation.  Many patients say that in effect they were not really asleep but in a “twilight condition” which they enjoyed.  The advantages of this type of anaesthesia are enormous both to patient and surgeon alike.  You will benefit in that when you awake you will not feel sick, will not have a sore throat and will be able to drink almost immediately.  Anaesthesia should not cause you concern. 

Hospital Administration

Patient Information Managers are appointed by to ensure that every patient is fully aware of the consequences of electing surgery.  PIM’s as they are known, are the people who will book your operation should you elect surgery.  However, before they do so they will need to know that you are confident of your decision and that you are aware of all aspects of your treatment and its effects upon you.  You may feel that the Facelift (Rhytidectomy) information you are given is more than necessary or, unduly pedantic.  We do not believe this to be the case, rather that well-informed patients make better patients.  The future for cosmetic surgery is too bright to leave patients in the dark. 

The Facelift (Rhytidectomy)

Unfortunately, some would say, the modern world is geared to youthful, appearance, and many executives worry about being bypassed by their juniors. There are several factors which influence ageing of the face.  A major one being heredity.

Almost everyone knows an elderly lady with a perfect complexion, who is seemingly immune to the process of ageing.  Another, is exposure to ultra violet light.  It is well known that people who live in tropical climates age prematurely.

The Facelift (Rhytidectomy) procedure is the most sought after within the over 40’s age group.  However, increasingly, Facelifts (Rhytidetomy) are being carried out on younger patients.  This is in part no doubt due to increased travel abroad, and the consequent exposure to ultra violet radiation.

In women, even the loss of bone from the skeleton as they age can be a contributing factor.  The loss of bone (osteoporosis) can be quite pronounced in old age and in many cases is responsible for the stooped position affecting elderly people.

Gravity is a constant factor, its effects being to pull the soft facial tissues downwards.  This causes sagging of the cheeks, which accentuates the crease lines that run between the nostrils and the corners of the mouth.  The effect is also seen on the jaw line, and underneath the chin (double chin) in the sub mental area.

People who have very expressive faces exhibit numerous crease lines, caused by the action of the facial muscles on the skin.  A Facelift (Rhytidectomy) has always been regarded as a major surgical procedure, but in reality need hold no fears.

It is important to remember that nothing can erase permanent creases and all the Facelift (Rhytidectomy) can be is “wind the clock back” by reversing the effects on appearance of gravity.

Although the occasional film star may undergo a celebrated Facelift (Rhytidectomy), the vast majority of patients are those normal people who take pride in their appearance and feel younger than they look.  This Facelift (Rhytidectomy) booklet contains limited and by necessity, brief information on how a Facelift (Rhytidectomy) is carried out.

The procedure was first described in 1912, and in some cases is still carried out today.  The skin re-drape was effective in that it tightened and lifted sagging skin and no doubt brought much pleasure to the pioneers who were the first patients.

It suffered than as it does now, with one real problem, the effect is often short lived.  In the United States, this procedure is known as the fluffy lift because the procedure and result are somewhat woolly.  It takes less than 2 hours to carry out and in the UK is carried out frequently!  We do not carry out fluffy lifts!!

This type of lift was carried out on a regular basis until the early 70’s when Swedish Surgeon Tord Skoog first described the SMAS (Sub Muscular Aponeuretic System).  This was a complete re-think and revolutionary in that it dealt not only with the lifting of the skin of the face but the underlying structures as well.

This meant that a face could be lifted and stay lifted for several years.  In some cases, in excess of a decade.  The SMAS type of lift is that favoured by competent surgeons and there are now many variations on the original concept.
Following the introduction of the SMAS Lift came the Tri-Plan Lift, the Deep Plane Lift, the Composite Lift and Sub-Periosteal Lift and finally to bring everything up to date, the Flute Lift.  All these methods use similar incisions but differ and/or additional techniques to achieve similar results.  It is important to remember that different methods do not indicate a departure from any formally established standard.

Many surgeons carry out Lipoplasty during a Facelift (Rhytidectomy) so as to ensure that the jaw line is clearly defined and the sub-mental fat pad (double chin) is removed.

When you meet your surgeons, you will be asked a general medical history, together with the details of any previous facial surgery.  Slight differences in facial symmetry are normal and will be pointed out (as they are often unnoticed by the patient).

If you smoke you will be told that surgery will not be carried out until such time as you have stopped for 6 weeks.  Smoking constricts (seriously in some cases) blood vessels and the risk of compromising even further, the blood supply to the face through a non-essential operation, is one we are not prepared to let you take.

Be warned.  There are many who will let you take your chance.  The result from smoking on the Facelift (Rhytidectomy) patient is well documented with many instances of patients losing cheeks through the inability of the body to supply the area with adequate blood……

Your surgeon will explain to you that certain areas of the face cannot be helped by surgery, such as the upper lip and crow’s feet because tensioning these areas would cause distortion of the facial features.  He will explain that these areas can be dealt with by the new skin re-surfacing lasers, or the more recent derma-sanding techniques, which are covered under separate notes.

By gently lifting the facial skin, remember this is not a face pull; the surgeon is able to show you what may be expected postoperatively.  It is important, that both men and women alike, are aware that the position of the hair in front of the ear is altered, and may be elevated for 2cm.

In men, the beard may be repositioned underneath and behind the ear, necessitating shaving in these areas.  The extent and positioning of the scars will be carefully described.  Facelifts (Rhytidectomy) are usually carried out under general, or twilight anaesthesia.  It is not necessary to shave significant areas of hair.

In both male and female, the incision starts approximately 2 inches above the upper pole of the ear and is hidden by hair at this point.  It then passes downwards in front of the ear, passing beneath the ear lobe and upwards behind the ear (in the groove between the ear and the skull).  It then angles backwards for about approximately 2 to 3 inches, where again it is hidden in the hairline.

The surgeon next then creates a pocket immediately in front of the ear and undermines the skin forward onto the cheeks and down as far as the jaw-line.  The underlying structure of the face is now accessible and the surgeon will make necessary adjustment to the muscles so as to ensure that the face will stay lifted.  The surgeon then completes the required size of the pocket by continuing along the incision which as previously described, runs over the jaw-line into the upper part of the neck, and then back up to the areas behind the ears.

Having made this pocket, the surgeon meticulously stops any bleeding from blood vessels under the skin.  Following this the loose, expanding skin, is elevated upwards, overlapping skin excised, and the wound closed by either miniature staples, or conventionally sutured.

The results of any properly carried out Facelift (Rhytidectomy) should be lasting but the procedure cannot halt the ageing process.  The clock can be turned back but you cannot stop it ticking.  However, it is reasonably safe to say that the delay in ageing made available to the average Facelift (Rhytidectomy) patient is sufficient for their adjustment to various changing social pressures.

The whole concept and philosophy of face-lifting in constantly being evaluated by plastic surgeons who increasingly are carrying out additional procedures during the operation to produce a better and more natural look; one which will last even longer.

We have already mentioned that the Facelift (Rhytidectomy) is a complex procedure.  Many patients think of it along the lines of a medical beauty treatment but it is in fact a major operation requiring the facilities and skills associated with major and complex surgery.  Remarkably, problems occur only rarely, but they do occur.

Occasional complications are post operative bleeding, delayed wound healing, nerve damage, and skin lumpiness or distortion.  Nerve damage and skin distortion are rare, when the procedure is carried out by a competent surgeon but nonetheless can still occur.

In the case of post operative bleeding, if a blood collection (haematoma) occurs, it may be necessary to evacuate the blood clot, or if minor, natural re-absorption will occur.

It is necessary to insert drainage tubes underneath the skin during the operation, which are removed a few hours later.  It is also usual for the surgeon to apply a head bandage in order to gently pressurise the incisions during the post operative night.  This bandage is removed the following day.

Delayed wound healing is a temporary complication which results in a small scab which separates after 1 or 2 weeks.

Behind the ear, and rarely in front of them, scars of certain skin types can stretch.  These skin types cannot be identified prior to surgery.   Often, these are easily hidden by normal hair but may become visible if the hair is cut short or lifted.  Whilst hundreds of complications can occur with any operation, however simple, most surgeons will never see the majority of these, provided they are properly trained and careful about their technique.

If, following surgery you were bandaged, these will be removed the following day and you may then return home.  It is important not to stoop, or carry out vigorous activities for 2 to 3 days; otherwise post operative bleeding could result.  Patients are provided with written post operative care instructions.

Sutures are removed at the discretion of your surgeon, usually between 5 and 10 days post operatively.  It is advisable not to apply any strong hair chemicals (bleach, ammonia, etc) for 4 weeks following surgery.

The only scar normally visibly, is in front of the ear.  Fortunately for the patient and surgeon alike, this is usually inconspicuous.  Some thickening and reddening of this scar may be expected, possibly for some months, but this invariably fades to a natural skin colour and texture.

Rarely the scars in the hairline may stretch a little.  This is where the tension of the lift is carried. This does not present a problem when the hair is worn down.  Massage of the scars speeds up the maturation process, and is recommended in all cases.

Massage should not be carried out in a way likely to increase tension on new scars.  As with all facial surgery, the hair is washed prior to the operation taking place.

Your hair will be carefully washed the day after your surgery, when all things being well, you should be able to return home.  Over the next few days you should wash your hair daily.  Obviously you should exercise care in the suture area.

Finally, although previously mentioned, a review of possible risk and problems concerned with the Facelift (Rhytidectomy) procedure is appropriate.

Infection-many causes, all require the same treatment-antibiotic.  Delayed wound healing-treatment at the discretion of your surgeon.

Allergy to dressings used during and after surgery.  This may cause skin irritations, or a feeling of bruising which could persist for several days.  Your surgeon will advise you if your report this problem.

Over-correction during a Facelift (Rhytidectomy) is rare, perhaps only apparent to a limited degree during the early post operative period when tissue swelling may still be present.  Over-correction would manifest itself by restriction of facial motion.  Were it to happen it would soon resolve itself.

Following the Facelift (Rhytidectomy) you may experience a feeling of numbness and tension in the neck and cheek areas as well as around the ear.  This is the result of the small sensory nerve fibres in the skin being separated during the operation.  Sensation should return to normal within 4 to 6 weeks of the operation.

Swelling may produce some temporary lag in the normal motion of the facial muscles but this should gradually subside without permanent change.

There are few special circumstances which require particular emphasis.  Patients with extremely short necks and a great deal of fullness in the soft tissues are not ideal candidates for this procedure.  Even when accepted for treatment such patients must recognise that the potential benefits will be limited.

Patients with thickened skin and a tendency towards oiliness also present additional undesirable qualities for good healing and optimum results.

All patients must recognise that marked degrees of skin laxity or thickness may not be entirely correctable.  Some recurrent sagging can take place even after the first 6 to 12 months.  Secondary procedures may be desirable to achieve maximum benefit.

There have been recent developments to improve results in these difficult cases which include special management of the neck muscles and selective removal of excess fatty tissue under the chin and lower cheek areas.  Requiring more surgical time, the procedures can be most rewarding.

Remember, even the most competent surgeon cannot guarantee absolutely either the result of his surgery, or the effect it may have on you.

Allow 14 days away from work following discharge from hospital, rarely more in certain cases.  Post operative instructions will be given prior to discharge from hospital.

Anterior Temporal (Partial) Facelift (Rhytidectomy) 

Surgical Anterior Temporal Facelift – Notes for Guidance

It is helpful to understand the basic construction of facial skin, in order to appreciate the various facial cosmetic treatments, including Facelift (Rhytidectomy).  The skin consists in-

• Water.

• Tissue: epidermis (the visibly surface layer) basal laminas, dermis layer fat layer under the skin.  The dermal layer supports the surface skin and gives it its shape and tone.  An important part of this layer is a network of: collagen, reticular and elastic fibres, which in the young skin are firm and elastic, with the necessary resilience to recover from the lines and wrinkles created by facial expressions, such as smiling and frowning.  However with the ageing process we find that:

• the collagen network starts to weaken.
• decrease the supply of the skin with blood, oxygen and nutrients.
• Decrease the Keratin production.
• Increase the dissipation and decomposition of fatty tissue and skin lipids.
• Decrease the secretion of sebaceous glands and sweat glands.
• The supporting bones gradually shrink a little.
• Slacken muscle.

The ageing process is genetically controlled, but over the years these biological influences are accelerated by:

• excess exposure to sunlight.
• The effect of gravity.
• General stress, strain.
• Smoke.
• Alcohol.

Thus, the skin sags, resulting in the looseness, folds and wrinkles, which we associate with age.  This happens to different people, at different chronological areas, which can mean that a person can look older than they might be, or wish to look or in fact feel.  Indeed, age is more an attitude of mind – one is as young as one feels.  Anterior Temporal (Partial) Facelift (Rhytidectomy) has indication in:

• ‘crow’s-feet’ correction.
• The correction of eyebrows, cheeks.
• Associate with upper eyelids surgery.

In our time, results have improved due to additional tightening of muscle (SMAS) and suction of the fat to the neck and chin, which are sometimes necessary to complete the end result.  An important point is that it should not be thought that the skin age more rapidly after the surgery.  The ageing process of the skin appears slowed down, or at the very least remains unaltered for a time.  The operation is carried out under twilight anaesthesia.

We will explain the operation in simple terms.

An incision is made in temporal region (just inside the natural line of hair) and prolonged in front of each ear (pre-auricular region).  The SMAS associated procedure involves working on the facial muscle and fatty tissue below the skin.  The Anterior Temporal Facelift (Rhytidectomy) involves the dissection of an anterior flap and then it is pulled in a middle tension (by stretching backwards and upwards, the excess of the skin is removed and the skin is sutured into position at the incision points.  It should be noted that the skin is not drastically stretched; it is only put under a similar tension comparable to the previous to ageing and sagging.  This is a rejuvenating process.
 
The operation time is 1hr-1.30hr.  The time varies depending on the complexity of the case.  You do not need to stay overnight in the hospital.  After the operation the face is bandaged in compression dressings and facial movement must be restricted for the first few days.

The staples (from temporal region) and the stitches (from pre-auricular region) are removed between 5-12 days after surgery and normally, after about 2 weeks, you will be able to return to work and socialise as normal.  Patience is required however as the time it takes for the temporal facelift to settle down properly and for the full effect to be achieved is 3-6 months.  Post operatively it is helpful to massage the face with moisturising cream.  It is very important to carefully follow the directions of the surgeon on aftercare to ensure the best results.

As with any surgery these are risks, but fortunately complications are rare and can be treated by routine procedures and are not hazardous to the patient’s health.  At first there may be swelling, bruising and tenderness as one would expect, but pain relievers will be prescribed.  As soon as the stitches are removed you may wear full make-up.  There will be scars when there is an incision although they will be inconspicuous in position and with time will fade to become virtually undetectable.

A temporary feeling of tension may be felt.  Numbness, across the cheeks may be noticed which may last 6 to 12 months, but is not permanent injury to the facial nerve which has been reported in medical literature, but this is very rare less than 0.1%.  In men there may be very slight alteration in the line of the hair and beard, pattern can be discussed with the surgeon.

There may always be permanent hair loss at the actual incision sites.  Bleeding under the skin occasionally presents itself, but does not ultimately affect the result of the operation.  To reduce the risk of bleeding and to allow the underlying tissues time to heal it is important as mentioned above, to restrict motion of the face after surgery.  Any exertion of any kind must be kept to a minimum for the first few days.

In certain cases albeit very rare, a secondary operation may be required, where there is a marked degree of skin laxity the initial temporal facelift may need to be re-enhanced by a second operation 6 to 12 months later.  It should be noted that the Temporal Facelift (Rhytidectomy) alone cannot remove all wrinkles, so other methods works well, i.e.: chemical abrasion, dermal abrasion, laser etc.  Any secondary or additional procedures would incur all the associated hospital and surgical fees.  Anterior Temporal Facelift (Rhytidectomy) is a well-established, very effective operation and successful operative procedure, which has benefited many thousands of patients, both male and female.

This leaflet has been prepared to give a basic understanding of the procedure before a consultation takes place, and to encourage any answer many of the questions, frequently asked about this type of cosmetic surgery.  Final decisions should not be made until an individual assessment has taken place with the surgeon.  There is no obligation to undergo surgery by attending for consultation.  If you have further questions or would like to arrange a consultation, please do not hesitate to call us.

General Anaesthetic

After you have discussed your operation with the surgeon, it will be necessary for you to consider your anaesthetic requirements.  In order for the operation to be performed painlessly, it will be necessary for you to have an anaesthetic of one type or another.  Although we try and avoid the use of full-blown general anaesthetics wherever possible, in many cases, for reasons of your absolute comfort and safety they are required.  Modern general anaesthetics are safe.  You need not fear them.  They are even safe for the type of patient seeking elective surgery because of their fitness levels.

If a GA has been selected as being appropriate in your case you will meet your anaesthetist before the operation but, because your operation is not urgent in a medical sense, it is sensible for you to be as fit and healthy as possible, prior to the anaesthetic.

In order to avoid unnecessary disappointment, this leaflet has been prepared describing some common problems, which can result in the operation being postponed.   If you are in any doubt, please contact the hospital prior to leaving home.  If it is essential to postpone your operation you will then be spared the journey, when a new date can be arranged.

Most people have never had an anaesthetic.  The latter part of these notes describes what will happen before, during and after your anaesthetic.  The description is quite detailed, in the hope that it will take away some of your anxieties.  Your anaesthetist will be taking care of your all through the operation, although you will only be aware of his presence before and after the operation.

Coughs, sore throats, colds and influenza, or any infection in the breathing passages, can be made much worse by a GA.  For this reason you should be symptom free for at least two weeks before an anaesthetic.  Important symptoms include a fever, sore throats, runny nose or cough.

It is very important that your stomach is empty before you have a GA.  For this reason you should not eat, or drink anything, for at least 6 hours prior to your operation.  This will be advised to you on the day of booking your operation with the Patient Information Officer.

Most medical conditions do not cause difficulties for your anaesthetic, providing that they have been adequately treated beforehand.  If you have a problem such as diabetes, chronic bronchitis, or asthma, which deteriorates from time to time, it is best to have your anaesthetic during a good period.

If you are worried that you may not be fit enough for an anaesthetic, ask yourself this question: “while I have suffered from this problem, have I ever been fitter?”  If the answer is yes, please phone the hospital before leaving home, so that we can advise you on the desirability of having an anaesthetic at that particular time.  It may be necessary to delay your operation for a few weeks so that your medical condition can be improved.  This may be a disappointment at the time, but is done for your comfort and safety.

If you suffer from high blood pressure, you may like to ask your GP to check it for a few weeks before your operation.  If your blood pressure is unacceptably high, your GP will be able to read it before your have your operation.  You will appreciate that your GP will already have cared for you during your medical illness.  He is, therefore, in the best position to advise on treatment, which will return you rapidly to full fitness.

Many people do not want their GPs to know that they are having a cosmetic operation.  This is because they believe that he will be unsympathetic.  This is very rarely the case.  We prefer to involve your GP in any treatment, prior to your operation, as his advice can be immensely helpful.  We will always ask your permission before contacting him and will only do so if you agree.  We hope that you will agree for the reasons just given.

It is important that you bring with you all pills and medications that you are currently taking.  It is important that your anaesthetist knows what you are taking prior to Facelift (Rhytidectomy), so that he can give you an appropriate anaesthetic, which will not interact with your tablets.

Excessive consumption of alcohol can cause bleeding during and after the operation.  It is better not to drink at all before the Facelift (Rhytidectomy) operation but if you feel the need, please do not have more than one pint of beer, or one short, on the evening before your operation is carried out.  If you smoke, you are more likely to develop a chest infection after your operation.  Any reduction in cigarette consumption is helpful.  Ideally, you should stop smoking completely from the time of your first consultation or for that period of time advised by your surgeon.  Smoking has an adverse effect on the outcome of many surgical procedures.

Abdominoplasty and face-lifting operations required you to stop smoking for 6 weeks prior to your operation being carried out.  Do not lie to your surgeon about smoking.  The result of doing so could be severe.

Your anaesthetist will ask you for details of your teeth.  What he wants to know is whether or not you have any crowns, bridges or cosmetic dentistry, which will require him to use a different technique.  Teeth can be and often are, damaged by failure of the patient in informing the anaesthetist that crowns or bridges are present.

The possibility of damage to teeth during anaesthesia is remote, if you have given full dental information prior to your anaesthetic.

Your surgeon will tell you when you can expect to go home after your operation.  If you are discharged on the day of your operation, it is dangerous for you to drive, operate appliances, or machinery.  Long journeys by public transport can be exhausting, even after a minor operation.  It is therefore advisable for you to arrange to be collected by a friend or relative.  You may also find it helpful to stay with someone overnight.  You should not drink alcohol for 48 hours after your anaesthetic or for that period of time advised by your surgeon post operatively.

Each anaesthetist uses a slightly different method.  It is not therefore possible to describe precisely, what will happen.  The following description, will however, give you some idea of what to expect:

Before your operation your anaesthetist will wish to see you.  He will discuss your medical history and will examine your heart and lungs.  A nurse will already have taken your temperature and blood pressure.  Some patients may also have a heart tracing taken (ECG).

The anaesthetist will decide whether this is necessary on the basis of your age, medical history and the examination.

Conversely so, you should not worry if your anaesthetist does not take an ECG reading.  This simply means that your obvious good health obviates its necessity.  An ECG is taken as an added precaution, and you should not assume that the anaesthetist thinks you are ill.  Before an ECG is taken, he will explain why he thinks it is necessary, and afterwards will tell you what it shows.  You will then have a chance to discuss you anaesthetic.  Many people worry unnecessarily because they have head “dreadful stories”.
Modern anaesthetics are extremely safe, and we hope that you will feel free to ask as many questions as you like so that we can set your mind at rest.  You may also be written up for some sleeping tablets, which are optional, but are often helpful the night before an operation.

Before your Facelift (Rhytidectomy) operation you may be given a pre-med.  This is usually a tablet, but in certain circumstances may be an injection.  The pre-med will make you pleasantly drowsy and reduce your anxiety.  Although you will have been starving in preparation for your operation, it is perfectly in order for you to drink a small amount of water to help you swallow the tablets.  At about this time you will be asked to put on a theatre gown, and to remove all jewellery, except your wedding ring, which will be covered with tape.  You should only wear the gown and your lower undergarment.

About ten minutes before your operation, you will be asked to get onto a trolley and taken to the anaesthetic room, which is next door to the theatre.  The anaesthetic nurse will confirm with you the operation you are having, and will then put on you a blood pressure cuff, and small stickers, which will allow your anaesthetist to monitor your heart beat whilst you are sleeping.

You will then be anaesthetised.  This will involve a small injection in your hand, wrist or below.  You probably will not feel the injection at all, but if you do, it will be no worse than scratching yourself.  You will be asleep within twenty seconds after the injection.

Some people feel a little dizzy just before they fall asleep, others fall asleep instantaneously.  Each person reacts differently, but the majority of our patients do not find our anaesthetic procedure either disturbing or unpleasant.

Whilst you are asleep your anaesthetist will be looking after you all the time.  His sole duty is your safety and welfare.  Several sophisticated electronic monitoring devices are used to assist your anaesthetist.  These constantly monitor your heartbeat, blood pressure, and the quality of anaesthetic being given.

All the machines are fitted with alarms to give your anaesthetist early indication of the very rare occurrence when an abnormality may arise.  This allows the abnormality to be corrected.

When the Facelift (Rhytidectomy) operation is over, your anaesthetist will wake you up.  By the time you become aware of your surroundings you will be in a special recovery room.

A nurse will be with you until you are completely awake.  You will still be having your heart rate and blood pressure measured at regular intervals by automatic machines.  When you are fully awake (usually about 15 minutes) you will be lifted back into your own bed where you may drift back into natural sleep.  Even though you will not be allowed out of the recovery room until we are confident that your anaesthetic has worn off, it is quite common not to remember anything until you wake from this natural sleep.

Most of these operations are not nearly as painful as your might imagine.  Often the pain can be relieved by simple tablets such as Paracetamol.  Stronger painkillers are always available should you need them.  The nurses will ask you at regular intervals if you are feeling discomfort, or pain, but you may ask for painkillers at any time.

Questions

Are there any risks associated with a general anaesthetic?

Every anaesthetic carries a small risk.  The risk is minimal provided that you are in the fittest possible condition at the time of your anaesthetic, you have ensured that your anaesthetist is fully aware of your medical history and current medication and that you are starved at the time of your operation.  You can help by being honest about your medical history and any previous anaesthetic difficulties.

If your anaesthetist is fully informed before your Facelift (Rhytidectomy) operation he can choose the best anaesthetic for your personal needs.  If there is a risk associated with your anaesthetic, you anaesthetist will discuss it fully with you.  Almost all problems can be overcome, although your operation may have to be postponed for a few weeks.  Postponement of an operation is always a disappointment for the patient.  We understand this, and would only suggest it if we felt that it would add to your safety.

Will I wake up at the end of the operation?

Yes, you will.  There are only a few reasons why patients do not wake up at the end of an anaesthetic.  Most are for medical reasons, which can be anticipated and treated, provided we know your medical history beforehand.  Very rarely does an accident occur.

Almost all accidents occur because the anaesthetist is inexperienced and fails to monitor the patient properly.  Your anaesthetic will be administered by a senior anaesthetist who has passed all the examinations and is employed as a consultant in the NHS.  The monitoring apparatus used at this hospital is all up to the minute technology.

Will I wake up in the middle of the operation?

No.  This problem nearly always occurs in ladies who are having a light anaesthetic for a Caesarean section.  Because the baby’s safety must also be considered, it is vital that the least possible anaesthetic is given.  Sometimes an anaesthetic that is suitable for the baby is too little for the mother.

When you have your operation, the anaesthetist has only you to consider and you will be given as much anaesthetic as you need.  Waking during anaesthesia does not occur often.  It is a fear you need not have at this hospital.

Some operations can, in suitable cases, be performed under local anaesthesia.  The patient is awake and only the part of the body being operated on is anaesthetised.  If this method of anaesthesia is used, you will not need to starve and your medical problems are less important.

Another type of anaesthetic we like to use is sedation therapy.  Instead of a full general anaesthetic, a local anaesthesia is used but with the addition of safe drugs which thoroughly relax you.  If you are awake during your operation, you won’t remember, or feel anything.  However, most patients doze, remembering nothing until they wake up in their own bed.

Many people do not like to be awake during an operation, or even the thought of being awake, even though they will not be able to see the operation itself.  If you feel that you are one of these people, but have been advised to have a local anaesthetic, sedation therapy is for you.  If you are given a sedative, you must be starved prior to your operation.

YOU SHOULD NOT DRIVE OR DRINK ALCOHOL FOR AT LEAST 12 HOURS AFTER THE OPERATION. 

This information has been prepared to help you understand your anaesthetic.  If you are worried in any way about what you have read, please contact the hospital so that a further explanation can be given.

We hope that you will be pleased by your new appearance.  Our aim is to make your stay at the hospital as pleasant and trouble-free as possible.

We hope this Facelift (Rhytidectomy) information has answered most of your questions.  If it hasn’t please jot down any concerns you may have which can be dealt with either by telephoning us on 0800 0281 329 so you can elect to take your enquiry further, during your consultation.  If you do attend for a consultation please feel free to bring along a relative or friend whose judgement you trust, if you feel their presence would support you.

Photographs

Many patients express disappointment at the fact that these notes do not contain photographs taken prior to and following surgery.  The use of photographs projecting “only favourable results” is misleading and such photographs bear no relationship to the surgical result, which can be obtained apart from the patient so depicted.

Photographs of patients show only what was possible in that particular case.  There is no guarantee that you will fare as well, or won’t do better.  If you are interested in seeing photographic examples of your surgeons work, ask for them during your consultation when he can positively ensure that no confusion is allowed to exist.

About our In-House Therapist

Suzie has studied and qualified in many therapies, among them: Psychotherapy, Hypnotherapy, Neuro-Linguistic Programming, Emotional Freedom Technique, Anatomy, Physiology and Physical Therapies.

Suzie has worked extensively on studying the effects of thoughts, life experiences and stress on individuals.  Now an Eclectic Therapist, she works with a wide range of clients at varying levels; from deep seated emotional issues to Image Consultancy.  Suzie’s extensive range of skills have been nurtured through her varied background and experience.  Having worked as a model for several years, she then moved into Theatre and TV, later training as a make-up artist.  It is hardly surprising; therefore, that Suzie is passionate about looking your best, feeling your best and being your best.  She is engaging, warm, grounded and potent individual with a wicked sense of humour.

More recently, Suzie has been working as a trainer and facilitator for key corporate organisations.

Don’t miss the opportunity to work with this unique therapist and coach who is keenly aware of the thoughts and feelings of those who wish to make a change.

A quote from Suzie:-

“Many years ago I had a cosmetic procedure.  Whilst I was very pleased with the result, I realise now that I would have benefited in having a caring professional to help support me in addressing other psychological issues that were present, I did eventually seek out a therapist and coach who worked with me, enabling me to take control of my life and make the most of myself and my opportunities.  Seeing the results from people who take time to work with a therapist and coach encouraged me in the belief that what I am doing is worthwhile and valid”.

Our Methodology

Has four main influences in which our therapist and coach is fully qualified and able to support you:

Life Coaching 

• Identifying goals and working towards them
• Overcoming any obstacles on the way
• Often used in conjunction with other therapies
• Promoting personal responsibility
• Understanding the techniques
• Putting into operation new ways of being

Hypnosis 

• One of the most powerful tools to aid relaxation and de-stress
• Allowing positive suggestions deep into your sub-conscious
• Giving lasting results

NLP (Neuro-Linguistic Programming) 

• Understanding self and others
• Using a range of techniques towards significant improvement
• Helping you communicate more effectively
• Building relationships and rapport with others
• A very powerful technique when used with hypnosis

Psychotheraphy 

• Using the essence of this therapy for coaching purposes
• Supporting more deep-rooted issues which sometimes occur

What you will gain from coaching 

• Clarity
• Focus to fulfil your true potential
• A new found confidence and sense of self
• You will be empowered to go out and be the best you can be!

Making the most of your for the rest of your life 

If you are considering a surgical procedure, it is quite normal to wish for an enhanced look.  Our therapist can also help you focus on the bigger picture, by discussing the psychological and emotional aspects, dealing with what is important to you: focusing on the thoughts, beliefs and feelings that run parallel to your decision.  In this way, you will gain the maximum advantage before, during and after cosmetic surgery, enabling you to make the right decision for the right reasons and with a realistic outcome.  In short, we will be concentrating not only on the “you” outside but also the “you” inside.

We have an extensive range of techniques that can guide, mentor and coach you through to:

• Personal well-being
• Making the most of yourself
• Professional success
• Understanding your strengths
• Achieving your goals
• Being the best you can
• Freeing you from guilt and limitations
• Increasing your self-confidence
• Losing weight (and keeping it off!)
• Eliminating fears and phobias
• Relieving stress

From a one-off session, discussing whether this is correct for you, to your decision to go ahead with surgery, our in-house therapist can help you from step one, supporting you through any fears and anxieties and any emotional issues.

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"Thanks for everything before and after the op and for always only being a phone call away - it meant a lot." - Louise