The Ageing Face

Created on 10th July 2009

Consultant plastic surgeon, Mr Taimur Shoaib discusses the art and science of facial rejuvenation

Time stands still for no-one. Unfortunately, that means from the age of around 40 onwards, we start seeing signs of facial ageing. The changes we see are complex but can be broken down into several simpler areas so that we can understand what is happening.

When a plastic surgeon looks at your face to see the signs of ageing, he will be looking at your skin, muscles, fat and bone. He will also look at your upper face, your middle face and your lower face. All these twelve areas (four types of tissue multiplied by three areas) will be analysed and a bespoke package of care will be produced for you.

The changes we most commonly see are drooping of the eyebrows, excess skin and fat bulging in the upper eyelids, lines in the forehead, fat bulging in the lower eyelids, fine lines around the eyes, sunspots around the cheek skin, loss of prominence of the cheek bones, jowls in the jaw lines, grooves between the nose and the mouth which then continue on from the mouth to the chin, neck folds and excess fat around the neck.

Each of these changes will vary by a different amount in different people, and this is where the skill of the surgeon starts to become important in analysing the problem and coming up with a solution.

Facial rejuvenation treatments - the bespoke facelift

Because there are so many signs of facial ageing, a facial rejuvenation operation is no longer just a facelift. Together, you and your plastic surgeon should formulate an individualised solution for what you see and what you can do.

In some people this involves non-surgical improvements (fillers, chemical peels and muscle relaxing injections), and in others there may be an operation involved. A facelift may well be combined with eyelid surgery, eyebrow surgery, liposuction, muscle tightening in various places (cheeks, neck, jaw line, eyelids), muscle relaxing surgery (especially when combined with eyebrow surgery or neck surgery), fat injections into areas where there are sunken areas of youthful fat, skin resurfacing (either with chemicals or a laser), along with non-surgical improvements.

During a facelift you will probably be put to sleep for a couple of hours. The skin incision is made near the front of the ear and it often extends upwards into the hair and backwards behind the ear. The skin is lifted up from the underlying fat and muscles to allow the muscles to be tightened. This automatically pulls the skin tighter and the excess skin is removed and redraped in its new rejuvenated position. At the same time, the eyelids, forehead and neck can be addressed with skin and muscle tightening.

Lastly, if you are having some plumping of youthful fat back into the cheeks and around the other parts of the face, then this is done at the same time. Different surgeons will do different procedures in a different order during the operation and not everyone needs all the areas of their face addressed.

Recovery times - becoming ‘restaurant ready'

The more we do in an operation, the longer the recovery time and in some people this is still the best type of treatment. However, there are now very modern facelifting techniques which plastic surgeons have developed in which ‘downtime' is minimised. Most people still require a couple of weeks off work, but with some treatments we can have people back doing most of their normal day to day activities within a few days.

Your plastic surgeon may be able to advise you on camouflage make up and other ways of getting you back to normal as soon as possible, sometimes within a few days.

Modern facial rejuvenation treatments are personalised to the problems and to what the person wants to achieve. Facelifts are becoming increasingly popular and can now give subtle but lasting effects, avoiding the windswept look of the past but giving a pleasant natural and youthful appearance.
CS&AM