Facelift and neck lift (SMAS and MACS)
With increasing ageing processes and due to the gravity, the face may start to look tired and old. This bothersome process (rhytidosis) may start already at the age of 40. Besides actual age and genetic aspects, factors such as nicotine, exposure to sunlight (UV damage), nutrition, alcohol, extreme weight loss, accompanying illnesses, stress and others play an important role.
The facelift is performed conventionally using a scalpel or by means of ultrasound technology (harmonic knife).
In a facelift, which can also be combined with a neck lift, the focus is not primarily on the reduction of excess skin only, but also on the reposition of the drooping soft tissue and its long-term fixation. Ageing processes result in drooping of the superficial muscular aponeurotic system (SMAS), accompanied by changes in the consistency and tone of the lipid and skin structure. Surgical access points in the temporal region vary widely, although they share a course from before the ear around the earlobe and towards the region behind the ear. The incision can be made anterior to the hairline or in the region covered with hair. After mobilising the skin, there are several options how to treat and fix the SMAS in place. This will be discussed in detail prior to surgery. A central step are the directions (vectors) of facial soft tissue relocation to avoid the impression of “tucking back” known from earlier techniques.
The SMAS technique involves removing excess soft tissue from the layer underneath the skin following the desired lifting effect (SMAS ectomy) or stitching it on top of each other for filling (plicature).
The MACS technique (minimal access cranial suspension) uses a shorter access path and applies permanent pursestring sutures to lift the tissue on the face and neck. The excess skin is evaluated only in the end and the skin is sutured back (readapted) without any strain, which is important to avoid producing distorted, wide and ungainly scars.
A facelift can be combined with a frontal lift, resulting in an increase in the duration of surgery.
During the first days, sleeping with the upper body in an elevated position (semi-recumbent at an angle of approx. 60 degrees) is recommended.