The effect of face lift that leads to improvement of chin and cheek slack, and a guideline for do...

Face lift is an operation that removes slack by making an incision in the skin from the ear to the inconspicuous area around the temple with a scalpel and pulling up the skin and subcutaneous tissue.

In addition to the face lift, as a lift-up treatment that leads to improvement of slack, a thread lift (thread lift) that pulls up the slack of the face and neck by inserting a special thread (thread) with a hook under the skin and high frequency There are irradiation treatments with machines such as HIFU (ultrasonic) and HIFU. Incision-type face lifts tend to have long downtime such as swelling and swelling after surgery, but they have a high lift-up effect and the effect lasts for a long time .

By knowing in advance the causes of sagging, the characteristics of facelift surgery methods and main surgical procedures, downtime and risks after surgery, and differences compared to other lift-up surgery, facelift surgery can be made more effective. You can receive it with confidence .

Causes of sagging face

Dripping of subcutaneous fat on the cheeks and around the cheeks

It is said that about one-third of the subcutaneous fat on the entire face is concentrated on the cheeks and around the cheeks, and one of the causes of sagging is the atrophy of the cheeks and the fat around them with aging. It is due to the fact that it hangs down (hanging) as it comes and loses gravity.

The facial muscles, the facial muscles, weaken with age because they are not used, and when the muscle mass decreases, the force to support the cheeks and the subcutaneous fat around the cheeks in their original positions weakens, causing drooping. Causes sagging. Therefore, it is said that those who originally have a lot of subcutaneous fat on the face tend to sag due to the drooping fat.

Loosening of supporting ligaments that connect facial skin to bones and fascia

On the face, there are ligaments that connect the deep fascia, which covers the skin and bones or muscles deep under the skin, like an adductor muscle. Supporting ligaments are columnar or lattice-like fibrous tissue that firmly connects the skin of the face to the bones or deep fascia and helps prevent the skin and the underlying subcutaneous fat from dripping.

The supporting ligament is originally a tough and elastic fibrous tissue, but when it deteriorates mainly due to factors such as aging and swelling habit, it becomes thin and loosens and cannot support the skin and subcutaneous fat, causing sagging .

In addition, bone tissue constantly repeats the cycle of bone resorption in which old bone is destroyed and bone formation in which new bone is created, but as we get older, bone resorption exceeds bone formation and the bone gradually becomes thinner. , The supporting ligaments may loosen.

Looseness of SMAS covering facial muscles

It is located under the skin, which has a three-layer structure of epidermis, dermis, and subcutaneous tissue (mainly fat) from the outside, covers the facial muscles, and exists over a wide area of the face from the temporal region above the ears to the face line. The thin, membranous tissue is called SMAS (superficial fascia).

SMAS, which is the foundation of the skin, is made of collagen, which is a strong fibrous protein, and does not loosen when young. However, when it loosens with age and hangs down, it cannot support the skin and causes sagging and wrinkles. It will cause the cause.

Reduction of collagen and elastin that keeps skin firm and elastic

Facial sagging is manifested by drooping subcutaneous fat, loosening of supporting ligaments and SMAS, as well as a decrease in collagen and elastin, which help keep the skin firm and elastic.

Collagen, which is a fibrous protein, occupies about 70% of the dermis, which is the lower layer of the epidermis, and hyaluronic acid, which is a jelly-like substance, fills the space between them while holding water. Furthermore, in the dermis, a fibrous protein called elastin binds reticulated collagen to each other and maintains the firmness and elasticity of the skin with a spring-like structure.

However, when collagen and elastin deteriorate and decrease due to ultraviolet rays, stress, aging, hormonal imbalance, etc., the thickness of the dermis becomes thin, and the skin becomes less firm and elastic, and sagging is likely to occur .

Face lift that improves sagging face

Subcutaneous fat that hangs down due to aging, loosening supporting ligaments, SMAS, and other tissues that cause sagging are surgically returned to their original positions, and the skin is pulled up to improve sagging. Face lift is an operation that aims for a youthful contour.

The range of indications for face lift surgery is generally from the entire face (middle face) excluding the forehead, eyelids, nose, and mouth to the upper part of the neck including the face line. Since the surgery name and coverage may differ depending on the medical institution, please check the website of each medical institution or the contact information in advance when considering a face lift.

In addition, face lift is an operation that is said to have been reported in Europe and the United States for more than 100 years. Initially, the skin is incised from the sideburns or in front of the ears, and the skin is simply pulled up and sewn together. Was the mainstream. However, at present, not only simply pulling up the skin, but also adjusting the subcutaneous tissue such as supporting ligaments and SMAS according to the degree and cause of sagging that varies from person to person, and removing excess subcutaneous fat have been established. I will .

The main face lift surgical methods used in many medical institutions, their characteristics and surgical contents are as follows.

Face lift by "SMAS method"

An incision was made in the skin around the ear, the thin membranous tissue SMAS was peeled off once, excess SMAS and skin were excised, and then the subcutaneous tissue including SMAS was pulled up so that the sagging was eliminated. The "SMAS method" is a face lift technique that is sewn and fixed in a state.

It is a face lift that tends to be selected for those who have severe slack from the cheeks to the vicinity of the face line, and it can be expected to improve the bulldog face by eliminating the slack, and it gives a youthful impression. You can aim for the line of the chin .

The face lift by the SMAS method has various treatment methods such as the range to peel off the SMAS, the shape when excising, the object to be sewn and fixed, etc., and the surgical content may differ depending on the medical institution, and the state of slack and the ideal finish The doctor chooses the best method. The general procedure for surgery is as follows.

Facelift surgery by SMAS method (extended SMAS-platysma)

1. If there is a lot of fat under the chin, remove it with liposuction and make an incision in the skin near the bulge, the tragus, just before the ear canal.
2. Make an incision in the skin from the auricular temporal groove, which is the groove on the back of the ear, to the back of the ear, and then make an incision to the hairline of the occipital region.
3. Insert a scalpel through the incision near the tragus and peel off the skin (peeling), then insert a scalpel through the incision behind the ear and peel off the skin to the neck (neck).
4. After proceeding with skin detachment from the cheekbone to the parotid gland (salivary gland in front of and below the ear), an incision is made in the SMAS to perform the detachment just above the parotid gland fascia, and the cervical muscle (platysma muscle) on the back of the SMAS. Connect and pull up the cervical muscle)
5. The SMAS is peeled off from directly above the platysma muscle, which is the muscle that extends from the face line to the neck, the ligaments (supporting ligaments) on the cheeks are cut off as needed, and the SMAS is pulled diagonally upward and sewn together, and then the excess upper part is sewn. Excising SMAS
6. After sewing the upper SMAS together, make an incision in the outer SMAS and move it to the back of the ear to fix it to the aponeurosis (*).
7. The SMASs are sewn together, the excess skin is excised as needed, and the incision is sewn together.

(* ⑥ is not always done)

Face lift by "MACS method"

The "MACS method" is a face lift technique that aims to lift up the skin by making an incision in the skin around the ear and then pulling up and fixing the SMAS using medical sutures. Compared to the SMAS method, the area where the subcutaneous tissue is peeled off is smaller, so it is a surgical procedure that is said to be relatively less burdensome to the body.

Face lift by MACS method is suitable for those who want to aim for natural lift-up without severe loosening of the skin, and it is said that downtime is shorter than SMAS method. The MACS method, which raises SMAS at two points on the neck and cheeks, can be expected to improve slack on the face line and around the cheeks .

The surgical procedure, such as the method of treating the subcutaneous tissue and the method of stitching, may differ depending on the medical institution, but the general surgical procedure is as follows.

Facelift surgery by the MACS method (Simple MACS-lift)

1. If there is a lot of fat under the chin, remove it with liposuction if necessary, and remove it after making an incision in the skin from the hairline above the ears to the front of the ears.
2. Make a hole with a diameter of about 8 mm in front of the helix leg to expose the fascia of the temporalis muscle.
3. After fixing the first thread through the fascia of the temporal muscle, suture the SMAS from the fixing point of the suture in the front of the ear to the vicinity of the mandible in a purse-like shape, turn upward and suture in a purse-like shape again. , Tie and fix near the fixed point on the front of the ear and pull up
4. After passing a second thread through the cheek and suturing the SMAS from the vicinity of the tragus to the vicinity of the corner of the mouth in a purse-like shape and pulling it up, the part of the SMAS swollen by the suture is fixed upward and flattened.
5. Stop bleeding at the bleeding site, pull up the flap on the cheek to remove excess skin, and then suture the incision site.

Duration of facelift effect and post-surgery course

Face lift that can be expected to have long-term effects

Since face lift is not an operation to stop aging itself, aging occurs over the years, but it is said that the progress of aging is slowed down by undergoing surgery.

It is said that the duration of the lift-up effect by the face lift varies greatly depending on the skill and knowledge of the doctor, and in the case of surgery where the area around the ear is simply incised and peeled off and only the skin is pulled up and sewn together to fix it. The duration may be less than 3 years.

Face lift is not a treatment that provides a permanent lift-up effect, but it lifts each subcutaneous tissue such as SMAS and fat in each part in addition to the skin with appropriate strength and orientation according to the degree and condition of ptosis that varies from person to person. If you have surgery under a doctor who can, you can expect a long-term effect of 10 years or more .

Therefore, in order to obtain long-term effects with face lift, it is necessary to confirm the details of surgery from the website of the medical institution considering surgery or contact information in advance.

Estimated progress after face lift surgery

Depending on the medical institution, you may be hospitalized on the day of face lift surgery, or you may wear a fixed band called facial garment for about two days to stabilize the surgical site. Five to ten days after the surgery is completed, the patient will return to the hospital to remove the suture.

Swelling and internal bleeding due to surgery tend to subside in about 2 to 4 weeks, and you may feel a tightness or swelling of the face for about 1 to 3 months. In addition, it is generally said that it takes about 3 to 6 months for the scar to become inconspicuous and finish naturally, and it is recommended to visit the hospital regularly to check the presence or absence of hematoma and the finish after surgery. It has been.

Facelift downtime and risks / side effects

Estimated downtime due to face lift

Post-surgery pain tends to be alleviated by taking painkillers prescribed as aftercare, with swelling peaking around the third day after surgery and large swelling subsided in about two weeks. The incision in the skin damages small blood vessels, and slight bleeding may cause the area around the incision to appear purple, but in most cases it becomes less noticeable after about 3 weeks.

In addition, since swelling occurs for about 3 months after surgery, you may not feel the effect of lift-up until you have settled down. It takes about 3 to 6 months for the scars on the incision site to become inconspicuous and finish naturally, but if you do not mind swelling or internal bleeding, you will return to your daily life such as work or housework within 2 weeks after surgery. It is also possible .

Risks and side effects of face lift

Hematoma

Hematomas may occur after surgery if you have high blood pressure or if you are taking a coagulant that prevents blood from clotting because it incises and peels off the skin and subcutaneous tissue. When a hematoma develops, it can be resolved by reopening the surgical site and removing it.

Skin necrosis

It is a post-surgery risk mainly in smokers (heavy smokers) , and in rare cases skin necrosis occurs around the ears due to the lack of blood flow caused by the shrinking blood vessels caused by smoking. In the unlikely event that skin necrosis occurs, the skin is regenerated by ointment treatment.

Facial nerve paralysis

Since small nerves run in a complicated manner on the face, the skin and subcutaneous tissue are carefully peeled off so as not to damage the nerves in the face during face lift surgery. If the nerves in the face are damaged by surgery, paralysis may occur, but even if the paralysis does occur, it is temporary and it is usually said that the nerves recover and improve over the years.

Left-right difference

The human face is not completely symmetrical in the first place, but if you have surgery under a doctor who has little track record of face lift, there is a risk that the finish will be different on the left and right after surgery.

In order to aim for a natural finish, a doctor who has abundant experience in face lift and can appropriately treat the range to peel off the skin tissue, the strength to pull up, and the object to be fixed for each case such as different skin and sagging conditions. It is important to have surgery at.

Other major risks / side effects

• Induration that temporarily hardens the skin due to bleeding at the surgical site
• Skin hypoesthesia that temporarily weakens the sensation at the surgical site
• Minor hair loss by making an incision in or around a part of the scalp
• Backtracking due to the force of the skin and subcutaneous tissue to return to its preoperative location
• Infectious diseases caused by bacterial invasion from the surgical site

Advantages and disadvantages of face lift and those who are suitable for surgery

Advantages and disadvantages of face lift

Those who are suitable for face lift surgery

• Those in their 30s and 40s who are beginning to worry about sagging faces
• Those who want to improve moderate to severe facial sagging
• Those who want to aim for a more youthful impression than their actual age
• Those who want a long-term lift-up effect
• Those who want to sharpen the chin line
• Those who did not get a satisfactory effect by injection treatment or irradiation treatment

Main sagging treatments other than face lift

Face lift has a longer downtime than treatments that do not require an incision, but its high lift-up effect makes it suitable for severe sagging, and long-term effects can be expected.

There are various options for sagging treatment other than face lift, and the main treatments that do not make an incision in the skin are irradiation treatment with a thread lift or machine that pulls up sagging using a special thread with a catch as follows. However, in any case, the face lift is good for the duration of the effect.

Thread lift

Thread lift is a treatment that pulls up the slack on the face and neck by inserting a special thread (thread) with a catch under the skin . Since the skin that has lost its gravitational force is physically pulled up with a thread, you can expect a lift-up effect that is easy to understand.

There are various types of threads, such as those with thorn-shaped protrusions called cogs and barbs and conical protrusions called bio-cones, and the pulling force differs depending on the shape and number of protrusions. If the thread is an absorbent thread that breaks down over the years, the duration of the effect is about 8 to 24 months, and if the effect decreases, it can be re-treated to make up for it.

Therma Cool

Thermacool is a machine that irradiates radio frequency (RF) energy, which is a type of electromagnetic wave . Radio frequency has the effect of tightening and promoting the production of proteins such as collagen by heat, giving the skin firmness and elasticity. It is an irradiation treatment that can be expected to have the effect of preventing and improving sagging.

Since the effect of Thermacool lasts for about half a year, it is recommended to receive the treatment once or twice a year. High frequencies do not damage the surface of the skin, so downtime is short and redness at the treatment site tends to be less noticeable within 24 hours. In rare cases, you may feel a slight twitch, but in most cases it will settle in 2 to 3 weeks.

Doctor Spa Clinic Face Lift

Mr. Yoshiro Suzuki, who supervised the article, taught me about face lift.