Facial rejuvenation
Stress, gravity, tobacco and the sun make negative impacts on human face, which become apparent as the years passed and affect all tissues of the face. Facial bones weaken, thin and lose their volume. The muscles lose their tightness, loosen and begin to hang down due to the ever-lasting gravity. 

Certain muscle groups overwork and cause an unattractive appearance (i.e. frowning eyebrows, wrinkles around the eyes). 

Fatty tissues suffer hernia between the loosened connective tissues and the muscles to become apparent. Soft tissues and the skin hang down, lose their volume under the eyes and on the cheeks, and pits and curves appear on weak points.

The skin looses, wrinkles, loses its elasticity and hang down together with all the soft tissues. This mechanism leads to what is called static lines on the face. On the other hand, after working for years, the mimic muscles lead to wrinkles on the skin that covers them, causing what is called dynamic lines on the face.

As a result, lines become apparent on the face, forehead and around the eyes; the eyebrows, cheeks, chin and neck hang down, and the eyelids develop fatty pockets, causing the person to look older, tired, sad and worn. Face lift can be performed on healthy persons who suffer these impacts of the aging process.

Face lift can be performed in a wide scope of operations including lifting the eyelids, rhinoplasty, enlarging the chin, reducing the chin, liposuction for double chin, and injection of fat and tissue.

The cheek standing as a single piece on the cheekbones, looking full, frontal and upward is associated with healthiness and youth. The eyebrows extending in the form of an arch lightens the upper exterior part of the eyes to make the face look attractive. As to the neck, the most conspicuous part of it is the chin’s contour. If there is a problem with the chin’s contour having nothing to do with a bone, face lift can correct the chin’s contour.

Anatomic structures standing frontal and upwards are associated with youth and healthiness; those standing back and downwards are associated with old age. This rule should be taken into consideration in selecting the appropriate surgical technique. The biggest mistake of the past practice was to lift the face laterally and upwards, causing the face to look indistinct and tight as if the person was put in a wind tunnel, and causing the mouths to elongate laterally. Today it is widely accepted that aging is a downward process.

Aging of the face occurs in two groups:

The central oval consisting of periphery of the eyes, the eyelashes, the forehead, the sides of the nose, and the mouth. The lower oval consisting of the cheeks, underside of the chin, and the neck.

Operations performed to lift the forehead, temples, eyebrows, lower eyelids, cheeks, the nose-cheek area and the mouth are called midface lifting, and are performed by employing the endoscopic method at the bone level to leave no trace. A midface lifting operation is performed by incising 1.5 cm cuts from inside the hair and 1 cm cuts inside the mouth. Endoscopic face lifting is performed at a deeper level i.e. the bone level, so that its results are more lasting.  The classic face lift technique is employed on the ears, chin’s contour and neck lying at the back and under the midface oval. What is decisive for a face lift operation is to select the layer on which it will be performed.

The lower oval consists of three layers on the cheek up to the bone. Technique to be employed depends on the layer to be lifted.

Skin is the most unreliable layer, it will loose earlier and quicker.

SMAS (Superficial Muscular Aponeurotic System) is a relatively easy technique, but is efficient at medium level.

Deep plane (SubSMAS) is the method we prefer. It requires good anatomic knowledge and surgical skills. Its result is more reliable, efficient and lasting.

The zones can be operated one at a time or together.

Neck lift is performed in general together with midface lifting and deep plane surgical operations.  Here the cut incised for chin lifting (midface lifting) is extended from behind the rear to the scalp. The neck skin and muscles are freed and hung upward. The bands (platisma muscles) which form when you stretch your neck are united and the muscles and the skin are stretched at their two planes. Thus the hanging and wrinkles of the neck are lifted, the chin angle is made prominent, and the neck is ensured to look tight. The cut incised for this operation lies behind the ear, so that it is not visible from the outside.

Injection of fat:

This method is very effective for thin faces at early ages. It can also be performed together with an endoscopic midface lifting operation. However, it should not be performed on patients having no volume problem with their faces, otherwise an extra volume is added to the face to make them look unnaturally fat and hang down like that of a bulldog. Therefore, said injection method should be employed as an individual operation or as part of a face lift operation only for the right patients.

 

Peeling, laser and dermabrasion

The term ‘peeling’ refers to peeling the surface layer of a damage caused by the sun and other environmental factors on the face and to increasing the collagen synthesis of the lower layers to make the skin younger and tighter. Peeling can be performed in a chemical way using a laser, or in a mechanical way through dermabrasion.  It can also be performed as part of other facial rejuvenation operations.

 

Endoscopic forehead, temple and eyebrow lifting:

 

This is an endoscopic lifting technique leaving no trace. It yields to very successful results for young patients or faces aged prematurely. For older patients, it can only be performed together with upper eyelid and eyebrow lifting operations.

Endoscopic reduction of frowning eyebrow muscles:

The corrugater and proserus  muscles can be freed and reduced to solve the frowning eyebrow problem in a lasting way (as opposed to the temporary way through botox). Endoscopic method can be employed to reduce the muscles causing the frowning effect.

Endoscopic subperiosteal midface lifting:

This is a face lift operation for patients age 20 to late 40s, and leaves no trace. It is performed for lifting the cheek hanging on the cheekbones, and the two deep curves (nasolabial and tear trough). It ensures the cheekbones to look healthy and full. It is also part of the radical face lift operations for patients in their 50s.

 

Deep plane (SubSMAS) cheek lifting:

This is the most efficient method for lifting and rejuvenating the mouth edges and chin contours after the cheekbone zone has been lifted by employing the endoscopic method.

 

Neck lifting:

This operation refers to removing excess fat from the neck, tightening the neck muscle along its middle line, and removing the excess skin from behind the ears.

 

Triplanar face lifting:

This operation refers to combination of the endoscopic operation for the cheekbones, the Sub-SMAS deep plane operation for the mouth edges and chin contour, and the muscle and skin rejuvenation for the neck. If a peeling operation is added in this combination, it should be called quadriplanar face lifting. It is foreseen that all these techniques will be employed in the form of  a suitable combination for all facial rejuvenation operations in the future.

Facial rejuvenation is performed in a surgical theatre after administrating anesthetics to the patient.  It takes 1.5 – 2 hours on each zone, and 4 – 6 hours in total. The patient is required to stay 1 or 2 days at the hospital. The face should be bandaged with a light pressure dress for 2 or 3 days post operation.  The patient might suffer such side effects as facial pain, tightening of the skin, edema, bruising, or numbing of the skin. Such pain can be easily taken under control by administering painkillers to the patient unless it is severe. Edema rapidly heals within the initial few weeks, but it takes approximately 6 months for the remaining inconspicuous edema to disappear and for the skin to settle in full on the face. As the edema heals within the initial few weeks, so does the tightening and numbing of the skin. Time for a possible bruise to heal varies depending on the individual. It can take up to 15 days to heal for patients with sensitive skin.