Most commonly, there are two distinct areas of the lower eye that can result in an undesirable appearance. Many “plastic” surgeons who claim to specialize in the area of the eyes and eyelids address this via what is called a lower lid blepharoplasty. They “simply” remove some of the fat under the eyeball – which would address part of the problem, and trim any “excess” skin. What has become apparent is that not only does this not address the lower bags, but may actually result in cosmetic and even functional deformities. The midface lift in its many forms addresses both areas, and in addition, rids the aging face of nasolabial folding (the lines that run from the outside of the nose to the corners of the mouth). The SOOF or suborbicularis oculi fatpad is the structure that makes up those saggy bags and can be distinguished from the postseptal fat (the fat by the eyeball) by pressing on the eyeball and witnessing no change in its size. This is what the midface lifts, and in the process helps that nasolabial fold, apart from removing the fat under the eyeball.
Because every surgeon has a preference for a particular procedure, every surgeon will have a different idea as to what constitutes the traditional face lift. The earliest procedures involved undermining the skin only. Incisions were placed behind the ear, and around to the front of the ear, continuing up, either behind the hairline, or in the hairline. This last determination depended on the patient’s anatomy, and the surgeon’s preference. A brow lift and forehead smoothing would commonly be included with the face lift. Excess skin was trimmed along the incision, the face skin thus tightened, and the edges sutured together. The technique addressed sagging skin well, but not the underlying soft tissues. In addition, because tension was placed on the skin, scars would at times be very wide and conspicuous. Finally, many believed that the results were not as long-lived as techniques that used deeper structures to tighten the face.
“Facelift” is lay-language for rhytidectomy or rhytidoplasty. Rhytids are wrinkles, they are due to loose skin, or damage to skin structure and can be present even in patients who do not have a lot of excess skin. Rhytidectomy/rhytidoplasty procedures address the sagging of the skin, and underlying soft tissue. Signs of aging in the mid, and lower face include prominent nasolabial folds (the lines running from the nose to the outside of the mouth), marionette lines (lines from the corners of the mouth to the chin, jowls, hanging, crepe-like front neck skin, and wrinkles. The face lift is used to lift droopy skin, and remove any excess in the middle and lower thirds of the aging face. Skin and underlying tissue is tightened, softening the nasolabial folds, marionette grooves, removing jowls, and restoring the angle between the neck, and jaw. If deep wrinkles are present, it may be combined with carbon dioxide (CO2), or erbium laser resurfacing. Phenol or TCA peels may be added as well.
Facelifting can restore a youthful appearance to the aging face. It can take up extra, baggy skin, smooth facial lines and wrinkles, and tighten a saggy neck.
It is not unusual to have areas of your face that feel hard after any kind of facial rejivenation, be it a facelift, necklift, or neck liposuction. This is because there is an inflammatory response that dissipates at different rates in different people. Assuming that other issues,infection or a retained foreign body for example have been ruled out, induration or that firm, leathery feeling can persist for as long a 5-7 months.
The answer depends on the time frame of the symptoms. Itching is normal when healing, but if occurs too early, it may signify a local allergic reaction to the suture, glue, or dressing used in the rhytidectomy. Burning may be a sign of infection, in which case the affected area would appear red, blanching, may drain, and be very tender to the touch. Later on, burning may signify healing nerves, as would a prickly sensation. If the sensation persisted longer than 6-12 months, the concern would be for improper healing of nerves, neuroma formation, Frey’s syndrome, dysesthesia, etc.