Dimitrije E. Panfilov
When we have situation where the neck skin is not very affected and the face could require some support, then we take into account only preauricular access for a so-called minilift. The deep layer, however, should be done well. For decades the majority of plastic surgery patients were older; there is now an increasing number of younger patients in their mid-40s, sometimes even in their early 30s.
The question occurs whether facelifting at such an early age is at all reasonable? If we conduct facelift surgery on a 60-year-old or on a 70-year-old, the surgery can cause a rejuvenation effect of 15-20 years. The younger our patients are, the smaller the effect of rejuvenation will be. There are not many traces of age to be modified on a 30-year-old. Yet her/his features can be beautified and harmonized.
There is another advantage of facelifting at an early age: traces of age will take effect later in life. This is due to the fact that the deep level of the superficial musculo-aponeurotic system (SMAS) is lifted well and fixated with lasting effect. That is why this procedure could be considered as prophylactic preservation of youth or prevention of an ageing look.
The media often causes speculation about how long the effect of a certain method of plastic surgery will last: 3, 5, 10, 12, 15 years...? Robert Flowers from Hawaii had luck when he found two female twin sisters in the USA: one of them had undergone facelifting, the other - because of health, family, and financial reasons - had not. Flowers organized a meeting between the two sisters, placed them on the couch, and took photographs: 10, 20, and even 30 years after
The effects of facelifting last forever. The skin and SMAS layers, parts of which we remove, do not grow back nor do they regenerate. The time lapse our patient has gained has everlasting effects. Yet we have to warn our patients: we can turn back time on the biological clock but we cannot stop it, it will go on. A 60-year-old woman can be made to look 45 again, but 15 years on she will not look 45 anymore, rather 60. Providing there is sufficient zest for life and health, we can conduct a second facelift surgery, which is a completely new operation, not a correction of the first.
In secondary procedures, we only have to respect the previous scars and, if necessary and possible, to correct them, to make them less obvious.
Please see the general bibliography at the end of this book.
Fig. 48.3. a Male patient, 40 of age, with dermographic markings for a minilift. b The same patient 1 day postoperatively. Comparison c before and d after 7 days: intradermal sutures to be removed, hair-wash allowed, he is resocialized
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