Facelift

Your face is an important indicator of how you look and feel. It's the first thing you see when you look in the mirror each morning and the first thing people see when they meet you. Even though you spend a lot of money on serums and creams to combat the signs of ageing, factors like gravity, sun, environment, smoking, stress, and grief still take their toll on your face. Do you see a tired face in the mirror with loose skin, hamster cheeks, and a sagging neck? Our innovative facelift procedures can make you look as fresh, relaxed, and young as you feel. The newest facelifts have become much less invasive, with a shorter recovery and smaller scars.

PROF. ALI PIRAYESH

"The result should be natural, fresh, and young. Like you've just been on holiday.”

Recovery

Treatment

Anaesthesia

Consultation

Facts about facelifts

With ageing, our skin changes. Cells divide more slowly, and the dermis becomes thinner. The dermis is composed of, amongst other things, elastin and collagen. Elastin gives the skin elasticity, and collagen keeps it nice and taut. Over time, however, these proteins break down, causing the skin to loosen and sag. Because muscles weaken and the fat tissue under the skin diminishes, the dreaded lines, wrinkles, lobules, and dents appear on the face.

Virtually invisible scars

Nowadays, surgical incisions in facelifts are rarely made in front of the ear but rather behind the small nodule located at the front of the ear and under the ear lobe, behind the ear, or they disappear into the hairline. This means that the old hairline will remain, the ears will not be pressed downwards, and will not change in shape or position relative to the face. The latest techniques ensure that the scars are barely visible even the day after surgery. The skin is lifted, and the deep layers of subcutaneous connective and muscular tissue are rebuilt and lifted, so your face is not just tighter but gets a natural, fresh, and relaxed look. Fortunately, the tightly drawn, hard-looking faces are a thing of the past — that is, if you choose an experienced and skilled plastic surgeon.

Disappointing results from mini facelifts

Prof. Pirayesh does not perform mini facelifts because, in his experience, patients are generally disappointed by the limited results. Also, the incisions for mini and full facelifts are identical, while full facelifts give better and longer-lasting results.

Thread lifts: Temporary effect, high risk of complications

One of the latest hypes is the so-called non-surgical 'thread lift’. During a thread lift, tissue is fastened and suspended from barbed wires, which are expected to settle under the skin after some time. Experience shows that the effect of these thread lifts is very temporary. Also, they may cause serious complications (the barbed wires placed in the sensitive subcutaneous tissue arguably have the same cons as semi-permanent fillers). Prof. Pirayesh is understandably against using thread lifts.

Different types of facelifts:

Brow lift

When Botox and fillers do not achieve the desired result, the eyebrows can be lifted through several techniques of eyebrow suspension. During a relatively simple procedure, the side of the eyebrow is lifted, giving you a small scar in the hairline. This procedure can be performed separately or during a face-lift procedure (the so-called Fogli method). Another possibility is to perform a brow lift during eyelid surgery.

The MAC’S lift

The MAC’S lift is a procedure at which Prof. Pirayesh excels like no other: In 2001, he wrote the opening chapter of the first book on the now so-popular MAC’S lift: a less invasive, and therefore widely used, facelift. Prof. Pirayesh has improved on several shortcomings in this procedure, such as the restructuring of the cheek and the improvement of the neck. However, the relatively simple MACS lift cannot satisfactorily improve and rejuvenate the neck region.

A mid-facelift or cheek lift

A mid-facelift or cheek lift is an excellent solution for people with hollow eyes, puffiness, and sunken cheeks. At first, the middle part of the face can be satisfactorily treated with fillers, Platelet Rich Plasma, and lasers. If these are no longer sufficient, a mid-facelift attaches the cheeks and middle part of the face to the very strong tissue surrounding the lower portion of your eye socket with invisible, deep sutures. As a result, it is not dependent on the sagging lower eyelid, as in traditional lower eyelid surgery. The incision of a mid-facelift falls just below the lower lashes. All other stitches are hidden under your skin. The recovery period of a mid-facelift is about two weeks. Through his experience in the UK, Brazil, and Belgium, where he has worked with many plastic surgeons, Prof. Pirayesh has mastered the mid-facelift technique and implemented several innovations, especially for ensuring the safety of the lower eyelid.

Neck and facelift

The neck often ages faster than the face: the skin is loose, the fat from your face has subsided, so you get lobules on your jawline (so-called "hamster cheeks"), and sometimes the accumulation of fat causes a "turkey neck". With a neck and face lift, both the lower part of the face and the neck are lifted. The neck and facelift are often combined with liposculpture of the area under the chin, jaw, cheek, and the upper part of the neck for best results.

APS deep plane facelift

Prof. Pirayesh has developed the APS deep plane facelift from the knowledge that your face does not age in one or two but three dimensions: it weakens your skin and makes tissue sag under your skin. You lose youthful volume around your lips, temples (marionette lines), and eyes. The APS deep plane facelift addresses these three aspects simultaneously: your skin texture is improved, your face contour is tightened, and you regain youthful volume. First, all areas of the face are lifted, the neck muscles are tightened, the upper lip and upper eyelid are lifted, and the eyebrows are subtly lifted. The substructure of the face — also known as SMAS tissue — is lifted so that the skin will look instantly tighter. The areas that have lost their natural fullness are enhanced with micro-lipofilling. Finally, you undergo laser resurfacing treatment, leaving your skin smoother and younger looking. Where traditional facelifts gave patients a tight, ‘wind swept’ look — combined with ageing eyes — the APS deep plane facelift gives a natural, fresh and relaxed look.

Revision facelift

Prof. Pirayesh is regularly asked to carry out revision operations following plastic surgeries that have been carried out elsewhere. Common problems include ears that are pulled down, hairlines that show visible scars of previous facelifts, the ‘windswept effect’ (where a facelift left the facial skin too taut), poor distribution of volume or too much volume in the cheeks, and the loss of fat which will give the face a hollow look. Often these problems are corrected by lifting the middle part of the face and repairing the deep layers of SMAS tissue. In addition, the hairline is corrected, the earlobes are restored, and facial volume is restored. A revision facelift is much more complex than an initial facelift and requires a highly experienced and skilled plastic surgeon.

PROF. ALI PIRAYESH

“The secret is to achieve the most natural result possible, with minimal means.”

Additional treatments for best results:

Fat transposition or lipofilling:  Prof. Pirayesh has further developed and improved the existing lipofilling techniques and belongs to a small group of plastic surgeons in Europe that commands the whole range of treatments, from lipofilling to advanced procedures for conventional cell enhancement. For example, the ADRC, or stem cell facelift, is a new technique that was preceded by decades of research. A patient’s fat cells are extracted (usually from the abdomen) using micro-liposuction and then purified, keeping the precious stem cells, blood vessel-producing cells, and growth factor-secreting cells. The collected stem cells and fat are injected into the layers of skin and muscle of the face to enhance volume in certain areas. A disadvantage of the conventional purification treatment was that it damaged many cells, resulting in about 60% of the fat cells dying. Prof. Pirayesh uses a refined purification process, producing a much higher cell survival rate of 85%. This means that the redistribution of cells is much more successful and affords longer-lasting results. This new technique is now preferred over cheek implants, which were once used to restore volume in the middle of the face. These implants provide quite a few problems: they fuse with the bone, become more visible, and are very difficult to remove. They can even damage nerves, causing numbness or pain.
Lip lift or lip enhancement : Thinning lips with wrinkles can give a face a cross, taciturn appearance. Sometimes this can be remedied with fillers, but when the red of the lips is too inverted, a lip lift can provide a solution. The upper lip is slightly lifted upwards, making the friendly, welcoming look return to the face.
Lasers are used to make your skin tighter and produce new collagen. This treatment does not require anaesthesia, and you can resume your normal activities straight after the treatment.
Liposculpture under the chin Fat deposits under the chin may be removed by liposuction and/or liposculpture to regain your smooth jawline. This procedure requires a small incision to be made under the chin. Healing takes about seven days.

The latest techniques

Prof. Pirayesh has received the best training the world has to offer and gained worldwide experience. He is a pioneer of the most advanced facelift techniques and has extensively published lectures at seminars for plastic surgeons worldwide. At the ISAPS conference in Rio de Janeiro in September 2014, he presented his innovative facelift techniques on 103 patients who suffered side effects from using permanent fillers.

The difference between an adequate and a fantastic facelift lies in the care Prof. Pirayesh will take to examine your face's features separately and as a whole in great detail. This allows him to determine which combination of treatments will give the most harmonious result. He does not use single, high-speed therapies, which may yield an unnatural, tight, ’frozen’ face, but will frequently opt for a combination of treatments that work well together, ensuring your face will obtain a natural, relaxed and fresh look. As prof. Pirayesh uses the latest techniques, you are guaranteed an enduring result. He performs additional treatments like stem cell facelifts, laser resurfacing, and fillers, which means he maintains control over the desired result.

It all starts with a consultation

No two faces are the same. The cosmetic needs and expectations of patients are unique. To ensure that you are happy with the result of your treatment, dr. Pirayesh develops a customised surgical plan for each patient. During the consultation, he will take the time to get to know you, discuss your requirements and help you make an informed decision.

He will ask about your general health and medical history, perform a physical examination, and assess the condition of your skin and the underlying tissues. Naturally, prof. Pirayesh will ask you to point out the features you want to improve, after which he will indicate whether your wishes are realistic and surgically possible. He will explain which type of facelift is the best option for you and which technique he will use. A clear photograph of yourself at around age 35 is very useful as a reference to the structure of your face.

Prof. Pirayesh will answer any questions, give instructions on preparing for the operation, and inform you about the cost.

Surgery overview and timeline

Duration of the operation: 3 to 6 hours

Anaesthesia: light general anaesthetic administered by a specialised anaesthetist

Length of stay: outpatient, usually one night. You need to be picked up by someone because you cannot drive yourself home.

Post-operation: swelling and tenderness. The first night your face will be bandaged against swelling. The following day prof. Pirayesh will remove the bandage himself. You will get a compression garment for your face and neck that you must wear day and night for one week and only at night during the second week. You will receive pain medication and instructions on wound care.

Complications: rare: fluid retention, infection, temporary numbness around the ears.
Recovery time: Facelift surgery is generally not painful and is manageable with the proper use of analgesics. Usually, you can resume your daily activities after one to two weeks. After several months, your scars, hidden in your hairline, behind the ears, and in natural skin folds, will have faded.

Results: a facelift creates a natural, tight jawline and a beautiful neck. You needn’t worry about getting a taut, ‘frozen’ face that you have undoubtedly seen and read about. Instead, your face will look younger, refreshed, and very natural.

Scarring: Prof. Pirayesh has developed a customised regimen, APS Scar Care, including aloe vera-based creams, laser treatments, and (if necessary) injections, to ensure that your scars heal in the best possible way.

Facelift surgery in six steps

On the day of your surgery, prof. Pirayesh will take several photographs of your face in different positions so that you can review the results properly lat. In addition, photos will be taken for your medical record.

Step 1. Anaesthesia

A specialist anesthetist will inject a light general anaesthetic into a vein through a cannula (a thin, plastic tube) in your arm or hand. The anaesthetist and his team will monitor you closely throughout the operation, ensuring you are comfortable and safe. The anaesthetist will discuss the anaesthesia with you before your surgery and will answer any questions.

Step 2. Different techniques

Prof. Pirayesh will discuss the best combination of treatments with you before the surgery. Read more about the various complementary therapies that can improve the outcome of a facelift operation.

Step 3. The incisions

After the general anaesthesia is administered, prof. Pirayesh makes the incisions in the crease before or in the ear, behind the ear, and into your hairline, separating the skin from the underlying fat and muscle layers. The deeper layers are lifted from the face, the excess skin is removed, and in the case of liposuction, the excess fat is suctioned out of the face.

Step 4. Suturing and bandaging

The incisions are closed with very small subcutaneous and topical sutures. Some surgical tape may be used to close the incision. Special suturing techniques ensure that the ears maintain their natural position and that your face looks relaxed. The scars will be barely visible, even right after the operation.

Step 5. Recovery and aftercare

You will remain in our surgery clinic for the next few hours, in the care of prof. Pirayesh and his team, until he feels it is safe for you to return home. In some cases, you need to stay overnight. You need to be picked up by someone or take a taxi home. You will receive pain medication and instructions on wound care.

Overall, facelift surgery is not painful and is manageable with the proper use of painkillers.
You should not drink alcohol or take blood thinners like aspirin (paracetamol is allowed).
The first days after the surgery, your face and eyes are swollen and bruised, but these will have mostly disappeared within two weeks.
You must wear a compression garment day and night for the first week and only at night during the second week to prevent swelling and pressure on the surgical wounds.
You may remove the compression garment to shower or wash your hair, as long as the water is not too hot, which could cause swelling.
You should rest for a few days and refrain from bending or lifting. You must hold your head upright as much as possible.
After one week, the stitches are removed, and you can gradually resume your normal duties, provided you take it easy.
You can return to work two weeks after surgery, provided you do not have to perform strenuous exercise.
The total recovery period takes several months, during which your face may feel tight.
Avoid the solarium or sauna, and don’t drink alcohol or take blood thinners like aspirin (paracetamol is allowed).
You may resume your normal activities from 4 to 6 weeks after surgery.
After several months, your scars (hidden in your hairline, behind the ears, and natural skin folds) will almost have faded.

Step 6. Wound healing and scars

Prof. Pirayesh is very savvy when it comes to promoting rapid healing. He has developed a customised regimen, APS Scar Care, including aloe vera-based creams, laser treatments, and (if necessary) injections to ensure that your scars heal in the best possible way. This regimen has ensured that many of prof. Pirayesh’s patients have hardly noticeable scars. However, it is impossible to pre-determine if patients will have problems with their scars healing.