Face


Facial aging is more than just droop. Read more:
Deflation is the first stage and starts early with a loss of volume affecting all tissue layers – skin, fat, muscle and bone. We call this atrophy and in thin women the face with age can come to look almost skeletal as the soft tissues melt away off the thinning bone. Deflation occurs especially around the mouth and other facial orifices and also occurs from the top down – forehead, temple and under the eyes.
Sag, droop or ptosis occurs with deflation and results in descent of structures, particularly a sagging neck, jowls and a sloppy jawline, a lengthening of the upper lip.
The skin deteriorates in many ways – the ability to replenish collagen decreases by about 1-1.5% per year after the age of 40 and is worsened by menopause. Elastin, another fiber, and the extracellular matrix including hyaluronic acid, also diminish and undergo structural changes. This results in the well-known changes seen in aged skin – fine lines and wrinkles, loss of elastic recoil, increased fragility and pigment changes.
Internal factors (your genetics, hormonal changes) and external factors (smoking, alscohol consumption, sun exposure, diet and stress) all impact on aging. Patients may seek facial rejuvenation or improvement (with youth comes beauty although that is not to say that older women cannot be beautiful too) because they simply don’t like what they see in the mirror, they are starting to look like their mother (or father) or because their expression does not convey what they feel. A look of tiredness, misery, sadness or anger may accompany facial aging. The face ages with the 3 Ds: Deflation, Droop and Deterioration. This happens in men too.
Facial rejuvenation is the process of reversing the aged appearance. It is usually a combination of facelift, some liposuction, fat grafting and possibly ancillary procedures too.
Younger women. Read more:
Younger women often request procedures to enhance and even rejuvenate their face. As the issue is not usually droop a facelift, which is a big procedure, is usually not required in younger women. Correcting the volume (lipo and fat grafts) and dealing with other issues (eyelids, brows, lips) can give a very satisfactory outcome. Here is a list of procedures I consider when I see younger patients:
- neck correction with either liposuction or a deep neck
- eyelid surgery
- facial fat grafting
- brow shaping
- lip enhancement
- buccal fat pad removal
- botox, other neuromodulators or filler
I don’t offer rhinoplasty.
As with older patients an individualized approach is best. I like to know the “issues” so that I can offer procedures that will be best for enhancing your appearance. Very often in younger women a group of smaller procedures will help the whole face.
Facial Rejuvenation
The goal is to rejuvenate the face in a harmonious and natural way, safely, with minimal complications and downtime. The goal is to take back the years. It is important to see the face to find the best solution for each individual. Old photographs are helpful to show the face in youth – they serve as a template or reference.
A facelift is performed to correct the jowls, jawline, neck and cheek wrinkles. It will reposition tissue back to a youthful position, but to create the curves and beauty of youth, however, the facial volumes needs to be fixed as well. The combination of facelift with liposuction and particularly fat grafting is a facial rejuvenation. Frequently ancillary procedures – eyelids, lips, brows – are added at the time of facial rejuvenation.

Facelift + Read more:
Facelifts are performed in my own licensed facility, Tranquillity Clinic, as day case surgery (in out the same day). Marking is done prior and you meet the anaesthetist to discuss the level of sedation/anaesthesia you prefer, and to discuss any concerns. On the table, once anaesthetised or sedated, local anaesthetic is injected into your face prior to surgery.
The incision passes from the under part of the sideburn to the ear where it follows the natural curves of the ear down to the lobe. The incision continues around the earlobe and then up in the groove behind the ear from where it turns to the hairline, and then down the hairline for a short distance. If the neck needs more lifting then the incision needs to be a little longer at the hairline behind the ear.
The skin is then elevated away from the underlying tissue. At this stage I will often do liposuction as well – to the neck, jawline, above the naso-labial fold. The deep tissue (the SMAS = superficial musculo-aponeurotic system) is then elevated. There are a variety ways of doing this whether with SMAS plication (stitching it up) or with a deep plane facelift (going into natural gliding planes of the face to allow the tissue to move up). There are other methods too. Once the deep structures are lifted, the skin is swept up, the excess excised, and the cuts closed, usually with dissolving sutures which provide long term support.
I finish off by shaping the face with fat grafts which not only finesse the appearance, but can also improve the skin (regeneration). Ancillary procedures like eyelids, brow, lip, neck and frequently Botox or other neurotoxin injections. Resurfacing can also be done. Facial Rejuvenation usually takes the morning and I finish the surgery at lunch time.
The cuts are taped and a dressing is applied around the face. You are transferred to the ward for aftercare. Once we are satisfied with your condition, usually later in the afternoon, you can be discharged home.


Day 5 after surgery showing the typical scar of facelift
Post Operative Recovery. Read more?
The procedure is not that painful, but your face may feel tight. Soft foods and voice rest is encouraged. Mostly surgery is done as day case surgery, so you can go home mid to late afternoon.
Rest helps recovery but you can get up slowly to go to the bathroom or kitchen, sit in a chair if you like, or when lying use a couple of extra pillows to elevate your face.
At the initial follow up 2-3 days post op the bandage will be removed and you will be allowed to wash your hair. Bruising and swelling varies from patient to patient, but mostly resolves 2-3 weeks after surgery. Manuel lymphatic drainage is useful from the end of the first week after surgery. There will be regular check ups by me post op.
If you are travelling to me for surgery, you should allow two and half to three weeks to recover and for check ups after surgery, after which you can travel.
Driving can be resumed from when you can freely move your head, usually about a week or more post op, and exercise can be resumed 6 weeks after surgery.
You will have an awareness of having had surgery for several months after the procedure. Nerves are slow to recover and it is not unusual to experience odd sensations like pins and needles as the sensory nerves grow back. Little contour irregularities are also not uncommon and these settle in time. The scars may go pinkish early on, but these will fade.

Risks and Complications. Read more:
All surgery carries the potential for risks and the possibility of complications. Risks, however are low and complications are rare. Minor complications are more common than major complications. If a complication occurs then my policy is to manage it and intervene where necessary. Frequently surgery is not required. Time is nature’s healer.,
Complications of facelift:
- Anaesthetic related problems. All surgery and anaesthesia carry a risk. The risk is very low.
- Bleeding. The risk of bleeding is around 1-2%. A bleed into your face may require surgery to drain it and to stop the bleeding source. This would require an additional operation (possible additional expense).
- Infection. Not a common problem due to the good vascularity of the face, but, nevertheless infection can occur. Infection can set you on the path to wound healing problems. Minor infections can be treated with antibiotics. More major infections may require surgical intervention.
- Wound healing problems: either impairment or delay. Slow or deficient wound healing (made worse by smoking) can result in skin or tissue loss and require dressings for a prolonged period of time to allow healing.
- Skin loss or other tissue loss. This can present as an area mottled redness or a purple discolouration, usually situated near the scar. It can form a scab or even go black. Most skin loss will heal over time with dressings.
- Suture abscesses. The skin is closed with dissolving sutures. The inflammation necessary to cause the sutures to dissolve can result in the formation of small pustules. If the pustule is opened a suture may be seen or felt and removal of this suture usually ends the problem.
- Nerve damage. The nerves are of two types: sensory nerves convey information about touch, pressure, pain, temperature to your brain; motor nerves convey messages from your brain to your muscles and injury to motor nerves results in weakness or paralysis, in other words like a stroke. Sensory nerves to the cheek are invariably injured during facelift. It will feel as if you are being touched through plastic or similar. Over a period of months, this is likely to improve. The commonest nerve injured in facelift is the nerve which supplies sensation to the earlobe. Injury to this nerve will cause your earlobe to be numb. The two commonest motor nerves injured are the branches to the eyebrows and forehead and the branches to the mouth. Injury here is likely to be temporary, usually not lasting longer than a few days or weeks, although rarely it can be permanent.
- Scars. How well you scar is largely a function of your skin type. I will suture you up as best I can, but some people do form bad scars. In the early part of the healing process, the scars will be red and raised, but after a few weeks this will settle down. Scars with too much tension on them can stretch.
- Cosmetic result. Perfection is rarely achieved. It is likely that there will be some residual neck sagging or jowling, especially over time. The neck tends to be the primary point of failure in time with recurrence of platysmal bands.
- Asymmetry is almost a guarantee. Almost everyone has an asymmetrical face with one seed being longer and thinner while the other side is shorter and squater. Most people have a good side. When operating on two sides of the body, as with facelift, it is normal for one side to heal faster, one side to be more bruised and swollen and it is normal for the two sides to be slightly different.
- Hardness, lumpiness, contour irregularities. These can occur probably due to small bleeds under the skin or depressions created by the deep sutures in the SMAS layer under the skin. Hardness and lumpiness will soften in time, facilitated by gentle massage in an upwards direction. Lumpiness and asymmetry from fat grafting can occur due to unequal take and resorption of fat. Correction may be achievable through a repeat fat graft or other procedure.
- Tightness. A feeling of tightness is not uncommon following facelift. This can make eating, smiling, talking, etc. difficult. Tightness will pass over days and weeks.
- Prior to surgery you are healthy, but surgery induces the sick state – you will be sore, bruised, swollen and not look like yourself. You may not be able to go out for a week or two. These changes can affect some patient’s moods and they can become moody post-operatively. This is not usually long lasting.
The results from facial rejuvenation can be very satisfactory. On average the clock can be taken back 10 to 15 years, but the aging process of course continues.
Page last updated: 20 October 2024

Testimonial
“Just a quick note to let you know that all is well, though I would like to have some fillers and a bit more botox on my forehead. I will try the local doctors, but would much prefer Doctor Lazarus to do the work. My friends tell me I look well, which I take as a good indication of fine surgery, because I look natural and not too pulled. I wish I could have my whole body lifted, but will stick with the face for now. Give my regards to the good doctor and those wonderful nurses and my best regards to you too.”
