Surgical or non-surgical – which facelift to choose?

Before there was Botox, fillers and a whole host of other cosmetic treatments, there was the surgical facelift, an extremely invasive surgery, with extended downtime and associated risks.

Now there are myriad treatments touted as “non-surgical facelifts”, some extremely effective, others not so much.

An open surgical facelift is still the gold standard for dramatic, lasting results to lift the lower face and neck but requires significant, invasive surgery with associated risks and extended downtime (bandages, drains, swelling, bruising) and fewer women and men are willing to accept that with the advent of less invasive options.

While there are pros to the traditional facelift, including dramatic results that are longer lasting, the cons include downtime that can run into weeks, with complications such as poor healing, scarring, collections of fluid or blood, nerve injury and weakness.

Prof Caitriona Ryan, consultant dermatologist and co-founder of the Institute of Dermatologists, explains what happens to the skin as we age.

“Production of collagen declines and the structure of the face changes with loss of bone density and subcutaneous fat and resultant sagging of the skin and tissues of neck, jawline, cheeks and brow occur.

“The most effective remedy is surgical intervention with a facelift or necklift. The typical downtime after a facelift is approximately two weeks, with an average cost of approximately €10,000, and an average life-time of 10 years,” she says.

Many patients now prefer to avoid the downtime and cost of surgical interventions and opt instead for minimally-invasive procedures to help tighten and lift sagging skin, where the cosmetic outcomes can often rival those of surgical procedures.

“Non-surgical facelifts use a combination of skin repair and tightening, and dermal fillers to add volume and support,” Dr Eithne Brenner, medical director of Manara Skin Clinics says.

“They can cost up to €2,000 for a full-face rejuvenation, and can last up to 18-24 months, depending on the products used. If muscle relaxation with toxin is used as part of the procedure, this effect lasts up to four months. ‘Non-surgical facelifts’ have minimal downtime, and no scarring. There can be tenderness for a few days and there is a risk of bruising. Smaller amounts can be used to address specific concerns such as thin lips or fine lines.

“Surgical facelifts can remove excessive skin, and lift and support tissues, so they are especially useful if sagging is severe. They can also be combined with dermal fillers or fat to restore volume and can be combined with skin repair treatments or toxin.”

‘Mini-lifts’

The average age for a full surgical facelift in Ireland is about 60, but ‘mini-lifts’ can be done on younger patients, Dr Brenner says.

“There is downtime, with swelling, discomfort and bruising, and inevitably there is scarring, but this will be disguised as much as possible. Most people would consider non-surgical options first, and possibly surgery later, if at all, but it depends on the individual and their preferences, and the extent of their facial ageing signs, and it depends on their suitability for the procedures,” she adds.

Prof Ryan explains three non-invasive treatments: ultherapy, Silhouette Soft thread lift and the “liquid facelift”.

“Ultherapy is a non-invasive, highly-focused ultrasound treatment that stimulates the production of new collagen and elastin deep within the skin to tighten and lift skin of the upper and lower face, the neck, under the chin, the eyebrows and to reduce fine lines and wrinkles of the décolletage and chest. This is incredibly popular in our clinic in women in their 40s and older. The cost ranges from €2,200-€3,700 and it is usually a once-off procedure.

“Another relatively recent, minimally-invasive alternative to the traditional facelift is the Silhouette Soft thread lift. Silhouette Soft temporary coned threads are placed in the midface, brow, jowls or neck under local anaesthetic to produce an immediate lifting effect. The threads are composed of PLLA [polylactic acid], which stimulates the production of collagen in the surrounding tissues, with a regenerative and volumising effect over the following three-six months. The effects typically last for around two years and the cost is around €3,000.

“The term ‘liquid facelift’ has also been coined for the minimally-invasive customised approach to treating age-related facial changes using a combination of dermal fillers and Botox injections to restore the structure of the ageing face while smoothing out wrinkles.”