The term “lifting” means stretching and is associated with the classical surgical intervention of extending the facial skin. The skin wrinkles are the result of the following mechanisms: ageing, the sequellae of actinic lesions and genetic disturbances. The skin ageing is an atrophy process; skin is made up of three layers: epidermis, dermis and hypodermis. The most important modifications proceed in dermis; its thickness increases at the same time with ageing, the elastic fibers are destroyed and the quantity of collagen decreases too.

The actinic lesions are represented by the degradation and thinning of the elastic fibers, the decrease of the quantity of collagen, the relative increase of the proportion of fundamental substance.

The free radicals of oxygen are involved in the ultrastructural destruction of the skin. The visible changes associated with the ageing process are: the reducing of osseous structures, the diminution of the thickness and elasticity of the skin, the decrease of skin adherence at the subjacent layers, the gravitational falling of soft tissues, wrinkles formation in the areas of adherence with the deep layers and in attachment areas of muscles.

At the age of about 30, it appears an excess of skin in the upper area of the eyelids, fine wrinkles on the side areas of the eyes and the deepening of the nasal-labial groove. At the age of about 40, wrinkles occur between the eyebrows and on the forehead, and the other ones increase.
At 50 years wrinkles occur on the neck, and the tip of the nose is drooped. At 60 years, the skin of the face is much thinner and the fat tissue decreases in the temporal and oral areas.

There are three types of face wrinkles: ortostatic wrinkles, proceeded from birth that become evident at the same time with the disappearance of the fatty tissue of the child and are situated on the neck; dynamic wrinkles determined by the movement of the mimicry musculature; gravitational wrinkles.

The surgery is addressed both to women and men unsatisfied by their facial appearance and neck. It allows the repositioning of the whole structural complex of the face, removing the excess of skin and fat, raising and settling the deep layers of muscles and readjusting the whole skin of the face and of the neck to the new content.

There is not an ideal age for performing a face lifting. The ideal candidates for this type of operation are the persons whose face and neck began “to go down”, but whose skin is still elastic and the bone structure is strong and well-defined. The majority of patients are between 40 and 60 years old.

The treatment with aspirin should be interrupted for two weeks and smoking will be ceased a week before the surgery.
The operation is performed under general anesthesia. The period of time required for such an operation is generally of 2-3 hours.

The incision is discrete, being hidden in the most part by the hair and the natural folds of the skin. It starts from the temples, through the front of the ear, then avoids the auricular lobe, runs on the posterior aspect of the ear and goes on into the hairy skin of the head. The skin is raised from the deep layers and will be stretched by traction obliquely and after the excision of the skin in excess, the skin will be fixed in the new position. Through this lifting is obtained the attenuation of deep wrinkles on the nose and lips, the slight raising of the eyes corners and the neck smoothing.

The lifting in two layers (the superficial muscular-aponeurotic system and the skin) follows the same phases. This technique also implies the intervention on facial musculature and on subcutaneous fat tissues and allows in this way the rearrangement of the muscular-aponeurotic elements in normal position. The hospitalization period is of 1-2 days. After about 2 weeks the patient can resume the daily activities using a suitable make-up and hairdo for scars masking.

Postoperatively a face oedema and ecchymosis occur; the facial mimicry will be partly precluded and the skin sensitivity will disappear in length of time. The pains decrease in intensity and are controlled through pain-killers. The complications can be hindered if they are strictly observed the plastic surgeon’s indications.

The surgical intervention is not a threat for patient’s life. It is extremely efficacious, and so it is not surprising that face lifting is one of the most requested aesthetic operations.

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