Facelift Surgery In Singapore

The Ageing Face
The passing of time leads to multiple changes in our facial features. Whilst ‘ aging gracefully’ is often a term used to assuage this natural process, it often leads to a tired, dull appearance, which can be undesirable to many.

Features of the aging face happen in all layers, from the skin to the bone. Starting from the outside in, our skin loses its suppleness, begins to sag, and develops patchy pigmentation, both as a result of aging as well as cumulative damage from environmental factors such as UV rays. Beneath the skin, the fat compartments of the face shrink, leading to a hollowed appearance in areas such as the temples, upper eyelids and cheeks. Deeper down, the ligaments, otherwise known as the support structures of the face, start to relax, leading to the drooping of the overlying fat and skin layers. Finally, the bony support structure recedes at the forehead, cheeks and jaw, leading to a flattened upper face, cheek retrusion and squaring of the jaw.

facelifting_cheek_jaws_eyelids

Much of modern plastic surgery is focused on slowing or reversing the ageing process of the face. Minimally invasive methods can help with parts of this and include skin care, laser therapy and other energy devices, fillers, botulinum toxin and implantable threads. However,surgical methods such as facelift surgery need to be employed.


Facial Anatomy


To understand a facelift, one must first understand the basic layers of the face, some of which are the target of pulling and lifting during the surgical procedure. Again from the outside in, you have 1) the skin, 2) the connective tissue and fat compartments, 3) the muscle and its fascia (otherwise known as the SMAS or superficial Musculo-aponeurotic system), 4) the loose connective layer or ‘spaces’ of the face, and 5) the fibrous covering of the facial bone, also known as the periosteum. Within these layers lies the complex vascular and nerve supply of the face, which through study and dissection, have been clearly and consistently elucidated.skin_layers_facelifting

Furthermore, the face can be divided into the upper, middle, lower face, and neck regions, each or all of which can be targeted during a facelift procedure. The upper face consists of the temples and the area from the hairline to the brow, the middle face consists of the area from the brow to the bottom of the nose, and the lower face consists of the area from the bottom of the nose to the chin. The neck can be subdivided into the area under the chin (the submentum), and the lower neck.



How does a Facelift work?
In a facelift, the previously described layers of the face are tightened in various ways to help to reverse the sagging caused by ageing, and to lift the landmarks of the face to their original youthful position, thus restoring volume where it should be.
The layers of the face that are commonly tightened or ‘pulled’ are the skin, the SMAS, and the periosteum.
In the past, skin only facelifts were employed to help to reduce the wrinkles of the face caused by loose skin. However, these resulted in an unnatural and ‘wind-swept’ appearance as it did not address the ageing of the other crucial layers.
Through research by pioneers such as Mitz and Peyronie, it was found that there existed a definitive, firm fibrous covering of the musculature of the face, called the SMAS. Through the tightening of this layer, volume descent of the face could be reversed along with lifting of the musculature. Many modern facelifts are based on SMAS tightening, with subsequent tension free removal of excess skin, which results in better scarring and a more natural appearance.
Periosteal lifts involve the deeper dissection of the covering over the bony skeleton and tightening of this layer through sutures or devices such as endotine hooks. This sort of lifting is usually reserved for the upper face, and occasionally the midface.

What types of Facelift are there?

Lifting options for the upper face include open as well as endoscopic techniques. Open techniques involve making a partial or full incision at the hairline and allow for rejuvenation of the forehead with the removal of excess skin. Care must be taken to minimize the scar, which can usually be hidden at or in the hairline. Endoscopic techniques utilize small incisions within the hair-bearing area and a telescopic camera to dissect and lift the brow. This technique does not leave any visible scars, but no skin is removed and is not suitable for individuals with higher foreheads. A good compromise is the temporal browlift, which involves a limited incision at the temporal part of the brow, allowing for a lasting lift of the brow peak.

The middle part of the face can be approached through incisions at the lower eyelash margin. Through this approach, prominent lower eyebags can also be addressed. The periosteal or the SMAS layer can be lifted to help bring the volume descent of the midface back to the natural position at the upper cheekbone.

The lower face and neck can be lifted through incisions just in front of the ear, extending around the ear to the posterior hairline. In cases where the lower neck does not need rejuvenation, the incision can be finished in a ‘short-scar’ fashion, whereby no incisions at the back of the ear are required. Once the SMAS layer is exposed, there are various descriptions of how it can be tightened, including plication, minimal-access cranial suspension (MACS), SMASectomy, and sub-SMAS procedures. Whichever technique is used, care must be taken to avoid injury to the facial nerve which can result in temporary or even permanent paralysis of the face. Once SMAS tightening is done, the excess skin is removed to enable tension free closure for more invisible scarring.

For Asians in particular, more powerful techniques have to be utilized to lift as Asian skin and soft tissue tends to be heavier and more difficult to lift. The most significant lift can be derived from the deep-plane facelift, which directly lifts the anterior part of the face and mobilizes the SMAS layer over the spaces by releasing and repositioning the ligaments of the face through strong sutures. This brings the tissues of the face back to the original position of youth, and restores the natural contours of the face.

The neck is approached via incisions extending to the hairline behind the ear, sometimes requiring a small incision at the area under the chin. Adjunctive procedures such as liposuction, buccal fat removal or fat grafting may be performed along with the facelift.

facelift_chin_neck

For all forms of facelift surgery, the performing plastic surgeon has to be familiar with the underlying facial anatomy to minimize complications including bleeding, loss of sensation as well as nerve and muscle paralysis. For more assurance, you should approach a fully-certified plastic surgeon in Singapore who performs facelifts regularly. Performed well, a good facelift can last at least 10 years.

The Facelift Consult
During the consult with the plastic surgeon, a thorough history and physical examination will be taken. Your goals, motivations and desires for the procedure will be discussed, to enable a wholistic decision is made to ensure lasting satisfaction. A past medical and surgical history is also important to elucidate risk factors for the procedure. The physical examination is paramount to determine the areas of the face requiring rejuvenation, the existence of any pre-existing asymmetry, as well as the techniques required. Often, a lift for other parts of the face besides the region is question may be recommended to achieve a balanced outcome to the facelift. Benefits and risks of the different methods of facelifting should be discussed. Though uncommon, risks of facelifts include pain, bleeding, infection, nerve injury, wound breakdown and scarring.

Preparing for a Facelift
Facelifts are commonly performed under sedation or general anaesthesia (GA). Occasionally, a patient may opt to have the procedure under pure local anaesthesia. However, this is not advisable as a full facelift can last up to 5-6 hours. Any medications or supplements that can increase bleeding and decrease wound healing such as aspirin, garlic and smoking should be stopped at least 1-2 weeks prior to the procedure. If sedation or GA is chosen, you will need to fast for at least 6 hours prior to the procedure.

What to expect during the procedure
The facelift procedure itself can be performed as a day surgery procedure, and there is usually no need to stay in a hospital overnight. You will be kept very comfortable during the surgery, and almost always no shaving of hair is required. After the facelift surgery, there may be small drains left which help to reduce post-surgical fluid or blood collections. These are removed within the first 1-2 days after surgery. After sedation, you will be observed for a few hours for recovery, and you can be discharged once you are walking and drinking water. It is advisable to have someone to accompany you home after any surgical procedure.

In recent years, fat grafting has become a popular adjunct, allowing for the natural restoration of volume loss in the face in addition to the facelift. Your plastic surgeon may recommend this in addition to the facelift surgery.

In recent years, fat grafting has become a popular adjunct, allowing for the natural restoration of volume loss in the face in addition to the facelift. Your plastic surgeon may recommend this in addition to the facelift surgery.



What should I expect during Facelift recovery?
After the procedure, you may be put into a facial pressure garment which helps to reduce swelling and bruising for the first 1-2 weeks. Placing cold compresses on the face also help with this. The stitches are usually removed at 1 week post-operatively, and almost all the bruising will be gone by the end of the 2nd week after the procedure. Swelling due to the procedure usually peaks in the first week, and by 2-4 weeks 80-90% of the swelling is gone.

Performed well, a good facelift can last at least 10 years. If patients desire further lifting after this period and are still in good health, repeat facelifts can be performed if required.

How much does a facelift cost?
Costs for facelift surgery in Singapore depend on the type and extent of facelift performed, and can begin from $6000 upwards. It is best to have an open discussion with your plastic surgeon about which procedure suits you best.

https://www.polarisplasticsurg....ery.com/articles/fac

Where On Your Body Can You Get Liposuction?

A toned body gives the impression of attractiveness and health. Whilst watching the diet along with a regular exercise program are the mainstays of achieving the ideal physical appearance, due to lifestyle and work choices this may not always be possible. In addition to this, there always seem to be certain areas of the body where stubborn fat persists. In these cases, body contouring procedures can help, with liposuction being the most commonly sought body contouring surgery.

Liposuction can be performed on almost any part of the body. The most commonly requested areas are the neck, the arms, the tummy, love handles and the thighs. These areas tend to gain weight the easiest, and retain stubborn fat that is refractory to exercise. In women, another particularly bothersome area are the anterior axillae or armpits, which appear as an additional bulge above the outside of the breast.

The liposuction procedure is best performed on an individual who has excess fat but adequate skin elasticity, to enable skin retraction after removal of the fat is done. A body mass index (BMI) of <30kg/m2 is also desirable. Lastly, being able to keep a stable or decreasing weight over the course of the months preceding the liposuction procedure should be a pre-requisite, showing that the individual is able to maintain the body shape after healing has occurred.

During the liposuction consult, your surgeon should discuss your desires and expectations with you, along with taking an adequate medical history and examination. As liposuction is an elective procedure, you should be in general good health without any debilitating medical conditions before considering the procedure, to minimize any untoward risks.

The Liposuction Procedure
The liposuction surgery is usually done under heavy sedation or general anaesthesia with a qualified anaesthetist to enable comfort and pain control. Small, inconspicuous skin incisions are made in well-hidden areas to first allow the infiltration of a wetting solution to the fat. This wetting solution consists of local anaesthetics and adrenaline, which help with pain reduction and bleeding control respectively.

Once the wetting solution has taken effect, usually after 5-10 minutes, the surgery can proceed. There are different methods of liposuction, with the most common ones being manual/syringe liposuction, power-assisted liposuction (PAL - MicroaireTM) and ultrasound-assisted liposuction (UAL – VaserTM). In addition, adjuncts such as radiofrequency tightening may be recommended to aid with skin tightening after the procedure. The type of liposuction performed is dependent on the area of the body, skin laxity and consultation with your surgeon. At Polaris Plastic & Reconstructive Surgery, our surgeons are well versed in all forms of liposuction and will optimize your outcomes through proper discussion, choices and selection.

The liposuction procedure can be done as a day surgery as long as less than 2 litres of fat is removed in that session. If there are more than 2 litres projected, the procedure has to be performed in an inpatient setting, with at least 1 night’s stay in hospital. This is to mitigate the risks of larger volume liposuction where significant body fluid shifts or blood loss can occur. Other risks of liposuction include scars from the incisions, asymmetry and contour irregularities. The worst reported complication of liposuction is death, which has received a large amount of press in the past. Performed well, all these risks are very minimal and can be mitigated through proper patient and procedure selection as well as anaesthesia from well-trained specialists. Whatever the choice, liposuction in Singapore has to be performed in an accredited surgery centre, and by an approved liposuction practitioner (the full list can be found on the MOH website).

Where on the body can liposuction be done?
As long as there is excess fat, most areas of the body are amenable to liposuction. The art is in deciding which type of liposuction to be done on each part to produce a beautiful, natural appearing body contour. A brief description of each part and the goals of liposuction for each are as follows:

Lower face and neck (commonly requested)
An attractive neck contour includes a visible jawline and defined angle between the chin and the neck. In cases of full necks with excess fat under the skin, this can be achieved through liposuction, which is often combined with energy such as ultrasound or radiofrequency to help with loose skin where present. Neck liposuction can be performed under local anaesthesia. On occasion chin augmentation with fat graft or implants may be recommended depending on your inherent anatomy and desired outcomes.
Upper arms (commonly requested)
Stubborn fat commonly exists at the back of the upper arms. Liposuction of the upper arms is usually approached through small incisions in the back of the armpit, which also allows access to the upper back. The goals are to create toned arms by highlighting the natural outline of the muscles, and create a more acute angle between the upper arm and side of the body. When done well, liposuction of the upper arms can achieve a very satisfying result.
Breast/Chest
In women, liposuction of the fat pad/accessory breast at the junction of the breast and the upper arm is done to achieve a smooth, concave contour, which is especially important when wearing a bra, swimsuit or tank top. This is done through small, well-hidden incisions in the armpit area.
In men, liposuction of the chest is requested to achieve a more muscular pectoral outline, as well as to treat the condition of male breasts, also known as gynecomastia. This is potentially a medically necessary procedure, as gynecomastia can be painful and debilitating. Most liposuction is concentrated at the lower part of the chest where fat usually accumulates. Occasionally, to help with a more muscular appearing chest, simultaneous fat grafting can be performed to the upper part of the chest. In cases of fibrous gynecomastia, a small incision around the areola may be performed to aid with the excision of the breast disc.
Back and buttocks
The areas of the back where liposuction is commonly performed include the upper outer back (in continuity with the arms) and the posterior flanks. The aim of liposuction is to highlight the natural hills and troughs of the muscles and bony surfaces of the back. Usually, only 3 small incisions are required, one at each posterior armpit line and one lower down just above the buttocks.
Liposuction of the buttocks is performed to enhance the natural outline of the gluteus maximus. Whilst not commonly requested, in select individuals, this is necessary to compliment liposuction of the lower back or upper thighs. Incisions for liposuction of the buttocks are usually very well hidden.
Abdomen and Love handles/Muffin-tops (commonly requested)
This part of the body is probably the most commonly requested area for liposuction. The goals in women are to produce a toned, hour-glass appearance, whilst in men, a more defined outline of the abdominal muscles and ‘six-pack’ is desired. With well-hidden incisions in the belly button and groins, this can be achieved naturally, with surprisingly minimal pain. The careful examination must be performed to assess the skin and integrity of the muscular fascia and exclude abdominal hernias, which can complicate liposuction procedures. A moderate amount of lax skin can be addressed through the addition of energy such as ultrasound or radiofrequency. In cases where there is too much skin laxity, an excision procedure may be required to produce the best outcomes.
Hips/’Saddle-bags’
In some females, due to body type and genetic makeup, fat at the hips stubbornly persists despite the rest of the body remaining slim. This area is commonly referred to as the saddle-bags. It is a very satisfying area to treat with liposuction, as the results are instantaneous and immediately, patients are able to wear clothing such as jeans that never used to fit before.
Inner/outer thighs (commonly requested)
Inner thigh liposuction is most commonly requested for the legs. In women, it is often difficult to achieve the ‘thigh-gap’ just through exercise alone. Utilizing hidden incisions in the groin crease, the inner thighs can be approached effectively, and the results are often very satisfying. Of note, contour irregularities tend to be more commonly reported in this area. Therefore, great care must be taken by your liposuction surgeon to mitigate this.
It is worth mentioning that in certain medical conditions such as lymphedema and lipoedema of the legs, liposuction can help to restore normal leg outline, relieve symptoms of heaviness and improve exercise and general quality of life. Patients with these conditions should seek out their doctor for advice on this.
Calves
Calf liposuction is not commonly requested as there is often not a large amount of fat deposited in this area. However, if there are small, stubborn deposits or patients request for greater definition, small-volume liposuction can be done to achieve this. Like the inner thighs, contour irregularities are more visible and need to be meticulously avoided.
Pros and cons, and the price of liposuction surgery
Performed well and on the right patient, liposuction can achieve a long-lasting, satisfying result and that beach-ready body. However, it should be viewed more as a body-contouring procedure rather than for weight loss. The amount of fat removed from liposuction does not often correlate to a certain weight, as fat is lighter. Lasting weight maintenance must be done through diet and exercise.

Additionally, patients with moderate to severe excess skin, such as those who have experienced massive weight loss through bariatric surgery, may require excisional procedures in addition to liposuction to restore the correct contours and treat problems such as skin chafing and infection. Liposuction alone should not be viewed as a skin-tightening procedure.

The price of liposuction surgery will depend on the extent of liposuction required. This is often based on a number of areas and/or the time required for liposuction. It is best to approach your surgeon for a thorough assessment, as well as a discussion on costs for this.


https://www.polarisplasticsurg....ery.com/articles/whe