As part of the aging process which happens to al of us sooner or late, our skin progressively loses its elasticity and our muscles tendto slacken. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces. The folds and smile linesdeepen, the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrowsdroop and the skin of the eyelids gathers in loose folds. In the skin the first sign is fine wrinkles developing around the lips, at the outercorners of the eye and lines of expression. The rate at which this happens varies from one person to another and is probablydetermined by our genes. Aging of the skin of the face does not necessarily reflect the rate that the rest of our body and mind isageing and many people feel frustrated that the face they see in the mirror is not the one they feel should be there. Substantial weightloss can produce similar changes in facial appearance to those of the aging process.
Who will benefit from a facelift?
The best candidate is one whose face and neck has begun to sag, but whose skin stil has some elasticity and whose bone structure
is strong and wel defined. Most patients are in their 40's to 60's, but facelifts can be done successfully on people in their 70's or 80's.
It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful. It is a procedure thattechnical y works wel but also increases morale and is wel appreciated by the patient.
Incision lines follow the natural crease, or tagus, in front of
Platysma muscle and its fibrous attachment (SMAS) are sutured
the ear and extend into the hairline above and behind the
tightly in front and behind the ear as an extra sling under the
What a facelift does not do?
A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles of
the forehead then you should perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles, freckles and rough areas wil
benefit more by chemical peel or laser resurfacing.
What should you do before the operation?
If you are overweight and intend to lose it you should do so before the operation. This al ows the surgeon to remove more skin and
therefore achieve a more pleasing result. You should avoid taking tablets containing aspirin and non steroidal anti-inflammatory drugs
such as Voltarol and Indocid for at least two weeks before surgery as they increase the risk of bleeding.
You should stop smoking at least two weeks before surgery as this is the main cause of reduced healing. It decreases circulation ofthe skinflaps, particularly behind the ears.
Have your hair permed and tinted, if you wish, before your operation as fresh scars are sensitive to these chemicals for a few weeks.
A facelift is carried out in a hospital and most surgeons and patients prefer a general anaesthetic. It is possible to carry out the
procedure under local anaesthetic and intravenous sedation but the patient would stil be advised to spend the night in hospital. Theprocedure, although long, can be combined with other operations of al sorts. The most common however would be an endoscopicbrow lift and an eyelid reduction. Other extra procedures which can be used to enhance the face at the same time are malar (cheekbone) and chin augmentation and lip enhancement.
This is an extension of the forehead lift which is designed to tighten the skin of the upper half of the face, as opposed to the standardfacelift which helps the lower half of the face. The Deep Facelift carried out endoscopical y avoids the same ear to ear incision. It isusually carried out at a younger age than the standard facelift. It tightens the skin of the mid-face and freshens the eyes, opening andlifting the outer angle and reducing the wrinkles of the crows feet. There will be swelling around and below the eyes which gradual yresolves in about a month. There wil also be scars beneath the eyelashes of the lower eyelid and sometimes in the upper gum line.
There is a slight risk of damage to the nerve which supplies the muscles of the forehead. This weakness is usual y partial andtemporary, on rare occasions it may be permanent.
Incisions are made above the hair line at the temples and extend in a natural line down the front of the ear, or just inside the cartilage atthe front of the ear, and continue around behind the earlobe and up in the crease behind the ear and off into the lower scalp.
Occasional y it may be necessary to make a smal incision under the chin. Sometimes only the skin is lifted fol owing separation fromthe underlying platysma muscle.
More usual y however the platysma muscleand its fibrous attachments (S.M.A.S.) is dissected free and sutured tightly to the solidstructures in front and behind the ear. At other times the skin and the S.M.A.S. layer are lifted together as a single layer, but wil stil besutured separately. Fat along the jaw line and under the chin may be removed by liposuction or on occasion through an incision underthe chin. The skin is sutured so that it is lifted upwards and backwards, just as when one lifts the skin when looking in the mirror.
Sometimes drains are inserted. Most surgeons wil bandage the face to minimise bruising and swel ing. These bandages wil stay forone or two days and the sutures are removed in 7 to 8 days.
After your surgery there is usual y some bruising of the cheeks and with gravity this tends to descend into the neck. Discomfort isusually mild and can be control ed with Paracetamol. It is normal for there to be some numbness of the skin of the cheeks and ears.
This wil usual y disappear in a few weeks or months. It is better to keep the head elevated for a couple of days to reduce swel ing.
Drainage tubes wil be removed a day or two after surgery. Avoid strenuous activity, saunas and massage for at least two weeks.
At the beginning your face wil look a little puffy and may feel rather strange and stiff. The scars can be very wel hidden by women withtheir hair and disc shaped earrings so that they should be able to resume work and social activities within a couple of weeks.
Camouflage make-up can be helpful in masking bruising.
Men find it more difficult to disguise the scars and wil need to shave their beard closer to the ear in front and also behind the earwhere the skin has been lifted.
The scars in the hair do not usual y show except that the hair is cut shorter immediately around the wound. There may be some slightreduction in hair growth in the temples, but this is not usual y a problem unless the hair is very thin and repeated facelifts are beingcarried out.
How long does a facelift last?
A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to always be there, in that you wil not
look as old as you would have done if it had not been carried out.
Choosing your surgeon
A facelift is a skil ed procedure and we would recommend that you choose a surgeon who has undergone a ful training programme for
cosmetic surgery. These surgeons wil be on the Specialist Register in Plastic Surgery at the General Medical Council. Al members of
the British Association of Aesthetic Plastic Surgeons (BAAPS) are on the Specialist Register.
J Clin Endocrin Metab. First published ahead of print March 29, 2013 as doi:10.1210/jc.2012-3888 Growth Hormone Research Society Workshop Summary: Consensus Guidelines for Recombinant Human Growth Hormone Therapy in Prader-Willi Syndrome Cheri L Deal,1 Michèle Tony2, Charlotte Höybye3, David B. Allen4,Maïthé Tauber5, Jens Sandahl Christiansen6, andthe 2011 GH in PWS Clinical Care Guide
UNIVERSITÀ DEGLI STUDI DI TORINO It is my distinct pleasure to be here today. Much of my academic life has been devoted to studying heart disease and heart failure in companion animals. Initially, and with modest expectations, I strived to learn how animals with heart failure could be treated more effectively. Later, my attention became focused on the early recognition of developing heart