Plastic surgeon, doctor Dominik Boligłowa reveals the deepest secrets of facelift / rhytidectomy:

Having a facelift is like having a drink from the fountain of youth. It can visually turn back the clock, upto a resounding 20 years. Together, with regard to your facelift, we restore your natural beauty. I would say that if your look were compared to the seasons we would be making you look like spring. It’s the return ticket to your youth or your original self.
The Facelift is not a procedure that alters your features, but a method that restores your former appearance, a way to harmonize the contour and shape of your face.

Of course, with time inevitably passing skin loses its tonus, firmness and elasticity causing wrinkles to appear. Over time, despite our best efforts, more and more wrinkles appear. Skin stretches and as a result of gravity and age it starts to sag.

The aging process touches not only your skin, but also your subcutaneous tissues, platysma muscle and a so called “SMAS”, the subcutaneous musculo-aponeurotic system. The subcutaneous tissues by pressing on skin indirectly cause skin to sag even more.

What we do through the facelift is revers that process by stretching, lifting and above all rejuvenate your face and neck.

Therefore, one would be mistaken for thinking that the face lift is only about using a scalpel or stretching skin. The secret is that a plastic surgeon also has to take care of the proper arrangement and snipping of subcutaneous tissues.

How to prepare for a facelift:

• The Facelift, as it is a surgical procedure, you will be required to prepare by having all your labs prepared, just like any other surgery. Furthermore, specifically for this procedure, you will need a very thorough cardiological examination, the details of which we’ll discuss during consultation.
• Unlike, e.g. nose surgery, when I ask my patients to prepare a drawing or photo showing their dream nose, for a facelift procedure I ask you to prepare and bring me old photographs of yourself. I mostly recommend finding photos from the time when you were the happiest with how you looked. Using those photos we attempt to restore this effect, so you have the possibility of feeling as happy and satisfied with your reflection, as you did those years ago and feel beautiful again.
• Since nothing gives more satisfaction to a plastic surgeon than the joy of his patients seeing the best version of themselves in the mirror reflection.

Q&A z zakresu  liftingu

• At what age should one decide for a facelift?

During every consultation I have a very open and honest dialogue with my patients. 
In some cases some of my patients interested in a facelift come to me much too soon. I can promise you that I will always tell you when it is the right time, the moment worth doing a facelift. Suggesting to wait might cause you disappointment, but let’s remember that the facelift is a procedure with the purpose of restoring the younger you. A facelift turns the clock back at least 10 or even 20 years. 
During my career I have performed several dozen face lifts, the youngest patient I had who underwent a facelift was 42. A very nice gentleman, and very determined, who lost a lot of weight, as a result his skin and the tissue underneath was sagging.
On the other hand, my oldest patient who wanted to undergo a facelift was an 81 year-old and it is not uncommon to perform a facelift after in one’s 70s.

• What does face lift process look like, step by step:

Before a facelift surgery, I always mark the exact lines where incisions will be placed, where the skin will be undermined and fat suctioned. If a young patient in his early 50s or even 45s comes for a consultation, who is not satisfied or not happy with his or her current appearance and would like to look much younger, then I usually perform a so-called “Mini Facelift” procedure, also called the ‘S’ lift or ‘short-scar’ facelift. Some call it a weekend facelift. There are different terms for this face lift. In a short-scar facelift these incisions are made precisely in the grooves of an ear and on its borders, sideburn and along the hairline towards the front and upwards. The full facelifts require also curving around the bottom of the lobule, behind the ear and along the hairline. The secret lies in the very precise placement of the incisions within or in proximity of the natural grooves and folds and in cutting the skin in an angled manner, to make the final scars completely invisible . Thanks to this method there are no visible traces of an operation, no one would even guess that you underwent a surgery.

• What next?

Then the Patient is carefully washed and anesthetized. In order to minimise the bleeding and facilitate a dissection the tissues are infiltrated with a solution containing vasoconstrictor, pain killer and neutraliser. First I suction the places with the excessive fat tissues. Afterwards, I incise and undermine the skin, it means it is separated from the deeper tissues. Then I lift, fixate and tighten the subcutaneous tissues in different directions, of course mostly upwards, to create harmonious an attractive midface with cheeks, to flatten nasolabial grooves and to outline and smoothen the mandibular lineage. As I described earlier, not only skin, but also subcutaneous tissue age with time and drop, so during a facelift, the plastic surgeon’s job is to tighten, colloquially speaking, the entire mechanism that holds your beautiful face. During a facelift, the plastic surgeon must tighten underlying tissues. I can either cut a piece of subcutaneous tissue and stitch it together, but most often when performing a facelift procedure I use so-called fastening/stitching sutures.

• Preferred technique:

My preferred technique for the short scar facelift is a so-called X-MACS or MACS-Lift, as described by Patrick Tonnard.

In this technique I clip a thick strong suture on very deep fascia, even the periosteum (at a level of temporal fascia) and pull it down on the subcutaneous tissues (to pull/grab these tissues together), and as a final step I smoothen the nasolabial fold.

Ultimately, the facelift is a removal of excess facial skin, tightening of underlying tissues to reach the final effect, which is wrinkle excision – rhytidectomy ( Ancient Greek (rhytis) “wrinkle” + (ektome) “excision”). In the end I redrap the skin. In contrast to subcutaneous tissues, it is crucial to pull the skin only upwards, in order to reverse the downward movement of the aging skin. Pulling the cheeks in any other than vertical directions would create the appearance of someone who was an astronaut during centrifuge training. In the end, I excise the excessive skin and suture. It is important to note that in severe rhytidosis, the upward movement of the skin won’t be enough to treat the neck. Severely ptotic neck tissues must be pulled sidewards. Pulling the tissues sidewards on the neck recreates a beautiful flat chin and neck. Older Patients require more movement on the neck, therefore they are more suitable candidates for a full facelift, where I also treat the subcutaneous tissues of the neck.

• What a full facelift looks like:

With a full facelift I repeat the steps described above, make incisions in the same places and move behind the ear. Behind the auricles, along the hairline, I continue the incision and then, as it is a full facelift I also need to tighten neck tissues especially If the skin on the neck is wrinkled and sagging, which is a common side effect of aging. This aging occurs when your neck muscles begin weakening and your skin loses its elasticity, or ability to stretch and stay tight. Sagging platysma muscle causes, what is known as, a turkey wattle, or a turkey neck. During a full facelift, this muscle is either fastened or reduced by a plastic surgeon. There are different methods to achieve this effect, however it can’t be done in any minimally invasive way. The neck treatment must be invasive, but don’t worry, because in the hands of the experienced facelift surgeon you will be fine. To treat the neck we need better access to the platysma, therefore we need this longer skin incision in order to address it properly. I usually do a Mario Pelle Ceravolo’s lateral displacement, which in my opinion provides spectacular results.
After treating the neck I treat the face in a very similar method as described above.

• How long do the effects of a facelift last?

If a patient decides to have a facelift as soon as in their 40s, most often it is a signal that such a person actually has a natural issue with their tissue flaccidity. Having a natural tendency for your skin being too flaccid may indicate that you may want to undergo the procedure again in the future. However, if you decide for a facelift in your 60’s, you will most definitely get a lifelong effect. A professionally performed facelift, with moderate tissue flaccidity, will last for up to 20 years.

• Are there any contraindications for face lifting surgery:

Unstable hypertension, taking medications and other blood-thinning substances can be a contraindication to facelifting surgery. I also ask my patients to cease taking any integrators or supplements 4 weeks before surgery.

• Convalescence:

It takes 1 to 4 weeks to recover after a small facelift. After removing the sutures, which we remove a week after a surgery, the compression half-mask should still be worn for a total of 3 to 6 weeks. Swelling after a small face lift usually disappears after 2 to 3 weeks.

Recovery after a full facelift usually lasts about 3-4 weeks, in extremely rare cases it can take up to 6 weeks. Most patients have no swelling or discomfort after a full facelift. Here, it is worth noting that some discomfort after a full facelift causes the need for wearing a pressure half-mask for several weeks. Patients, especially ladies, cleverly mask these inconveniences after a full face lift surgery, putting on beautiful, ethereal scarves and pashminas.