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Facelift Surgery


Hands of that clock on the wall don’t care about anything and keep moving. It doesn’t matter whatever happens they will keep moving. A similar clock in our cells keep working in our body, and that stubborn power called as gravity holds on to all the tissues in our body and pulls them down very strongly. The first sign of them winning the battle is GETTING OLDER.

First, elastic powers of the skin will lose their resistance. Then the fabric covering all of our body will lose its collagen support. The fabric is a thin one. These are milestones building us. Ones that are lost on one side should be replaced by another. However, production mechanisms started slowing down, and not as fast as it was during youth. If you have irregular eating habits, and especially if you are friends with smoke, your production factories are knocked out. If you are extremely exposed to sun, and especially if you are a fan of that unreasonable machine called solarium, it means your production cycle is hurt more, elastin damage is more, and your body turned a bit more into a garbage thanks to oxidant remains.  When we add the damage of gravity for years to those broken structures, then we can picture more clearly how it progresses.

So far, I have talked about overall impacts of aging. Although aging process affects all of our body, probably you just thought of it only for face. However, those impacts can also be observed on boobs, abdominal skin, hips, and genital area. Yet, we usually identify aging with face look. Therefore, in this article I prefer talking about aging focused on face.

As we age, old skin quality on our face disappears. Skin loses its gloss. Yellowish-brown colored matte look replaces pinky color on the face. Those fat islets which gives fullness to our face also lose their volume in years. Fastener ligaments, holding those fat islets where  they are supposed to be located in (think them as suspensory ligaments), have become loose and lost their ability to hold fat islets. In early aging, under eye fat islet and cheek fat islet start getting separated from each other. Because ties holding them are different, and cheek islet is more susceptible since it is heavier. We describe it as having round grooves on under eyes, although most of us call it as having eyebags on lower eyelids, it is actually not a correct description. What is happening in reality is our cheek fat islets moving lower rapidly, and leaving eye fat islets alone there. And membrane limiting eye fat islets gets looser for sure, but the actual mechanism develops the other way. We can call it as phase 1. While aging keeps continuing, cheek fats get lower and leave grooves around nose deeper. And we call it as phase 2. While the same process keeps going, sagging around our chin starts. It is described as bulldog cheeks due to the similarity in look. And now phase 3 is just in front of the door. At the same time, eyelid and eyebrow droppings and sagging accompany the ongoing process. If your neck joins to this complexity and starts sagging, we reach to the phase 4. As it is already not enough of bad news, we start losing facial bones. We always talk about bone loss of old people, but we never remember loss of facial bones.

I hope you have lived a happy life so far. Because what is important is not the duration of life, it is the quality of life. Now, we can discuss about what can be done surgically to improve the quality and joy of your life. I will share my ideas with you considering what is to be done in each phase I tried to explain earlier. You may find some of my ideas too radical. I defend them as they are my own ideas, and I don’t imply anything regarding works of any of my colleagues. Everyone defends their thoughts in a way.  I don’t know if you have ever taken a picture of yourself headstand. If you do, you may realize that a lot of problems on your face are lost, and you look younger.

We talked about the mechanism of those problems above. Main problem is the high gravity and moving of fat pads lower. Then, the first thing to do is lifting the sagging one back to its old place. I have some criteria for choosing the method. Depending on what I have been explaining above about aging mechanisms, for phase 1 and 2 what needs to be done lifting on the middle of face (mid-face lift). Where is the mid-face? Mid-face is the name of the area obtained by drawing through the sides of nose grooves, horizontal lines of lip sides, and lower part of outer eye borders. The procedure can be operated in a couple ways. Mid-face can be reached by endoscopy through an incision on the hairy skin, or an incision at the bottom of eyelashes on lower eyelid. Sometimes you might need to do both at the same time. Some physicians integrate both incisions with an incision in mouth. If there is excess on the under eye skin, it is inevitable to perform the incision at the bottom of the eyelashes. In most of my operations, I use incision at the bottom of eyelashes. Normally, I don’t perform incision in mouth. If incision is planned to be performed only on the hairy skin, it has to be performed as endoscopic since it is not possible to reach and see midface in another way. If you are at phase 3 or 4, mid-face lift will not be satisfying. The procedure I explained will not be able to lift sagging skin from chin lines to lower. Already, the point for those tissues to be lifted is not 90 degrees up.  Therefore, with an incision starting from front part of ears and going through ears back, face lift should be operated by correcting cheek tissues. Neck can also be intervened with the help of this incision. Of course upper eyelid and brows lifting procedures should also accompany face lifting because while operating face lifting, leaving eyes and brows sagging will harm the harmony of the face.

Well, we dealt with sagging problem, and moved fat islets upper. We even performed face lifting to stop sagging on cheeks and neck. Are we done with the problems?

Of course, not. We mentioned about bone loss during aging (due to osteoroposis or teeth lose) which may result in volume loss on face. Some times with some patients, during mid-face lift procedure we cannot even find fat islets in necessary volume or amount to move upper. These patients will absolutely have better look after mid-face lift, but if we have the chance to add that bone volume, we will end up with better solutions. Therefore, fat filling or implants (prosthesis) can be applied to the malar location. At the same session, malar implants (cheekbone implants) can be implanted, and then mid-face lift operation can be performed. Fat filling can also be used, but it should not be forgotten that a part of fat grafts will be lost in time. Besides, malar implants and malar fat injections are the procedures I usually perform for the patients without any aging problems to get sexier facial look.

What is the right age for facial lifting?

There is no specific formula or age limit for this. Whenever you realize those problems I mentioned earlier on your face and you want to correct it, it is the right age. Some sagging problems are not directly related to the age; however, they might be derived from your anatomy. But just to give you some impression I can say that middle ages for mid-face lift, and late ages for face-lift needed in the phases 3-4 might be suitable for the operation. Yet, it changes for each person. Different ages might be suitable for different people.

 Can face lift be operated together with other operations?

I usually perform combined surgeries because when they look at the mirror, my patients usually see one or more points on their body that they are not happy with. However, the problem is generally in coherence as a whole. Especially on face, each specific structure affects each other directly. We can combine your face lift operation with mid-face lift, eyelid, brow, nose, and ear operations. There is no problem for combining it with the operations for other parts of your body as well, as long as you don’t have any medical problem against long operation hours.

What kind of things can I face at pre-operation and post-operation periods?

Surgery will be performed under general anesthesia. Operation takes 2.5 hour for mid-face alone, and 4 hours for combined mid-face and face lifts. For eyelids 30 more minutes should be added to the operation duration while for brows or temporal lifts you should add 1 more hour. You will carry paper bandages on lower eyes for 5 days. If face lift is operated, you will have elastic bandages. I usually do not use drains. Swelling and bruises are natural for these surgeries. You should not bother them as they will only be problem for about 2 weeks. Following the surgery 1 week after you can go back to your social life routine, and start putting make-up on your face.

Can’t I have good results by having fillers of my own fat?

Fat fillers can be used for a lot of reasons, and very good results can be obtained when it is used in the right place. If the patient accepts the truth that a part of fat will be lost in time, and multiple sessions might be needed, then there is no problem. Due to high amount of stem cells they include fat tissues increase tissue quality in the locations they are injected. It gives volume to the injected area. Thus, more fresh and younger look is obtained. As it is clearly explained, fat fillers create perfect results for right patients with carefully planned operations; however, in advanced sagging problems it can bring satisfying results only when it is combined with face lift.

What can I do to deal with these problems instead of face operations?

As a plastic surgeon, I prefer surgery if the patient is suitable since sustainable and visible results can be obtained. Best result satisfies both patient and the doctor. I can recommend non-surgical solutions under 2 conditions: Firstly if the patient is on early stages of the problem, and secondly if the patient strictly against the surgery. Then, what are our options? To increase the skin quality and tighten it, we can use laser treatments, injections, radiofrequency, silhouette soft, meso lift, and stem cell treatments. After a while following the surgery, we can apply those treatments also to surgically treated patients to increase skin quality.

What do you recommend for skin?

Those surgical manipulation methods we explained so far are to correct your anatomical bone structure and the cover of it. But, no surgery can give you freshness and vitality feeling on the skin. For upper layer of your skin, I recommend fractional laser, chemical peelings, Q-switch lasers, radiofrequency, skincare, derma stamp, derma therapies, fillers, botox, mesotheraphy, and a lot of dermacosmetical products. Those minor operations are important complementary treatments.

Then, after all how much younger I will get, and how long it will sustain?

I don’t know J No, it is not a joke. I really don’t know. You will go back to the age of your last picture taken on which you cannot see those wrinkles, sagging, and volume loss. With this surgical intervention we take the time back for you (of course not metabolic); however, unfortunately time will keep moving forward. You can preserve these results for long years with the support of good eating habits, staying away from smoking, and skin care. Both theoretically and practically this procedure is a lasting surgical intervention. Tissues moved upper and tighten cheeks hang on to their new place, and sustain their lives there. Thus it is promising long years.

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Op. Dr. Ozan Balık

Ozan Balık, M.D. was born in 1975. After he graduated from Adana Karşıyaka Highschool in 1992, he started Electronic Engineering major in Istanbul University. While he was having a series of operations he realized his tendency to medicine. In order to say “Don’t worry, they will be safe in here.”

Contact Op.Dr. Ozan Balık Levent Mah. Çilekli Cad. No:10 Beşiktaş İSTANBUL Tel: 0212 215 53 33 - Whatsapp: +90532 4458733 Mail: ozan.balik@gmail.com

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