A Complete Analysis of Facelift Side Effects: A Must-Read Before Surgery

In this session, I have prepared information regarding the types of facelift side effects, the reasons they occur, and how to avoid them. Hello, I am Dr. Kim Yongwoo, Chief Director of Returning Plastic Surgery. Recently, the demand for facelifts has increased rapidly. As many clinics perform facelifts, it seems there are also many people suffering from side effects. It appears that patients planning for a facelift are having more concerns after seeing reviews of facelift side effects. Before undergoing surgery, let’s take a detailed look at what facelift complications exist, why they occur, and what the methods are to avoid them.

1. Hypertrophic Scarring
2. Pixie Ear
3. Skin Necrosis
4. Cheekbone Protrusion (Mantis-shaped Face)
5. Unnatural Flounder-shaped Face
6. Nerve Damage - Facial Paralysis

Hypertrophic Scarring Insufficient SMAS dissection, excessive skin resection The part that people worry about the most is probably scarring. In the case of facelift scars, it cannot be seen simply as a matter of constitution (skin type); it is a case where the dissection range is small or the tension on the suture area becomes strong because too much skin was cut away. Since scars grow larger as the force trying to open the incision area occurs, it is important to ensure that no tension is placed on the skin during skin suturing. If the retaining ligaments remain because the dissection was insufficient, the tension placed on the skin increases as the sagging recurs later; also, in cases where one gets greedy and removes the skin excessively, the tension on the skin increases, leaving a lot of scars. Therefore, emphasizing it once again, it is important to perform retaining ligament dissection through wide dissection and ensure that all tension is placed on the SMAS elevation, thereby minimizing the tension placed on the skin. When surgery is performed this way, scars hardly remain.

 

If the retaining ligaments are not cut and the dissection range is small, a lot of tension is placed on the suture area due to the force trying to sag again, resulting in a lot of scarring. On the other hand, with wide dissection, the tension placed on the suture area is minimized, so scars do not remain much.

[Hypertrophic scar occurred after facelift]

If you perform wide retaining ligament dissection and minimize skin tension, you do not need to worry about facelift scars.

Pixie Ear Correction method is Facelift Revision There is a pixie ear phenomenon where the earlobe is pulled downward increasingly after a facelift. Pixie ears also occur for reasons similar to hypertrophic scarring. If retaining ligament dissection is not done properly, a force trying to sag continuously is placed on the suture area, pulling the earlobe and causing progressive deformation. The causes of pixie ears and scars are the same.

[Case of pixie ear deformation occurred after past facelift, corrected by Facelift Revision by DR Returning]

Pixie Ear Correction If you simply cut and sew at the stretched earlobe area, it will unconditionally recur. For effective correction, we must approach via the deep plane again, dissect the retaining ligaments, lift so that all tension is placed on the SMAS, and suture the skin of the earlobe area without tension.

Skin Necrosis

[Case of skin necrosis occurring due to tension at the suture site]

Skin necrosis is probably one of the most fatal facelift complications. Skin necrosis often occurs around the suture site, and in some cases, it can occur on skin distant from the suture site. Cases occurring at the suture site can happen because blood flow drops when the suture tension is high. Also, if skin dissection is too large, it can happen if blood flow is not effectively supplied to the distal end. Especially in patients with diabetes or cardiovascular diseases, post-operative blood flow is not good, so extra caution is required in post-operative care. For this reason, Dr. Returning prefers the Deep Plane Facelift, which has less skin dissection than the Dual Plane Facelift.

In Dual Plane dissection where skin dissection is wide, the possibility of blood flow disturbance in distal skin is higher.

Skin necrosis occurring in areas distant from the suture site happens when the skin flap becomes too thin during the dissection process, damaging skin blood vessels; in the case of necrosis occurring in clearly visible areas of the face, the solution is difficult, and major cosmetic problems can arise. Therefore, care must be taken so that the skin flap does not become too thin during elevation in patients with thin skin.

Cheekbone Protrusion - Mantis-shaped Face If the 45-degree cheekbone is large, the SMAS elevation can make the tissue in the cheekbone area thicker, resulting in a face where the cheekbones look more prominent. It is a very unfortunate event if you tried to improve a sagging face but ended up with a "cheekbone ascension" face. Unfortunately, once a face shape change occurs, the solution is very difficult, so we must ensure it does not happen during surgery. In the case of patients with developed lateral cheekbones, Dr. Returning sets the SMAS incision site low so that the overlapping SMAS part is located below the cheekbone, and pays attention to ensure contour improvement after lifting by using fat manipulation such as buccal fat repositioning or liposuction.

In patients with developed lateral cheekbones, lowering the SMAS incision position can prevent cheekbone protrusion.

[3 Methods to prevent cheekbone protrusion] (Link Omitted)

Unnatural Flounder-shaped Face

[Unnatural impression caused by pulling in the wrong direction during lift]

While the Mantis type caused by cheekbone protrusion is a problem, a wide and flat "Flounder-shaped" face caused by pulling unnaturally is also a problem. This happens when there is a problem with the direction of pulling the SMAS. The SMAS must be lifted in a vertical direction and the skin must be pulled in a diagonal direction to result in a natural face after lifting. This must be applied slightly differently depending on the face shape. If the SMAS and skin are pulled in a horizontal direction, a flounder-shaped face can occur. If such an unnatural impression occurs and the grain between the SMAS and skin adheres unnaturally, it may be difficult to correct even with revision surgery, so it is important to lift with the exact vector in the first surgery without fail.

The lifting direction of the SMAS must be vertical. If pulled in a horizontal direction, it becomes a flounder-shaped face.

Nerve Damage - Partial Facial Paralysis Functional checks of facial expression muscles are mandatory before and after surgery. by Dr. Returning

The part that patients receiving a facelift worry about the most is probably facial paralysis. Since permanent functional impairment remains in the case of fatal nerve damage, it is the most fatal complication among facelift side effects.

There are 5 branches of the facial nerve.

[Red Line] Boundary to be careful of nerve damage during dissection

The facial nerve is a motor nerve. The reason we do not discuss sensory nerves much is that while small sensory nerve branches are damaged during skin dissection, they recover over time, and cases leaving permanent damage are extremely rare. Therefore, what must be careful about is the facial nerve, which is a motor nerve, and this is the nerve that governs facial expression muscles. The facial nerve gives off 5 branches. They are the Temporal branch / Zygomatic branch / Buccal branch / Marginal Mandibular branch / Cervical branch. Among these, the important ones are the Temporal branch and Marginal Mandibular branch, and damage to these causes permanent facial paralysis. On the other hand, in the case of the Zygomatic branch and Buccal branch, adjacent branches communicate with each other a lot, so even if there is slight damage, they recover easily within 2-3 months, leaving no sequelae of facial paralysis.

Schematic diagram of facial nerve rising from retaining ligaments

[Source] Neligan 4th edition

The facial nerve starts from a deep layer in the area in front of the ear and comes up to a shallower layer as it comes to the front of the face. Since it comes up along the retaining ligaments where the retaining ligaments are, caution is required during retaining ligament dissection. That is the reason why many clinics give up on retaining ligament dissection. However, as mentioned earlier, if you do not dissect the retaining ligaments, sagging recurs and facelift complications arise, so they must be dissected. I tell you again, this very point is the reason why you must receive surgery from a plastic surgery specialist skilled in facelifts.

Accurately dissecting so as not to damage the nerve during retaining ligament dissection is the reason why a skilled plastic surgery specialist is needed!

Among facelift side effects, there are many cases where resolution is difficult or impossible with revision surgery. While it is the same for all surgeries, facelift surgery must be performed by a plastic surgery specialist with a lot of experience. This was Dr. Kim Yongwoo, Chief Director of Returning Plastic Surgery. I hope everyone receives safe facelift surgery. Thank you.