A full description of facelift surgery
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A full description of facelift surgery

A full description of facelift surgery

(一) Sagging eyebrows and eyelids

It is caused by the loosening forehead tissue, eyebrow depressors and gravity, and the phenomenon of sagging eyebrows is one of the most indicative aging-look issues.

(二) The root cause of frown lines between eyebrows
There are three depressor muscles between the forehead, brows and the eyes. The excessive activities of these muscles will cause the eyebrows to recess (frown) and sag. These wrinkles makes one look very serious.

(三) The root cause of horizontal wrinkles at the nasal radix
It is caused by excessive activities of nasal radix's bunny line muscles.

(四) The root cause of the forehead wrinkles
When the sagging upper eyelids comes into contact with the eyelashes or interferes with the eyesight, it would stimulate the contraction of the forehead muscles, and the contraction of the forehead muscles causes the horizontal forehead wrinkles.

(五) The root cause the lower under-eye bags
The aging of the lower under-eye bag is often mistaken for having too much fat. In fact, the sagging lower under-eye bags is caused by the loosen eye ligaments, located inside the orbits, that support the eyeballs, thereby causing the sagging eyeballs to oppress the fat inside the orbits to move downward. When the orbital septum is also loosen and cannot support the weight of the fat, the lower under-eye bags are born. The downward movement of the lower eye fat often results in sunken eyes.

(六) The root cause of tear trough and nasolabial folds
The inner side of the tear trough is the junction of the septal and orbital portion of the orbicularis oculi muscle. On its lower side, there is a ligament called orbital retaining ligament connected from the periosteum to the skin, thereby forming a fixed portion that lifts the lower eyelid from continuing to fall.

When the eyelid falls down, the palatal fat below it would sag. Only this ligament part is sunken in a fixed manner, and this is one of the mechanisms that causes the tear trough. At the bottom of the nasolabial folds, there are also similar ligaments attached to fix them on the skin, and when the malar bone fat above sags and stacks there, it results in nasolabial folds.

(七) The root cause of flesh under the lower jaw
There is a mandibular ligament connecting to the outer skin of the chin, and the cheekbone and cheek fat on top of it happens to stack there.

(八) Sagging cheekbone fat
The superficial musculo-fascial system attached to the bottom of the cheekbone and cheek fat is relatively loose, so it is prone to sagging, causing different degrees of hollowness below the cheekbone.

(九) Double chin and neck bands
The cosmetic effects of the forehead facelift surgery include: 1) Removing forehead wrinkles 2) Adjusting any sagging eyebrows 3) Removing crow's feet 4) Removing frown lines between brows 5) Correcting asymmetric eyebrow heights

The circumstances that require facelift surgery?

The facelift surgery can be divided into partial facelift and full face lift. Partial facelift can again be divided into upper forehead facelift, temporalis facelift and mid-face and lower facelift. The purpose of all these methods is to make you younger rather than turning you into another person. Therefore, besides becoming young, the effects of the facelift surgeries should also be natural and harmonious. There is no better or worse among these surgical methods, as each of them has its own advantages and disadvantages, so they are suitable to different patients. We will describe them briefly as follows:

一、Traditional forehead facelift
The traditional opened facelift surgery is to cut open the scalp at 5cm off the hairline and separate the tissues downwards, then lift the forehead flap, pull it backward and remove the excessive scalp before stitching.

The advantages of this method are direct, fast, and the effect is long-lasting. Its disadvantages include more surgical bleeding, the hairline will move up, a longer period of numbness at the top of the head, and it will leave scars on the scalp. In response to these shortcomings, endoscopic upper forehead facelift surgery was developed.

二、Endotine Facelift

The "Endotine" is the collective name we use for the fixation devices used in the facelift surgeries. In fact, fixation devices of 3 claws, 5 claws and multiple claws have been invented and applied to surgeries for other parts. Endotine is a soft tissue fixation device produced by Coapt Corporation of USA. Its material is a polymer called Polylactide, and it can be naturally decomposed and absorbed by the human body in about 6 to 12 months. During this span, the human body will heal itself to form a permanent fixed tissue.

三、 Endoscopic minimally invasive forehead facelift

Starting from the early 1990's, the surgeons no longer remove the scalp. Instead, the lift it up and pull it back to tighten it before fixing it on the skull with different methods. The advantages of this method include smaller scars, less bleeding, and lesser degree of scalp numbness (someone do not agree with this). The disadvantages include that the surgery is more difficulty, the device is expensive and complicated, and the surgeon must receive special training and practice to handle it with ease.

四、Endoscopic facelift surgery
It is more suitable for people who are in the early stage of facial aging (patients around the age of 40 obtain the best effect), with less noticeable forehead wrinkles and flatter foreheads. On the other hand, it is less suitable for patients with forehead wrinkles, glabellum wrinkles, sagging eyebrows, puffy eyelids, sagging skins, severe sagging eyelids or round face.

五、 Mid-face and lower facelift

The issues on the upper face can be improved with the forehead facelift, but for issues on the lower face, the patients must rely on the mid-face and lower facelift surgery. The surgical method is to make incision from both sides temples near the hairline close to the ears to the back side of the front edge of the ears, and then perform dissection of tissues before lifting up, tightening and fixing the sagging fat tissues. Lift up the sagging skin tissues to tightening the skin, and then remove the excessive skins and stitch up. It can flatten the nasolabial folds as well as the loose skin at the lower edge of the cheeks.

The mid-face and lower facelift is more complicated than the forehead facelift surgery, mainly because the blood vessels and nerves passing through the mid-face and neck are very complicated. Therefore the surgeon must be careful during the course of the surgery, and the operation time is longer, usually taking more than three hours. General anesthesia is usually performed for the surgery, and the swelling of the face can last for 2 to 3 weeks.

六、Endotine-Ribbon Facelift
Whether a facelift surgery for the lower face and the neck will be successful mainly depends on the firmness of facial fascia and muscle fixation. Therefore, when Coap of USA introduced a new device with multiple claws for fixation of lower face and the neck called Ribbon, it provided the plastic surgeons with another choice to more effectively fix the facial fascia and muscles.

Since the traditional sutures still have the tissue avulsion issues, which can lead to early loosening or sagging of the fixed tissues, the use of this material which does not have any side effects on the human body (it can be can be fully absorbed by human body in about 1 year) but provides a long-term fixation effect helps taking the technique of lower facelift surgery another big step forward.

七、All-dimensional Operation
Sometimes the surgeons combine upper and lower eyelid surgeries, local liposuction, implantation, local autologous fat (or artificial dermis Alloderm) injection and transplant, laser dermabrasion, and Botox injection to make certain improvements. Since there are many procedures involved, the entire operation often takes quite long, but when the overall effect is excellent, sometimes even surgeons feel like they are performing magic.

八、ThermaCool facelift
Facelift is actually not a very appropriate term here. From the viewpoint of a plastic surgeon, it is at best a skin tightening treatment. It utilizes the electric wave energy to continuously heat up the deep dermal tissue (3 to 5 mm) to a high temperature of about 65°C, thereby causing the deep collagen of the skin to shrink in and achieve a skin tightening effect.

The surgery only requires local anesthesia. The patient will feel some pain during the surgery, and after the completion of the surgery, the patient will only suffer slight swelling on the face with no wounds.

No special treatment is required after the procedure. The entire facial treatment takes no longer than 1 hour, and after repeated treatments, most people will gradually see results after about 2 to 6 months. The procedure costs about NT$80,000 to 100,000, and it provides better effects on the upper face and forehead than other parts of the face, and sometimes the face will become slimmer.


九、The methods and features of the new type of brow/eye lift
The surgeon will open up an incision of 2-3cm inside the hairline near the temple, and then make an opening about 3cm below the incision to enter the subcutaneous fascia. Through the pulling force of the fascia, the sagging eyebrows and eye corners can then be lifted up. By utilizing the endoscope, the bleeding is minor, the wound is small, and the scars are hidden inside the hairline.

The new type of brow/eye lift can flatten the wrinkles on the forehead and brow ends, change the shape of the eyebrows, correct the sagging outer angle of eyes, and lift up the height of the eyebrows.


Q 1. 拉皮手術後可維持幾年?



Q 2. 拉皮手術術後傷口明顯嗎?



Q 3. 拉皮手術後表情會僵硬不自然嗎?



Q 4. 臉部拉皮手術可以改善哪些老化部位?



Q 5. 如果以前做過拉皮手術,皮膚又再鬆弛還可以再拉嗎?



Q 6. 內視鏡拉皮和傳統拉皮有何不同?

內視鏡拉皮出血少傷口小,但對於額頭過寬的人就不太適合,因為內視鏡拉皮是將皮向上拉,並沒有做皮膚的切除所以額頭過寬而又鬆弛的人來說,光往上拉會顯得額頭過分的寬高,就會顯得有點不成比例。 同樣的對於中臉部分的內視鏡拉皮也要注意。自己臉部的皮膚是否鬆弛,因為內視鏡拉皮手術都沒有做切除多餘皮膚的動作,所以對皮膚鬆弛的人來說傳統的拉皮手術仍是考慮的選項之一。


Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

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