Functional Flexibility Of The Face
3 December 2019 onur
We perform facelift surgery to correct the laxity in the facial skin and subcutaneous tissues during the aging process. Facelift surgery is designed to make the loose and saggy facial skin tauter and more stretched. Our potential patients often put the palms of both hands on their cheeks before the surgery, pull them to the side and upwards and express their expectations from the surgery by saying, “I want my face like this”.
If you had a facelift, your face needs to be stretched, right?
We don’t have our faces only to look good. It also has many other functions.
For instance, we need to open our mouth while eating. Each time the mouth is opened, the jawbone stretches the skin of the lower cheek like an awning. In order for our mouth to open, there must be a certain flexibility in the tissues around the mouth. Similarly, in order for our eyes to open and close easily and for our mimic muscles to move, there must be a certain degree of flexibility around the eyes. Without some flexibility in the neck skin, we cannot move our head comfortably. These examples are not exhaustive but you got the gist. We call the minimum flexibility required for the face to maintain its functions as “functional flexibility of the face”.
There is a direct relationship between the functions of the face and the way of aging. For instance, the more active your laughing muscle is, the deeper your nasolabial fold will be. As you laugh, the soft tissues of the midface are compressed like an accordion. This chronic compression is called the “concertina effect”. The repetitive chronic compression motion is considered to be among the main causes of midface volume loss. When the volume decreases in a specific area, the skin on that area becomes relatively loose and sagging.
Similarly, in people with a strong masticatory muscle, the volume loss in the temple due to the compression of the masticatory muscle is observed earlier and more severely. When the temporal volume decreases, the skin in this area and the outer part of the eyebrow get relatively loose and sagging.
Eyebrows droop faster in people with very active facial expressions.
People with a prominent chin and a wide oral aperture are more prone to sagging in their midface and cheeks at an early age.
Examples are non-exhaustive.
The key point you should know is that the functions of the face affect the aging process as well as the process after the facial rejuvenation surgery.
In facelift surgery, no matter how much you stretch the face, after a certain period of time, the face will restore the functional flexibility it needs,
- through the stretching of the skin under tension,
- thanks to repetitive movements.
We tell you that in the early period, the face will be more stretched than its final state and this tension will regress to a functional level within 6 to 12 weeks. There will definitely be some relaxation in the first 3 months after facelift surgery. The extent of such relaxation will be determined by the functions of your face.
Therefore, we recommend our patients to limit their oral aperture, not to make intense facial expressions as much as possible and avoid sleeping in positions that will deform their faces during the early recovery period (6-12 weeks) after the surgery.
At the end of month three, your face may not be as tight as you want or imagine. This is because no facelift surgery is permanent enough to overcome the functional flexibility of the face in the long run.
One of my academic research areas is about how the effectiveness of facial rejuvenation surgeries around the mouth could be increased and how to make this effect more permanent. The technique I developed, which I call “facelift with double-level SMAS plication”, was designed to prevent early recurrences due to functional flexibility after facelift surgery.
The most important factor that causes the skin to relax earlier than desired after facelift surgery is exaggerated oral aperture. In the first 3 months after the operation, biting apples, eating burritos and yawning like a lion are forbidden. You need to limit oral aperture. You can eat anything you want, but in small, soft bites. For example, you should prefer soft meatballs instead of hard meat. This is also the reason why we do not want patients to get dental treatment in the early postoperative period. Completing dental treatment before facelift surgery is preferred.
Another factor that contributes to the relaxation of the skin after facelift surgery is the sleeping position. Reiterative forces applied on the face during sleep may loosen the sutures that hold the deep tissues in place in the early postoperative period. We do not want the sutures to get loose before healing is complete. Therefore, we do not recommend that patients lie in the prone position for the first 6 to 12 weeks after surgery.
Another factor that may cause the relaxation of the skin and subcutaneous tissues before recovery is complete after facelift surgery is the use of exaggerated mimics. Relapses are common after forehead lift/brow lift surgery in patients with intense facial expressions. No matter how strong you fix them, the hyperactive muscles around the eyes will keep pulling down the surgically-lifted eyebrows in the long run. Therefore, in some forehead lift techniques, the muscles that pull the eyebrows down are deliberately weakened. Similarly, strong and continuous contraction of the laughing muscles and the platysma muscle in the neck may pull the face down after facelift surgery. We do not want you to have a sullen expression on your face after surgery, but we recommend that you minimize the use of mimics and miss your friends who make you laugh out loud.
Without adequate knowledge of the normal functions and anatomy of the face, you may not see what to expect regarding the results of surgery. In summary, you should not expect an overstretched face. After the operation, your face will still be flexible, and some related signs of aging will naturally be there.
Please feel free to contact us for detailed information on facial rejuvenation surgeries.
Take good care…
… of yourself and your beauty.