Endoscopy has revolutionised many fields of surgery. Thanks to this technique operations, which in the past were significant interventions leaving noticeable permanent scars, can now be carried out with small incisions and minor side-effects.  In aesthetic facial surgery, too, endoscopy is playing an ever-growing role. Lifting the eyebrows is considerably simpler in many cases, as undesirable incisions and scars can be reduced to a minimum. However, if a significant amount of surplus skin has to be removed, the well-tested and commonly used method of forehead lifting should be resorted to. Both techniques should, in any case, be taken into consideration.

Aging affects all areas of the face. The effects are seen most in the eyebrows, which droop, the cheeks, which follow the downward pull of gravity, and the neck, which loses its youthful definition. If, for example, only the face is tightened, the result may be particularly unharmonious, as suddenly the various features of the face are no longer as well-matched. A much better result is achieved if the eyebrows, cheeks and neck are all lifted and tightened in the same way. The healing time is scarcely any longer than for a restricted lifting.

Lines in the face caused by aging or intensive sunbathing can make a face appear particularly old.  Laser treatment has been used successfully to smooth the lines in the face for several years.The effect can be as impressive as after a facelift. After about three weeks most patients can resume normal social activities, but should avoid the sun for at least three months. 

Aging can cause all the mobile structures under the eyes and in the region of the cheeks to slacken and move downwards. This leads to deep rings under the eyes and flattening of the cheeks, making the face appear old and tired. Mid-face lifting specifically lifts the expressive muscles and the tissues lying above them, allowing a younger, fresher contour to be attained. The necessary incisions are at the edge of the lower lid and in the hair of the temples. In some cases the intervention can be carried out with minimum invasion using an endoscope.

A facelift should always take into consideration the individual signs of aging to be corrected. If the face has become slack primarily in the region of the cheeks and there are only slight changes to the neck due to age, midi-lifting may achieve harmonious rejuvenation. The skin and the deeper layers are corrected more than in a mini-lift. In contrast to an extensive lifting, hardly any correction is carried out on the neck. Therefore most patients are able to resume normal social activities after a few days. Following the intervention, we recommend that patients spend at least one night in the clinic.

When the first signs of aging appear in younger patients, they usually affect the cheeks, which become slacker. The results are rings under the eyes, deepened nasolabial folds and hanging corners to the mouth. A mini-lift targets the cheeks, lifting them and restoring their shape. In order to attain lasting results, the deeper layers and the expressive musculature are lifted and tightened. The intervention takes about one and a half hours, can be carried out under a local or a light anaesthetic and can also be carried out as outpatient treatment. After only a few days most patients are able to resume normal social activities.

When a face ages, the skin loses elasticity and lines start to appear. At a deeper level, all the mobile structures move downwards, which is the reason why the face appears flatter in the region of the cheeks and broadens towards the chin. The objective of space-lifting is to reverse this tissue displacement. Here the deeper layers (SMAS) are separated and returned to their original position. This gives the face almost line-free skin and a youthful shape.

Due to age, changes occur to all areas of the face and neck. However, the age at which this commences and the extent of the changes varies. The decision about which corrections are appropriate  has to be made on a very individual basis. In younger patients, especially, it is sensible to consider each third of the face separately (forehead/eyebrows, central face/cheeks, neck). Lifting restricted to these regions can be highly effective and reduce the stress and side-effects for the patient. 

• Glossary