It used to be clear what a facelift was: plastic surgery under anaesthesia that made incisions near the hairline, then pulled back and excised loose skin to take ten years off your face. Most of all, a facelift was something I would never, ever think of doing. And then I met DR WONG CHIN HO of W Aesthetics, in Singapore, who told me about the deep-plane facelift; he made me think again. Dr Wong did his fellowship in face-lifting, and he lifts a lot of faces. Some years ago, he skilfully excised three small growths from my face (the legacy of sun damage in my foolish youth), so I’ve had personal experience of his incredibly fine stitching technique. He discusses his work in more detail here.
What can a patient expect from a facelift?
The decision to have a facelift (or any kind of plastic surgery) might be one of the most significant decisions that you will make. Many patients instinctively know when the time has come for them.
I like to put things into perspective and to be clear about what is possible in terms of the degree of improvement that can be achieved, given individual skin quality, skeletal structure and the extent of ageing-related changes.
Who is a good candidate for face lifting?
Someone who is looking for profound rejuvenation. But if you’re not keen on surgery and will be satisfied with a very subtle result, non-invasive techniques involving high-tech radiofrequency and ultrasound can tighten and rejuvenate the skin to some extent.
Non-invasive methods don’t work for the jowls, as you can see by manually lifting your own cheeks. There’s excess skin above them, and that needs to be removed.
To remove sagging jowls and really get a fresh appearance takes a surgical facelift. Ageing is not just a question of sagging, either. There’s also the issue of facial shape. The youthful shape is triangular or heart-shaped; now, with jowls appearing, it becomes squarish.
What sort of facelift do you perform?
I do what is called a deep-plane or composite facelift, which addresses both the skin layer and the layer below it. It gives a completely natural result – you simply look like your younger self.
Because the tightening is done in the support layer of the skin, rather than in the skin itself, we avoid the stigma of a traditional facelift – that “wind-tunnel” look. Now, with our better understanding of the anatomy of the face, we are able to achieve much better results, and just as safely.
Nowadays, the incidence of nerve injury with the composite technique is the same as it is with traditional facelifts, just one percent.
The result is more natural, and the effect is longer-lasting.
Who developed the deep-plane facelift?
The deep-plane facelift was first described over 30 years ago by Dr Sam Hamra in Dallas, who achieved superb results. In those days, however, the technique was not popular, because it was considered dangerous. It works at the deeper plane where you find the facial nerves, so there’s a real risk of nerve injury.
The pioneer in the understanding of facial anatomy – and also my mentor – is Dr Brian Mendelssohn from Melbourne. Together, he and I contributed a chapter on Facial Soft Tissue Spaces for the third edition of Neligan’s important work, Plastic Surgery Principles.
With this understanding, we can get into those facial spaces safely with minimal risk to the patient. The risk of nerve injury associated with the new, improved composite technique is the same as it is with other facelift techniques: one to two percent.
In my experience, it has been a real advance for Asian patients, who tend to have thicker, heavier skin that the traditional facelift is less effective in lifting.
Are there any differences when performing facelifts for Caucasian and Asian patients?
Profound rejuvenation results may be achieved for Caucasian and Asian patients alike with the deep-plane technique. However, because of differences in tissue characteristics and skeletal anatomy, technical adjustments are required to deliver good outcomes.
Caucasian skin is lighter, thinner and more delicate than Asian skin. We can drape it more effectively and recovery is generally quicker. Asian patients require more extensive release to the front of the face in order to lift their thicker, heavier facial soft tissues.
To the point: What would you recommend for me?
You look very good for your age, and you’re lucky to have hardly any eye bags. You have a great skeletal structure and a good jawline and cheekbones, so you would achieve a great result with the composite facelift. I would recommend the full facelift – and for you, we could use the short scar technique.
Another component of ageing is deflation. To restore volume around the eyes and the forehead, I would harvest some fat from elsewhere on the body, and graft it into the sunken areas to re-volumise them. This “lift and fill” approach is the essence of the modern facelift.
When is the right time to have a facelift?
If you have it done while your skin is still in good condition – before you obviously need a lift – you will achieve the best results. Once ageing is advanced, it’s more difficult to get a great outcome.
Only the patient knows when the time is right. Often, her decision is triggered by a life event such as a daughter getting married, or perhaps the death of a spouse. I always say that the main purpose of this surgery is not to please the eye, but to uplift the soul.
Deep-Plane Facelift Cost in Singapore: From $30,000 to $36,000
Downtime: About three weeks
Duration of effect: Lasting
W Aesthetic Plastic Surgery
#06-28/29 Mount Elizabeth Novena Specialist Centre, 38 Irrawaddy Road
6570 2528 | waesthetics.com
This article first appeared in the February 2023 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!
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