Non-Endoscopic Temporal Facelift

The temporal lift improves the signs of ageing in the temple region. This region is situated between the forehead and cervico-facial areas, which may also benefit from a facelift. The temporal lift, which can be performed in isolation, is in practice often combined with eyelid surgery (blepharoplasty).

This aesthetic surgery cannot be covered by health insurance.

It is not intended to alter facial features but to reposition anatomical structures, particularly the eyebrow tail, to the position they held some years earlier.

Tissue sagging in this region is essentially cutaneous.

The temporal lift is performed via a scar located:
• either within the hair (intracapillary scar) but at the cost of a setback of the hairline
• or at the hairline edge (precapillary scar) but with the risk of some scar visibility.

With an intracapillary scar, the temporal skin is elevated by exerting traction on the deep planes. The procedure is thus more effective and avoids any traction on the scalp, limiting the risk of alopecia (hair loss) and significant setback of the hairline.

With a precapillary scar, chosen because the hairline is already quite receded and/or the amount of skin to remove is significant, the undermining is subcutaneous. Only the glabrous (hairless) skin is removed and the hairline is slightly advanced.

The temporal lift restores a more harmonious distance between the lashes and the eyebrow tail.

When eyelid surgery is combined, the temporal lift reduces the skin resection and incision length on the upper eyelid.

The procedure, performed on both women and men, can be carried out from age 40. However, it is sometimes performed much earlier when the imperfections are constitutional (hereditary factors) rather than age-related, such as initially low eyebrows.

This technique may be combined with eyelid surgery, as mentioned, but also with other cosmetic surgery procedures (forehead or cervico-facial lift, lipostructure).

In the long term, ageing continues and the face continues to experience the effects of time. Facial maintenance with specific skin treatments (laser, pulsed light, etc.) and injections (botulinum toxin, fillers) helps maintain the result longer. A new procedure, often more moderate, may sometimes be necessary.

The patient's motivations and requests will have been analysed. A careful study of the temporal region, its relationships, and more broadly the gaze, will have been made.

A standard preoperative assessment is carried out in accordance with prescriptions.

• The anaesthetist will be seen in consultation no later than 48 hours before the procedure.

• No medication containing aspirin should be taken in the 10 days prior to the procedure.

• Smoking cessation is strongly recommended at least one month before and 15 days after the procedure. Smoking increases the risk of postoperative complications. Stopping smoking 6 to 8 weeks before surgery eliminates this additional risk.

If you smoke, discuss this with your surgeon and your anaesthetist.

• Hair should be washed the evening before the procedure and make-up carefully removed on the day of surgery.

• It is essential to fast (no food or drink) for 6 hours before the procedure.

Type of anaesthesia:

The temporal lift can be performed under general anaesthesia or under local anaesthesia combined with tranquillisers administered intravenously ("twilight" anaesthesia).

The choice between these different techniques will result from a discussion between you, the anaesthetist and the surgeon.

Hospitalisation:

The procedure can be performed as a day case, i.e., with discharge on the same day after a few hours of monitoring.

However, in some cases, a short hospital stay may be preferable. Admission then takes place in the morning (or sometimes the day before in the afternoon) and discharge is authorised the following day.

Each surgeon adopts a technique of their own, which they adapt to each case to achieve the best results.

However, common basic principles can be identified:
• With an intracapillary scar, the incision of approximately 4 to 6 cm is entirely hidden in the hair, a few centimetres behind the hairline and parallel to it.
• With a precapillary scar, the incision length depends on the amount of skin removed.

From the incision, undermining is performed in very precise anatomical planes, the extent of which depends on the tissue laxity of each case.

Tissue retightening is then performed.

The elevation of the eyebrow tail and skin redraping are assessed with care to preserve the natural facial expression.

The procedure may last between 40 minutes and one hour for both sides.

Discharge may occur either the same evening or the following day when other procedures have been performed simultaneously.

During the first days, maximum rest is required and all strenuous effort should be avoided.

During these first days, the patient should neither be surprised nor worried by:
• a small skin ridge at the upper part of the temporal scar,
• oedema (swelling) that may be more pronounced on the third day than the first,
• ecchymoses (bruising) in the region,
• a sensation of painful tension at the temples.

With intracapillary scars, these are not visible with the hair styled. Sutures or staples placed at the scalp level are removed on the 8th postoperative day.

With precapillary scars, these are visible but will fade from the 4th postoperative month as hair grows through them. They can of course be concealed with make-up during the first months.

As a general guide:
• by the seventh day, presentable to close family,
• by about the twelfth day, presentable to friends,
• but to appear before people from whom you wish to conceal the operation, three weeks should be allowed.

After two to three months, a good idea of the final result can be obtained. Physical improvement is generally accompanied by improved psychological well-being.

If in the following years a cervico-facial facelift were indicated, a further temporal procedure would not be necessary. Regular, spaced botulinum toxin injections into the orbicularis muscle fibres help maintain the result longer by reducing the depressor effect of this muscle on the eyebrow tail. However, the skin ageing process continues, and maintenance of the skin through medical and cosmetic procedures is entirely advisable.

These essentially involve partial recurrence of tissue sagging (ptosis), notably of the lateral eyebrow, which may require retightening under local anaesthesia.

The temporal lift, although performed for essentially aesthetic motivations, remains a genuine surgical procedure, which implies the risks associated with any medical act, however minor.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

Regarding anaesthesia, during the consultation, the anaesthetist will personally inform the patient of the anaesthetic risks. Having recourse to a fully competent Anaesthetist, practising in a truly surgical setting, means that the risks incurred have become statistically very low.

Indeed, techniques, anaesthetic products and monitoring methods have made immense progress over the past thirty years, offering optimal safety, especially when the procedure is performed electively and on a healthy person.

Regarding the surgical procedure: by choosing a qualified and competent Plastic Surgeon, trained in this type of intervention, you minimise these risks as much as possible, without however eliminating them entirely.

Fortunately, postoperative recovery is generally straightforward following a temporal lift performed according to standard practice, and true complications are quite rare.

In practice, the vast majority of procedures proceed without any problems and patients are satisfied with their results.

Nevertheless, despite their rarity, you should be informed of the possible complications:
• A haematoma requiring rapid evacuation. • Localised alopecia, rare and most often temporary.
• Infection is exceptional when the procedure is performed under normal aseptic conditions.
• Nerve damage, particularly injury or stretching of the temporal branch of the facial nerve, potentially causing paresis, but recovery usually occurs within a few months.

Overall, risks should not be overestimated, but one should simply be aware that a surgical procedure, even an apparently simple one, always involves a small element of uncertainty.

Choosing a qualified Plastic Surgeon ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.

These are the information elements we wished to provide as a complement to the consultation. We advise you to keep this document, re-read it after the consultation and reflect on it at your leisure.

This reflection may raise new questions for which you will need additional information. We are at your disposal to discuss them again at a future consultation, by telephone, or even on the day of the procedure itself, when we will in any case see each other before the anaesthesia.