Indications:
aging face and neck as exemplified by
appearance of
- jowls
- sagging neck
- increased depth of nasolabial folds
(smile lines)
Age range varies and is
based on physiological aging rather than strict
chronological aging. The average age is roughly 50 years
with a typical range from 45-65, although the occasional
patient may be even younger or older. Final assessment is
determined at the time of consultation.
Goals: to
rejuvenate the face in an effort to make a more youthful
appearance. It is critically important to avoid an operated
look in this procedure. Many patients avoid face lifts for
years because of the “wind-blown” or “surprised” look. What
is not noticed is the many women and men who look naturally
younger than their stated age who have had excellent face
lifts.
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Technical highlights:
There are many types of
face lift procedures. Typically superficial "skin only"
dissections require less operative time and recovery, but
are not as long lasting, nor as natural looking in the long
run as some other options. My surgical approach is to
provide a quality face lift through the use of the deeper
layer termed the SMAS. This layer has the texture and
strength of “gristle” on a steak. The force is applied to
the SMAS layer, which pulls the skin passively as the two
layers remain attached. This dissection allows a more
vertical lift as opposed to a more horizontal pull typically
seen with superficial approaches. This technique also aids
the goal of a more natural-looking face lift by not placing
the pull on stretchable skin, which can look over-stretched
in the short term yet relaxing more quickly resulting in
earlier recurrence. Eventually thin, stretched skin is a
tell tale sign in older patients with multiple face lifts
performed with superficial techniques.
I believe therefore that
the proper symmetrical directional pull (more vertical
rather than more horizontal) of the proper layer (SMAS
rather than skin) results in a good face lift. However,
attention to detail with regard to hiding skin incisions,
avoiding improper elevation of the sideburns, and ensuring
that the earlobe is attached properly results in an
excellent face lift, which should always be the goal.
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Complications:
A list of complications is
available in printed form and will be discussed during
consultation; however, the main complications specific to
face lift procedures will be mentioned here.
-
Facial nerve injury -
I have never had a permanent facial nerve injury to my
knowledge, but it can happen in extremely rare
instances. I personally mark the facial nerve in every
case on the morning of surgery. Its course and
protection are foremost in my planning. Temporary
weakness is uncommon but may occur, resulting in a
temporary asymmetrical smile. Partial weakness may occur
due to simple pressure on the nerve with relatively
insignificant trauma. Partial injury uniformly resolves
within a few days or rarely as long as a few weeks.
-
Numbness - occurs
temporarily on all dissected skin of the face and neck
for several days to weeks in some patients. Injury to
the greater auricular nerve can rarely occur causing
temporary or even permanent numbness of the ear
General complications:
-
Infection - a recent
published article of over 3500 cases performed at
Dallas
Day Surgery Center (my surgery center) reported an
infection rate of less than 1%. This is well below the
national average, although infection rates of 0% are
impossible.
-
Bleeding - excessive
bleeding can occur in any operation and is slightly more
common in face lifts, especially in men and repeat
procedures. It is important to stop all aspirin and
anti-inflammatory medication prior to surgery for at
least 2, and preferably 3, weeks.
-
Deep venous thrombosis
and pulmonary emboli - this condition is fortunately
uncommon but is one of the most serious complications
that can occur post operatively. It can be reduced to an
extremely rare occurrence by the use of compression
garments routinely worn by all of our patients
undergoing longer procedures.
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Recovery:
All information below is
based on an average patient including 2 standard deviations
i.e.…95% of all patients. Some patients fall outside these
descriptions and have a better or worse recovery than the
average patient for unexplained reasons.
Pain - not
typically problematic in face lifts. Any pain is usually
present for 24 hours and is not particularly severe in
most instances. Any discomfort is usually behind both
ears. There is always tightness across the neck under
the chin from ear to ear. The perception of the severity
of this tightness varies from patient to patient.
Drains – these are placed behind the ears in the
scalp and are used to drain the neck area for 24 hours
typically, but may be left in place for 48 hours.
Swelling - Steroid dose pack is given for 5 days
and minimizes swelling in the first 48 hours. Maximal
swelling typically occurs on the 4th to 5th post
operative day as the dose pack is tapered and begins to
decrease on day 5 to 7.
Bruising - usually maximizes on the 3rd to 5th
day and resolves over 2-3 weeks.
Driving - You can resume driving when you can
drive to the level you were able to drive at
pre-operatively . . . this decision is is up to you. You
must be able to brake and respond quickly. You must be
able to quickly and easily turn to eliminate your blind
spot. When these conditions are met you may resume
driving, typically in the 2nd or 3rd week.
Social return - Most patients feel comfortable
socializing in foreign environments (places and
locations they do not usually frequent) at 3 weeks to
avoid seeing close friends and acquaintances. At three
weeks, healing is still taking place and will still be
visible. You should be aware that you will not yet look
like yourself for about 6 weeks. I choose a surgical
technique that optimizes result, but takes a while to
recover. I do not know of shortcuts to success, and will
not hide the facts of recovery.
Depression - It is not unusual for patients, no
matter how stable and solid, to experience some
depression in the postoperative period from about the
1st to the 3rd week. If depression is experienced it is
not a sign of weakness, as it may occur with any
surgical face change, even when the changes are very
positive. We are all impatient and must be reassured. If
there is a real problem you can be certain that it will
be identified and addressed. An honest explanation of
your progress will be given to you at each visit.
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How long will the results
last?
A return to social life is
most comfortable at 6 weeks. I believe this can be judged
when close friends are complimentary of the change. Casual
acquaintances may not even be able to tell exactly what
change has occurred, but rather proclaim that you look
rested or may have even lost weight or changed hairstyles.
The difference relates to how much change is needed
depending on the degree of aging at the time of face
lifting. The more aging is noted at the time of operation,
the more dramatic the change. The results can be very
positive, but may be unavoidably noticeable. It is important
to be honest with your support structure (significant
others, husbands, wives, children, and family). I encourage
you to bring spouses to the consult, as you will need their
understanding and encouragement during the recovery process.
It is important for them to understand the recovery process
as clearly as you do.
Although 6 weeks is the
standard time to return to full social interaction, I tell
patients that if I were to take a single photo to submit to
some type of theoretical “Plastic Surgery Contest”, I would
do so at 6 months as very subtle swelling and relaxation is
complete by then. It is also important to realize that aging
continues and that every year after that 6 month picture you
will appear a year older. Surgery does not stop the aging
process. However if you compare your photo with the
pre-operative photo it should take 8-12 years to catch up,
depending on which portions or aspects of the face you are
looking at. Some aspects of the eyes and brows may never
appear as aged again depending on the exact procedure
chosen.
Cost?
We do not feel that it
would be appropriate or ethical to post prices for
procedures on the internet. We do, however, understand that
cost is a factor you must consider. We would be happy to
speak with you about this so that you may determine whether
the procedure you are considering falls within your budget.
Our pricing structure is based on the time, complexity, and
surgical costs involved. Please feel free to call our office
at 214-823-1978 and speak with either Kurthene or Annette
for more details.
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