Advanced Facelift Technique (Transcription)

Since about 2002, we started performing facelift surgery a little bit differently. It combines the best of mini face-lifting with traditional face-lifting, so patients come in, we give them a cocktail of medications, some Valium or some other oral medications, meaning we don’t need to perform this under IV sedation and you don’t need to be intibated, you don’t need to paralyze you and perform this under general anesthesia. What we do is we mark where we’re going to make some incisions and the markings are going to be made inside this bump on the ear called the tragus, there’s a marking it comes right around the lobyial or the ear lobe and about one or two centimeters at the back of the ear. No longer are we making incisions all the way up the ear or all the way down the back of the scalp the way we used to.

There is also an incision at the root of the ear, it comes right out of the tragus and there might be a little incision here. What we do then is patients are relaxed, come back to our operating room and we begin to localize the localize the patient and what that means is we’ll go ahead and inject some local anesthesia , much like if you had a mole or skin cancer we can numb that up. This is the worst part of the procedure and it’s not very bad, it’s really just numbing up a little more or skin cancer that you may have. Once things are localized for awhile I’ll come back, we’ll make the previously marked incision and I’ll go ahead and explain what we’re doing. We’ll make our incision, we’re going to elevate the skin and beneath the skin there’s a layer called the smas, the sub muscular aponeurotic system, it’s an acronym, and the best way to think about this is if you have a boneless chicken breast, there’s a white, tough layer over that chicken breast, very similar to the layer that we’re supporting that’s not actually muscle but it’s a fibrous layer that has begun to descend over time.

As that smas layer descends over time we begin to develop folds, jowls, jaw line and neck problems, so our job is to re-support, to re-suspend that smas muscle and we do that using absorbable sutures. At that point we have the smas tightened and this represents a lot of left over or extra skin, we’ll simply remove that skin and use some very fine sutures to close that incision. The reason I’m pointing out this particular feature is because what we don’t want to do is we don’t want to simply come in and pull the skin, this is often the case for procedures you might know as the lifestyle lift or other skin only mini face lifting procedures. Our job is to support the underlying smas to fix the problem one, so the procedure is lasting, typically these procedures last about seven to twelve years and two, so you look natural and not pulled, so we’ll perform that on one side, we’ll go to the other side and do the same thing.

Sometimes in the next area you’ll see these patients have these little bands and what the bands represent, there’s a muscle called the platisma muscle, we have a muscle that generally joins in the midline, joins in the middle portion of the next and the connection is very attenuated, which means that it’s very weakened and often it separated and as it separates we can see the edges of those muscles and we call that banding, so what we might do is make a little incision right through here, from the right and the left platisma muscle, and simply suture them back together, that’s typically performed at the beginning of the procedure so that we’re actually fixing the problem so as we tighten the smas to the right and the left, we’ve actually completed the neck repair a lot better.

A lot of patients do ask, oh my gosh, am I going to be awake during this procedure and the truth of the matter is, we’ve been performing the advanced facelift procedure this way since about 2002. Patients do remarkably well, most patients are nervous, I would be nervous if I was having some facial procedure but the cocktail, the medication that we give you orally relaxes you very well. After we get things localized and you’re numbed up, and once we begin the procedure, you do realize that you don’t feel anything, you might hear some noises, we play some nice music for you, if you’d like to have a conversation with us we’ll talk but generally after about fifteen minutes or so, most patients fall asleep naturally by themselves and their comfortable throughout the procedure.

One of the benefits of using our cocktail and performing this under local anesthesia, are the biggest advantage is there are no risks, we don’t have the risks that general anesthetics pose and of course with most surgery the risks that we always talk about, having lung problems or cardiac problems, have to deal with the anesthesia itself. In addition, certain general anesthetics can cause what we call vassal dilation, what does that mean, that means that some of the medications that we take can expand the blood vessels a little bit or create more blood flow, that could create additional bleeding, a potential for the need for tubes and drains an then an extended recovery period. When we use local anesthesia well, what we’re doing is we’re creating vassal constriction, just the opposite, that means the lidocaine, which numbs the tissue, contains epinephrine, and epinephrine which you might know as adrenaline, is a substance that will actually constrict blood vessels so for example, if you had a mole or skin cancer and we injected it, and let’s say it’s right here, you will actually see the tissue begin to blanche, it will turn white, and what’s happening is the epinephrine is constricting that blood vessel, there’s less blood flowing to the tissue and now during the procedure, we lose very little blood, in fact we may lose only several teaspoons of blood during this entire operation.

The benefit of minimal blood loss is that we can move from one step to the next, we can go ahead and do our job and get you to the recovery period. The recovery period after an advanced lift procedure is remarkably fast, patients actually look quite good the next day, typically with very little bruising. Immediately following the advanced lifting procedure, we do use a dressing, we do place a dressing around your head, most patients find this somewhat comforting, they expect after surgery that they have something. The truth of the matter is, we like to put it on because you’re going to go home, you’re going to want to inspect everything and frankly it’s easier if you go home, just rest, take Tylenol, you might take half of a Vicidan, you really won’t have much discomfort or pain and the next day we’ll see you back, we’ll take the dressing off and you will be shocked, you’ll be surprised, you’ll have a nice clean jaw line, your neck will be improved. This is surgery, you will look a little bit like a chipmunk, and you’re going to have some swelling but typically very little bruising. Generally about five or six days after that appointment you’ll come back and we’ll remove those dissolvable sutures that we placed.

If you’ve taken any medication overnight you’ll probably want somebody else driving you back to the office, we’ll unveil you, we’ll take the dressing off and following that appointment you can go home, shower, shampoo and go for a walk if you want. This is surgery, I don’t want to minimize it too much, we don’t quite have a magic wand yet but you look quite good, most women with hair can cover that area of swelling quite nicely the next day. One of the questions I’m asked a lot is why does this procedure only take forty five to fifty minutes and the truth is, the entire procedure, you are probably with us for about three hours. We spend more time in preparing for the surgery and that is it takes us a little bit longer to mark things and localize the area, we probably spend about fifteen to twenty minutes just doing that, then we’ll wait about ten minutes before we get started. However, because of the care that we’ve taken on the front end and the fact that we localize the tissue well and we don’t have bleeding, we can move from step to step and the procedure takes about forty five to fifty minutes.

Patients will often wonder whether or not we’re taking any shortcuts with our surgery and what I like to reiterate again is that we are performing a smas face lifting procedure and as I described before, it’s making sure that underlying fiberous layer, that smas layer, is supported properly that will give you a natural result and will give you a long lasting result. The other aspects of the advanced face lifting procedure are what you might deem ‘mini lifting’, that is performed under local anesthesia, shorter incisions, less surgical time and a shorter recovery time and as mentioned, we’ve been performing it this way since 2002. The patients that we see, and I would suspect most patients undergoing these sorts of treatments are interested in a natural look. If we go back and walk through step by step in how we are performing these treatments, by supporting the underlying smas layer it allows us to not put too much tension on the skin therefore looking unnatural.

There’s nothing wrong with living in West Palm Beach, if you go down to Florida, West Palm, you probably will see a lot of faces that look pulled and stretched and windblown and that’s because their tissue has lost elasticity and the surgeon has tightened the skin, there is too much tension on the skin and/or they have not supported the smas properly. When patients come to see us, the general goal is to look more refreshed and rejuvenated, patients specifically don’t like the jowls, they don’t like the folds or they don’t like the neck tissue hanging down. Typically we’re not trying to make patients look different, we’re trying to make them look more youthful and we’re trying to make them look more refreshed and the way we achieve this, and I absolutely promise and guarantee this our patients this, is that do you understand what we’re doing, here’s the skin, here’s the smas layer, if we’re supporting the underlying smas properly you will look natural, you will not look overdone.

We support the smas as well as we can. The overdone appearance comes if we try to put too much pressure or tension on the skin which we won’t do. For the average patient have an advanced face lifting procedure preformed, we typically remove the sutures on day six or seven and most patients at that point, who are going to work, can go to work. We find that patients who have undergone the advanced face lifting procedure are happy, patients are very satisfied not just with the outcome but with the overall experience. Patients come in, concerned about the fact that this is going to be performed under local anesthesia, they’re not sure what that means, but most patents end up falling asleep.

Patients love the fact that they’re treated, the procedure takes less than an hour typically and that they’re recovery  is much faster, there is typically very little bruising, they’re back to work, they’re back to their life faster, their back to activities and working out much sooner and I think that patients are really thrilled that this is an option for them. Many of our patients are concerned about undergoing an elective procedure and the risks associated with general anesthesia, especially because a lot of our patients are right around fifty, forty five to fifty years old, that means they typically have kids at home and there’s some guilt associated sometimes with undergoing these procedures and taking care of ourselves.

The advanced face lifting procedure is a wonderful opportunity for these patients to undergo a safe procedure that’s effective and yields a wonderful outcome. So our facility is really designed with the patient in mind and besides the fact that we an accredited surgery center and we do things safely, we also recognize that privacy is of major concern for some patients. Following the procedure, patients are sometimes coming in with their dressings on the next day and we do have a post operative waiting room, you’re not waiting though, you’re walking in the door and your immediately being escorted to the treatment room where we can go ahead and take care of you, so privacy is of utmost concern to us because it’s important to you.

So many patients are also concerned about leaving the center the day of their procedure, and so we move from the operating room and you are escorted via one of our nurses through a separate exit so you don’t need to run into to anybody in the office or any patients that might be coming in the office who might be your neighbor. Whether or not you are one of our high profile patients or an average citizen, your important to us and your privacy is something that we take very seriously, so we have ways to walk into the office and ways to exit the office so that nobody sees you. Patients who are seeking the utmost privacy in terms of coming to our facility and leaving our facility, they don’t want to share things with family members or friends, we will provide a car service for those individuals and make sure the safely arrive at the office and they arrive home safely following their procedure.