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Rhytidectomy
(facelift – daVinci Quick Recovery Facelift)
First
off, I want you to forget everything you ever heard of or knew
personally about a facelift……..even if you’ve personally had a
facelift before. The days of big bandages, excessive bruising
and swelling and months before you are comfortable getting back in
the public eye are gone, if……….. you choose the right
procedure. The
S-lift, or at least the more modern version of it.
Depending on who is doing this facelift, and what little personal
quirks they have adapted to it, you’ll find this modern facelift
called all kinds of things; the SMAS lift, QuickLift,
MACK
lift, and
now in my practice we’re calling it the daVinci Quick Recovery
Facelift.
In
the last 10 years, there’s no area of cosmetic surgery that has
advanced more for the benefit of the patient than the facelift.
No more pulled tight, wind blown unnatural results. No
painful, long recovery. Thanks to modern surgical techniques,
we have taken the facelift to a new level of excellence. I’m
sorry I didn’t jump on the “modern” band wagon sooner but
I’ve always been the conservative type. This new method of
correcting the sagging muscles in
a unit is not the way most of us were taught to do a
face lift. To some extent, I think we are all resistant to
change. In fact, it’s my belief that most surgeons continue
to use the old methods.
Now
days, I refer to my face lifting procedures as the daVinci Quick
Recovery Facelift. It’s still just a tried and true face
lift. So why do I call it the daVinci Quick Recovery facelift?
After all, for years we called it the QuickLift. I have
given incision placement my own little twist and I’ve added some
additional protocol which, in my opinion, gives superior skin
recoil……..but mostly it’s because Sharon, my nurse and my
facelift patient, is a portrait artist………and she liked the
name daVinci. Also, when we used to refer to it as
the QuickLift, I was licensed by, and paid to participate, with a
national marketing campaign out of
Pittsburg
called QuickLift. They offer wonderful training and marketing
development, TV commercials, brochures, etc. For a guy like me who
doesn’t know, nor care to learn, about all those sort of things it
was wonderful. I’m not a marketing guy. I’m a
plastic surgeon. If it doesn’t hurt, bleed or cry………I
don’t know what to do with it.
I
wanted to get the word out about the modern facelift but I didn’t
know how. My partnership with QuickLift was wonderful. You may
have seen the QuickLift commercials on TV. They were gorgeous,
weren’t they? Believe me…….. I didn’t have a thing to
do with the production or distribution. I left that to the
folks at QuickLift. As time passed, once the word was
out – I found patient word of mouth recommendations and the
website met my needs so I stopped advertising with QuickLift.
The actual name QuickLift is a licensed term/trademark. Now
that I’m not involved with the marking program, I can’t use the
name.
Sharon
wanted to call my version the daVinci Quick Recovery Facelift.
Ask me, and I’ll just say a facelift is a facelift. I’m
just grateful the girls still call me boss, not
Leonardo
!
Sharon
is wonderfully
artistic and she paints a mean oil portrait but I admit she’s a
little too right brained to be a great clinical photographer.
We’ve gone round and round about this for years and years now.
I like to complain………..but not enough to do it myself (grin.)
Sometimes our before and after views aren’t exactly alike and
it’s hard to keep a postop patient from cracking a smile (because
they’re so darn pleased and feeling pretty is a good
thing)………. but we try…. to be as uniform as possible when
taking our before and after photos. We may not be perfect but
you’ll never see a tucked double chin in the before and an
extended neck leaning forward with a big smile in the after.
When
you are considering a facelift I would really advise you to
carefully do your homework. There is a barrage of
‘look a likes’ out there. Carefully, check the credentials
of any surgeon you are considering. You can verify the
credentials, and years of
experience, of any plastic surgeon by calling 800 635
0635. Call the Better Business Bureau. Take your time.
Get to know the doctor and the staff. How much experience does the
doctor have? How long has the doctor been in the same location?
How long has the staff been with him/her? Visit more than once
if you have to. Make sure you’re really
comfortable with the set up, where
you’ll have your surgery, the level of experience of
the doctor and the staff who will be assisting….and more
importantly the ability to handle an emergency. It’s fair for you
to ask all these questions.
In
my opinion, the office is not an appropriate place to do any surgery
– let alone a facelift. We can’t keep our office sterile
and we would be ill equipped to handle a surgical emergency.
The fact that most surgical emergencies don’t have anything to do
with the surgery being done doesn’t mean you don’t have to be
prepared to handle them. And………. give this some
thought……….I know it seems appealing to save a few dollars on
anesthesia cost but……….are you really OK with hearing snip,
snip, snip in your ear? What about the smells of surgery?
Are you OK with smelling your blood vessels being cauterized?
Can you really lay still, not grimace, not talk, not twitch etc.,
for several hours so the doctor can do a good job? If you are
aware of everything going on do you think your blood pressure might
get a little high which might lead to more bleeding, bruising and a
longer recovery. Faces are not alike and a face lift cannot be
a cookie cutter procedure. That’s where experience comes in
because when doing a facelift there is a great deal of artistic
vision involved.
If
something seems too good to be true, it probably is. Be sure
to ask what the fees quoted include. Is it just the
surgeon’s fee or is it inclusive of the surgeon’s fee, facility
fee and the anesthesiologist. Something like a facelift,
which will influence how others view you, and more importantly, how
you look at yourself……… everyday, for the rest of your life is
an important investment and decision. Don’t cut corners.
Don’t you agree?
The
photos above are of my nurse and office manger,
Sharon
. Basically, what we are doing is comparing her appearance in
her early 40’s to her late 50’s. The very first picture
was taken in a studio by a professional photographer when
Sharon
was in her early 40’s. The subsequent clinical photos span from
just before her facelift procedure in 2005 to the most recent one
which was taken in May 2009. The second is a clinical photo
taken under the harsh florescent lights in our office a few days
before I did her facelift in 2005. The 3rd is clinical
photo taken in the office 5 days after her facelift on the day she
came back to work. The last two were taken in December 2007
and May 2009. This type of correction is not
unusual with the newer face lifting procedures. In fact, most
people feel they look like they did in photos taken about 10+ years
ago. Once
Sharon
’s husband,
Michael
, saw that it wasn’t such a big deal…………we did his
facelift a few months later.
All
of you will have a chance to meet
Sharon
at the time of your consultation.
Sharon
goes over the whole procedure with you, in what we call a preconsultation,
before I even come in and give you the real consultation.
It’s nice for you, as a prospective patient, to have the benefit
of seeing the placement of the typical scars, etc., on someone in
the flesh.
Sharon
is a good sport about being “checked out.” The procedure
has evolved some since
Sharon
and
Michael
had their facelifts in 2005. Additional techniques have been
added to even further enhance skin recoil and scar placement.
Patients
seem surprised when we tell them they will meet with the doctor at
their first visit. We’re told some practices bring you in
for a first evaluation with ‘a consultant.’ You only meet
with the doctor if you decided to schedule surgery. I’m not
saying that it’s wrong. It’s just not how we do it.
My thought is….how can you possibly decide you want to hire me to
do any procedure for you until we’ve looked in the mirror together
and spent some time talking it over. Who knows, your concern
might be better addressed by another surgical procedure or sometimes
even a nonsurgical procedure. You
will meet with me personally the first time you come in.
This is a thorough consultation. We think our “hearing it
twice” approach is helpful in making sure you really comprehend
all that we discuss. We want to make sure you get all your
questions answered. This takes some time so plan on being with
us for 30-45 minutes. There is no charge for this
consultation.
We
plastic surgeons have become so much more savvy in the recent years.
The old type facelift where you were bruised and swollen for months
is a thing of the past………..a least, in my practice. In
the past, unless you were a celebrity who could hide out for months
with unlimited funds………..you just couldn’t have a facelift.
Today’s typical facelift patient can enjoy beautiful, natural
looking results with very little downtime, bruising, swelling or
discomfort………. at an affordable price. Most of the time,
the expense won’t be what you’d spend on a one carat diamond, a
cruise, trip to Europe or to put new furniture in the living room.
The benefit is that what you gain moves forward with you
your whole life. The average patient will take pain medication
a day or two. Most patients are back to work in a week or so
depending on how strenuous your job is and how private you want to
be. You can shower and shampoo the next day. Soap,
water, shampoo, conditioner, etc., are good for the sutures.
No kidding.
In
the past, the skin dissection was much, much more extensive which
accounted for all the bruising, swelling and increased risk of
damaging the facial nerve. The correction was in more of a
backward direction. The results were more of a startled look with
the majority of the correction in the cheek area. The
neck….not so much. Sure you had fewer wrinkles but the look
was not particularly natural. Unfortunately, the older results
also didn’t last as long as we might like because we primarily
relied on the tightened skin to hold everything in place and
maintain the shape. Today’s modern procedure uses a
technique pioneered by Dr. Saylan, called the SMAS. This
approach lifts and supports
the sagging tissues/muscles of the lower face including the cheeks,
jowls and neck
internally with an upward
correction. This internal support puts everything back right
where it sagged from so it gives a very natural look……….. like
the look you had some years back. Of course, the excessive
skin is still excised and removed but the weight of the sagging
internal tissues are supported with a special internal suturing
technique we call purse string sutures. We aren’t asking the
stretchy skin to “hold all the weight” anymore. We
are also using some of the body’s short comings to our advantage
against future gravity and future aging. Let me explain.
When
we get deepening of the line from the nose to the mouth and jowls
it’s because we’re loosing skin elasticity and gravity is
working on us. Generally, the fatty jowl it is really what used to
be your apple cheek. This fat pad has migrated downward
because the skin in the jaw line is loose. We all stand in
front of the mirror and give ourselves that little mini lift with
our thumb and index finger and think, ‘if only.’
Well that’s what the daVinci Quick Recovery Facelift
does… from the inside.
Follow me here and you’ll get what I mean.
If
you bind your right elbow at a 45 degree angle for several weeks the
muscle will shrink and you won’t be able to straighten your arm.
That’s a bad thing. The purse string suture that we
speak of sort of does the same thing. It diminishes the
activity of the muscle groupings in your cheek/neck allowing them to
shrink because of inactivity. They reposition more like they
were when you were younger …that’s a good thing. This is
why patients having this type of lift compared to the old way regain
more of the beautiful, natural fullness in the cheeks. They will
typically look just like a younger version of themselves (not their
sister or their cousin.) Most patients can compare their
results to photos taken about 10+ years ago. BUT, even more
importantly, even though you don’t see it, feel it, know it’s
there, etc., the purse string suture is like an internal bra for
your face. This internal support (the purse string suture)
does not allow gravity to affect you the same as it did before you
had your facelift. We can’t stop the hands of time from
ticking but we can turn them back AND slow them down somewhat.
The other thing that is nice is that because we don’t create that
“face lifty” look it is easy to be discrete.
We
can’t measure it and we’re not telling you the daVinci lift
stops future aging but we feel it surely slows it down. With
the older lift most patients felt they got around 5 years out of it
before they were thinking about a second procedure. We’re
always a little skeptical about something new and I’m the
conservative type (let someone else work out all the bugs on their
patients) so the progression from the old approach to the new
procedure was a slow gradual one for me. I’ve been doing the
newer approach exclusively (called the SMAS) since 2005. We
just don’t have enough data to tell you how much longer the
internal support will extend the benefits over the old procedure but
we think it has to be significant.
As
we age, there's not a one of us who can escape the effects of
gravity, too much sun and fun and stress. The first signs seen are
generally vague changes in the skin quality followed by tired eyes,
loose jowls and deepening of the creases from the nose to the mouth.
Smoking and sun damage accelerate this process dramatically.
Take a look at the smoother, firmer texture of you breast or belly
that hasn’t been exposed to so much sun if you don’t think
sunning makes a difference. Artificial sun beds cause harm
also.
We
still feel young at heart, we still act and feel the same, but the
vitality of our appearance is starting to diminish. Some of us
accept these changes gracefully and others want to fight it all the
way. If we start early enough, sometimes a facelift isn’t the
first line of defense. A nonsurgical approach may give you
wonderful results. We have wonderful ways to rejuvenate the
skin. Some options might be Aesthera light based treatments,
Portrait Plasma Wrinkle Removal and Skin Rejuvenation and good,
medical grade, skin care products such as Obagi Nuderm Skin Care,
Obagi Clenziderm Acne Treatment and Tri-luma. We also have
advanced ways to help the patient with acne.
But
if you really need/want a facelift we are here to help. It is
not the ordeal it used to be. Today’s modern facelift is a
convenient outpatient surgery with very little downtime, bruising or
discomfort. Most people are back to work within a week.
A facelift of any sort doesn't necessarily make you look years
and years younger; however, most daVinci patients feel they look as
they did in photos taken about 10+ or more years ago. The
correction is upward, not backward which avoids that unnatural,
pulled look. You always look like yourself…..not your sister
or your cousin. Our objective is for you to look the best you can at
whatever age you are. We prefer the comment, "Hasn't he/she
aged nicely?" rather than "What a great face lift!"
Patients
expect facial cosmetic surgery to be more of an inconvenience and
require more recovery time than it does. In days past, a facelift
was a difficult procedure and recovery but with todays surgical and
anesthesia advances, it's a much kinder, gentler and more user
friendly surgery. Keep in mind; we're dealing primarily with skin so
this isn’t a high risk or high maintenance procedure. We're not
operating on your heart, your liver, lungs or any other vital organ.
OK,
let’s talk frankly for a moment. You’ll see things in the
media about this lift and that lift……….they’re tagged with
all different kinds of names. There are places that do “a
facelift” in the office in an hour using only local anesthesia for
what seems to be a really attractive price….(you’re not paying
facility and anesthesia charges) but really, stop and think about
it. We don’t even do surgeries like breast biopsy, tubal
ligation, etc., in an office setting under local anesthesia.
Why would you even consider doing something as important as a
facelift like that? Financially, it might sound attractive at
first but are you really comfortable with the idea of hearing snip,
snip, snip in your ear or smelling your own blood vessels being
cauterized………for about three hours?? That’s about how
long it takes me to do the average facelift.
When
you compare procedures, facilities, surgeons, etc., you have to be
careful that you are really comparing apples to apples. The
patient in her late 30’s, early 40’s who only needs the
slightest little skin only tuck so she can stay ahead of the game
might do well with the more limited in office approach. I’m
not saying the “other approaches” are bad but the majority of
patients I’ve seen in the past 30 years are well past the point of
needing such a limited treatment. Traditionally, by the
time a patient request a facelift, he/she is at the point of needing
some real internal correction and support and some skin removal
to achieve good, long lasting results. That’s what we
all want, isn’t it?
The
daVinici Quick Recovery Facelift is an outpatient procedure done
under general anesthesia. It doesn't stop the aging process but it
can turn back the clock by repositioning sagging internal tissues,
diminishing excessive skin folds in the face and neck and improving
the angle of the jaw. A facelift won't remove every wrinkle such as
crow's feet or laugh lines nor will it lift saggy eyelids or brows
or improve a weak chin. There are other procedures for these
problems.
The
daVinici facelift is a precision procedure using an incision
starting in the hairline in the temple extending in the natural
crease around the ear and back into the lower scalp behind the ear.
In this less invasive approach, the skin is loosened in a semicircle
about 2.5 inches around the ear. From this minimal approach,
the internal sagging tissues are identified, elevated and secured
using a special suturing technique. The skin is then redraped
and the excessive skin is removed. There is a small incision under
the chin and liposuction and ultrasound are used to obtain the
optimal jaw line, cheek elevation and skin recoil. All
incisions are closed under magnification. Bandages are minimal
and held in place by an elastic sling that goes under the chin and
hooks on top the head with velcro. This sling helps promote the best
skin recoil.
 (Elastic
Sling)
You
can expect some swelling and bruising. It's a good idea to bring
dark glasses and a scarf. You may be light sensitive and your hair
will be a mess. You can generally shampoo the day after surgery
after you have been to the office for your 24 hour checkup.
It's important to sleep with the head elevated. Ice bags, as
directed, will minimize swelling and discomfort.
You
will be given an 8.5 x 11 sheet of paper to take to your pharmacy so
you can have your medications filled ahead of time.
Medications typically include an antibiotic, pain medication and
something for swelling. Just in case you need it, we also give
you something for nausea and anxiety. What you don’t use you
can throw away. The medication for swelling is called Medrol
Dose Pack. You turn the pill pack over and the instructions
are on the back. You start this medication the day of surgery with
the supper dose after you get home. The doses
indicated for breakfast and lunch on the first day are discarded.
Patients
don't usually complain about this particular procedure being
terribly painful but there's no question it's annoying for a few
days and, just like any other surgery, there's some element of
postoperative discomfort. We recommend that you take the pain
medication the first two days – even if you think you don’t need
it. Another helpful hint is that the herbal remedy called
Arnica
Montana
is very helpful in minimizing bruising. This comes from the
health food store. It’s usually packaged in itsy bitty
tablets that dissolve under your tongue. Follow the package
directions and start it about 5 days ahead of your surgery. If
you know you bruise easily start it even sooner. Staying off
all aspirin products 10 days before the surgery is a must.
Part
of the sutures are usually removed in about a week and the others
come out at about the two week mark. You can always wear
makeup in the areas up to the sutures. Within a few days of
the sutures being removed you can start wearing makeup on the suture
lines. Most people are back to work, etc., in 7-10 days. This really
depends on just how private you want to be. You must take it easy
and avoid stooping and bending for three days, but you're never
really incapacitated. After the first three days, you may gradually
resume all normal activity, except heavy lifting and straining,
which should be avoided for a couple of weeks. You'll be anxious at
first because, let's face it, you don't look great right off the
bat. You'll feel a bit stiff. Your features may be a little
distorted from the swelling and bruising. Even though the incisions
are usually hidden behind hair and in the natural creases of the
face and ears, you'll be conscious of them. They typically fade with
time and in most people they are scarcely visible. The hair bearing
skin in the beard area of men will be repositioned and some men may
have to shave a little behind the ear where beard growing skin has
been repositioned. Hair color should not be used for two weeks
before surgery or three-four weeks after. When you do color,
protect the fresh scars with Vaseline. We don’t want
chemicals on the fresh scars. It will make them stay red for a
long time.
At
the time of your first consultation, I'll take a medical history.
I'll need to know if you take any medications or have any problems
with uncontrolled blood pressure or if you've ever had any problems
with surgery or anesthesia. Since aspirin acts as a blood thinner,
which will cause more bleeding and bruising, please avoid all
aspirin products 10 days before surgery. Of course,
smoking is bad for all surgery. Those who smoke or use
nicotine patches always have a higher rate of complications and
stand the chance of diminishing the success or prolonging the
healing of any surgery. Nicotine is a vasoconstrictor that restricts
maximum blood flow to the skin.
All
surgery has some inherent risk and collateral damage you have to be
willing to accept. The typical things you're advised of whether
you’re having a baby by C-section or your gall bladder out, i.e.,
infection, bleeding, hematoma, bruising, swelling, etc. Rhytidectomy
(facelift) rarely produces any serious complications. In fact, the
only thing I have personally seen was some temporary weakness in the
corner of the mouth in one patient and a prominent scar in front of
one ear in an African American patient that needed a couple of
revisions. Those were with the older more invasive approach years
ago. With the more modern procedure, which is less invasive,
we’ve seen a few sutures come loose and need to be resutured, a
couple of hematomas (collection of blood under the skin) a couple
patients needed scar revision. One patient was sensitive to the
suture material. And…..there have been a couple of patients
who just weren’t pleased. No matter how great I think the
result is, if the patient isn’t happy it’s disappointing for all
of us. No matter how rare, there are; however, a few things
unique to this procedure you should be aware of
As
with any cosmetic procedure, the first possibility is patient
dissatisfaction. We anticipate and hope the results will meet your
expectations but that's not a guarantee any plastic surgeon can
make. All wounds to the skin, whether surgically created or
otherwise, leave a scar. We place the scars where they're generally
inconspicuous and, after normal healing, rarely detectable on casual
observation; nevertheless, all scars are permanent and not totally
predictable. We are primarily operating on the skin, and although
it's extremely rare, the facial nerve responsible for control of
facial muscle movement like wrinkling your nose, raising the brows,
puckering, etc., could be temporarily or permanently bruised or
damaged. In days past, the old procedure had dissection down into
the area where this was always a concern. Now we have nerve
stimulators but the newer procedure which has less dissection in the
area where the nerve is close to the skin just keeps us out of the
area where you are likely to get into trouble. In my opinion,
that benefit alone is just as important as the decrease in pain,
expense, healing, etc. Just like any other surgical
site, everyone will have some numbness of the skin in front of the
ears. It will take a long time for the sensation in the area
in front of the ear to return to normal. The average is
usually 3-6 months but I have seen it take longer. Of course,
I’ve also seen it back to normal in a few weeks. These
things are really normal consequences of surgery rather than what
you would call a complication. Most true complications are
quite rare and usually temporary. They would include, but are not
limited to, slow or poor healing, bleeding at the time of surgery or
soon after, hematoma (collection of blood under the skin), poor
scarring or over correction which might look too tight. On the
other hand, you may think I didn't do enough which would be under
correction. Most of the time, these issues just require observation
and conservative care but something like bleeding could require
additional surgery. Anytime you have to go back to the operating
room, there’s always additional expense. I'm happy to
discuss any concerns you might have openly and honestly. Nothing in
life comes with any guarantees, but, in my experience, most patients
are delighted with their results.
Rhytidectomy,
facelift, daVinici lift or what ever you want to call it won’t
dramatically change your life. In most cases, with a little makeup
and a couple of fibs, it's easier to be private than you might
think. Friends, co- workers, etc., may offer vague compliments but
it's rare for anyone to notice specific changes in your appearance.
The more youthful, rested, alert look you achieve will benefit you
for the rest of your life. For many, once will be enough. Others may
want the procedure repeated later in life. What we know is what you
gain cannot be taken away from you. If you’re in your 50’s
when you have your procedure and you look like you did when you were
in your 40’s afterwards then when you are 60 you’ll look more
like you’re 50, etc. We don't stop the aging
process…………..darn. That's OK because, for most of us, it's
not that we want to necessarily look years and years younger, we
just want to look as good as we can. We don't want to be ahead
of the curve. Just like all elective cosmetic surgical
objectives…… we're back to…… being the best we can with what
we have to work with, aren't we?
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