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Okemos Michigan Plastic Surgeons Cosmetic Surgery Procedures  

Minimal Incision Facelift & Necklift

Frequently Asked Questions about Minimal Incision Facelift & Necklift

How long will the results last?

With good skin care, no smoking, and limited sun exposure, the results should last 7 to 12 years.

Should I lose weight before a small incision facelift?

This is not necessary. If you actually plan to lose more than 30 pounds, you may wish to wait until much of the weight is gone before having a small incision facelift.

Is there an ideal age to have a facelift?

No. Any age between 30 and 75+ may benefit from a combination of these procedures.

What can I realistically expect as a final result after a small incision facelift?

I tell patients to expect a 50% improvement. Most will have closer to a 75%+ improvement. If you will be satisfied with a 50% improvement, you should be very happy with the results. If you expect perfection, or a 100% improvement, this is not the procedure (nor am I the surgeon) for you.

When can I return to work after a small incision facelift?

Most patients should be able to return to work within 3-7 days, assuming that they realize that some bruising and swelling will remain. If you are "in the public eye," are very concerned about your appearance, or do not want anyone to know that you had surgery, allow at least 5 business days for a return to work. The sutures, altough very fine, may be visible in front of the ear for 10-14 days. Most women can hide these with their hair.

How soon can I return to normal activity after a small incision facelift?

We ask that you do no heavy lifting, grunting, or groaning for 5 days after the surgery. Strenuous exercise can be resumed about 10 days after the surgery. Conservative aerobic activity can be resumed after 7 days. Sexual activity, lifting, running, bowling, jogging, and other strenuous activity should be avoided for 10 days. You are encouraged to walk one mile the next day. Desk work can be resumed within 1-2 days.

Is it really safe to do a "facelift" in the office?

Yes, when the facelift is this type. In fact, the recovery period is much easier after office surgery than it usually is after systemic anesthesia or hospital surgery.

What are the risks of small incision facelift? Are they less than a traditional facelift?

Often, traditional facelifts are featured on The Learning Channel, or the Discovery Channel, which show massive dissection and removal of skin and very "deep" facial surgery. The face is completely wrapped in bandages for weeks, and drains are often used. For many patients, this is no longer necessary to obtain excellent results. Many of the more progressive cosmetic facial surgeons have all but abandoned the traditional facelift, since comparable results are possible without such invasive surgery. All surgery has some risk. In a small incision facelift, the risks are reduced for multiple reasons. Anesthesia is less severe, allowing a faster recovery time and less risk. Smaller incisions are made, and tissue dissection is less. Because of this, injury to surrounding structures in much less likely. In any cosmetic surgery, the most "desirable" complication (no complication is desirable) is that the surgeon performs slightly less surgery than might be planned, in a safe and controlled manner. While more surgery or "touch-ups" can always be done later, it is impossible to go back and "do less," and very difficult to "undo" what has been done.

What is a "Weekend Facelift?" Why is it called that?

The term "Weekend Facelift" was coined by a West Coast surgeon. It is a small incision facelift similar to the procedure done at Trillium, with several exceptions. This surgeon almost always uses a chin implant, and also applies a laser to the inside skin of the neck, through the small incision used for the chin implant. He contends that the results are better using the laser this way. In all other ways, he is performing a "generic" small incision facelift. The name implies that recovery takes only a weekend, which is somewhat misleading. It is true that this type of facelift surgery has a much faster recovery time than a traditional facelift, and provides excellent results. It is entirelly unrealistic to expect a full recovery from facial surgery after a weekend. For the most part, the Trillium small incision facelift is very similar.

What are the alternatives to a facelift?

Alternatives to any surgery are always present, and we will be glad to discuss any or all of them with you. Your goals for facial improvement are critical factors. If you wish to improve the texture of the skin, or lessen fine wrinkles, a facelift is not the best option. If you wish to eliminate the creases from the nostrils to the corners of the mouth (naso-labial folds), the facelift may soften them, but will not completely remove them. A facelift will not affect the upper one third of the face, the eyelids, or the brow. Any facelift procedure primarily improves the lower one half of the face, the neck, the jaw line, and the lower cheeks. Facial exercisers, exercises, and stimulators are sold on cable TV, and can cause a mild improvement and tightening of the facial features. Lotions, potions, peels microdermabrasion, and CO2 laser resurfacing can create wonderful changes in the skin texture and color, but will not remove excess fat, or tighten the muscles and skin of the lower face and neck. Sometimes facial liposuction alone (or with a chin implant) can create wonderful changes for relatively younger patients with good skin. For some patients, only additional volume in the face will produce improvement. This is done with temporary or permanent fillers. Our favorite is to graft your own fat to your face.

What aging changes can a small incision facelift improve?

Pictures and drawings can best show the possible changes. Fat beneath the chin, "a gobbler," sagging of the jaw line, excess neck skin, looseness of the lower face, and poor definition of the jaw line all respond very well to the small incision facelift. Significant excess skin of the neck can be improved, but sometimes requires further skin removal to achieve optimal results.

What is actually done in a "traditional facelift?"

An incision is made from the top of the ear, in front of the ear, around the ear lobe, and into the neck skin, usually at least 6- 8 inches in total length. The face is dissected from the ear to the corners of the mouth, down into the neck, and behind the ears. Significant amounts of skin are removed, and the facial structures are pulled tighter. Some surgeons also perform liposuction, and may also include a chin implant and eyelid surgery. Some surgeons also perform laser skin resurfacing at the same time. This often requires 4-6 hours or more of surgery, and is usually done with general anesthesia. Some surgeons (one locally) feel that better results are obtained when the facial skin is "stretched" with hooks for several days before the surgery, with patients wearing this apparatus prior to the actual surgery. While the results can be very good in any facelift surgery, for many patients, much of the risk, expense, and extensive surgery involved may be unnecessary.

Should I be concerned if my surgeon is not a "board certified plastic surgeon." Can other specialists perform skillful facelifts?

Other specialists routinely perform very skillful facelifts. While "board certified plastic surgeons" are usually very competent, this is no guarantee that they are any better or worse than any other cosmetic surgeon. This is a topic complicated by politics, economics, ego, and marketing. Many "plastic surgeons" (and their associations) would have us believe that all cosmetic and reconstructive surgery of any kind must be performed by their small "guild," or the patient is at great risk. This is untrue. For the most part, it is an attempt to maintain "market share" in cosmetic surgery. By all means, investigate your surgeon, learn what his/her education and experience is, and whether or not he/she is board certified in a specialty. The "plastic surgical lobby" would have us believe that all plastic surgical residencies teach all methods of cosmetic surgery. This is untrue. They would also have us believe that a surgeon is not capable if he/she has not done a "plastic surgery" residency. This is untrue. In fact, when most of the current plastic surgeons were in residency, many of the current cosmetic surgical procedures did not yet exist , and, therefore, could not have been learned in their residencies. How did they learn them? The same way that we all did, in multiple short courses, training with experts in surgery, by study, and by doing. The surgeon who taught me tumescent liposuction (he invented it in 1987) is a dermatologist. Yet California plastic surgeons contend that he should not be allowed to perform tumescent liposuction (a procedure which he invented and has taught worldwide, to plastic surgeons and others) because he is not a "plastic surgeon." That is ridiculous. I am board certified in ophthalmology, and as a cosmetic and reconstructive surgeon, have performed over 13,000 cosmetic and reconstructive eyelid and upper facial surgeries in the last 21 years, many more than most plastic surgeons. I am a Fellow of the American Academy of Ophthalmology and the American Academy of Cosmetic Surgery. Yet some plastic surgeons contend that I should not be doing eyelid surgery, because I did not do a "plastic surgical residency." That is both ridiculous and illogical. Should I be doing small incision facelifts? You must be the judge. I have attended "live" facelift surgery courses, am very comfortable with facial surgery, and have been taught tumescent liposuction by its inventor. I have performed over 250 "body" and 150 "facial" liposcutions. I have been taught small incision facelift techniques by international experts during "live" surgery, and I have assisted an internationally renowned surgeon with complete facelifts. Since 2003, I have performed 130 small incision facelifts at Trillium. Ultimately, you must be comfortable with your surgeon and his/her capabilities. Ask as many questions as you can, be very curious. You deserve answers to your questions, professionalism, candor, and adequate time to make an informed decision. Beware of any surgeon who attempts to rush you into a decision, or who claims that he/she has never had complications.

Facelift Myths:

Facial aging is caused by excess fat and skin.

Aging above the neck is actually caused by loss and redistribution of fat. Although extra skin can be apparent, the underlying muscles are much more important, and must be tightened to cause the desired change. Infact, facial aging above the chin line is frequently secondary to loss of muscle volume and fat. This is why patients over 40 who are mildly overweight usually have fewer facial wrinkles, tighter skin, and may have faces which are actually somewhat younger looking than you might guess.

There is only one kind of facelift.

Many facelift variations exist. There is no single type which is best for all patients. Surgery must address your individual problems, and the specific goals which you have for the desired cosmetic outcome.

I'm over 55, with loose skin. The small incision facelift can't help me.

Often, this is not true. Many patients over 55 can benefit greatly from a small incision facelift, particularly if the problem is the angle of the jaw and/or the neck and chin.

I must reach a certain age before I have a facelift or facial rejuvenation.

Not true. Patients ages 30 to 75+ may benefit from facial rejuvenation. There is no advantage in waiting until a certain age for surgery.

I should go to the experts in a larger, distant city for my facelift.

In many fields, the definition of an expert is someone who is at least 70 miles away, regardless of his/her actual abilities. Some patients prefer to go "out of town" for surgery, concerned with confidentiality. Office surgery can minimize this fear. While I often encourage patients to visit at least two surgeons before they decide (especially if they do not know either surgeon), many of the latest techniques can be found "close to home," but may not be well publicized. If expense is a factor, understand that prices can vary tremendously, even within a small geographical area, and often have little to do with the quality of the surgery or the surgeon. With few exceptions, the larger the population center, the greater the charges. A small incision facelift at Trillium is $5,100, while in Washington D.C., the same surgery costs $6,500-$12,000. In New York City, some surgeons are charging $12,000-$20,000, for the identical surgery. In some instances, prices are actually higher in smaller areas, since the surgeons feel that they are providing services not available locally, and that there is no competition. Some patients insist on what they perceive to be "big name" surgeons. While I would never suggest that price be the major factor in such a decision, the enormous variations in cost are difficult to rationalize. Obviously, this can be a complicated psychological and emotional decision. Some patients believe that the more they pay, the better the surgery. This is usually untrue. Research and meet your surgeon, find someone whom you trust, who is concerned for your welfare, and with whom you feel comfortable. Surgeon's personalities vary as much as those of their patients. Take your time, know your surgeon, have written questions, know your goals.

A facelift cannot be done with the patient awake, and requires general anesthesia.

Often, the choice of anesthesia is made by the surgeon, for his/her benefit, rather than the patient's best interests. The small incision facelift can be usually be done comfortably with local anesthesia, tumescent anesthesia (a type of local), and supplemental oral sedation. Discuss this with your surgeon.

Hospital surgery is safer than office surgery.

In cosmetic surgery, this is usually untrue. Many of the most serious complications in cosmetic surgery, especially liposuction, have occurred in the hospital, with an anesthesiologist present. This is probably because too much surgery was attempted at one time, and the hospital environment gives the doctors a "false" sense of security. Although unusual, serious complications can occur when a surgeon is too aggressive, uses poor judgment, or succumbs to the wishes of the patient to "get it all done at one."

Facelift surgery can be dangerous, and requires over 4 hours of surgery, general anesthesia, drains, and bandages around the face. Until I learned small incision facelift surgery, I was not particularly interested in performing extensive, complicated facelift surgery requiring general anesthesia and a long recovery period. With the small incision facelift, the surgery may require 2-3 hours, rarely more. It is no more dangerous that any other office surgery, such as eyelid surgery or dental surgery. In fact, it is safer than the removal of wisdom teeth, since that requires IV sedation, which we do not use. Many patients have told us that both body liposuction and our facelifts are easier for them than having a filling at the dentist.

I have performed over 17,000 surgeries in an office setting. Of that number, less than 10 patients in twenty one years (0.0005%) have required significant alteration or postponement of the surgery for medical problems. Although my experience is no guarantee of future results, few of my patients has ever had a significant systemic complication, and none (0 of over 17,000) of them has ever required hospital admission. I deeply believe that the best treatment for systemic complications is to try to avoid them entirely, whenever medically and humanly possible. This requires my constant, absolute willingness to deny certain patient requests, and to avoid situations of increased risk, if at all possible. For some surgeons, this is difficult, given the effects of ego, economics, and patient persuasiveness. I try to be completely forthright with patients regarding their suitability for surgery.

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