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Facelift

INTRODUCTION

Your face is your most prized feature. It reflects how you feel inside to the world. Many of our patients feel like they are 20 on the inside, but their face does not reflect that. Facial aging affects the skin, muscle, and fat of the face. In order to truly rejuvenate the face, all the layers need to be addressed. A facelift that is well performed by an experienced plastic surgeon will accomplish that. The reasons why men and women choose to have facelifts in their forties, fifties, and up to their eighties vary, from wanting to look good to competing in the workplace to being able to shave better.

When someone looks in the mirror and is unhappy with their face, it can sometimes be difficult to verbalize why they are unhappy. Assuming that genetics and the aging process play a role in a person’s unhappiness with their appearance, it is important to identify the problem and offer a surgical solution:

• If a patient is unhappy with excess fat in their neck but has good skin tone and good muscle tone of their neck, then he/she is a good candidate for neck liposuction.
• If a patient is unhappy with excess fat in their neck and has loose skin and/or muscle in their neck, then he/she is a good candidate for a neck lift.
• If a patient is unhappy with laxity in their neck as well as their jowls and jaw line, then he/she is a good candidate for a mini facelift
• If a patient is unhappy with their neck, jowls, and cheeks, then he/she is a good candidate for a facelift.
• If a patient is unhappy with droopy eyebrows and wrinkles in the forehead then he/she is a good candidate for a forehead lift.

BENEFITS OF FACELIFT SURGERY

• Very natural results without a “done” look.
• This facelift technique is moderate in terms of aggressiveness. It provides an excellent long-term result (about seven to 12 years) with a low risk of major complications.
• The scars are very nicely hidden. In most cases, it is difficult to appreciate them. Hair is not shaved, and the hairline is not raised.
• This technique is flexible and can be adjusted to different shapes with varying amounts of fat, laxity of skin, and laxity of muscle, with excellent long-term results.

PREPARING FOR SURGERY

An initial consultation is set-up where we discuss the facelift procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are asked to stop medications that cause bleeding, such as aspirin, or aspirin-like products (Motrin or Ibuprofen), a week before this procedure. You are asked to stop smoking two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.

PROCEDURE DESCRIPTION

A facelift rejuvenates the cheeks, the jowls and the neck. It is the gold standard for facial rejuvenation, and the best time to do it right is the first time by a plastic surgeon who is experienced in performing facelifts.

The way that we perform a facelift is essentially a cheek lift plus a neck lift. First, the face is injected with tumescent solution to decrease bleeding and pain during and after the procedure. Next, if liposuction is needed to remove excess fat in the face, then it will be performed. After that, the skin is elevated from the underlying fat in the cheeks, jowls, and the neck. The underlying support layer of the cheeks are tightened to lift the cheeks and jowls to give a more youthful face. Any excess fat in the neck is removed, and the muscles are tightened. A special suture is used to lift the muscles and give the neck a long-term youthful look, as well as a well-defined jaw-line, despite the pull of gravity and the aging process. After the underlying fat and muscle is addressed, then the excess skin is removed, and the incisions are carefully hidden around the hairline, inside the ear, and behind the ear. Two drains placed behind the ears to remove the fluid that accumulates after a facelift. Fat transfer to the mid-face (cheeks and nasolabial folds) can be performed to restore facial volume loss associated with aging. It is complimentary to a facelift which addresses laxity of tissue, and both procedures are often combined.

HOW WE MINIMIZE COMPLICATIONS OF FACELIFTS

At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible, anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.

General Complications
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.

Bleeding
Bleeding after a facelift happens in about 1-2% of patients in general. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. The use of tumescent solution is performed during a facelift to minimize bleeding. Furthermore, the use of drains helps manage any post-operative bleeding as well. In our practice the rate of significant bleeding is about 1-2%. The treatment of a hematoma or a blood clot under the facial skin is to open the incision and remove the blood clot. Typically, this is a straightforward procedure.

Infection
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after a facelift is extremely rare.

Open Wounds
In a facelift, there is manipulation of a relatively large amount of skin and the closure of skin under some mild tension. Because the incisions are under tension, there can be either loss of some skin or a small opening of the wound around the hairline or near the ears. To minimize this potential complication, we urge our patients to stop smoking two weeks before and two weeks after surgery, to improve the result of their facelift. Open wounds, if they happen, are treated with dressing changes and cleaning of the wound in the office as needed. This can occur in about 1% of patients. Usually, the wounds heal very well, and nothing further needs to be done with nicely hidden scars. Very rarely, we will need to do a scar revision to improve the appearance of that scar.

Nerve Injury
The rate of significant facial injury is about 1-2%. In our facelift technique, we do the dissection away from the major nerves to avoid injury. The result is a minimal rate of nerve injury. Sometimes, temporary loss of sensation or function from a “stunned” nerve or a bruised nerve may occur in the time period after surgery. This may result temporarily in an uneven smile, but full nerve function usually returns within days to weeks.

Smoking
Smoking is an absolute contraindication in facelift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.

RECOVERY

Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most facial procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.

To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.

MAXIMIZING POSITIVE OUTCOMES

At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.

There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.

We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.

We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.

WHY CHOOSE BITAR COSMETIC SURGERY INSTITUTE?

Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.

For more information, call our office at 703-206-0506.

Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.