PROMISES
A surgical procedure, in combination with certain other procedures,
can provide a more youthful appearance of an aging face. Advertisements
promise beauty, youth and happiness.
PITFALLS However, there are many factors to be considered.
No Two Facelifts are the Same
Modern marketing often reduces operations, such as a facelift, to
the status of a commodity in which all facelifts, likened to other
services, are represented to be exactly the same. A facelift is
far from a standard procedure and, in fact, there are many techniques
and variations. Differences in facelifts can be quite significant:
Extent of the surgery -- how much is done.
A simple removal and resuturing of the skin around the ear, can
produce “facelift” scars and even temporary tightening
of the skin of the face. However, the benefits are negligible.
More extensive procedures have a similar placement of incisions,
but are more extensive and more effective. Each surgeon must determine
the extent of surgery to be preformed, based upon his/her experience
and judgment. Many factors must be considered including:
Effectiveness of procedure
Extent of the deformity to be corrected
Goals of surgery
Risk of complications
Length of convalescence
Depth of the surgery -- the actual layer “lifted”.
Historically, facelifts started as a simple tightening
of the skin. Today, there are procedures done at different depths;
some provide a lift at the level of the facial bones.
Use of implants and filler materials. This
may be indicated if the surgeon determines that there is a deficiency
of bone or soft tissues. However, the addition of an implant
or filler produces added volume and changes the appearance of
the face; this may be good or bad depending on the goals
of patient.
Cosmetic surgery
can improve one's appearance --
but it can also change it!
Removal of fat. Selective removal of fat can
have a positive effect, especially in the neck. However, in the
face, it may be detrimental, especially as the patient ages.
Use of technology. Use of lasers, endoscopes,
fixation devices, and liposuction, is determined by the surgeon.
Technology may have actual benefits or may be used for its marketing
value. High tech has the implication of being better! However,
in cosmetic surgery technology can be over utilized, more expensive
and potentially more risky than conventional (open) methods.
Goals of surgeon and patient. What does the
patient expect from the surgery and what is the surgeon trying
to accomplish? Does the patient and surgeon prefer a natural
postoperative appearance or an extreme makeover (see below for
an example)?
What was her goal and what was the goal of her surgeon?
Risk of complications. Cosmetic surgery is
real surgery and complications can occur. Facelifts vary in terms
of relative risk of the procedure. No surgery is free of potential
risk.
Length and severity of convalescence. This
varies greatly with each procedure.
Patient Considerations -- Worth Understanding:
Patient’s goals: goals should be realistic -- the final
result depends on quality of skin, bony structure, etc.
Patient’s motivation: the best reason for this surgery
is to make one feel better about him/herself.
Patient should be in good general health, and should maintain
a healthy lifestyle.
Patient should thoroughly understand the pitfalls of this or
any elective surgery -- and should weigh the perceived advantages
of the surgery against risk, expense, time out of normal activities.
Despite marketing to the contrary (e.g., Extreme
Makeover) PATIENTS SHOULD UNDERSTAND THAT AN IMPROVED APPEARANCE
DOESN’T GUARANTEE HAPPINESS.
This is the reality of cosmetic surgery and, in particular, the
facelift and is the reason it is important for a consumer to do
his/her research. However, specific information can only be obtained
from a personal consultation with one or several surgeons certified
by the American Board of Plastic Surgeons.
OUR APPROACH
OUR GOAL IS DEPENDENT ON THE GOALS OF OUR PATIENT. HOWEVER, WE STRONGLY
BELIEVE A NATURAL, POST-OPERATIVE APPEARANCE IS THE HALLMARK OF A QUALITY
FACELIFT. THIS IS OUR OBJECTIVE AND WE FIND IT OBTAINABLE.
SOME SPECIFICS OF OUR APPROACH TO FACELIFT SURGERY IN DALLAS
Personal consultation with the surgeon, not an assistant.
Local anesthesia and twilight sleep by a nurse anesthetist. (CRNA)
Office surgical suite; accredited by the American Association for
the Accreditation of Ambulatory Surgery Facilities (AAAASF)
No hospitalization necessary, however, we do provide overnight care.
Limited and carefully placed incisions minimize final scars and avoid
damage to the hair and scalp and changes in the location of the hairline.
Deep tissues are managed by various techniques depending individual
changes to be corrected
fat reduction and/or suspension, fat grafting
muscles of the neck are tightened to reduce banding;
other deep tissues are addressed as indicated.
Limited use of technology. Our experience shows the best
results are based on careful surgical technique and not on
the use of high-tech equipment.
Use of skin care, chemical peels, etc., to optimize the end result.
No pressure dressings, and usually no dressing
at all. Limited use of drains which are unnecessary due to
use of the progressive tension sutures (PTS). We find patients actually
do better without tight pressure dressings - which others commonly use
- as they have less swelling, discomfort, etc.
The Progressive Tension Suture
(PTS) Facelift
We originated a procedure
that has greatly simplified our facelifts, while significantly reducing
our complications, improving our results, and shortening our patients’
convalescence. We have been using this technique over the past 6
years and have found it to be reliable and long-lasting
(6 years is our longest follow-up).
Placement of PTS Under the Skin to Advance and Anchor the
Skin Flap
Following the appropriate management of the deeper tissues of the
face, the skin redraping and tightening is accomplished
by the use of progressive tension sutures (PTS). These are sutures
that advance and anchor the skin to the underlying tissues. This
is a very simple, yet effective technique that has the advantage
of:
The distribution of pull over the entire skin surface (instead
of only at the skin closure!)
No tension on the skin closure -- resulting in less scarring
More even draping of the skin -- no lines of
tension visible
Overall enhancement of the natural appearance
of the face.
Elimination of the space under the skin flap and secure
anchoring of the skin flap to the underlying tissues -- which
results in:
No place for fluid to accumulate
No drains or pressure dressings necessary
Prevents disruption of early healing as the tissues
move together and not independently
Less swelling and bruising
Speedier healing and therefore, faster recovery.
For more related information please see these articles on our website:
PROMISES 
