Face Lift (Rhytidectomy)

                The Goal of every face lift surgeon is to give every patient happy after surgery. The quest is for maximal results with a minimum of risk.
                Before surgery you should come to
TPSC. for preoperative consultation since thoughtful and honest preoperative approach that is realistic will avoid future misunderstanding and disappointment.
                The gains may be remarkable but there are definitive limitations and risks. Rhytidectomy is a surgical procedure that remove excess skin to eliminate skin sag and also relocate the hanging infra struc
tive of skin such us aponeurotic system to the higher (youthful) position . It does little to improve fine lines which is often treated by another nonsurgical method.

                 You may be a good candidate if you consist one or more of the followings.

  1. forehead and brow ptosis , feel heavy or hanging upper eyelids
  2. sagging cheek
  3. jowls, absent lower jaw contour
  4. deep nasolabial fold
  5. neck skin laxity, " turkey gobbler fold "

                 Face lift surgery can be divided into three parts according to facial area

  1. The upper component consist of the temporal , forehead and brow
  2. The middle consists of the cheeks and jowls
  3. The lower third consists of the neck and submental area

                  Each section of the face need separate evaluation and different procedure.

How should you prepare yourself before surgery ?

                  At the time of consultation if you wish to proceed with this kind of surgery you must bear in mind all of these facts.

  1. sun damaged actinic skin does not heal well as normal skin.
  2. smoker have a much greater tendency for skin death compare to nonsmoker . Basically you should halt smoking at least two weeks prior to your facelift schedule day.
  3. excessive bleeding usually occur for the poor controlled hypertensive patient.
  4. underlying serious medical disease such as diabetes mellitus, severe anemia etc.. may jeopardize your capacity of wound healing.

How do I perform the face lift ?

                  For single area of the face lift surgery ( either upper, middle or lower ) I prefer to have it done at the TPSC. under local anesthesia with preoperative heavy oral sedation with the free standing ambulatory basis.
                  With regards to more comprehensive full face lift I advice you to have it performed in the hospital under the general anesthesia or standby intravenous or twilight anesthesia.
                  Through the entire procedure at the hospital, the anesthesiologist will monitor your vital parameters as his routein.
                   Each side of your face will be infiltrated with 2% lidocaine with 1 : 1000 adrenaline 50 cc diluted with normal saline 50 cc. or more depending which type of anesthesia being used.

The incision

                  For the upper third lift, I will place the upward curve incision from the root of your ear staying about 3 cm . behind the temporal hairline.
                  The length of this incision vary from 7 - 10 cms. For the midface lift, The incision is made in the preauricular crease extending downward sweeping around the earlobe .
                  For the lower third , the incision is continued upward on the back of the ear to the point at which the top of your ear overlies the postauricular hairline then turns posteriorly following the posterior hairline.

The facial dissection

                   There are many varieties how the facial skin and soft tissue structure is raised. My personal technic is creation of two planes of dissection ; the skin and the SMAS. ( submusculocutaneous aponeurotic system ) plane.
                   SMAS lift is mandatory to uplift the underneath structure laxity and also serves as the good foundation for the final tightened skin to rest upon.
                   After the SMAS is pulled and the excess removed I will add the extra special suspending nonabsorbable sutures which will anchor the SMAS to the more stabilized structures in the upward and backward directions
                   Then the bleeding is checked , skin is draped and the excess is resected following the previous incisional line. Meticulous skin suturing gives rise to unsightly final scar outcome. I use the stapler to close the hair baring skin.
                    Finally I will apply nonadhesive dressing with few layers of fluff gauze and light pressure wrap around elastic bandage over all the operative areas.
Vaccumm drain may be inserted further full scale facelift.

Post operative recovery and care

                    If the vaccuum drain is used, I will discard it on the next 24 hours.
At Day
2, I will remove all the dressing. You may shampoo your hair, wash your face and dry the surgical wound. Please paste the antibiotic ointment over the wound. I usually instruct all the patients to let the wound air dried ( exposure technic ) except in some particular reason.
At Day 5, all the skin sutures are removed.
At Dat 8-10 withdraw the stapler Swelling, bruising and temporary numbness are usually expected for the face lift, however severe pain is uncommomly anticipated. The swelling may last for few weeks post op. and it gradually subside afterwards.

Understanding risk

                    Face lift complication is greately reduced by the well trained plastic surgeon. Any attempt to reach perfection must be tempered by conservatism. Some of the potential complications are,

  1. blood collection
  2. skin necrosis
  3. infection
  4. facial nerve paralysis
  5. sigthly scar
  6. earlobe malposition