Facelift
Subj: Face
I am considering a face lift and am interested in comments from
anyone that has had facial plastic surgery. I am 50 years old
and am wanting to remove wrinkles and sagging skin around my
jaw line. I've read about the new laser surgery for wrinkle removal.
I am interested in any and all comments regarding your experiences.
Pro and Con.
Dr. Bermant comments:
This should not be construed as medical advice. I am a Board
Certified Plastic Surgeon.
You need an analysis by a reputable plastic surgeon before
deciding what techniques are best suited to your problems. There
are various types of surgery that each has different strengths
and weaknesses. One of our newest tools is laser resurfacing.
This is for some of the finer wrinkles. The laser will not correct
for underlying fat bulges, weakened or sagging muscles or skin.
Surgical facelifts do not address the finest wrinkles. Laser
techniques may replace some of our chemical peels (phenol or
TCA). Laser / chemical / surgical can compliment each other in
the right setting.
But be careful. We have only a very short track record with
the newest laser techniques. Do not get me wrong, this may be
an exciting new technique that may pan out to have long lasting
results. The prior response has no factual evidence since there
just are no studies that go that far back for the laser technique.
Also watch out, the laser unit is very expensive. Guess what
- this can taint the "sell" to pay the rental / purchase
price. An ethical surgeon will go over your problems with you,
map out the various risks, benefits, and ALTERNATE METHODS OF
CARE.
If you are looking for a local physician: The American Society
of Plastic and Reconstructive Surgeons can be reached by calling
1-800 635-0635. They will send some preliminary information and
a list of board certified surgeons in your region.
If I can be of further assistance, please let me know (E-mail
preferably)
Subj: Re:Face Lift
From: DoctorDave,
I am a plastic surgeon (certified by the American Board of
Plastic Surgery) in Salt Lake City, and I am certified on the
UltraPulse CO2 laser. I use both conventional and laser techniques
and find they both have a place in the treatment of facial aging.
I would like to comment on some of your observation:
1. Laser facelifts do not last longer than conventional lifts.
The pulsed CO2 laser has only been around for about 3 years,
and NOBODY has enough experience to say how long they will last.
20 years sounds a bit optimistic, I would say. More likely 5-8
years.
2. Conventional facelifts do not make the skin more "open
to wrinkling". (see below)
3. Facelifts (here in Salt Lake City) cost about $6000, about
1/2 your estimate. Maybe some surgeons go higher, but not many.
4. Laser face lifts are not without risk, and I have seen
several patients with scars from improperly done laser lifts.
5. Conventional face lift techniques have come a long way,
and excellent results lasting 10 years or more are not uncommon.
Also, conventional facelifts offer correction of more problems
than just "wrinkles". If you had a pair of old pants
that were too large, and all wrinkled, you would first tailor
the pants to fit you (that's a conventional facelift), then you
would press out the wrinkles (that's a laser lift, or chemical
peel, or dermabrasion, or Retin-A). Each procedure has it's place.
Conventional facelifts can also be done in the office as outpatients.
If you (or anyone else) have any questions about this or other
plastic surgery topics, please drop me an E-mail at DoctorDave.
Thanks!
Subj: Re: Facelift
I am 47 yrs. old and am planning to have a facelift--my
friend in California had one last month and said she had a new
procedure called a "deep-plane" face lift. How is this
different from a standard facelift?
Thank you.
Dr. Bermant responds:
This should not be construed as medical advice. I am a Board
Certified Plastic Surgeon.
Deep plane facelifts differ in the layer elevated is just
over the bones. In SMAS facelifts, the muscle plane is the tightened
layer. Other planes worked on is the skin layer. Working on each
layer involves specific risks. Sometimes elements of each method
are combined into a technique specific for that patient.
Different patients benefit from various techniques. It depends
what has happened to your face. A direct person to person evaluation
is necessary to recommend what combination of techniques are
best suited for any one patient.
I hope this information proves of some use. If my office can
be of further assistance, please let us know. We can be reached
at: (804) 748-7737. My staff and I try to ensure the comfort
of our out of town guests during their consultations and procedures.
Michael Bermant, MD
I am writing this from Calgary, Alberta. Canada. I
am 21 years old and want to know can you send me some information
about cheek contouring. I want to get some fat <buckle fat>
remove so that I can have a more hollow cheek apperrance look
like model <Kate Moss>.
Thank you for your time.
This should not be construed as medical advice. I am a Board
Certified Plastic Surgeon.
Cheek recontouring is done either by liposuction (removing
localized collections of fat with a suction machine) or by moving
the fat through an open incision around the eye or in front of
the ear or inside the mouth. Sometimes the cheek can be highlighted
by adding to the cheek bone with bone or synthetic material.
Not all patients are candidates for all operations What may feel
like fat may just be your important gland (the parotid) that
makes saliva. Foreign material can cause problems, so putting
something in the face for appearance needs to be investigated
carefully. All of this surgery can cause injuries to nerves,
scars, asymmetry, and dynamic irregularities.
I hope this information proves of some use. If my office can
be of further assistance, please let us know. We can be reached
at: (804) 748-7737. My staff and I try to ensure the comfort
of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: Post Op facelift
I am a 43 year old male generally considered young
(and cute) looking for my age. Over the years I had gained and
lost some 70 pounds which caused some excess skin sagging on
my face, neck and eyebrows. On February 11 of this year I had
a facelift (SMAS) and upper and lower Blepharoplasty. Admittedly,
I was not prepared for resultant healing process. Although it
had been explained to me, those words paled by comparison to
the actual experience. Now, seven plus weeks later, I have been
taping my eyelids for the past three and half weeks to correct
the ectropion that has developed as a result of the surgery and
each day face myself in the mirror horrified by the distorted
shape of my now 'fat' face. Although a lot of healing has occurred
reducing the facial swelling and the operation, regarded as successful
had no other complications, I am afraid that gone forever is
my youthful cute appearance, replaced by some hideous monstrous
mask which is now my 'face' . I am feeling quite hopeless, having
already passed through depressed and angry. I'm not even certain
if I have a question at this point. The thought of having additional
surgery to correct the way I look to regain my thin face or correct
my ectropion nauseates me. I don't know what you or anyone could
possibly offer me at this point. I doubt I will become the cosmetic
surgery poster child this year. I do think anyone considering
this should be aware of what can result even in procedures deemed
very successful .
This should not be construed as medical advice. I am a Board
Certified Plastic Surgeon.
Your result CERTAINLY does not sound typical for those performed
by a skilled plastic surgeon. Was your surgeon board certified
by the American Board of Plastic Surgery or some "want to
be" plastic surgeon whose boards are by some other specialty?
Even skilled board certified surgeons, however, have complications.
The nature of surgery is to have potential complication. The
knife and healing are nothing like manipulating an image on a
computer.
An ectropion can be a complication of eyelid and facial surgery.
The more a surgeon pushes the "envelope' to make an eye
look younger, the higher the risk for an ectropion. Some problems
are temporary and work themselves out with some massaging, taping,
and time. Others require surgical intervention. In certain patients
are at much greater risk for eyelid complications with only a
marginal tone before surgery. I recommend techniques to improve
the lid tension AS PART of the facelift surgery in such patients.
Just what do you mean by a fat face? Usually after a face
lift the face is more tight, extra fat and excess skin are removed.
Many patients have some diminished sensation in the elevated
skin flaps near the ears. Some have described this temporary
(rarely permanent) loss of sensation as a feeling of "fullness".
At just over 7 weeks you are early in your recovery. It really
depends on the extent of the surgery, method of the operation
and the individual's healing patterns. Some of the deeper plane
facelift methods have extended swelling and healing after surgery
courses. Does your surgeon know about your feelings? If you were
my patient, I would certainly want to know. Sometimes the problem
can be expectations beyond what surgery has to really offer.
Sometimes it just takes some time to get the results we want,
tissues healing is never as fast as we would like. What does
your surgeon say?
I hope this information proves of some use. If my office can
be of further assistance, please let us know. We can be reached
at: (804) 748-7737. My staff and I try to ensure the comfort
of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: face neck healing time
I am considering having work done around my jawline
and neck . I have had a brow lift and love the resluts. How long
will I need to heal so I can go out in public and it will not
bve noticeable
This should not be construed as medical advice. I am a Board
Certified Plastic Surgeon.
Time before going "out in public" varies with MANY
factors. The type of surgery is the first unknown. "work
around my jaw line and neck" can be as simple as a minimal
liposuction to an extensive face and neck lift. Recovery time
involves reduction of swelling and bruising until the patient
feels comfortable being seen. The amount of residual swelling
that bothers each person varies. Women can cover bruising with
makeup and have less of a concern with the discoloration. Each
person resorbs blood at different rates - how fast does the black
and blue regions tend to go away in that individual? How does
that person heal, some stay swollen longer.
Some face and neck lifts can be fine for public in 2-3 days, others
need several days to 10 days before they feel comfortable. I have
posted an eight day after surgery set of photographs
to demonstrate this point. Certain operations and patients may need
more time. There are just too many unknown factors to give time limits
on someone who is not my patient that I do not know what they really
need..
I hope this information proves of some use. If my office can
be of further assistance, please let us know. We can be reached
at: (804) 748-7737. My staff and I try to ensure the comfort
of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: Scar /facelift
Please help! I have extensive built up scar tissue
as a result of a face lift that didn't go well. I trusted the
doctor's explanation and let him perform a second operation.
Now it is much worse. Area's of my face are very firm, hard in
fact. He tells me he will not t ouch it for 6 months. I don't
know what to do. I am distraught and depressed. As if the situation
wasn't bad enough. I have no money left to seekout another doctor
to repair my face. What can I do? Please advise me.
This should not be construed as medical advice. I am a Board
Certified Plastic Surgeon.
Yours is not a typical problem. Facelift incisions are hidden to minimize
exposure. Although bad scars are possible, they are very rare. Scars
do evolve over time. Many times waiting about 6 months (with scar
care) changes occur that obviate the need for further surgery. I work
with MY patients to try to optimize their scars after surgery. I cannot
comment about a patient's scars without an examination and evaluation
nor can I imagine any good plastic surgeon who would. The scars seen
on the photographs I have posted
ARE typical for my facelift surgery.
I hope this information proves of some use. If my office can
be of further assistance, please let us know. We can be reached
at: (804) 748-7737. My staff and I try to ensure the comfort
of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Bulletin
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