Published: Dec. 17, 2008
Updated: Apr. 26, 2012
In this DukeHealth.org podcast, Dr. Jeffrey Marcus discusses cosmetic procedures for the face -- aka facelifts.
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As most Americans are aware, there’s been an increase in the number of patients seeking cosmetic surgery over recent years. In general, cosmetic plastic surgeries increased in volume by almost 60 percent between 2000 and 2007. This is a large increase. Much of that increase comes from the tremendous growth in minimally invasive cosmetic procedures like injectable fillers and Botox. But actual surgical procedures have also increased as well, although the increase has been slightly smaller.
Several areas have increased significantly, including face lifting, which has increased by almost 15 percent. Nose reshaping, or rhinoplasty, remains still as one of the top-five cosmetic procedures. (Rhinoplasty is the subject of a separate podcast through Dukehealth.org.)
In this segment, I will talk about surgical cosmetic procedures for the face and some of the most common things asked by patients.
In general, for cosmetic surgery in 2008, one of the most important things to do is to listen to the patient. The surgeon must listen to his or her patient to understand what their goals are and what they hope to achieve through surgery, and we must be able to list their options in a realistic way.
By “realistic,” I mean that patients must be aware not only of the great outcomes that are possible with plastic surgery, but also some of the limitations that exist, the risks, and the recovery time that’s associated with it. For example, a busy executive may desire a major change, but may have little time in her schedule to accommodate the recovery. So the approach has to be tailored to the individual patients.
Patients should be aware of all the options that are available -- from traditional approaches to some of the newer, less invasive techniques.
The goal of most cosmetic facial procedures is to restore a youthful appearance. Ideally, most patients would like to restore their appearance to what it was many years prior.
Face-lifting procedures date back to the early to mid-1900s, but they have evolved considerably of course over the years. It seems that every day now, we hear of another new or pioneering advance in cosmetic surgery -- the latest and greatest facelift.
The truth is, most of the procedures are done in similar ways, but they do have some differences. All facelifts involve some form of incision. At a minimum, the incision does have to go in front of the ear and wrap around the earlobe and extend behind the ear to a certain extent. Much can be done using a very limited incision like this.
From this approach, we hear of many types of facelift techniques that are so-called “minimally invasive” techniques or “short-recovery” facelifts.
For patients who need a minimal or modest change, these are terrific options. Using these types of incisions, we are able to suspend the soft tissue beneath the skin, reposition them, and restore the shape of the face to give it a more youthful appearance. These approaches do not rely on stretching or pulling of the skin to give you the result that you need, and patients end up with very natural-looking results.
These are not as good options for patients who are older or who require more of a significant lift. For patients who need a more significant change, who have very pronounced aging features, it is difficult to accomplish as much using a minimal approach. These are patients who are best served using the more traditional facelift techniques that have been around for a number of years.
Through a more traditional approach, we have the access and the opportunity to make the changes that are necessary to rejuvenate the face. The only difference between a traditional facelift and many of the minimally invasive or “short-scar”-type techniques is that the incision does extend slightly into the hairline and slightly further behind the ear and along the posterior hairline.
These incisions are very well hidden, and they are the most common approach to facelifts still in the United States and worldwide. But what can a facelift accomplish?
The most common complaints from patients presenting for facial rejuvenation are the presence of prominent jowls, loose or excessive skin of the cheeks or the neck, excess skin or fatty tissue along the neck, vertical bands along the neck, creases along the nasal labial fold -- so-called “marionette lines” -- and simply wrinkles.
Depending on what things concern a patient, the surgeon can offer a number of procedures designed to meet their needs. Again, the more change a person needs, the more a surgeon needs to do. As they say, you can’t get something for nothing. And if it sounds too good to be true, it probably is.
The most important factor for determining if a patient is a candidate for a short-scar type of technique is the amount of skin looseness that is present. The more skin that needs to be removed at the time of the procedure determines how the incisions need to be oriented. This is particularly true for the neck.
What is the down time or recovery period associated with facelift surgery? A traditional facelift is still the most common and generally requires about a week to ten days until most of the swelling and bruising have gone away. During this time, most patients generally see their surgeon one or two times during the week to check on their progress, apply appropriate dressings or garments, and remove stitches.
Short-scar or minimal-access types of techniques have less down time; this is true. Most patients still do visit their surgeons once or twice during that first week. However, by the end of the first week, most patients have already returned to work.
There are risks associated with cosmetic surgery. While most plastic surgeons are pleased to see the national attention that is given to our specialty, most also notice that there’s also infrequently a reminder that plastic surgery is surgery.
Doctors and patients have to take it seriously. And as a patient, you need to be an informed consumer. Be sure to check the credentials of your surgeon, including board certification. Surgical procedures should be done in a safe setting. This includes both the facilities and the personnel, who have to be equipped to deal with any and all problems, should they arise.
For this reason, at Duke, we believe it’s just as important to have expertise in anesthesia as it is to have expertise for the surgeons. Procedures done at the Duke Aesthetic Center are done under the supervision of a board-certified anesthesiologist.
Other risks in facelift surgery include such things as bleeding, infection, scarring, or injury to other structures nearby. These risks are fortunately very low, and most of them are preventable. But the risks are not zero.
These are just some brief facts on facelift surgery for facial rejuvenation. There are many other procedures and techniques that are designed to help your appearance. Some include the use of fillers and Botox, as I mentioned previously, eyelid surgery, nose surgery, and surgery for the brow. Your plastic surgeon can discuss these options with you.
These are exciting times for plastic surgeons. The advances made in recent years have allowed us to do things not before possible. However, as I said before, we must remember that plastic surgery is still surgery. It’s important to be informed, know about what we can do for you, and know the limitations of what we can do for you.
If you are interested in meeting with a Duke plastic surgeon to discuss the possibilities of facial rejuvenation, please contact the Duke Center for Aesthetic Services at 919-681-8555 or check out Dukehealth.org. Under Services, look for Plastic Surgery.
This is Dr. Jeffrey Marcus for Duke Plastic Surgery. Thank you for listening.