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Case Studies

Facelift Atlanta

Facelift – another of those iconic procedures that identifies itself as aesthetic surgery.  Facelifting – along with rhinoplasty - is one of the oldest of the modern cosmetic surgery procedures having appeared in the medical literature in the late 1800’s.  As the facial skin thins and sags it becomes the most visible of the signs of aging and the one that everyone wants to hide and to reverse the relentless course as the skin droops over the jaw line creating turkey waddles and jowls, wrinkles, and a host of minor changes that register in the unconscious as “old”.  The cosmetics industry has spent billions to find a cream that will reverse the sagging of skin.  The world’s population has spent many time those billions to buy those creams but all for nothing.  There are creams and potions that will improve the quality of skin but correcting sagging is not possible with a cream at this time.  Sagging of the skin can only be corrected with surgery.  Not with exercises.  Not by sleeping in a different position.  Not by using the latest gadget from some television infomercial.

Unfortunately for Plastic Surgeons, during the past couple of decades, bad facelifts seem to have become very common.  Every patient who has seen me for correction of an aging face during the past 10 years has commented that they are afraid they will come out looking like some of Hollywood’s celebrities known for their overstretched facial skin, distorted lips and mouths, and/or eyes that are better suited for a cat.  And that is just the women.  Some of the men are totally unrecognizable!   It is especially sad that people who have the financial resources and the where-with-all to seek out the best in aesthetic surgery will wind up with marginal doctors doing cosmetic surgery (for which they have little or no training and less experience) and with results that are bad to say the least.  This makes my job that much harder as an anxious patient is difficult to educate and fear is a major negative factor in healing.  You need to have every confidence in your Plastic Surgeon and in the work that is about to be done.  And that confidence must be justified by diligent research on your part to ascertain that what you want can and will be done as proven by the doctor’s previous work. 

Before Surgery

Your job, before you even see or talk to a Plastic Surgeon, is to determine who of the many doctors doing cosmetic surgery in your area is truly qualified to do this type of surgery.  Remember that experience – with consistently good results - counts.  Call as many of your friends as possible.  Call your friend’s friend if necessary.  Go and see the result of as many people as you can.  You will find that before long you can see what you don’t want as well as what you like.  Ask your doctor but remember that most physicians refer to their golfing buddy, mainly because they don’t know who does really good work.  DO NOT MAKE THE MISTAKE OF THINKING THAT ALL COSMETIC SURGERY IS THE SAME - A COMMODITY OR AN OBJECT THAT CAN BE BARGAINED OR BOUGHT AT THE LOWEST PRICE.  You are buying the artistry and skill of a surgeon that has been trained in the techniques of aesthetic surgery but must then apply his or her innate abilities to produce a result that is natural, normal and you – for the rest of your life.

Once you have settled on the Plastic Surgeons that you want to consult, make your consultation appointments.  If those doctors are any good, you will be paying a consultation fee.  During the consult, if you find that you don’t like what you see or you are not sure the doctor is listening to you, or the vibes are just not good, pick up your purse and excuse yourself.  Even if you have paid a good sum for the consultation, it will be the best money you have ever spent because nothing is worse than having the wrong doctor operate on your face!  Find an aesthetic surgeon who takes the time to listen to you and answer your questions.  Not only that, he needs to educate you regarding the surgery, the things that you should be doing in anticipation of the operation – getting you in top shape for your procedure.  All of this takes time.  Most of the consultation should be with the doctor (and will last about an hour), not some assistant or secretary or even a patient coordinator.  After all, the doctor is going to do the surgery, not his office personnel.  Make sure you are comfortable with the doctor and his staff.  Even if you like the doctor, if the staff is not to your liking, look out.  The staff can be an obstacle in the postop period just when you need access to your physician.

A facelift, by itself, is not as common as it was in the past.  Each of the features of the face including the forehead, the brows, eyelids, the nose, the shape of the mouth, the ears, cheeks – every aspect of the face including the position of the hair must be evaluated even if there is nothing wrong and nothing surgical to be done.  Changing one aspect of the face will affect other features to a greater or lesser degree and those changes must be considered.  In my office, I do not like to recommend procedures to a patient who has not mentioned an interest in that procedure.  However, I do point out to the patients what the result of the intended surgery is and how it may affect other areas.  For instance, if there is a lot of sagging skin in the cheeks, jowl and neck, a facelift may negatively impact the lower lids due to the upward rotation of the cheek skin causing accentuation of lid lines or wrinkles and that can require surgery on the lids to produce an overall smooth effect.  Additionally, in the same circumstance, the design of the incisions will need to change to make sure that the temporal hair (sideburn in men) does not rotate or move significantly as that is a dead giveaway that you have had a facelift – plus it looks ridiculous.  There are so many considerations in the way a facelift is performed that it is truly designed individually for each patient.  You cannot just do the same thing to each person and get a good result.  And you cannot do a facelift in an hour that will last and be the best that it could be.

The consultation is the time to convey all of your concerns.  It is also the time for the physician to evaluate your individual needs and formulate a plan to address your concerns and your desires.  The Plastic Surgeon must also determine how realistic your expectations are and guide you with his experience as to what can be expected as a result.  At this point you should expect to be shown previous work (photos of several cases) and an offer made to speak to previous patients who have had the same or similar procedures.

In my office, once all the aspects of surgery have been discussed, once the patient’s questions have been answered, then the patient coordinator will discuss the other things related to the procedure – how to schedule surgery, what to do (or not do) prior to surgery, what lab tests are necessary, what will it cost, when are the fees due, will the patient be staying overnight, will financing be used, what medications need to be stopped (or started) and when, are there special vitamins or supplements that are recommend.  The list goes on.  There is a similar list for after the surgery.

Remember, this is surgery.  It is not getting your hair cut.  Yes, there are laboratory tests that you must have.  Yes, there is a preoperative history and physical exam that must be completed.  If there is a significant previous medical history, then a release from your treating physician must be obtained.  If lab tests indicate a problem, then this must be cleared before surgery can be started.  Everything must be done in a certain sequence and at a certain time so that nothing is forgotten that will prevent you at the last minute from having your procedure.

Skin preparation is begun as far in advance as possible.  There are frequently skin creams to prepare for surgery and always a deep pore cleansing facial at least 2 weeks prior to surgery.  Creams to prevent or reduce bruising are ordered.  Medications to prevent fever blisters (herpes) may be required.

If you have considered the procedures and decided that facelift is right for you, if you have decided that this doctor is right for you, it is time for the surgery.

The Surgery

At The Institute, the surgery will be done in the IAS Surgery Center, a fully accredited outpatient surgery center contained within The Institute for Aesthetic Surgery.  The staff there is well trained and experienced in all aspects of aesthetic surgery, and, more than that, many have worked with me for as much as 20 years.  The anesthesia is provided by the Department of Anesthesia of St. Joseph’s Hospital of Atlanta.  There is no finer, safer facility in Atlanta or the southeast.  Your anesthesiologist will be with you throughout the entire case monitoring you constantly as we do not use PA’s or nurse anesthetists.  I alone, assisted by the surgical first assist, will do your entire surgery.  There are no doctors in training working on your face.

Post Surgery and Recovery

Following completion of your procedure, and following recovery from anesthesia, most of the facelift patients are transferred to the Hospitality Suite (also contained within The Institute) for overnight care with a private duty nurse or caregiver.  There you will be monitored constantly for vital signs and your needs instantly cared for.  The most important postop care is iced compresses to the operated areas, constantly applied and changed frequently for 48 hours.  (The skin and deeper tissues will swell for 48 hours after surgery or injury.)  Following this initial period, the ice is stopped and warm compresses applied four times a day for 20 minutes to facilitate removal of the bruising and swelling.  Patients in the Hospitality consistently applaud the nurses and caregivers there for their compassion and attention to detail.  Patients find this facility calm and restful as they listen to music, or (for those that do not have compresses on the eyes, watch television or listen to books on tape.  Cell phones and laptops are restricted.

There are instructions for each aesthetic surgery procedure that are given to each patient.  Follow these instructions exactly as they are designed to speed your recovery and to prevent postoperative complications.

Facelift patients will be seen 5 days postop for initial stitch removal, those that can be seen about the ears or chin.  The next visit is usually 1 week later for removal of all the other stitches.  Warm compresses are continued usually until the 10-14 day period.  Patients are expected to be well enough to return to work after 2 weeks.  Judicious application of a camouflage cover-up will hide any residual discoloration but 95% of bruising and swelling should be gone by then.  Conscientious application of the iced compresses followed by the warm compresses will achieve this goal.  Scars will gradually return to normal skin color and contour over several weeks.  Your appointments in the office will then be:  during the 3rd week, the 6th week, at 3 months, 6 months, 1 year and at 2 years.

My goal is to make sure your goals are met (as well as my own) and to make sure the results last.  If I don’t like the result, I will be the first to say so.  If you don’t like the result, tell me and at the appropriate moment it will be fixed if at all possible.  You are a representative of my work and as such I expect the result to be the best that can be obtained.   Until that is obtained, the work is not finished.  Our medical aesthetician will begin to normalize the skin of the face during the 3rd postop week and will educate you in maintenance of the skin for maximal results over the longest period of time.  At this point her input is invaluable.  Most of the facelift patients take advantage of referrals to hairstylists and colorists and other consultants.  Multiple photographs are taken before and after surgery with final photos take at 1 and 2 years.

Risk and Complications

This is a surgical procedure and therefore complications may occur.  I can’t imagine how many times I have said this to patients during the consultation.  Frequently about this time, a glaze comes over the eyes and the patient “tunes out”.  Risks of surgery and possible complications are not the most pleasant thoughts when you are excited about getting your new look but my advice, pay attention.  The cause of a complication may not be something done at surgery, but rather something you inadvertently do in the postop period.  Serious complications such as infection or life-threatening situations are extremely rare.  Most “complications” are actually something that delays healing and therefore the patient is inconvenienced because they cannot return to work or to their usual social life as soon as expected.  The list of usual complications and their causes are covered in detail at the consultation so listen attentively.

The Cost

When budgeting for facelift surgery, remember there is the fee for the surgeon, the cost of the surgery facility and the fee for the anesthesiologist.  There are miscellaneous other costs such as lab tests, medications, preop physical, postoperative caregivers, etc.  Once you are seen in consult and all factors evaluated, a final cost will be quoted for you.  If you would like to get a general range of fees, please call the office at 404-252-3672 and ask for the patient coordinator as she will be able to ascertain your general needs and give you a baseline average cost.

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