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| FACIAL AND EYELID PLASTIC SURGERY DERMABRASION You will do yourself a service if you read what follows carefully, for here you will find answers to many of the questions that are most often asked by patients interested in this type of surgical correction. The purpose of cosmetic surgery is to make you look as good as it is possible for you to look. It cannot do more than that. If you are expecting a transforming miracle from surgery, you will unquestionably be disappointed. Plastic surgery is a combination of art and science. Surgery is not altogether an exact science, and because some of the factors involved in producing the final result (such as the healing process) are not entirely within the control of either the surgeon or patient, it is impossible to warranty or guarantee results. Surgical results from facial and eyelid plastic surgery, however, are more predictable in some patients than others. This is determined by a number of factors, such as the physical condition of the skin, the presence or absence of facial fat, the relative ‘age’ of the skin, the type and number of wrinkles present, the underlying bone structure, hereditary and hormonal influences, and others. It is not possible by surgical operation to make someone who is forty years old look as if he or she is twenty years old, or younger. While this may seem obvious, I mention it because some patients believe, through misconception or misinformation, that the clock can be turned back in a miraculous fashion. It cannot. Surgery intended to improve sagging skin or wrinkles necessarily leave scars. Despite what you may have heard, all surgical scars are permanent and cannot be erased. The job of the plastic surgeon is to try to place scars in the natural lines of the face and eyelids, where they are least noticeable, and are more easily hidden by make-up or hairstyles. While such scars are permanent, they are rarely noticeable or cause any trouble. Now for some specific questions: How long will the surgical results last? Plastic surgery of the face, neck and eyelids slows down the clock, but does not stop it. How soon you will want, or require, another operation is highly individual. One can only speak in averages. In general, the operation of facial and neck lift, which is for the improvement of jowls along the jaw line and the loose skin of the neck, may need to be redone in about five to ten years. A few patients are encountered, who, for one reason or another, stretch more rapidly, so that another operation may be desired in a shorter period of time. Of course, there are some who never require it again. The operation to improve or correct ‘bags’ of the eyelids usually provides a lasting result. As one grows older, the skin may become looser or redundant, and a trim of loose skin may be necessary at a later time to achieve maximal improvement. In those patients where there is exceedingly marked aging and excessive skin of the neck, face and jaw, sometimes (but extremely rarely) it is necessary to perform a second operation within a year to achieve the maximum improvement possible. Is facial surgery considered to be a major operation? This type of surgery rarely produces serious complications. It is, however, a surgical procedure, and as such, can be subject to unpredictables. Fortunately, these are usually minor, and are amenable to treatment. These will be discussed in detail with you, if you so desire. It is considered a major operation. Why are preoperative photographs important? Just as the chest surgeon cannot operate in an intelligent way without x-rays of the chest, the plastic surgeon cannot operate on the face and eyelids without medical photographs. These photographs are not meant to flatter you. You will probably find them to be harsh, and not suitable for framing. They will show your face in every detail. These photos aid greatly in the performance and analysis of the technical variations in the surgery. What type of anesthesia is used during the operation? Either local or general anesthesia can be used, according to preference. Most procedures can be done with a combination of sedation and local anesthesia. No memory of the procedure or discomfort is the result. General anesthesia requires the services of an expert Anesthesiologist or Nurse Anesthetist who charge separately, and necessitates the surgery be performed in the hospital or outpatient surgery center. How long is the operation? The actual surgical time will vary for each patient, depending on the amount of surgery required. A facelift usually requires three to five hours, and eyelid surgery one to two hours to perform. This does not include the time needed for preoperative preparation, anesthesia and recovery. Are bandages applied? Bandages are applied to the head and neck after a facelift. These are removed the day after surgery. Ice water compresses are applied to the eyes for the first 24 hours, following eyelid surgery. Although this will not improve or prevent all bruising and swelling, it will help to minimize it. Bandages are applied for several reasons; one being to keep the operated area as immobile as possible. Therefore, it is also important that telephone calls and visitors be kept to a minimum for the first 48 hours after the operation. Post-operative pain is rare, and whatever discomfort there may be is usually mild, short-lived, and easily handled with routine medication. When are the stitches removed? Eyelid stitches will be removed on the third to the fifth day after surgery. Following a facelift, some stitches in front of the ears will be removed in three to five days, and in most instances, all remaining stitches will be removed by the tenth to twelfth day. The removal of the stitches is quick and uncomplicated. If you are not a Sarasota area resident, you must remain in the Sarasota area for a minimum of 2 weeks following surgery, so that I may continue your care. When can make-up be applied? Eye make-up can usually be applied two days after removal of the stitches. This includes mascara, eye shadow, eyeliner and artificial eyelashes. Facial make-up can usually be applied the day after all stitches have been removed from the other areas. At this time, you may wish to use some type of concealing make-up, if there are still bruises present. An aesthetician can assist you with this. It is important to remove all make-up very thoroughly at the end of the day, using an upward motion. Oiled eye make-up removal pads are recommended for the removal of eye make-up. When may I get my hair done? The day after your bandages are removed, following facelift surgery, you may comb your hair out using a solution of warm water and a large toothed comb. Your first shampoo will be done here at the office before your first post-operative visit. After that, shampoo your hair gently with baby shampoo for the first few times following your surgery. Hair rollers may be used, but loosely. A hair dryer may also be used with the cool setting, since at that time, you may not have full sensation in the areas operated upon, and could burn yourself. Tinting and coloring usually may be done about three weeks after a facelift. Is the hair shaved in preparation for the operation? The hair is not shaved. At the time of facelift surgery, a small margin of hair behind the ears is trimmed where the incisions will be. A similar area is trimmed inside the hairline above the ears. Neither area will be visible once the hair is combed over the incisions. Who takes care of me after surgery? Since facelift surgery, eyelid surgery and dermabrasion are usually performed in our office surgical unit, you will spend some time in our recovery area following the operation. Because you will have been heavily sedated, someone who is physically able to assist you will be required to drive you home after your surgery, and stay with you at your bedside until you are awake, alert and able to walk unassisted. You should go directly to bed. You will require assistance to and from the bathroom, and in taking the prescribed medication. Someone must remain with you for the first 24 to 36 hours following your surgery. This can be a spouse, friend or an adult child. You are not to be left alone for any reason. Pain medication should be kept to the minimum prescribed, since an excessive amount of pain medication delays the period of time in which you are capable of caring for yourself. The pain medication can be very constipating, and often can produce nausea when taken on an empty stomach. My office may be called at any time, day or night, if there are any questions. What happens in the post-operative period? You must remember that before you see the improvement you are expecting, you will go through a standard post-operative period in which you will look quite battered and bruised, followed by another temporary period of time when you will look ‘strange’ to yourself. This varies considerably with each patient. When both facial and eyelid surgery are performed together, you should set aside six weeks for recovery. In some patients, this time may be shortened by a few days, and in others, a slightly longer period of time is required. You should also bear in mind that in some patients undergoing cosmetic surgery, often there is a temporary period of slight emotional depression immediately following the surgery, during the time when you look your worst. This is quite normal, and should not alarm you. It is not easy to see yourself bruised and swollen, particularly when natural expectations are towards improving your appearance. Fortunately, this period usually passes rather quickly. What are Chemical Peel and Dermabrasion? Chemical peel (chemosurgery) and dermabrasion are two alternate methods of achieving the same desired result - restoration of wrinkled, scarred or blemished skin to a more youthful appearance. One involves application of a chemical solution to, in effect, peel away the top layers of skin; the other utilizes a mechanical procedure to abrade or sand the top layers of skin. Both techniques lead to a new skin surface. In both procedures, usually, a pink, tighter, smoother skin will emerge, relatively free of blemishes and wrinkles in the area treated. In the initial period after the procedure, because of some swelling and a ‘puffing’ out of the fine lines and wrinkles, the results may be more dramatic than is the case when the final healing process is completed. At that time, fine lines may reappear as the swelling subsides, but they will not be as prominent as before the procedure. In the case of severe acne problems, large pits may require a second or third treatment, or even surgical excision. In the initial stages following either procedure, there will be some swelling. The skin may take on a deep red color, not unlike a severe sunburn. This will eventually change to a pinkish hue, and finally, when the skin has been completely regenerated, the new skin will gradually appear lighter than it did before the procedure. Exposure to direct or indirect sunlight should be avoided for a period of several months following the procedure to prevent a splotchy appearance. Sun screening lotions are important. We recommend a sunscreen lotion with at least an SPF 15 factor. Tiny whiteheads (milia) may appear. If they persist, they can usually be washed away with a soaped washcloth. Although the complete effects of scarring and wrinkling are not entirely eradicated, there usually will be improvement revealed by a more youthful, fresher looking skin and appearance. Neither technique is a substitute for a facelift, but rather are complimentary procedures often performed in conjunction with a facelift. Just as a facelift cannot eliminate fine vertical lines near the upper and lower lips, or ‘crow’s feet’ around the eyes, neither can chemical peel or dermabrasion eliminate loose, sagging or excess skin. What about Laser Surgery? The latest ‘breakthrough’ in facial plastic surgery is the ‘laser facelift’. Lasers have been used in medicine since the early 1960’s. Dark birthmarks, tattoos, and abnormal collections of blood vessels, have all been treated by various lasers. Even the ‘W. C. Fields nose’ (Rhinophyma) may be treated with laser therapy. Dr. Strausser was the first to use lasers for plastic surgery in Sarasota in 1984. The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation. A laser is a highly energized source of light whose energy may be transferred to any tissue. Each type of laser (CO2, Argon, Tunable Dye, Ruby, etc.) has a different wavelength, depth of penetration, and energy. In transferring this energy to the tissue, the tissue usually becomes heated, and in the case of skin (with the CO2 laser) the cellular water content is vaporized from exposed cells and they die. These cells then flake off or may be gently rubbed off, exposing new, fresh appearing, pink skin underneath. This process can eliminate superficial wrinkles. Some initial swelling that occurs will also contribute to a temporary diminution in the appearance of wrinkles. Unfortunately, this latter effect is transient. The planing of the skin, however, can provide a lasting effect similar to dermabrasion or deep peeling. The laser also allows more control in the depth of treatment. The procedure is usually less time consuming and essentially eliminates the bleeding one gets when dermabrasion is used, as well as, the unpredictability of the depth of treatment associated with peeling procedures. As is true with any of these procedures though, a limited treatment results in a limited result, and a deeper treatment carries an increased risk of scarring. Because the laser can cause a heat injury to the skin at the edge of the treated area, a delay in healing often accompanies this type of treatment. A raw or unsightly appearance can last from a few days to a few weeks. While any skin removal can cause discomfort, that following laser treatment is usually minimal and short lived. While there are reports of prolonged discomfort and increased numbers of telangiectasias (spider veins) after treatment, these seem to be the exception rather than the rule. As with dermabrasion and chemical peels, laser treatment is not a substitute for a facelift, forehead lift or eyelid surgery. It is rather the latest tool for us to achieve a smoothing of fine wrinkles. Dr. Strausser will discuss its use with you, as well as the pros and cons of alternative treatments for your specific skin type and problems. No single type of treatment is right for everyone and your individual needs will be carefully discussed before any particular treatment is undertaken. Remember, you will usually be feeling fine within a few days of surgery, but you must restrict your activities to allow the healing process to follow its natural course and to avoid tearing sutures or causing any post-operative bleeding. The full healing process takes 6 months or longer, but by 6 weeks after surgery, you will be about 90% healed, and ready to resume all normal activities. Your body’s final scar remodeling and sensory nerve regrowth are those healing properties which take the longest time to complete, and may go on for a long time. If you have any other questions, be sure to get them answered in advance, by my office staff or me. Well-meaning friends are not a good source of information. Find out everything you want to know, as a well-informed patient is a satisfied one. Aesthetic & Cosmetic Surgery of Sarasota |
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