Lifestyle Lift® FAQS & Fiction by Paul Howard, MD

Facelift Scar Comparison

Facelift Scar Comparison

How is the LSL better than other Facelifts?

The LSL is not a breakthrough procedure nor are any of the LSL techniques new in any way.  THE LSL is first and foremost a marketing company that hires physicians to do a version of the LSL.  In fact, their surgeons are not even required to do the LSL procedure.

How is the LSL different than other procedures?

The LSL is a version of the short-scar facelift procedure that was first described by others.  Included in the procedure is a so called SMAS plication which has been around for 20+ years and is one of many ways to tighten the deeper layers of the face.  The only possible advance the LSL offers is that it is performed under local anesthesia which has been available since the 1920’s.

Is the Lifestyle Lift® Cheaper?

The cost of the LSL procedure is different depending on where in the country one lives.  The fact is that the actual cost of the LSL is roughly equivalent to what most Plastic Surgeons charge especially when you consider the “fine print” procedures that are required on almost all patients.

Is there a difference in recovery from the LSL?

The rapidity of recovery depends more on the individual surgeon than the exact procedure performed.  Patient selection is probably the most important adjunct in recovery time and LSL patient selection is initially done by “consultationists” without even a medical degree.

Will I Bruise More?

One of the ways a Plastic Surgeon can decrease bruising is due to the technique chosen and in many cases whether or not the surgeon uses drains expeditiously. Part of the LSL marketing scheme brags about not using drains as if not using drains when indicated is somehow better.

Are the LSL Scars Better?

The short facelift scar pattern is pretty much the same for everyone.  The execution of the scar varies from surgeon to surgeon, but the scars don’t seem to do as well nor are they properly positioned in many of the LSL procedures (my personal experience). It is also easier to obtain good scarring with frequent follow-up and in-depth patient instruction which is not typical in practices that are volume driven like the LSL.

What is the Most Important Decision when Choosing a Facelift?

Most people believe that the most important aspect of achieving good results in facelift surgery is the choice of SURGEON and not the procedure or any number of other considerations.  It is interesting that the one thing that the LSL marketing scheme minimizes is the surgeon; such that the surgeon is the last person one meets in the process.  The consultationists and the people who collect the money seem much more important and meet the prospective patient well before the surgeon is chosen for you.

Read more about top facelift surgeon Dr. Paul Howard Birmingham, Alabama.

Call today to schedule your Facelift Consultation with Dr. Paul Howard

205-877-PAUL

Dr. Paul Howard on Google+

Lifestyle Lift – The Small Print by Paul Howard, MD

It’s clear that the Liftstyle Lift ® (LSL) brand is a marketing juggernaut.  Cable, non-cable, internet, Debbie Boone is everywhere “lighting up my life.”  Their TV testimonials are uplifting by simply showing regular people with that blank stare pre-operatively and that smiling, happy visage after their LSL.  It is easy to see why there are so many lawsuits accusing this marketing company of being false and deceptive in their TV ads.  One of the oldest Plastic Surgery tricks to improve facial surgery results is to take the post-op photos of the patient smiling; smiling is the first and best natural rejuvenator lifting the sagging face without a single stitch.  Giving in to the “marketing police,” the LSL folks do add a few sentences in fine print at the bottom of the TV ad admitting that each patient had a litany of other procedures in addition to their LSL.  It is the other procedures in the small print that actually determine the quality of the result and are the subject of this article.

Over the time that I’ve been in practice, two things have actually vastly improved my facelifting results.  Recently, it has been the use of local anesthesia with sedation rather than general anesthesia.  The second improvement has been improvements in the neck contouring and the blending of the lower eyelid with the cheek as an adjunct to our version of the mid-face lift.  In the LSL marketing parlance these are called “neck firming” and “eyelid firming” procedures that really make a difference in the quality of the result, especially when the patient is not smiling.

Eyelid blending has always been a problem except in the extreme cases of facelifting procedures done at deeper levels that allow for more tension on the SMAS and facial muscles with their fascia.  These operations are not an option for many people who cannot take 3-6 weeks out of their busy schedules to be swollen.

One of the integral causes of the dark circles and lower lid “crescent,” in addition to the weakening of the tissues that are meant to contain the lower lid fat allowing the fat pockets to bulge outward, is the dropping of the thin lower eyelid skin down onto the cheek accentuating the junction between the thin lid skin and the thicker cheek skin.  Lifting the midface necessarily raises the lid-cheek junction upward creating excess lid skin.  This is addressed surgically by making a lower lid incision through the muscle so that the lid-cheek junction at the orbital bone can be addressed directly.  Blending of the lid and cheek is done at the same time that the bulging fat is partially removed or simply cauterized.  The remaining tissue (septum) is cauterized to thicken it so that it can then be bolstered by dissolvable sutures.  The extra lid skin created is conservatively excised and a temporary muscle tightening stitch is placed to keep the lower lid from pulling down during the early phase of wound healing.

This description of surgical lid-cheek blending may seem highly technical to some.  For those less interested in details, the net result of the operation is depicted in the photos (note that the patient is not smiling, although she wishes she could!)

Eyelid Surgery Before & After by Dr. Paul S. Howard

Eyelid Surgery Before & After by Dr. Paul S. Howard

The basis of a good result in the lower eyelids as well as the neck is the performance of a proper mid-face lift with an aggressive approach to the jawline and jowls.  The LSL, when done well, can provide this platform to address the neck, lower eyelids as well as the cheek as a unit.  It is very rare to see a patient who has never had surgery that requires only a mid-face lift making these so called “firming” procedures an integral part of facial rejuvenation yet they only get a small print footnote in the marketing juggernaut that is the Lifestyle Lift®.

Dr. Paul S. Howard

Top Facelift Surgeon Birmingham Alabama

Dr. Paul Howard on Google+

Advances in Facial Rejuvenation – How They Occur by Paul S. Howard, MD, FACS

Facelift Alabama

Plastic Surgeon Birmingham Alabama

“Doc, how can you make me look better, fresher, and maybe even a little younger looking?”

The answer to this question depends on many variables, but actually is easy for each individual surgeon to answer.  In fact, all surgical advances begin with a patient asking a doctor his opinion on a problem that is bothersome to the patient.  In the early 1900’s, the question may have been, “Doc, can you get rid of this unsightly hump on my nose?”  Maybe it was a teenager who wondered if her protruding “Dumbo ears” could be set back.  In the 60’s it might have been, “Doc, what can you do for these fat deposits on my thighs?”  Each of these questions was first met with skepticism by the surgeon followed by a moment of reflection and ending with the promise to get back to the patient after having a chance to think about it.  These accumulated “moments of reflection” are the substance of hundreds of manuscripts and then textbooks describing all of the innovations that have become the essence of Plastic Surgery as we know it today.

Recently, the question that continues to arise refers to looking more youthful, but is tainted by the attempt of many surgeons and non-surgeons to answer this question with a multitude of poorly conceived procedures, potions, lotions, and quick fixes that frequently fail to provide the answer to the question.  Photos that are presented fail to show youthfulness and frequently are not honest and believable.

The part of this anti-aging scenario that surgeons have come closer to accomplishing is the anti-gravity part where the desire for a procedure that lifts drooping facial tissue, especially the cheeks, forehead and neck, is accomplished with minimal incisions, safe anesthetic techniques and a rapid recovery time to the resumption of normal activities.  These accomplishments in facelifting are actually recent because advancements only happen when our patients ask for them.  There came a time when massive swelling and bruising, general anesthetic and a month recovery was not good enough and patients asked for more (or less).  It became clear that simply tightening skin to elevate facial fat and remove wrinkles was a simplistic approach to facial rejuvenation.  Although lifting and tightening worked to a certain degree, it did little or nothing to address that facial deflation by the loss of fat is an integral component of the aging process.  The use of fat transplantation, as is has now been perfected, has provided a therapeutic answer to deflation while fulfilling basic Plastic Surgical principles as described by Ralph Millard, MD.  In a nutshell, fat transfer is the result of identifying a problem, replacing what is lost with tissue in-kind, all the while improving the donor site via liposuction – Dr. Millard would love it!

This is the magical point in the scenario where luck comes into play as it applies to the “law of unintended consequences.”  The smartest of our brethren saw it almost immediately, but the rest of us took a while to see that which was right in front of us.  Our fat grafts carried with them a myriad of growth factors, cytokines, and unknown chemicals that helped the grafts “take,” but also exerted their influence on the overlying skin; the last aspect of the aging face addressed surgically.  By the simplest of methods – observation – it was noticed that the skin was visibly improved by the fat grafts; it had more collagen, more elasticity, improved texture, and an improvement in the fine lines and wrinkles.  As our knowledge evolved it became clear that these secondary consequences were the result of the stem cells that we now know to exist within the fat grafts.  The next small step was to isolate the adipose-derived stem cells from the fat and reintroduce the stem cells to improve the “take” of the fat and add improvement to the skin.  The addition of other known growth factors found in platelets as a PRP boosted the rejuvenation ability of fat grafts even more.  I think it has also become quite clear that depositing these rejuvenating aspects with an appropriate scaffold (fat) beneath the skin improves the results drastically from the awkward attempts to simply rub these against on the skin’s surface.  It follows that the best we can do from the surface is to accelerate the turnover of the skin cells and remove as many of the dead cells as possible; hoping to unveil the dermal and sub-dermal improvements obtained from our stem cell assisted lipo-transfer protocol.

What I have described is the way Plastic Surgical advances happen.  Doctors and patients have been dancing this question and answer Waltz for over a hundred years so it should be of no surprise that many of the questions were asked a hundred years ago, but the answers have only recently shown themselves to those who continue to look for them.

Call today for your consultation! 205-877-PAUL

Read more about Dr. Paul Howard and his minimal incision face lift.

Dr. Paul Howard on Google+

The Lifestyle Lift™ vs. The Howard Lift by Paul S. Howard, MD

Facelift Alabama

Plastic Surgeon Birmingham Alabama

The Lifestyle Lift™ (or LSL) continues to generate publicity, both good and bad, in the beauty business universe.  Ongoing lawsuits in the State of Florida brought by attorney general Pam Bondi as well as dueling articles in Plastic Surgery practice magazines explaining and dismissing the litigious nature of the LSL Company keep the spotlight on this controversial marketing company.  It is not known, the malpractice history of the LSL doctors, yet their history of suing and being sued regarding their trademarked name and aggressive marketing practices is well documented in public forums.  Let me be absolutely clear, LSL is not a facelift nor any kind or combination of surgical procedures.  Once again, the LSL is not a facelift.  The precise nature of the company is a little vague but we do know that it is a marketing juggernaut flooding the TV waves, radio and more recently the internet with a multi-million ($15 million or so) dollar ad campaign featuring the once popular Debbie Boone, daughter of teen idol Pat Boone of white-buckskin-shoe fame.

When one analyzes this expansive company it is easy to understand why there is a cottage industry of cases (patients) searching for Plastic Surgeons to re-do or correct the surgeries done under the auspices of this marketing company.  The LSL brand is metastasizing to every possible market as researched through their massive call bank in Troy, Michigan.  The major problem they are experiencing is the fact that they have grown rapidly, have roughly 90 doctors on the payroll nationwide, and it appears they are having one helluva time controlling the quality of their product.  Roughly 20% of their surgeons are actually Board Certified Plastic Surgeons.  As with any statistical analysis, there is a bell curve describing the quality of their surgeons.  It’s just the numbers are so large that the one’s with poor results number in the thousands every year.

The LSL marketing machine touts 3-4 facelifts a day (per doctor) and a procedure that only takes an hour to do.  When you consider that many of their surgeons are youthful, an hour facelift is improbable.  It seems that time is made-up by handling the incisions with haste.

Dr. Paul S. Howard

Regardless, Forrest Gump said it best, “Life’s like a box of chocolates, you never know what you’re gonna’ get.”  You can say same about the LSL.

In our efforts to separate what we do from LSL, we make a point of offering only one facelift per day performed entirely by a myself, a Real Board Certified Plastic Surgeon with no consultationists, no fellows or residents involved with the personalized patient care.

As far as the facelift procedure itself, our Howard Lift has many commonalities with the LSL except it was developed from patient requests and follow-up over many years and not to satisfy a preconceived marketing plan.  Also, the Howard Lift is only the base procedure taking care of the cheeks and jawline.  Each patient receives a complete evaluation including the neck, eyelids, brow, and nose as needed.  A complete skin care evaluation with appropriate skin care including chemical peels and CO₂ laser resurfacing as indicated.  All of this is included at a cost comparable to the LSL except you know your Board Certified Plastic Surgeon and his entire staff prior to the day of surgery.  Follow-up is provided exclusively by myself and my staff so there are no covering physicians or strangers involved in your surgical care or follow-up.

For an in-depth explanation of our philosophy of practice and opinions on the surgical issues of the day, log-on to our web site www.thehowardlift.com and access our photo galleries and informative Faceliftology™ Blog.  The number one reason for unhappiness with a Plastic Surgical result is a lack of information and not being fully informed about your surgeon and his

Dr. Paul S. Howard is Board Certified by the American Board of Plastic Surgery.  To schedule a consultation with Dr. Howard to discuss your cosmetic surgery goals, please call 205-871-3361

Dr. Paul Howard on Google+

*Faceliftology is a registered trademark, registered by Dr. Paul S. Howard, Plastic Surgeon Birmingham, Alabama.

*The LifeStyle Lift is a registered trademark, registered by Lifestyle Lift Holding, Inc. Michigan.

What the Hell is a Consultationist?

I, and many other who enjoy the English language, have been wondering which new words would be added to the lexicon of America.  These new words, or neologisms, are usually chosen by a group of exudate linguists to be included according to the extent of pervasiveness of their usage.  This begs an answer to today’s question: what the hell is a consultationist?

Upon checking Webster’s and Harper Collins dictionaries, no reference is made for the noun consultationist.  The closest reference is for consultation which we all know means an appointment or meeting to seek professional advice especially from doctors or lawyers.  It is through this prism that the term consultationist has come into my practice universe and the lexicon of Plastic Surgery.  Apparently in certain Plastic Surgery mass-marketing schemes, the number of patients seeking information is much greater than the doctors available to provide information thus leading to a new paradigm for Plastic Surgery practice by placing the here-to-fore unknown consultationist into the complex surgical information loop.  Naturally, not every Plastic Surgeon answers every contact for surgical information, but we all provide detailed information to our office staff who field those questions from the public.  The flow of accurate information through surgical surrogates called consultationists to the patient seems fraught with uncertainty proportional to the number of individual surgeons responsible for the information provided by surrogates.  The information provided, by necessity, must be wholly generic in nature as no one but the Plastic Surgeon can provide the necessary depth of knowledge and experience to provide anything approaching a real consultation.  These new Plastic Surgery mass-marketing schemes, in addition to spending millions of dollars on TV, radio, print, and internet, have actually added a layer of advertising bureaucracy as the information requests are funneled through a new layer of marketing specialists called consultationists.  These new patient calls have become “sales leads” rather than actual consultations.

This new marketing centered paradigm created a number of questions all of which surround the activities of the newly minted consultationist.  For instance, who are these people, how are they reimbursed, what is their background and training, and who decides what they say and who do they report to: the physicians, marketing director, or corporate management, or all of the above?  Is the protection and dissimulation of the brand primary or does accurate surgical information take precedence?  Regardless of the answers to these questions, the marketing consultationist has added an entirely new level of bureaucracy that can only be financially justified if information requests turn into actual doctor consultations.

Clearly it serves no purpose for any prospective patient to be denied a real consultation so the information flow through consultationists carries no more weight than any well-crafted patient directed web site.  The web site will certainly answer the single most important question at any consultation: who is your doctor?

It seems this one single question which would seemingly be the easiest to answer during any real consultation is usually the hardest question for a consultationist to answer generally depending on how many doctors are the recipients of this marketing service or sales lead.

I’m not sure I have been able to actually answer my initial question: What the hell is a consultationist?  My best research tells me a consultationist is but a cog in the marketing paradigm for certain large companies that endeavor to sell some kind of trademarked surgical procedure in some generic fashion.   The challenge is to maximize the marketing of the procedure, even if the procedure is not proprietary or in any way original.

The focus of the expert marketing must maximize the procedure and minimize the surgeon because each surgeon is an individual, but the procedure is universal and much more available as a marketing center piece.  This type of marketing plan when well executed can be enormously effective unless the “generic” surgeon pool is depleted or becomes technically antiquated and changes do not keep apace the market for facial rejuvenation.  Many of the predictable corporate problems are a result of the realities of size and success.  Time will be the arbiter regarding consultationists.  In the meantime, most of us will try to muddle on without them.

Read more about top face lift surgeon Dr. Paul Howard and his minimal incision, quick recovery facelift.

Board Certified Plastic Surgeon specializing in Facelift

Who is a Candidate for the One Week Facelift? by Paul S. Howard, MD

It is axiomatic that all facelifts are different and certainly one cannot recover from all facelifts in a single week.  What I wish to describe is the optimal situation from both the patient’s point-of-view and the surgical perspective.  Choosing the right patient with application of the correct facelift procedure under optimal anesthetic conditions will usually yield the quickest recovery: one week from my perspective.

Who is the best candidate for the facelift procedure?  Ideally, the best candidates for facelift are women between 40 and 60, healthy, non-smokers, with the proper motivation and support.  More specifically our ideal patient is active and actually benefits from a return to normal activity in a week.  As with any surgical procedure, the difficulty and extent of deformity provided by the patient is important.  In the perfect world described here, our female patient has moderate aging of the cheeks with early marionette lines, somewhat deepened nasolabial folds and the presence of the “bubble” of cheek fat tissue obscuring the jawline.  Once these conditions exist, there is no amount of injecting or fillers that can camouflage or “lift” tissues to redefine the jawline.  Some skin elasticity remains as opposed to our older patients with “leather” skin, and a multitude of deep wrinkles indicated a total loss of elasticity.  Weathered skin is usually due to extensive sun exposure without sun-block, as well as environment toxins and smoking.  These older patients with skin elasticity problems are still candidates for facial rejuvenation, but the operations are more extensive and cannot be recovered in one week.  Minor aging of the neck can also be treated simultaneously and does not prolong our one week recovery.

We try to address as many skin quality problems as possible pre-operatively.  We prescribe the nightly use of a Retin-A, hydroquinone, steroid solution as well as a cleansing facial treatment pre-operatively if possible.  We frequently recommend lower blepharoplasty with our midface lift and thus recommend an eye exam prior to blepharoplasty in most cases.  Previous surgery for cataracts or glaucoma is noted as the post-operative incidence of swelling in the form of a chemosis is more likely in these patients and may take more than a week to resolve with prescription eye drops.

Optimal anesthetic conditions include the use of local anesthesia with sedation rather than general anesthesia.  The control of blood pressure within a narrow range of the pre-operative value is necessary to minimize swelling and bruising that is expected when emergence from general anesthesia is necessary.  Aspirin and NSAIDS are stopped 2 weeks pre-operatively, and Bromelein and Arnica are recommended peri-operatively.  The liberal use of ice on and around the eyes with constant head elevation, regional blocks for peri-orbital anesthesia, and minimal injections directly in the ultra-thin eyelid skin reduce the chances for injection bruising in the lids.

The most important discussion to lessen edema, bruising, and to expedite recovery within one week is the choice of the mid-facelift and the details of its performance.  Lapsing into technical jargon, our lift is a short-incision mini-lift with a multi-vector, progressive tension SMAS plication.  The combination of techniques results in an aggressive lift with a minimal of undermined skin resulting in minimal “dead space” to accumulate blood or fluid.  For this small area of undermined skin, we have further developed a system of “micro-drains” utilizing vacutainer tubes as the collection/suction mechanism.  These 21 gauge drains are effective for removing any possible fluid collections and are removed at 24 hours post-operatively.  These small drains are incorporated into 24 hour post-op compression dressing, and in most cases the patients don’t know they exist.  The light compression dressing is augmented with “rest-on foam” on the neck and adjacent to the peri-auricular incisions.  This foam is also removed at 24 hours and is replaced by an ace bandage to compress the dependent portion of the neck and to protect the ears, especially at night.  The neck compression is important to achieve our goal of one week to “street-ability.”

Incision care is of the utmost importance to achieve our goals.  Gentle cleansing using peroxide once a day with careful application of Aquafor, especially around and behind the ear where it is difficult to see and for the dissolvable lower eye-lid stitches.  If the lower led sutures are allowed to dry, they will become brittle and will not dissolve on schedule at about 5 days.  The nylon sutures about the ear and in the submental neck are removed at 5 days except for a few “key” sutures in areas of tension.  These key sutures are removed on day 7.

Lastly, a word or two on the general aspects of healing.  It should go without saying that a calm, smoke-free, supportive environment is important to have the mindset to heal uneventfully.  We request careful attention to the instructions provided and the comfort to call at any time if any uncertainty arises.  All of the medications are provided for a reason and should be taken exactly as prescribed.  We will go over all of your medications in detail with you so there are no mis-understandings regarding when to resume them.  Controlled activity beginning post-operatively day one is important.  There will be three office visits during the first week and of course these are very important.  It is probably equally important for your mental recovery to parallel your physical recovery.  Although we aim for your physical recovery to be well along at one week so that you can be in public, your recovery will continue for many weeks and months to total normality.  We use serial photography to allow you to follow your recovery visually, which in most cases, helps your physical recovery and state-of-mind as well.  You will receive copies of all photos as well as the constant reminder of your pre-op condition with a set of your before photos as well.

We believe that we are all “goal oriented” people and that goals for life as well as for recovery from surgery are important.  Our goal for you is a one week recovery and we will provide you all of the tools necessary to achieve this goal.

Read more about Dr. Paul Howard, Plastic Surgeon Birmingham, Alabama and view facelift before and after photos.

Dr. Paul Howard on Google+

Anesthesia for Facial Plastic Surgery

Facelift Alabama

Schedule your facelift consultation with Dr. Howard by calling 205-871-3361

There is a movement afoot to try to legislate safety in Plastic Surgery by controlling what we do rather than taking the more difficult route of controlling the credentials and training of practitioners.  State governments must find it less offensive to certain constituencies to legislate what we do and how we do it rather than more directly addressing the office surgical setting by requiring each and every practitioner to have a minimal amount of core training in the procedures legislators deem unsafe.  When non-professionals try to address concerns on medical safety it always appears that some group of doctors may be affected and their arguments always seem to be based on possible financial restraints or financial hardships that fully trained and credentialed doctors may not suffer.  The implications are that all doctors, regardless of training, are essentially equal.  No such assumptions are proffered for neurosurgeons or cardiac surgeons.  There is no legislation attempting to equalize specialty surgeons by defining what we do to make the entire group safer.  No one has proposed the idea that cardiologists, with little or no surgeon training, should be allowed to do open heart surgery as long as they operate in a safe manner and do the operations in approved facilities.  It would seem safer to address the training and credentials of those performing open heart surgery rather than restricting cardiologists to “simple” open heart cases.  This is much like restricting non-Plastic Surgeons to “simple” or low volume liposuction searching for a safety standard by “dumbing down” the operation and its possible complications.

In another way, many surgeons and non-surgeon administrators have convinced people that surgery is always safer when performed under general anesthesia with an anesthesiologist in attendance.  The fact is that almost all facial Plastic Surgical procedures done on adults for cosmetic reasons are safer when performed without general anesthesia, and its riskier counterparts, mask anesthesia and monitored anesthetic care.  The latter two are basically general anesthesia without the benefit of a secure airway and in facial cases, a difficulty in administering oxygen as needed.  It’s easy to declare that all patients need the most sophisticated and complex care in all circumstances with the assumption being that this is the safest way to proceed.  One aspect of plastic surgical complications that seems to be consistently overlooked is the general anesthetic contribution to all complications.  The fact that general anesthesia is related to complications is found in the surgical maxim that complication rates increase rather drastically after 2 hours under general anesthesia.  I don’t believe that operations longer than 2 hours are inherently more dangerous.  Many surgeons think that their meticulous technique, while sometimes slow, gives better results even though they may require hours longer under general anesthesia.  As a general rule, those surgeons who expedite the operation to decrease operative time are the safest.  The only way to further increase safety is to take the general anesthetic out of the picture.  Interestingly, using local anesthetics and regional blocks requires an entirely new skill set and, most importantly, it requires patience.  Adding sedation in the form of oral medication helps to make the experience more comfortable, but adds very little to the complication profile as these are the very same medications we use in our post-operative outpatient patients.  We have found that the intravenous use of medications such as versed and morphine creates large increases of medications with a short half-life and is more likely to cause nausea and vomiting.  Nausea is a much less common problem with oral medication especially if Phenergan or Zofran are used with the pre-operative oral medications.

In the past, the major complaint with local anesthesia with or without oral sedation is that it can burn when injected.  There are a number of techniques that surgeons can utilize to make the injections much less painful.  Almost all of these techniques require only a bit of patience from the surgeon.  The most commonly used anesthetics are Xylocaine and Marcaine.  Due to the acidic pH of Xylocaine, most surgeons have for years added bicarbonate to decrease the “burn” when injected.  The problem with adding bicarbonate is that it decreases the ability of the Xylocaine to work as well and may require a larger volume of injection.  Knowing the details of Xylocaine led to a search for better anesthetics.  Our search led us to Paris, France where we discovered Septocaine.  We found that Septocaine has about the same complications and dosage profile as Xylocaine.  The difference with Septocaine is that it is less painful to inject, it tends to work faster, and provides what patients describe as a more “intense” numbness.  We have used Septocaine as a primary local anesthetic for over 10 years and I am sure it is more comfortable for the patients. The downside is that it is more expensive to use.  This is a small price to pay for patient comfort.  It is important to understand that the reason for all of this discussion is to make sure our facial plastic surgery patients are comfortable, pain-free, and safe while having surgery.

From a medical/surgical point of view there is a very specific and important reason to use local anesthetics and oral sedation rather than general anesthetics.  We are convinced that the vast majority of post-operative facial swelling after facelift surgery is caused by transient but significant changes in blood pressure during and immediately after surgery.  In fact, I believe most hematomas and swelling occur in the period of time after the procedure is finished during the period of time when the patient emerges from general anesthesia.  We believe that controlling the blood pressure at pre-operative levels throughout the operation and especially at the end has decreased swelling post-operatively dramatically.  Blood pressure control and the judicious use of epinephrine in our local anesthesia with complete patient monitoring has completely changed the first 24 hours after surgery – much less bruising, swelling, hematomas.

One might ask why everyone who does facelifting wouldn’t do it with these techniques.  The primary reason is probably the patience it requires and the fact each facelift should be done by itself each day.  This fact resulted in our “One Facelift a Day” promise.

Read more about top facelift surgeon Dr. Paul Howard and his no general anesthesia facelift.

Z2QVWK2FWQBQ