First Facelift

The term “first facelift” is showing up more and more frequently on Google searches these days. Although what the term means is intuitive, it is not a medical term that plastic surgeons frequently use. Medically speaking, the proper term is “primary facelift” but you can’t argue with a Google search.

Not particularly in tune with the “mind” of the internet, my assumption is that a first facelift is considered intrinsically different than secondary (second) or tertiary (third) facelifts. While there is some truth to the fact that first facelifts are performed differently than the others, there is no truth to the thought that a plastic surgeon can be an expert at firsts and not seconds or thirds. Although I am unaware of any statistics to the effect that at least half of the patients who have a first facelift before the age of 55, will also have at least a second as well as any number of touch-up procedures.

The importance of first facelifts is that any plastic surgical procedure including facelifts, eyelid surgery, rhinoplasty as well as cleft lip and palate achieve the best results the first time they are done.

Thus, the term first facelift. A good first facelift can lead to an even better second and even third. I truly was not aware that “first facelifts” were something people look for, or Google for, but I learn something about Google every day. With that said, I’m probably the best first face lifter around these parts.

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

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

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 facelift surgery 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 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.

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 facelift 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 to prepare for facelift surgery 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 facelift 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 Alabama facelift surgeon Dr. Paul Howard plastic surgeon and view facelift before and after photos.

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