Selective serotonin reuptake inhibitor-induced hyponatremia and the plastic surgery patient. Dr. Pitman: Any rebuttals? There's not much we would recommend for laser treatments here, but we would normally recommend everywhere else.
Of course, it's very important to leave an adequate cushion of "essential fat" under the skin when you elevate the flap. Necklift Plus Candidate. Please remember that with a mid face or cheek lift, you are also getting a lower blepharoplasty at the same time. I would use a submental incision and a three-quarter–length sulcus incision for access.
Learn about our Medical Expert Board Print A facelift, also known as a rhytidectomy, can improve the most visible signs of aging caused by the effects of gravity, stress, and sun exposure. I think you can improve her neck and give her a better cervicomental angle. General anesthesia is preferred. Click the link below to fill out your information and start for the next steps towards a new you! Dr. Pitman: The next patient is a 62-year-old woman requesting improvement in the appearance of her neck (Figure 3). Farmington, Connecticut Facelift | Connecticut Facial Plastic Surgery. However, a more horizontal vector is used in wide faces to improve submalar hollowing and avoid further midfacial widening (Figs. Remember, this was a quick procedure done with minimal sedation and local anesthesia that took about 30 minutes! Berner RE, Morain WD, Noe JM. Cardiovascular disease. If the anticipated distance is >5cm, then a prehairline incision is chosen to prevent postsurgical sideburn distortion. 5-inch "helper" incision behind the earlobe on each side to blindly undermine the lateral neck and to make it easier to exit the neck suction drains behind the ears at the end of surgery. Facelift patients first wash their face and hair three times with an antibacterial soap. Most surgeons will lift the muscle or SMAS in 1 direction. Otherwise, the majority of patients are best served by an intertragal incision to prevent postsurgical skin color and texture mismatch of the tragus and lateral cheek.
I am not worried that she had skin slough before, looking at the way it has healed from this photograph. It is not that uncommon to pierce the platysma when vigorously performing lipoplasty in the anterior neck, and it is then possible to injure one of the marginal or cervical branches of the facial nerve. Loss of definition in the lower face including the development of jowls and a double chin. Hypertension is a controllable risk factor for hematoma; 35, 36 therefore, strict multimodal blood pressure control is essential to minimize complications (Fig. For those patients, an isolated neck lift, which always includes a jawline clean up, is a reasonable choice in lieu of a face-neck lift. Puckering under chin after neck lift photos. We do not know what work was initially done to her face. As soon as you're able, we encourage gentle walking. The endotracheal tube is placed midline and not secured, as it is monitored closely intraoperatively. SPECIAL CONSIDERATIONS. Dr. Pitman: She had lipoplasty of the anterior neck and lateral SMAS elevation.
For younger patients who don't need a traditional Facelift, this procedure is an excellent, less invasive, alternative and can be performed under local anesthesia with little downtown after surgery. His retruded chin was also elevated (pushed upwards) with the procedure to look more normal and even his jowls were improved. With an improved understanding of facial anatomy including the facial retaining ligaments and intervening superficial and deep fat compartments, 3–5 the modern facelift requires an anatomically targeted approach. If she has, I would not be overly aggressive. The decision to open the neck is determined preoperatively based on the presence of cervical skin laxity and is accessed via a 3–4 cm incision marked 1–2 cm posterior to the submental crease. I should also mention a structure I call the "malpositioned gland, " which is a gland that is fixed in an abnormal medial and inferior position by congenital intracapsular adhesions. Attitude and expectations. The decision to either carry the incision posteriorly into the scalp or inferiorly along the occipital hairline at the junction of the thin and thick hair is based on the estimated skin resection. Lipoplasty marginal mandibular injuries usually recover. Puckering under chin after neck lift surgery. Additional to physical changes, a neck lift could increase an individual's self-esteem and confidence in their appearance. The "high SMAS" face lift technique. Further, this particular method of a neck lift may be best suited for individuals with low skin elasticity, leading to sagging of the skin. As the swelling goes down, your skin will loosen and then stabilize. 31 Other authors advocate a more aggressive lateral platysmaplasty while avoiding a submental incision.
68 year old female before and 2 months after mini lateral neck lift (2 small 1 cm incisions). Beale EW, Rasko Y, Rohrich RJ. The surgeon must be cognizant of the inelasticity of gauze dressings and anticipate a degree of postoperative edema; therefore, the kerlix wrap must be loosely applied to avoid pressure on the skin flaps. Platelet gel sealant use in rhytidectomy. This procedure took 14 minutes in the office under local anesthesia. Dr. Aston, would this also be your approach? I would make a submental incision in the submental skin crease, clean it up, and suture the platysma together. So the bottom line is that you really have to know where you are going; but that said, partial gland resection can be done safely, and over the years I have done hundreds of gland resections without a problem. Dr. Pitman: Would you approach her neck anteriorly, as well as laterally? Puckering under chin after neck lift procedure. In contrast, long faces with narrow bimaxillary width, jowling, and redundancy medial to the lateral canthus require extended skin undermining for more complete release of the mandibular septum, zygomatic, and masseteric retaining ligaments for proper skin redraping and medial SMAS advancement (Fig. The medial platysma borders are plicated with figure-of-eight 4-0 Mersilene from the inferior mandibular border down to the level of the thyroid cartilage, followed by a 2-cm inferior transverse platysma myotomy (Fig.
It is very important that liposuction is done in combination with a healthy diet and lifestyle in order for you to reap the best results. Pulikkottil BJ, Dauwe P, Daniali L, et al. In my hands, the best fix would include a partial resection of the superficial lobes of the submandibular salivary glands, assuming there was no contraindication, such as a dry mouth condition, and the patient agreed to the resection. 24, 25 Therefore, the modern facelift should involve a "Lift-and-Fill" approach. I think you might be able to clean up her neck with some lipoplasty, undermining, and fat contouring as Dr. Feldman proposed. It will reduce your recovery time. The scar can be tailored and be longer or shorter depending on what excess skin bothers the patient. In this picture, you will notice the patient is looking downwards and trying to touch her chin to her chest. Complications Of Facial Surgery Before and After 03 | Thomas Funcik MD. Of course the scar is red because not enough time has not passed for scar maturation which can take 6 to 12 months. A midline approximation or tightening of the platysma might also be necessary, and the left submandibular salivary gland may need a partial resection or tuck-in depending on what was found at surgery. 9% and 9%, with a higher incidence in males.
The facial retaining ligaments transmit through the SMAS to the overlying skin, either originating from the periosteum (zygomatic and mandibular retaining ligaments) or from underlying muscle fascia (masseteric and cervical retaining ligaments). The procedure consists of removing excess skin and fat, tightening underlying muscles, and re-draping the skin of your face and neck. In this case, I would first remove the excess submandibular fat and then see if there is still a gland bulge present. Was or is she a smoker? This was a 14 minute procedure done in the office under local anesthesia. Loose skin and excess fat. Many of our patients combine a facelift with procedures like blepharoplasty, browlift, or a nose job. I realize that is a relatively unconventional approach, but she has a relatively unconventional grimace. Bucky L. Facelift, how deep how wide. Getting Better Results in Facelifting : Plastic and Reconstructive Surgery – Global Open. Dr. Feldman: I would first do an appropriate subcutaneous defatting, either by an open fat resection technique or by lipoplasty, and then reassess the contour and definition of the hyoid angle. I would probably do some small cannula lipoplasty of the jowl area and possibly consider fat transplantation to the prejowl area to achieve a smoother jawline. I would lift her because of the laxity. Notice how the submental angle is now harmonious in the lateral view. The midface or cheek ages and descends downward.
Common Reasons to Get a Revision Facelift. Dr. LaFerriere: The only comment I would make is that I would be concerned about over-operating on someone like this with regard to the digastrics. A cervicoplasty may only be suitable for candidates with excess skin from aging or weight loss rather than a surplus of hanging muscle or fat. 57 Furthermore, male patients are counseled to avoid vasoactive medications (eg, Viagra; Pfizer, New York, N. Y. ) Dr. LaFerriere: She does not have platysma function on the right; you can see the muscle on the left. You may feel some tightness and numbness on your face and neck. Her small degree of chin ptosis is easily correctable with a leveling technique, which simply means reapproximating the subcutaneous fat and the skin at an even level on each side of the submental incision.
So that's another way of improving posterior mandibular contouring.
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