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for Eyelid and Facial Plastic Surgery

Drs. Kevin Perman and Albert Cytryn


Phone (301) 571-0000
6420 Rockledge Drive, Suite 4300 | Bethesda MD 20817


Not all faces age the same way, but our reactions to our own facial appearance when we look into the mirror and the conclusions that we come to when we look at another person’s face convey a whole host of immediate and often lasting impressions.
  What happens in that moment when we draw those conclusions? One may look happy, sad, tired, energized, positive, negative, confident, shy -- the list of impressions is all too long. These impressions, right or wrong, are where it all starts.  To quote Bonnie Raitt, “Those lines are hard to take when they’re staring back at you.”  


Why a Facelift? 


To paraphrase Sir Isaac Newton, ‘nothing beats gravity’.  Genes, lifestyle, stress levels and environmental elements also play a role, but there is no denying that you can feel great but look tired at the same time.  Facial rejuvenation surgery, and for that matter any aesthetic facial procedure, will not stop the aging clock, but that is not the goal. The objective of facial rejuvenation surgery is to move the clock back some and achieve a more rested, fresher look without looking surgical. 

Rejuvenation of the aging face often requires a combination of techniques.  Peels, laser resurfacing, dermabrasion, liposculpting (fat grafting), alloplastic facial fillers (Restylane, Juvederm, Perlane, Belotero, Voluma etc.) and neuromodulators (Botox, Xeomin, etc), can all augment the beneficial result of face and neck lifting surgery  or even obviate the need for incisional surgery, but when facial laxity reaches a critical point, the aging face must be evaluated as a surgical unit. 


Evaluation and Decision Making 


As noted before, not all faces age in the same way, nor will one procedure satisfy every patient’s needs or wants for facial surgery.  Skin changes, volume loss and tissue descent will be major variables and although every face ages, some age more rapidly and some parts of an individual face may even age faster than another part. 


It is best to evaluate the face, by separating it into three distinct zones:  The Rule of  Facial Thirds.  From top to bottom consider: 1) brow and upper eyelid; 2) lower eyelid and mid-face to nasolabial folds;  and 3) jawline to neck. 


With a thorough evaluation and discussion of the facial zones, the patient will better appreciate the realistic goals and options offered through surgical rejuvenation and ancillary procedures. 


While final decisions belong to the patient, with an in-depth dialogue, touching on patient goals, concerns and even fears, post operative disappointment can be avoided 


Three Most Frequently Described Facelift (Rhytidectomy) Procedures 

These procedures differ mainly in the location and extent of dissection.  The more superficial procedures potentially offer less risk, but possibly a shorter length of improvement, whereas, the deep-plane procedures may offer a more dramatic, longer lasting result, but carry greater risk. 

     Subcutaneous Rhytidectomy-skin lift only, with fixation sutures.  No SMAS tightening. Low risk, but may not offer enough support for a long lasting result. 

     Smasectomy- Via plication or imbrication, the SMAS is “strengthened” to augment the subcutaneous dissection, offering a longer lasting result.  

     Deep Plane Lift - A more aggressive lift, but may greater risk (risk of possible facial nerve injury). 


Almost always, the above-described approaches to facelift will include neck contouring, addressing pre- and sub-platysmal fat and tightening of the platysma, addressing bands and laxity. 


What Happens Before, During and After a Face Lift 


Because the surgical plan for facial rejuvenation is customized to each individual patient, only a broad description/outline will be covered here. 

A check list is developed and reviewed with each patient, covering which procedures will be performed, and the potential risks, benefits and options of each. 

For example, when a patient chooses a combination of treatment techniques such as different surgical procedures  (eg  face and neck lift along with blepharoplasty), along with injections (Botox and Juvederm filler), each one of these procedures is covered separately in detail, so that the patient undrestands how each procedure will be performed and what to expect during the post-operative recovery period. 


Patients must be cleared by their primary care physician/internist to undergo anesthesia, whether it be intravenous sedation or general anesthesia.  

Patients are required to stop all medications, prescribed or OTC, which can cause and/or contribute to blood thinning.  Post operative bleeding and even hemorrhage are described in the surgical literature, but as infrequent as this occurs, this risk goes up exponentially on medicines like baby aspirin, NSAIDS (Motrin, Aleve etc), OTC nasal decongestants and a host of herbal supplements.  A cigarette smoker considering face lift surgery must be nicotine free for at least 4-6 months and submit to testing to document. Nothing ruins good surgery and a great result faster that cigarettes. 


Bruising and Swelling and Afterwards 


Everyone is bruised and swollen to some degree, but there is great variability from patient to patient.  Specific needs will be addressed during the consultation period. For example, some patients may require drains for one- two days; some patients who live alone may require someone to stay with them.  Suture removal is approximately 7 days after surgery depending on individual healing, The time for make-up and concealer is variable but will be discussed in post-operative visits. Because healing is such so individual in nature patients are advised against big social plans for 3-5 weeks. We encourage all patients to make a long list of questions.  If you wish more than one consultative meeting to ensure that all questions are covered, that request will be accommodated. The best educated patient makes the best informed decisions.