Facelift Series #4: Facelift Fears

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host Summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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The title of today's
episode is Facelift Fears,

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another in our Facelift series.

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What are we talking about
in this episode, Dr. Bass?

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Today's topic is things that
people worry about when it comes to

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having a facelift.

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Things to keep them from going ahead
with one or just make them feel that

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somehow it's not a good
thing that facelift is bad or

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undesirable.

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And some of these things are conscious
things you think about and you can state

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out loud.

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And other things are just general
impressions of the procedure or

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impulses that we have
about having the procedure.

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And fears and caution are a vital part of

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our self-preservation instincts,
and that's a good thing,

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but only up to a point
because if taken too far,

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our fears prevent us
from achieving our goals.

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And this is true not just in
plastic surgery but in all of life.

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But of course here we're talking
about achieving our beauty goals.

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So being paralyzed by these fears
prevented from taking action

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ends up being counterproductive
to the goals of self-preservation

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and maintenance because self-preservation
instincts and body maintenance

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are closely related to our
desire to maintain our beauty.

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So it's an interesting back
and forth at play here,

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which points out the need
for balance in all things.

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That all makes sense, but let's get to
some specifics. Dr. Bass, Dr. Edinger,

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can you tell me about some of
the things that patients fear?

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There are two basic categories of things.

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There are medical risks
and there are appearance

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concerns.

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I have the top of the
list for medical concerns.

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It's being afraid of anesthesia.

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There are several types of
anesthesia that are used in facelift,

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including general anesthesia
where you go completely to sleep,

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a twilight or sedated form of anesthesia,

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and then also local anesthetics who
are minimal to no sedation is on board.

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The risk for anesthesia overall are very
low and we get medical clearance on all

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patients who are at a higher risk to
make sure that they're safe to surgery.

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And that's an important point.

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There is a degree of
risk in everything we do,

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not just in medicine but in life. But
of course, if those risks are very,

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very low, it's reasonable to go ahead.

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So I hear the concern
about anesthesia all time.

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That process of anesthesia can be varied

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based on the individual facelift
surgeon's preference and

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discussion that a patient
has with the anesthesiologist

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to get to something that everybody
is comfortable with and believes is

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safe.

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But typically some type of
anesthesia is used for most facelift

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today,

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but the risk of having a
serious problem from anesthesia

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is like the risk that you'll
die in a car crash this year.

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And that's a real risk. I mean,
when we're driving in the car,

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we look before we pull into the
intersection, we look both ways.

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We make sure the light is green,

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but the risk is not high enough
to make us hide at home in our

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apartment and not go out.

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Some people are also worried about the
pain they're going to experience after

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surgery. Good news here is there's very
little pain after facelift surgery.

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We get great pain control with little
to no narcotic pain relievers and most

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patients are very comfortable
following surgery.

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And patients tend to describe the
discomfort as more of a bruised,

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swollen feeling than actual pain.

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So it's pretty low on a scale
of discomfort from one to

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10,

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it's probably somewhere in the
two to three range for most of the

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recovery period, and that's the
typical experience of my patients.

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I often prescribe 15 or 20
pain reliever tablets and

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most of my patients are taking three
or four of them in the first couple of

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days and then they just take Tylenol.

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Okay. And are there other medical risks?

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Well,

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patients worry about all kinds
of medical problems that can

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occur during the healing and there
are some things that they have to

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consider that we either know
are going to occur or that could

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occur and Dr. Edinger will
tell us a little about those.

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First of all, everyone is going to get
some degree of bruising and swelling.

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The amount they get and the duration that
it lasts is variable for each patient.

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Typically a couple of weeks for most of
the bruising and swelling to reside is

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common for patients.

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Patients are also commonly afraid of what
their friends and their neighbors are

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going to say if they don't want anybody
to know that they had a procedure done.

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I've had patients get very

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creative in their responses to neighbors
and friends in order to hide the fact

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that they had surgery done and it is
something that can easily be hidden.

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The other fear I commonly get asked about
is how long the incisions are going to

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take to settle and how to best hide them.

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And these are things that are super
common that we have all patients ask about

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and that were really tricky in surgery,

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hiding them and helping you afterward
to make sure that people won't know when

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you walking down the street,

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friends of the family you
don't want anybody to know.

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And perspective on this varies
a lot in different parts of

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the United States. I
practice in the northeast,

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in New York City, most people
are not telling friends,

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family and certainly not telling
coworkers that they had some kind of

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surgery done. They don't
want to discuss it publicly,

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so they're trying to hide it.

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And the key part of that
is planning enough time for

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recovery,

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enough time to be out of the public
eye so that you'll look presentable,

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not stimulate a lot of questions
when you return from the

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procedure.

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If you try to short
circuit that recovery time,

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you don't allow yourself enough time.
You're more likely to get caught out.

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Now other parts of the country,

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they're not very concerned that someone
knows they had a cosmetic procedure or

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they're very open about it
and they're showing people.

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And so this issue goes
away, but where I practice,

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most folks are trying,

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not that it's anything to be ashamed of,

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but they are not trying to make
a point of it to anyone else,

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and that's something you just have to
plan for a little bit. Although there is

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some variation and we will
talk in a later podcast

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episode about how to prepare
to get good results with your

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facelift and have a minimum of recovery,

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how to take care of the facelift in
the early healing period and some

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technical things that facelift
surgeons are doing these days

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that help us really telescope
down that recovery time.

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The other thing that's important to
realize is it's a little different for

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men versus women and even women with very

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short hairstyles have some of the
same issues that men have with a

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short hairstyle.

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It's harder to camouflage incisions
until they fade with longer

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hair.

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It's a little easier to pull a little
hair in front of an incision so

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folks don't see it until it has a
little time to be better healed.

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And if you wear makeup when you go out,

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it's easier to camouflage. If there's
a little trace of a bruise that's

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80 or 90% gone,

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that will camouflage
pretty easily with makeup.

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If you can't go out with makeup on,

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it's not part of how you
dress or how you go out,

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then it's going to be harder. So
since most men don't wear makeup,

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they have to worry a little more about
how they're going to hide that bruising

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than most women who even if they
don't routinely wear makeup,

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could feel comfortable going
out with some makeup on.

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And in this way,

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some stage actors actually do
pretty well because stage makeup is

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very heavy and it will hide
bruises really well and so they can

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return to working with that heavy
stage makeup on even when a few

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things are still showing.

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Got it. Are there other surgical
risks you can tell us about?

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Risks we talk with patients about are
hematomas or bleeding after surgery that

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may or may not have to go back to the
operating room to address infections,

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skin loss, nerve injury,
those are the main ones.

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We're going to talk about all of these
in some of those episodes I mentioned

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how we prep for that,

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how we take care of things during
the early recovery and some

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advanced techniques and technologies
that surgeons are using to help these

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days. But overall,

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it's important to follow all of the rules,

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the restrictions,

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the care plans to have a
careful medical history and

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a careful medical clearance
because that will minimize

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risks bleeding.

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The big thing is tight blood
pressure control skin loss relates to

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nicotine,

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whether it's in tobacco vaping or
some kind of nicotine replacement

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medication that really
has to be eliminated

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to minimize risk of skin
loss and nerve injury

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risks are fortunately very, very low.

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That's part of the virtue of seeing
an experienced facelift surgeon that

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they're intimately
familiar with the anatomy.

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Some facelift techniques bring
you closer to some of the

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facial nerves than others,

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and so somebody needs to be
experienced if they're doing

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those techniques,

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and that is something to discuss
how much effect that has on risk

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with each individual surgeon.
There are also some very,

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very aggressive facelift
techniques and at first blush,

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sometimes that sounds really appealing.
Well, I want the best facelift,

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the most aggressive facelift.
I want to look the youngest,

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but that sometimes costs you in risk or in

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recovery time with maybe a little benefit,

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maybe no added benefit.

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So following a standard technique
that's in widespread use that's

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been refined both by the surgical
community in general and by

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the individual plastic surgeon and
their experience of doing many,

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many facelifts is what gives
you the best safety margin to

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avoid any kind of mischief during surgery.

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Okay, and that brings us
to appearance concerns now,

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what can you tell us about those?

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So topping the list is the
fear of looking unnatural

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or changing the way you look,

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and this is an understandable
concern for patients.

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It's something patients
worry about a great deal,

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but it's not a big problem
in a typical first or second

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facelift with an experienced
facelift surgeon,

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there are things we do in plastic
surgery that are designed to change

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who you look like when we're
doing that intentionally at the

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patient's request.
Things like rhinoplasty,

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adding cheek implants or procedures
where we move or change the

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bones of the face. We're
trying to reshape things,

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make you look like someone
a little different.

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Facelift is about rejuvenation.

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It's about keeping you
looking like yourself.

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Just the way you look a number of years
back when you were a little bit younger

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and modern facelift
should not distort your

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appearance.

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It should preserve your appearance
and just restore the use of your

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appearance.

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And I'll just put some more
detail into those issues.

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When it comes to looking unnatural,

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is this something we are very aware of
and work very hard to keep you looking

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like a natural or fresh version of
yourself. Like we've said multiple times,

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we don't want anyone to
know you had surgery,

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you haven't been to recognize that
you look more refreshed in regards to

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changing the way you look. Again,

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we don't want to change who you are
and what you look like in your defining

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features.

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We just want to set the clock back for
you and getting you a chance to look like

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you're younger self regarding
an incomplete correction.

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You work really hard to walk that fine
line that exists between making you look

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operated on and unnatural and not being
aggressive enough and leading you with

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perhaps some residual neck or skin laxity.

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All patients ask about symmetry and I
always say that we are asymmetric to begin

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with and will be asymmetric to end with.

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We try hard not to introduce any new
asymmetries and we're always mindful it's

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alon a when we start so we can make
things look as symmetric as possible.

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I agree with all of those
points Dr. Edinger made.

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I think that's all very important stuff.

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The best compliment I can get
on one of my facelifts is when

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a patient says they disappeared for
a week or two to recover and their

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friend said, oh,

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you looked so rested when you came back
from that vacation and coming back.

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And if somebody said, oh,
you had a great facelift,

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that's not a great facelift because
they could see you had a facelift.

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We want them to just say, oh, you
look so rested. Did you lose weight?

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They know you look great, but they
can't put their finger on why.

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So that's the goal and that's
what modern face lifting is

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designed to produce for you.

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I comment on symmetry also as Dr.
Edinger said a hundred percent of

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us are asymmetric, and in fact,
if we were literally symmetric,

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we'd look unnatural because there is no
human that's symmetric. Our eye would

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tell us that doesn't look
normal. But asymmetry,

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we'd like to be small.

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And so where we see an
asymmetry and an aging change,

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we're going to adjust our technique.

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We typically have to do slightly
different things on each side of the

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face based on the floor
or foundation anatomy

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that's in the face, the bone structure,

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which may be a little asymmetric and
based on how each side of the face has

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aged,

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we get differential sun
exposure because our left side

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driving around tends to get
more sun than our right side.

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And so aging changes are going to be
a little different and surgeons know

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this. We compensate for that.

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We'll hopefully move you towards symmetry.

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But as Dr. Edinger said,

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we're never going to get to
perfect symmetry. And in fact,

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we wouldn't really like to because
we would look unnatural if we did.

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You two have talked about a lot
of concerns. What about scars?

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Is that a major concern for patients?

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Yes, it is.

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It's a big fear that patients
talk about quite a bit.

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And one thing we have to
accept with any kind of a

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surgical procedure is there's
always going to be some kind of a

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scar, but the facelift
scars fade over time.

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They're never invisible,

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particularly the incision in
the crease behind the ear.

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The retroauricular incision is
something your hairstylist can see.

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You can never hide that from them.

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Hopefully they're not talkative and they
won't say anything to anyone else but

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they've seen it before, believe me,
especially in a place like New York City.

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So patients worry an awful lot about
the scars and they worry more about the

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scar in front of the ear and that's
because that's where people can

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see it.

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But that scar is the incision
that typically heals the vest

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in facelift and the hardest to see.
So it's usually not a problem

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after facelift surgery and
enough time for healing.

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The exception to this is when
you are a known hypertrophic

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scar former,

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you had a previous surgery or a
previous injury and it healed with a

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hypertrophic scar,

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not just a bad scar because you scraped
your knee and picked at it for two weeks

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while it healed and you got a scar from
that. But you had to see the doctor,

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they were treating a
hypertrophic scar or if you are a

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keloid scar former and
people with a clear strong

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history of making those kinds of scars
need to have a careful discussion with

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their facelift surgeon.

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But most of the rest of us can point
to a few little injuries or maybe a

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surgical scar and if there
wasn't a particular problem with

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healing from that scar,

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it indicates we'll probably do
well with facelift. If we run

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into a problem with a scar,

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there are quite a few things
we can do to treat those,

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including injecting various
anti-inflammatory medicines,

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topical applications,
and silicone gel strips.

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There are a number of laser
treatments we use for scars,

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and I've done a fair amount of research
into this and I treat a lot of problem

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scars with a variety of laser
devices as well as the option

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to surgically revise the scar
just in a small local anesthesia

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procedure,

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trim out a little bad portion of
scar and titch it very tiny in

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the hopes that not during a big operation,

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it will heal a little better
the second time around.

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Is there anything wlse
listed should be aware of?

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For the overarching theme
here of appearance concerns,

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this is a reminder that this
isn't a permanent solution
that's going to stop the

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clock and end the aging process.
This is a tool to set the clock back,

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but the clock is going to keep ticking.

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The surgery typically lasts 10 to 15
years like we had mentioned before,

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and then you're often going
to need to repeat it again.

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And before we close out this episode,
can you share your takeaways, Dr. Bass?

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Just to recap what we've discussed,
it's natural to have fear.

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Fear is protective.

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It shows you're human and
you're thinking about things.

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I get worried when I have a
patient who seems oblivious.

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They have no concerns.

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I'd rather have a patient who's
consumerist and wants to understand

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what's involved and what
the risks are. Fortunately,

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the risks are minimal. In
modern plastic surgery,

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these things are very well
studied in very well refined.

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So despite having these fears,

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the medical risks are very low and
steps that we take during the medical

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clearance and during,

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after the procedure work
to keep them at an absolute

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minimum. The fears that are
related to appearance or natural,

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I don't think there's a plastic surgery
patient who doesn't wonder about and

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worry a little bit about how they're going
to look and how the procedure's going

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to come out.

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But with a well performed procedure
by a plastic surgeon who is

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experienced in facelift,

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this can restore your younger
appearance rather than altering your

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appearance. The risk of telltales
is minimal and the scars

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generally healed to be difficult
to impossible to see a problem.

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Scar, as we just discussed,
can be revised or treated.

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So overall, if you're
bothered by skin laxity,

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you're middle aged or older,

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some form of surgical face lifting
is almost always the correct

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option. There are non-surgical treatments,

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but they won't get you the results
you're looking for in these circumstances

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once you've hit the point of
what medically we call moderate

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laxity,

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the facelift has continued to
evolve to be a more complete

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correction with less recovery
and less risk than historically.

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So it's not your grandmother's
facelift, it's a 21st century facelift,

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which believe me, is bigger
and better. For that reason,

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it's not worth letting fear keep you from
looking your best and showing the face

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that you want to the outside world.

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Definitely. I feel much better about
the facelift when I hear the facts.

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00:21:29,470 --> 00:21:29,830
Thank you,

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Dr. Edinger and Dr. Bass sharing what
worries people about the facelift and

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helping to separate fear from reality.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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00:21:41,410 --> 00:21:43,300
Follow us on Apple Podcasts,

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00:21:43,360 --> 00:21:45,610
write a review and share
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00:21:45,760 --> 00:21:49,270
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00:21:49,270 --> 00:21:52,840
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contact us with comments or questions,

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00:21:52,840 --> 00:21:54,040
we'd love to hear from you,

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00:21:54,130 --> 00:21:58,810
send us an email at
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00:21:58,810 --> 00:22:01,330
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