Analysis in consultation and preoperative preparation of the patient before rhytidectomy

Before the initial consultation of the patient, which is planned for rhytidectomy, you need to take care of the appearance of your office. Initial contact with any patient of a cosmetic surgeon begins with a questioning during a phone call. At this time, the patient may not yet have reliable information about you as a surgeon to decide on an advisory visit to you. An employee who answers calls in your office must have a friendly and pleasant voice, be very knowledgeable and try to give the potential patient reliable information. However, his task does not include telephone consultation, since this should be done by a doctor. The question of prices will inevitably arise, and this conversation should not become a hindrance to the patient's visit. Asking prices should be in comparable competitive limits for your region.

Briefly agreeing on the consultation, the patient should receive a compilation of exhaustive information concerning subsequent procedures, as well as a booklet or brochure with expanded information on transactions that are of interest to him. Well-written, informative brochures and booklets about counseling are preferred by thoughtful and legible patients. These can be academic brochures for each operation, but the personal information that you want to bring to the patient should also be included in the collection. This will really shorten the duration of the consultation and improve the process of establishing relations. A well-informed patient who begins communicating with a doctor at this level is likely to be satisfied after the operation.

On the day of the consultation, there may be several meetings with your leading staff. Although preliminary information on what will happen in the office and what to expect from this day is useful, the most important thing for the patient remains a meeting with the surgeon. It is important that this unhurried, private and confidential conversation takes place, if possible, soon after the patient's first appointment, the consultation must begin exactly at the appointed time - this will underline the importance of this patient for you and can become a key moment in the relationship with him.

Immediately before the meeting with the patient, it is desirable that the photographer performed a photograph of the patient. A high standard of consultation in modern face surgery is a repeated visual confirmation of what you think he or she can expect as a result of the operation. A discerning patient in the marketplace usually insists on this.

In the course of an initial one-on-one consultation, it is very important to find direct contact with the patient. It is necessary to understand the reasons why the patient came to the decision to improve the appearance of the face. Is the patient's main problem being corrected with standard rhytidectomy? Often the main problem is the true superficial wrinkles of the face, which are more correctly treated not by a facelift. If the patient is mainly concerned with deep cheek-labial furrows and less worried about the line of the lower jaw and the lowering of the skin and fat under the chin, rhytidectomy (a more precise term for a face lift) may not be a suitable procedure.

The surgeon with the help of the patient must determine what his true motivation is in relation to the operation. A change in the life situation, such as, for example, a divorce, in itself, is not a contraindication to facial plastic surgery. However, patients who hope that cosmetic surgery will solve their life problems may not be suitable candidates for such intervention. Those who sincerely believe that they are doing this to increase their self-esteem, and not for someone else, are more likely to receive psychological satisfaction. Patients should really imagine what can and can not be achieved surgically, and the surgeon must provide this information during the consultation.

To determine the expected speed with which loss of elasticity tissue and the overall aging process will occur, it is important to assess the family history. It is necessary to establish a lifestyle and social preferences that accelerate the aging process (frequency and degree of insolation, smoking, etc.).

The patient must complete a detailed anamnestic questionnaire. It is important to establish whether the patient had previously had cosmetic or any other surgery, whether there was drug intolerance or complications of anesthesia. Usually this is firmly embedded in the memory of the patient. It is very important to prepare the patient for the appropriate positive psychological experience. If the patient is afraid of anesthesia or the very thought of the operation, it is necessary to extinguish it, focusing on the positive aspects of what can be achieved as a result of the surgical intervention.

Of course, it is important to collect a complete medical history, determining whether there is any medical condition that prevents cosmetic surgery on the face. Cardiovascular disease in itself is not a contraindication to the operation, but before it is performed it is necessary to consult a cardiologist. Of course, an unstable heart disease is a contraindication to any anesthesia and surgical intervention. To determine the sensitivity of the patient to anesthetics, it is important to assess the liver and kidney function. It is necessary to take into account the presence of allergic reactions to any medications that are planned to be used during surgery and anesthesia.

Diseases that prevent the implementation of a facelift, a little. In particular, they include progressive autoimmune diseases affecting the skin of the face. Scleroderma and systemic lupus erythematosus are not contraindications to surgery, if there are no manifestations of the disease on the face. One should be wary of some other autoimmune diseases, especially paying attention to the drugs that the patient takes to suppress the autoimmune response. They can depress the patient's immunity or slow the healing process. Neither diabetes mellitus itself, nor the constant intake of corticosteroids, especially in low doses, are contraindications to surgery. A relative contraindication, depending on the interest of the parotid glands and stagnation in the salivary glands, may be Sjogren's syndrome. The most important autoimmune diseases associated with perivasculitis.

A history of complete radiotherapy in the parotid or lateral surfaces of the neck excludes surgery. Long-term chronic circulatory disturbance, affecting microcirculation, makes the allocation of the skin flap too risky. The use of isotretinoin (Accutane), although not typical (in terms of age) for patients seeking a face-lift, is a relative contraindication to surgery. There is virtually no evidence that a delay in the healing of incisions, specifically associated with isotretinoin, can occur. Treatment that can prevent a surgeon from using a mixture of epinephrine with a local anesthetic, or a proven allergy to any local anesthetic, is a contraindication to performing a facelift, even with adequate, adequate hemostasis.

Obesity in itself is not a contraindication to performing a surgical facelift if you take into account that the results of the operation may be unsatisfactory. The patient, who is overweight and is going to significantly reduce it in the next 3-6 months, certainly should advise to lose weight before surgical facelift. The loss or addition of 4-6 kg after the operation, in general, will not affect its overall result. On the contrary, any patient who is in the middle of a diet course that can lead to a deficiency of vitamins and other nutrients should be advised not to be operated on. By the time of surgery, a person should not only be healthy - the right diet is necessary for the normal course of the healing process. Patients with significant excess weight should be discouraged from surgical facelift due to inherent limitations, even when using extensive liposuction. Lifting itself is not an operation to reduce weight, and thinning of the skin of the middle part of the face is inappropriate and fraught with complications.

During the examination, the surgeon should be able to explain to the patient what outcome should be expected from rhytidectomy. Medical examination is absolutely necessary before the surgeon can show the patient on the computer screen the probable final form of the neck and cheeks. A good candidate for a brace is a patient who has a slightly thickened skin, minimally damaged by the sun, retaining elasticity corresponding to the chronological age. In patients whose skin has prematurely lost elasticity, despite its smoothness and the absence of photodamage, the improvement can be very short-lived.

Full patients with thick skin should not expect too much from rhytidectomy. This concerns not only the achievement of the first results, but also the period during which soft tissues retain tension and elevated position, may be less than average due to the increased mass of tissues and the action of gravitational forces.

The apparent loss of elasticity of the cheek tissues, to the same extent as the weakness of the skin, the subcutaneous muscle of the neck and fat in the sub-chin and submaxillary region, at first glance, is the reason for planning a facelift as an appropriate operation for the patient. Of course, the planned improvement should largely serve as an excuse for surgical intervention, as well as for possible risk. There are patients with a very low degree of soft tissue sagging or the presence of other signs that are corrected by a tightening, which should be advised by either other procedures or a later re-treatment, when the signs of aging become more pronounced and the operation becomes appropriate. Today's patients have become more legible in matters concerning the timing of the beginning of the facelift. The surgeon should be responsible for not recommending, and the patient should not insist on an operation with dubious benefits.

Patients suitable for surgical facelift may have an outstanding chin and strong bone structures, in particular protruding cheekbones. Patients with severe cheeks and minimal cheekbones may be disappointed with the outcome of an isolated soft tissue lift. Improve the outline of the face of the face can be due to the increase in bilge elevations. In addition, in order to achieve a rejuvenating effect of the standard facelift procedure, hypoplasia or loss of subcutaneous soft tissues in its middle due to congenital causes or the aging process, an increase in the sub-malar region is often required. An alternative to these two techniques may be an approach to facelift, like a midface lift or a mixed lift. In patients with a violation of the bite of Class II, hypoplasia of the chin or microgeny, a good neck line is equally badly achieved. In such cases, in order to achieve satisfactory aesthetic results, a correction of the occlusion or at least an alloplastic increase in the chin is indicated in facelift. This is obviously one of the advantages of pre-operative video shooting, thanks to which the patient can observe the results of braces obtained by interfering with soft tissues or those after the modification of bone structures.

It is important for the surgeon to determine the magnitude of the cervical-chin angle, which is determined by the underlying muscular tissues and the position of the hyoid bone. In many patients, it is difficult to achieve an improvement in the cervical angle due to the low position of the hyoid bone, and this must be accurately demonstrated in the mirror and video. The surgeon should not simulate an excessive correction of the cervical angle on the computer, but must take into account the true angle of the underlying tissue of the patient's neck, so as not to create a false or unrealistic impression of what can be achieved by a facelift. It is ethically important to show the patient the correct possible results of the braces. This can affect the patient's satisfaction with the surgeon's work. Moving the hyoid bone or changing the shape of the digastric muscle has been described, but is not recommended when performing the neck stage of standard rhytidectomy. It is necessary to understand what can be achieved by molding lipectomy and platysmoplastics, which sometimes give remarkable results, but have inherent limitations.

Before the end of the consultation, the surgeon must answer all patient questions and discuss the operation as a whole, its possible alternatives, hazards and limitations. A fully informed patient understands the risk and benefit of surgical intervention, as well as alternative therapies that can be used in his case. The patient must understand what and how will be done during the operation, even if he does not understand or does not want to know the details of the surgical intervention. At the end of the chapter, complications of rhytidectomy, or surgical facelift, will be described. The patient should, at least, be adequately informed about the possibility and the relative frequency of their development. The dangers of anesthesia should be discussed in general terms, in terms of choice and alternatives. But questions related to the dangers of using specific pain relievers can be clarified by the doctor who uses them (an anesthesiologist).

[1], [2], [3], [4], [5]