Face Lift Surgery

Planning and marking out suitable places for the incisions necessary for facelifts have a great influence on long-term results. Changes in the line of hair growth or the appearance of scars in visible places can cause complete dissatisfaction of the patient, despite the good result of the suspender itself. The natural appearance of the hairline, the freedom to choose a hairstyle and the invisibility of scars distinguish a good plastic surgeon from the one whom patients consider one of the best. Hairdressers and cosmetologists who perceive the results of facelifts from their specific position, often praise and recommend to their clients surgeons paying attention to the detailed planning and size of the cut.

There are three defining moments that should be taken into account when planning the incisions for facelift:

• How to deal with a parotid hair bundle, including tanks? Each patient in his own way refers to the location of the lower part of the tank and the width to which it extends anterior to the ear curl. If the line of hair growth on the temple is 1-2 cm below the attachment of the upper part of the ear curl, you can plan a cut that bends up and back. To prevent reduction forces, create a scar of minimal width and prevent alopecia in the hairline area, a curved rather than a straight vertical incision is necessary. Since the hair growth line does not rise above the attachment point of the upper edge of the ear curl, the patient will not have cosmetic disorders in this area. If the line of the tank before the operation is at the place of attachment of the ear curl, an incision is required under the hair growth line; This usually requires an additional temporal incision, if a pull-up is needed in this area. The cut can never be performed in front, around the temporal bundle of hair and along the anterior temporal line of hair growth. All scars in this area will be noticeable, and they can not be hidden under thin, strongly inclined hair, since they come out to the skin in the backward direction.
• The incision in the anterior ear region should, at least, follow the natural curves of the ear. Patients, of course, prefer the incision, hidden behind the trailing edge of the tragus, so that it is "inside the ear." A parotid incision will not be visible if it follows the natural curvature of the attachment of the ear curl and goes about 1-2 mm behind the goat, and then leaves at the junction of the ear with the face. Alternatively, in patients using hearing aids or having a very deep pre-compression depression and a high tragus, a curved incision can be made that extends into the notch and then outwards around the curvature of the curl. However, the loss of pigmentation in the rumen, no matter how thin, forever creates a visible line and may require a change in hair style in the future.
• The incision behind the ear should be directed upwards, to the back side of the ear and above the furrow, so that when it heals with some reduction of the scar and the ear moves slightly backward, the latter falls on the bovine furrow, not on the skin behind the ear. The incision should make a smooth bend around the attachment of the ear so that the BTE does not cross the skin in the place where the ear is projected onto the hairline. In most cases, the incision should be carefully tilted posteriorly, into the hair behind the ear. When moving the BTE skin back and forth, the rear border of hair growth can be compared without a step or other deformation. However, when there is an excess of skin on the patient's neck that needs to be moved backwards, it is often necessary to hold it along the hair growth border behind the ear before pulling the cut in the back to the hair. Due to this, a large amount of skin can be shifted back and forth, without leaving behind the BTE limit of hair growth. The incision should never be seen at the base of the hair growth line, directed towards the front surface of the neck.

To facilitate manipulation on the front surface of the neck in the sub-chin, an additional incision of 1-3 cm is required, immediately anterior to the already existing sub-chin. Before the infiltration of anesthetic, to mark the area of anesthesia and subsequent preparation of tissues, a dashed line is applied to the skin. Some surgeons prefer to mark out the area of the zygomatic arch, the flap of McGregor, and the angle of the lower jaw. Additional drawing of the contour of the jaw and protruding edges of the subcutaneous muscle can help in isolating areas that require correction during surgery.

An option for facelift in men, as well as women with significant hairiness in the parotid region, is an incision smoothly bending in the parotid region, in the often often present anterior furrow. Such a cut must not be completely straight; It is preferable that it should recede from the notch and pass in front of the tragus. Moving the skin carrying the hair, back and up, it is necessary to leave the skin area without hair (a very important part of the consultation is the precise determination of the incisions and their designation in the map, graphically and in writing).

Anesthesia with surgical facelift, even in conditions of adequate sedation, requires the infiltration of an appropriate amount of local anesthetic with adrenaline to reduce bleeding from the skin. Although many surgeons prefer inhalation anesthetics to achieve complete anesthesia. Intravenous sedation is always required with constant monitoring of blood pressure and saturation of blood with oxygen. For this purpose, a special employee is appointed - an anesthesiologist, a certified anesthetist or a nurse under the supervision of the operating surgeon. For the success of sedative anesthesia, it is necessary to fully examine the patient before surgery. If the patient is confident that he will not experience pain, discomfort or other inconvenience during the operation, he will be mentally prepared for the effect of the prescribed sedative. In general, it is good practice to prescribe oral sedation to a patient for relaxation before intravenous administration of a sedative. Modern medicines provide a sufficient amnestic effect, along with full sedation and analgesia. Any injectable anesthetic should have some continued action, so that the patient feels comfortable for several hours of the early postoperative period. Infiltration of cut lines is best done with 1% xylocaine with adrenaline 1: 50000.

This provides not only good anesthesia, but also maximum hemostasis due to vasoconstriction. Infiltration of areas requiring overlap should be performed with 0.5% xylocaine with adrenaline 1: 100,000 or 1: 200,000. Some hemostasis is required here.

The total amount of xylocaine must be carefully calculated. Never inject, simultaneously or within 1-2 hours, more than 500 ml of xylocaine with adrenaline. An overdose of xylocaine with subsequent intoxication may be the result of an unjustifiably large amount of this local anesthetic. It may be advisable to complete infiltration on one side of the face before starting it on the other side. This sequential infiltration, since it is carried out 10-15 minutes before the incision is made on the side of the incision, is safe and effective.

The patient should then be prepared for surgery by twisting small strands of hair and securing them away from the incision lines and the operating field. You can fix hair with adhesive tapes. After preparation and obkladyvaniya operational field with sterile underwear surgery begins. Hair shaving is not required. Preoperative prophylactic antibiotics are administered to all patients using a cephalosporin drug 1 day before the operation and for 4 days after it.

[1], [2]