Q: I tripped and fell in my kitchen 14 days after original facelift and 12 days after hematoma fix. Should I be worried?
Excellent question.
First you should check in with your surgeon.
In general a fall after surgery should be investigated for the cause of the fall. Patients are at risk for heart problems, stroke, blood clots, and other complications after an extended surgery. Ruling out a life threatening problem is most important.
If you did not develop a new hematoma you should be ok. If your surgeon used deep sutures to hold tissues in place it is possible you may have popped or broken a suture. This is one more reason to check in with him or her.
Best wishes,
Alexander Anzarut
Q: How great is the risk of infection in the hospital for a facelift & when would I know I got infected?
This is an excellent question.
The risks of an infection after a facelift is very low. The excellent blood supply to the face makes this uncommon. Many dermatologist doing cancer procedures on the face use clean laytex non-sterile gloves. Studies have shown their infection rate is no greater than those who use sterile gloves. I am not suggesting you should have surgery without sterile glove. I am trying to provide evidence for the low risks of infection in the face.
In my experience with facial surgeries infection occur for two main reasons. Patients who develop a bleed (hematoma) often get infection if the hematoma is not drained. The other group who develop infections are patient necrosis (areas of tissue that die). This is usually due to tight skin closure, problems with skin flap elevation, or smokers.
Hospitals have the disadvantage of being less private and less relaxing for patients. They have the advantage of having many advanced care providers available should you have any complications or concerns. It is always important to consider who is providing the anesthesia. An excellent facelift depends on good anesthesia and peri-operative blood pressure control. Many anesthesiologist have little experience providing care for aesthetic surgery patients. If you do go to a hospital make sure your surgeon is working with an anesthesiologist he knows and trusts.
Best wishes,
Alexander Anzarut
Q: Does aging after a facelift have the same pattern as before the surgery? Is aging determined more by genetics or by lifestyle?
Excellent question.
Fine wrinkles on the skin are related mainly to sun exposure and smoking history. These are best treated with resurfacing, smoking cessation and sun protection.
Changes in the neck may be related to descent of the submandibular glands, deep fat descent, laxity of the platysma muscle, and finally skin. The aging after a facelift depends on the type of lift performed. A procedure that relies of lifting and tightening structures will always lead to recurrence in the neck. Conversely a facelift based on the methods of Dr. Bruce Connell involves partial submandibular gland removal, deep fat removal, platysmal tightening, and skin redraping. This type of "couture" lift may lead to some recurrent skin laxity and less often recurrent platysmal laxity. The most common area of recurrence is the crepe appearance to the skin at the central neck. However the heavy fat and oblique line of the neck should not return. This is why people should avoid neck and face procedures that rely on 'lifting' alone or removal of superficial fat (for example liposuction).
In the upper portion of the face the area needs to be filled. If surgeons rely only on lifting the area will drop again and hollow. When needed can be done with implants, fat grafting or fillers. The elevation of the deeper SMAS layer should extend to the corner of the eye. If not you may develop a deformity at the upper cheek known as a smile block.
When a facelift is done correctly aging of the skin will continue. Neck fullness should not recur to the same degree. When a facelift is done incorrectly with lifting and over resection of the skin aging will occur with progressive deformity. The appearance will be unnatural.
I hope this helps. I know it does not answer the entire question. In summary a poorly done facelift will lead to earlier recurrence as well as unnatural deformities.
Always seek a board certified plastic surgeon, ideally one who has spent time working with the Masters of faceliift surgery.
Best wishes,
Alexander Anzarut