Advanced Plastic Surgery Center - Arlington

A: YES YES YES. I cannot emphasize this enough. Board certification by the American Board of Plastic Surgery is the ONLY way to ensure your surgeon 1) has had the requisite training specific to plastic surgery, 2) maintains certification through regular recertifications and maintenance, 3) adheres to ethical and safe practice guidelines, and 4) operates in an accredited facility. The American Board of Plastic Surgery exists solely to keep the public and patients safe no matter how many reviews someone has online. Do not be fooled by other medical "boards" such as the "board" of cosmetic surgery which is not a recognized "board' by the American Board of Medical Specialties or by a doctor who advertises that they are "board certified" without specifying the American Board of Plastic Surgery. They may be board certified in a field unrelated to the surgery in which you are interested.

A: I counsel my facelift patients that the results will last around 10-12 years. Think of a facelift as "setting the clock back." The goal is to make you look refreshed and more youthful--and still like yourself. After facelift surgery, you will continue to age, and I recommend maintaining a very good skin care regimen including medical grade products and regular laser more microneedling treatments.

A: This is a common question that many of my facelift patients have. I favor deep sedation to general anesthesia for facelift surgery as it gives the patient the most comfort to allow me to execute surgery and give a perfect result. I understand the allure of avoiding general anesthesia, however, with a deeper understanding of the spectrum of anesthesia, I find patients prefer this approach over other types when weighing risks and benefits. Anesthesia is best understood in the context of a spectrum of sedation. There are four levels of sedation: 1. Minimal, 2. Moderate, 3. Deep and 4. General anesthesia. The same types of anesthetic medications are used with each level of sedation---just varying amounts and combinations. Think of minimal sedation as taking a xanax prior to a minor procedure. This is common in dentistry and other fields. The patient can follow verbal commands, but may have some cognitive and functional impairment (i.e., don't drive yourself home!). With minimal sedation, you still feel pain, so your surgeon would inject numbing medication in your face while you are awake so that you don't feel surgery. At times you may still feel pressure or uncomfortable sensations similar to having a cavity drilled and filled while you are awake. Moderate sedation is the next level of sedation where consciousness may be impaired, but you are still able to make purposeful responses to verbal and tactile stimulus. Similar to minimal sedation, the surgeon is relying on injecting local anesthesia to avoid you feeling the surgery. The next level, deep sedation, is where an anesthesiologist uses medications (usually through an IV) to decrease consciousness to the point where you may not respond to limited painful stimuli, but may still be able to breathe on your own. This is a common level of sedation used in colonoscopies and other similar procedures. In general anesthesia you do not feel painful stimuli. You may still be able to breathe on their own but often requires assistance from the anesthesiologist. My preference for facelift surgery is the spectrum between deep sedation and general anesthesia. Once asleep, I comfortably inject local anesthesia into the surgical field so that you don't feel painful stimuli and the anesthesiologist may limit the amount of anesthetic medication (and therefore the level of sedation) is required. This not allows you to be comfortable during your procedure without experiencing pain, but also minimizes the untoward effects of anesthesia such as nausea and vomiting and speeds recovery.

A: In my opinion and experience, it is always best to combine complementary procedures together when it is suitable and appropriate to do so safely. If a surgeon is competent in all aspects of facial rejuvenation, including face and neck lift, as well as eyelid lifts and brow lifts, then I would recommend pursuing all these procedures at once. Typically, the periorbita or the area around the eyes as well as the midface and lower face and neck all complement each other and when one area is addressed to achieve rejuvenation, the others should also have a thorough surgical or non-surgical plan to make sure that the result is comprehensive. The times that I would recommend to separate procedures are if a surgeon is not competent in a certain area or if the length of surgery precludes a safe operative time.

A: It is best to wait until you have healed completely from the laser treatment (usually after one month) to have any surgery to the face. If performed too early, it would be dangerous to have a surgical face lift immediately after a CO2 laser treatment as this would compromise the healing of your incisions. Once the skin has recovered sufficiently, you will be able to undergo a facelift without issue.