Doc Martin's

126 Quincy Rd.
Cheyenne, WY 82009
(307) 632-9970

Face Lift

Rhytiectomy, more commonly known as a face lift, is designed to elevate and remove excess skin and subcutaneous tissue, in order to provide a more pleasing jaw line. This is to remove upper face and lower neck laxed skin, due to the aging process and gravity. The incision usually extends from the hairline in front of the ear, and extends around the bottom portion of the ear lobule, halfway up the post-auricular sulcus, across to the hair line and down the hairline on the neck. The most common nerve that is traumatized in this procedure is called the Great Auricular nerve, and this provides sensation to the ear and scalpThe most significant nerve that can be traumatized during this procedure is the frontal branch of the facial nerve, causing paralysis of the forehead and possibly even changing the ability of the person to even blink their eyes. This trauma should be attempted to be avoided at all costs by the surgeon, and does not commonly occur more than 1% of the time. The marginal mandibular nerve which moves the lower lip down upon smiling, can also be traumatized, but occurs less than 1/10th of 1% of the time and is most commonly associated with incisions made through the platysma muscle in the neck area.

The procedure is done by elevating the skin and subcutaneous tissue on the face and neck, and some times associated with the removal of fat from the sub mental area. Sutures are place in the subcutaneous tissues, or the parotoid fascia and paltysma muscle, to put this in a more esthetic position, and to take out some laxity in order to provide a better cosmetic result. These sutures are usually permanent and are not noted after the procedure, and usually do not cause any problems. These can number anywhere from 1-4 on either side of the face. The incision is usually closed in serial fashion with removal of excess skin. Subcutaneous sutures are essential and rarely do come through the skin post-operatively, but this can occur. They are necessary to remove tension on the skin, to minimize the scarring that takes place. Areas of the skin where incisions are made, that are not covered by the hair, are usually closed by 6-0 nylon sutures. Areas within the hair are closed with staples.

The maximum points of tension are at the upper part of the ear, the inferior portion of the ear, and on the incision line in the immediate area right behind the ear. Areas that are problems with regards to revascularization and scarring includes, the area right behind the ear, and this is commonly associated in patients who smoke or have not quit smoking for six months prior to this procedure. This is due to the fact that the flap is quite long and that they have decreased blood vessel patency and vascularazation, secondary to smoking. This is not a significant contraindication to doing this procedure, but most surgeons will require that their patients stop smoking for at least six months prior to the surgery, and that they are totally aware that this is the most significant complication with increased scarring that will be noted, secondary to their smoking.

Pictures are usually taken preoperatively and post-operatively for this procedure. It is not uncommon for patients to do multiple facial cosmetic procedures for facial rejuvenation. Some of these procedures are done by some surgeons in conjunction with laser resurfacing, but the trauma related with working with the epidermis and the subcutaneous tissues at the same time, may increase complications. This is the reason why I do these procedures separately.

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