It is important to know that a prospective patient’s choice in surgeon is critical in reducing any incidence of potential scarring and other complications from Facelift Surgery. A second component in ensuring proper healing of the incision areas is that patients comply with pre and post-operative instructions.
Anatomy of a Facelift
The old saying goes that “beauty is only skin deep”. A Facelift, however, is much deeper than just the skin. A Facelift involves carefully reshaping the skin while avoiding the nerves, muscles, ligaments and blood vessels that make up the structure of the face.
Causes of Facelift Scarring: Cigarette Smoking
Dr. Slupchynskyj insists that patients stop smoking at least two weeks before undergoing a Facelift procedure and at least two weeks after. Since the nicotine in cigarettes constricts minute blood vessels and lowers the amount of blood in the facial tissues, cigarette smoking can slow the healing process and lead to red scars. Some patients may even be prescribed anti-smoking drugs to prevent complications from smoking if they feel they truly feel they cannot quit.
Causes of Facelift Scarring: Collagen Vascular Disease
The protein Collagen is a vital part of the skin. Collagen gives skin much of its structure and supports the nerves, blood vessels and connective tissue throughout the face. Collagen Vascular Disease is a class of autoimmune disease in which the body’s immune system attacks the collagen, treating it as an invasive agent rather than a natural protein. Without the functioning collagen to restore the skin’s health after surgery, some visible scarring can occur.
Causes of Facelift Scarring: Blood Disorders
Some blood diseases, such as hemophilia and Von Willebrand’s Disease, can inhibit the creation of platelets, the blood cells responsible for clotting. Dr. Slupchynskyj may recommend against having a patient with such a disorder undergo the procedure. When a patient with such a disease does have a Facelift, the plastic surgeon may have supplies of donated platelets transfused into the patient to prevent excessive bleeding. Even with such precautions, patients with bleeding disorders will often experience some scarring.
Causes of Facelift Scarring: Medications
Patients on some strong medications, including the anti-acne drug Accutane, may be prone to some scarring after a Facelift procedure. Dr. Slupchynskyj recommends that patients refrain from taking Accutane at least six months to a year before surgery to avoid complications. Dr. S. may express similar concerns over other anti-inflammatory drugs, including steroids, which may inhibit the healing process.
Causes of Facelift Scarring: Hair, Ear and Skin Problems
Since the primary incisions for a mid-face lift are made around the hairline and the ear, patients with hair growth problems (e.g. alopecia), are deformities or patchy skin coloration (e.g. impetigo, vitiligo) will have visible scarring more often than patients free of such disorders. Patients of some ethnic groups or who have highly sensitive skin may also experience hypertrophic scars due to irritation around the incision site.
Prevention of Facelift Scarring: Pre-Procedure Consultation
Before the procedure, Dr. Slupchynskyj consults with all his patients to set the expectations for the procedure, including any conditions that may result in scarring. Dr. Slupchynskyj always educates the patient on how the procedure works and what to expect during the recovery process, while the patient relates any issues that might arise as to the healing process. Both parties will frequently prepare for the consultation by researching various conditions and take extensive notes during the consultation appointment.
Prevention of Facelift Scarring: Double-Layered Sutures
One technique that Facial Plastic Surgeons use to reduce the appearance of scars is to place a set of sutures under the top layer of skin along with those on the surface of the incision site. The double layer of sutures prevents the tension on the surface that can occur with sutures only on the surface. Absorbable sutures can also be used in the deeper layer, which seep into the lower layers of skin as the wound heals. The upper layer is closed with non-absorbable sutures to prevent any visible red marks from the incision closure.
Prevention of Facelift Scarring: Incision Placement
The biggest factor in the success or failure of a Facelift may be the placement of the incisions. Since the incisions are typically placed along the hairline near the ears, Dr. Slupchynskyj always takes into account how the incision scars will look if the patient has either short hair or wears their long hair away from the ears.
Prevention of Facelift Scarring: SMAS Surgery
The superficial muscular aponeurotic system (SMAS) is the name given to the network of muscles, nerve cells and ligaments that make up the underlying structure of the face. While a standard Facelift stretches the skin and pulls it back near the ears, the SMAS procedure works on the supporting musculature to restore sagging cheeks and jowls. Scarring in SMAS procedures has been reduced by using a technique known as an SMAS rotation advancement flap, which is often used in the removal of tumors of the parotid gland.
Prevention of Facelift Scarring: “Sideburn” Placement
Not all Facelift scars are the results of incisions, some occur as a consequence of poor suturing and placement on the part of the surgeon. When the procedure is finished and the surgeon starts to suture the incision, he or she can sometimes miss the mark and place the sideburn area too high, which can leave a visible line along the side of the head. Dr. Slupchynskyj has seen many patients with this complication who underwent their first Facelift Surgery with another surgeon.
Treatment of Facelift Scarring: Topical Treatments
Some over-the-counter creams and ointments are effective at minimizing the appearance of post-surgical scarring, mostly by bleaching or discoloring the skin. Others, such as the popular prescription medication Retin-A, can moisturize aid in the healing process. However, some treatments that are effective for some types of scars are not always as useful as others. Patients can often obtain a prescription for topical treatments to prevent or treat scars.
Treatment of Facelift Scarring: Silicone Gel
One of the most popular forms of topical treatment is the application of a silicone gel around the scar. The silicone compound binds with the top layer of skin and reduces the swelling and irritation near the sutures. Some forms of the silicone gel ointment also have special ingredients that add a sun protection factor (SPF) to prevent pigmentation differences between the scar and the surrounding skin.
Treatment of Facelift Scarring: Cortical Steroids
Since the skin near the ears is relatively thin, the sutures at an incision site can undergo some tension leading to irritation and redness around the incision site. Some doctors have used cortical steroid injections to reduce the inflammation and lower any raised scars. Cortical steroids act as an anti-inflammatory agent and reduce the volume of irritated tissues.
Treatment of Facelift Scarring: Scar Revision
In some extreme cases, the scars resulting from Facelift Surgery may require an additional procedure to minimize or remove them. Such a case can occur with a thickened scar, a scar that lies at an angle from the normal grain of the skin, or one that distorts the features or inhibits the movement of the face. Patients seek Dr. Slupchynskyj for scar revision as a result of Facelift Surgery with another surgeon. Depending on the severity of the scar, the damage can be repaired either during an outpatient procedure under local anesthesia, or it may require a skin graft under general anesthesia.