Search for tag: "facelift"

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Interviewer: So you look in the mirror and you're starting to see the signs of aging on your face. What options are available to you at any point in life? I'm here with Dr. Cori Agarwal. She is an Associate Professor of Plastic Surgery at the University of Utah Health. So Dr. Agarwal, what are the kinds of people that are coming in for facelifts or rejuvenations? Is there a particular age, or is it all across the board?

Dr. Agarwal: It's definitely all across the board. I think when people start to see their face change at all, there is a little bit of panic that age is coming and they want to come in and see what their options are to slow things down or maintain their youth as long as possible. So we get people even in their 20s or 30s who may be seeing new wrinkles show up and asking what could be done and is it time for a surgery or what other options we can offer them.

Interviewer: At 20 or 30, what kind of things are we seeing? Are we, you know, just a little wrinkles and stuff and what options are available for, say, that age group?

Dr. Agarwal: So in that age group, it would be rare to have a full face lift recommended, but it's very common that you would benefit from things like Botox, which relax the wrinkle lines and maybe fillers that would soften some of the early wrinkles that you would get at those early ages. Other options at those ages would be products that can rejuvenate the skin, like Retin-A, some light chemical peels, things short of surgery.

Interviewer: So we're not looking at a full face change, you know, pull everything back up. It's these small rejuvenation type changes for that age group.

Dr. Agarwal: Yeah. And one thing to point out though is that everyone does age differently. I think a lot of it comes down to your genetics, your exposure to the outdoors and the sun and wind. People can age earlier. So sometimes in the 30s, that decade, people will benefit from a small surgery of some kind, and it's worth coming in and talking to your surgeon at that point if you have certain areas that are starting to sag or droop.

Interviewer: So when you get into the you said a small surgery, I've heard mini facelift or what kind of small surgeries are available?

Dr. Agarwal: Smaller surgeries could be something like eyelid lift, blepharoplasty where there's just a little bit of extra skin. If there is such a thing as a mini facelift, that really focuses on the middle portion of the face, less so on the neck. And another option is facial fat grafting where you're just plumping up some areas, like the cheeks, possibly to add some a youthfulness.

Interviewer: So besides these fillers and, you know, smaller surgeries and other options available, what is the age that most people are getting, say, the full facelift?

Dr. Agarwal: There isn't an absolute age, but I think we start to see people coming in who would benefit from a lift somewhere in the late 40s, 50s. I think those decades, the neck becomes more lax, and I think it's when the jowls form and the neck becomes lax that you're really looking at needing something more rather than just use more minimal techniques to correct that. If you have extra skin hanging in the jowls and neck, you're probably going to do best with a facelift.

Interviewer: So say a patient is looking in the mirror and they're seeing some of the signs of aging, what's the first step that they should do to find out what procedures are even available to them?

Dr. Agarwal: So I think the best advice for that individual is to go in and have a consultation and talk to your surgeon and learn what's out there, learn about what may be best for you, what you're looking for, for your skin type, for your age and I think you can come up with a plan. And you may combine surgery with some of these resurfacing or noninvasive techniques out there to really optimize your result.

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Interviewer: What is the difference between a mini facelift versus a normal facelift? Dr. Eric Cerrati is the director of facial plastic surgery at University of Utah Health. And Dr. Cerrati, I'm just going to guess here, I think the difference probably is, like, a mini is just a smaller version of a facelift. Am I right? Do we need to go further?

Dr. Cerrati: Kind of true, but there are some, you know, details we should talk about.

Interviewer: Okay. It's a little more complicated than what I just made it.

Dr. Cerrati: Exactly.

Interviewer: All right. So what is the difference between a mini facelift and a normal facelift?

Dr. Cerrati: So, first off, they recently did a study surveying facial plastic surgeons all across the country trying to define that exact question. And what they found with it is that there is no consensus about what the difference is except that a mini facelift has a shorter scar. As far as the techniques and recovery and those sorts of things, they all differ from surgeon to surgeon.

Interviewer: Okay. So, really, it's interesting that you've got a lot of different people, they all have different definitions. So, for the customer or the person who's coming in, it's important that maybe they ask a few additional questions to find out how that particular person defines it.

Dr. Cerrati: Exactly. So every surgeon has, you know, their own techniques that they do for facelift surgery. It used to be, back in the day, was just tightening skin. And now we've learned that, you know, a more natural, more rejuvenated look is to tighten the muscles underneath the skin. And so that layer is either, you know, pulled tighter, it's resected, and then, you know, sewn in a more suspended fashion, the ligaments of the face are at least. You know, I personally do a deep plane facelift, where I release the ligaments of the face and re-suspend it in a more natural position. So my mini facelift is essentially the same thing, just with a shorter scar.

Interviewer: Okay. And that also sounds like it could differ from surgeon to surgeon.

Dr. Cerrati: Exactly.

Interviewer: Yeah, yeah, okay. So let's back up a second here. A patient comes in. They're interested in a facelift. They come into your office. They think maybe they want a mini facelift. They don't know for sure. Where do you start this conversation?

Dr. Cerrati: So, really, patients who are going to be, you know, good candidates for a mini facelift are ones that don't have a lot of excess skin or neck skin laxity. And that's really what the extended incision allows you to do, is to remove that excess skin. You know, it tends to be underneath the neck. So for younger patients, say 40s, 50s, you know, usually you can just keep the scar kind of right around the ear and not really extend it back into the hairline, which would qualify for a mini facelift.

Interviewer: Gotcha. And what about somebody that maybe had a lot of weight and then lost a lot of weight? It sounds like maybe a mini facelift would not be the best option because you've got more skin to take care of.

Dr. Cerrati: Yeah. So that differs patient to patient. But usually, those patients have more skin laxity that needs to be addressed.

Interviewer: Okay. So, to summarize, I mean, am I getting the summary right, a full facelift is when perhaps you've got more skin that needs to be tightened versus the mini facelift where it's somebody younger, maybe somebody who hasn't gained a lot of weight, lost a lot of weight, that doesn't have as much skin to move, they could get the mini?

Dr. Cerrati: Exactly, earlier signs of aging.

Interviewer: All right. So what's the difference then in recovery time, cost? I would think a mini might be less recovery and cheaper?

Dr. Cerrati: For faces that qualify for a mini facelift, it is a little bit cheaper, and the recovery time is a little bit shorter because it's less of a recovery for the neck portion. But, you know, I usually tell all my patients it's similar recovery, in that, you know, they have a face wrap that's on for 24 hours that's taken off. I don't use any drains, whether it's a mini or a full facelift. And again, there are variations from surgeon to surgeon. If someone really has very minor signs of aging and, you know, qualifies for a mini facelift, then a slightly less aggressive technique can be used, and that would significantly reduce the recovery time.

Interviewer: And do mini facelifts tend to look a little bit more natural then too?

Dr. Cerrati: I find that the technique actually affects how natural a result looks. I find that the deep plane facelift gives the most natural look, you know, and that can be done in a very aggressive fashion or a less invasive, tailored fashion for the patient. But every procedure is customized to the patient and what their needs are.

Interviewer: All right. And you have that conversation with the patient when you come in. How long does that normally take?

Dr. Cerrati: Oh, our consults usually last anywhere from 30 to 45 minutes, and we kind of go through everything.

Interviewer: Yeah, gotcha. Okay. Let's talk about the procedure itself. Where is it generally performed?

Dr. Cerrati: I do it in the hospital setting, so here at the University of Utah, but the main hospital. And I also have an office and an operating room at South Jordan, both university facilities.

Interviewer: Is there an advantage to being able to have access to a hospital as opposed to maybe just being in a standalone clinic?

Dr. Cerrati: I think the advantages of coming to a university facility, whether it's out at South Jordan or one of our satellites locations versus the main hospital is that all the physicians within the university, you know, are board certified, very highly qualified, and you really receive topnotch care. In some private offices, you don't have board-certified anesthesiologists watching throughout the entire case. And so, you know, we really focusing on the details so that every patient gets the best possible care throughout their procedure.

Interviewer: Gotcha. And when you do a procedure with a patient, how do you and the patient then define success? So, when the procedure is done, you know, the patient is fair . . . because I would imagine this is kind of a scary thing. It could be a scary thing going in. Like, "Am I going to get the results I want?" This is, you know . . . how do you kind of work with the patient to make sure they get exactly what it is that they hoped for?

Dr. Cerrati: So I would say, across the board, facelift surgery is probably one of the highest satisfaction rates out of all facial plastic surgery procedures. But we mimic what we do by pulling on the skin and trying to give the patient idea what the jawline and what the cheeks would look like afterwards. We show them before and after pictures and try to have as detailed of a conversation as we can.

Interviewer: And then, what about the risks, because that would be something else that perhaps would be a concern? I think we kind of touched on this a little bit. Here in the university setting, you're going to have, you know, like you said, the anesthesiologist is here to make sure that that goes okay. What are some of the other risks that you look out for that you really try to mitigate?

Dr. Cerrati: So the surgical risk in the procedure, there's bleeding and infection. Obviously, we do everything we can to try to minimize those. Anytime you make an incision to the skin, there's a risk of scarring. Facelift scars, you know, we hide them as best we can behind all the little crevices in the ears. So it's all hidden in shadows. And, you know, the main risk is really that you're close to the facial nerve, you know, the nerves that innervate all the muscles of the face. You know, we are a couple, you know, layers above it, but it is within a few millimeters. So careful surgical technique and training really allow you to get the exact result that you're going for.

Interviewer: Yeah. So you really want somebody who knows what they're doing.

Dr. Cerrati: Exactly.

Interviewer: That's got the skill and does a lot of the procedures and that sort of thing. So, hopefully, this is just probably a small part of the conversation you might have if somebody actually came in for a consultation. If somebody has any more questions, where would they go at that point?

Dr. Cerrati: So I always welcome patients, you know, when we're first having this conversation, obviously, ask everything. I kind of give them my spiel kind of start to finish. And I tell them if they ever have questions, write them down, call the office, come back in, we can do another conversation. And so that way, they're fully informed, fully comfortable with proceeding. I mean, the most important thing is the patient needs to be very comfortable with the surgeon, you know, the facility, and the plan that they're undertaking.

Interviewer: You mentioned that the patient should be really comfortable with the surgeon performing the procedure. And I know there's a lot of surgeons here that perform mini facelifts and normal facelifts. Give us some just general advice on how you might be able to figure out, you know, who might be best for you because, you know, it might be you, it might be one of your talented colleagues.

Dr. Cerrati: Exactly. So there are a handful of surgeons here at the university, all very talented, come from slightly different training, but offer very good work. And that's why it's very important for the patient to have an in-person consultation. In that way, they feel comfortable with the surgeon that they're choosing.

Interviewer: And regardless of whether it's you or one of your other colleagues, are there some things that you all have in common?

Dr. Cerrati: As being part of the university, we keep abreast on all the cutting-edge technologies here, offer the most advanced facial plastic surgery procedures. And again, we all come from slightly different training, which, you know, plays to the advantage of the different care that we can offer here at the university.

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Interviewer: What to know if you're considering a facelift. That's coming up next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Eric Cerrati is a plastic surgeon at University of Utah Health, and he specializes in cosmetic and reconstructive surgery of the face and neck. And if you're thinking about having a face lift, hopefully we'll answer some of the questions that you might have.

So why do patients consider a facelift? What kind of leads them to making the decision that that's something that they want to pursue?

Dr. Cerrati: So a lot of times it's a patient, middle aged and they're starting to notice the jowling or the extra skin that's kind of hanging down over the chin. That's really kind of the first signs that people are looking at.

Interviewer: And when one says facelift, is it generally the jowling that we're talking about that we're fixing, or does facelift encompass other things?

Dr. Cerrati: The most common thing is facelift will redefine the jawline. That's really the main target area, under the chin and along the jaw.

Interviewer: All right. And when somebody comes in and you do an evaluation, which is what you recommend, that you see a specialist, how do you help determine if they're a candidate for it or not?

Dr. Cerrati: So first and foremost, it is an elective surgery, so the patient needs to be medically fit for the procedure. Then as you look at body habitus to make sure the patient's not having weight shifts or that sort of thing, to make sure you can get him a lasting result and something that they're happy with. And a lot of it does have to do with patient selection. You want to make sure that their hopes and wishes is something that you can accomplish.

Interviewer: Sure that what they're asking for is something that can actually be done.

Dr. Cerrati: Exactly.

Interviewer: So what can't facelifts do? Do you get patients coming to you that say, "I want a facelift," and they're trying to accomplish something that just can't be done?

Dr. Cerrati: Absolutely. There's the anatomy of the neck and the way that the neck is structured that some patients are more, say, ideal candidates for a facelift and some that are not, in which case you can't get a very defined jawline.

Interviewer: So there are a lot of different types of facelifts and ways to do a facelift. When a patient comes in and starts asking you about those different things, how do you walk them through that process?

Dr. Cerrati: So you can go through all the different types of facelifts, skin only and addressing the underlying tissues and that sort of thing. But really, all these things are not necessarily important for the patient. The patient needs to be familiar with their surgeon and make sure the surgeon has the proper credentials. And if the surgeon has the same aesthetic and can achieve the goal that the patient wants, the approach that they use isn't necessarily the most important thing.

Interviewer: Got you. So a lot of times you're kind of explaining that, I'd imagine.

Dr. Cerrati: Exactly.

Interviewer: So somebody wants to get a facelift. What does that kind of look like? I would imagine there's not a lot of preparation if they are already healthy and whatnot. They would come in, have the procedure. How long does it normally take?

Dr. Cerrati: So the procedure can last anywhere between, I don't know, say two and a half to four and a half hours. All the incisions are really hidden behind the hairline and then around the ear. After a couple weeks, those incisions are very hard to see. And for me, I do do some planning pre-operatively to try to minimize any type of bruising and to help the patient throughout the whole process. At the end of the day, it is an elective procedure and these patients do not want to feel sick and have a long, drawn-out post-operative course.

So I do a lot of things before surgery to kind of help the patient get through that and minimize. I also don't like to use drains and prolonged dressings and those type of things, so patients can really get back to their daily lives as fast as possible.

Interviewer: Is there kind of a range in there? Does it really vary depending on what procedure's been done?

Dr. Cerrati: It really varies, but usually I tell people after two to three weeks they're really back to their pre-operative status.

Interviewer: And if you go back to work, are people going to be able to see visible signs at that point that you've had something done?

Dr. Cerrati: So after about two weeks, a lot of the swelling and bruising has pretty much subsided. The incisions may be slightly red, but patients can really get back to their normal routines after two weeks. At that time they can also. . . After the first week you can really apply makeup, so a lot of it can be hidden.

Interviewer: Got you. And the results, do they last? For how long?

Dr. Cerrati: So depending on the approach, if you address the underlying deeper tissues, usually the results last about 10 years, is kind of the ballpark range. It's because the aging processing and with gravity, it's still going on. So even though you've had the procedure, the aging process continues.

Interviewer: And picking the right doctor to do a facelift is really important, because it is your face. So how does somebody know that they have somebody that is going to really do a good job for them?

Dr. Cerrati: So the number one thing I would say is the patient should do their homework. They should look to see who the surgeons are, where they've done their training and what pathway they've taken in order to get to become a plastic surgeon who's operating on someone's face.

Interviewer: Are there some certifications in general that you should kind of make sure that the surgeon has?

Dr. Cerrati: Absolutely. So is there a residency in plastic surgery that's monitored by the American Board of Plastic Surgery. A fellowship by the American Academy of Facial Plastic and Reconstructive Surgery, and that's also a board certification as well. And those are really the two main ones.

Interviewer: And it's your opinion that you should look for somebody who has both of those?

Dr. Cerrati: Either one of those.

Interviewer: Oh, either one of those?

Dr. Cerrati: Those are two separate pathways.

Interviewer: They're two separate things. Got you.

Dr. Cerrati: So for myself, I did a fellowship by the American Academy of Facial Plastic and Reconstructive Surgery.

Interviewer: And if they don't have one of those pathways, then maybe be a little cautious?

Dr. Cerrati: I would raise a red flag.

Interviewer: All right. And ask some more questions at that point?

Dr. Cerrati: Absolutely. In addition to qualifications, you should really feel comfortable with your surgeon. Even after the initial consultation you don't have a great feeling, go back and visit the office again. And just make sure before you sign up for anything that it's something that you're happy with and that you're confident that the surgeon can give you the results that you want.

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