Question 1

What are the advantages of a facelift compared to other procedures like fillers?

Accepted Answer

Facelifts and fillers should be seen as complimentary and not competitors, but it is essential that you get advice from a surgeon who can offer both options. Using fillers or non-surgical techniques when surgery is best will result in bad results and can put your health at risk.

Question 2

Will facelifts get rid of wrinkles?

Accepted Answer

After a facelift, there should be a dramatic improvment in wrinkles in the cheek and neck areas, but wrinkles around the eyes and mouth may stand out more in comparison. Be sure to consider whether treatment of these features will be necessary to maintain harmony in your facial appearance.

Question 3

Can a facelift cause nerve damage?

Accepted Answer

Facelift surgery can damage motor nerves creating temporary or permanent abnormalities in facial movement. It can also damage large sensory branches resulting in abnormal sensations or pain in areas of your face. An expert surgeon will minimize the risks of these occurences, but it's impossible to eliminate all risks. Every facelift (even every incision) involves small nerve branches being cut, and in some patients this can result in permanent symptoms.

Question 4

How do you wash your hair after a facelift?

Accepted Answer

You can go in a shower the day after a facelift. It is best to have someone with you, and a chair or bench to sit on if you feel dizzy - we have known people to faint the first time they shower after surgery. Expect to have a little bleeding, but don't be alarmed. Use of an antibacterial agent like chlorhexidine as a shampoo is our recommendation until scabs along the incision lines are gone.

Question 5

How do you sleep after a facelift?

Accepted Answer

We recommend a position with an elevated chest and head. A pile of pillows can be used if a lounge chair is not available. Sleeping with your neck alone flexed by a pillow is not helpful- both chest and head need to be elevated to encourage blood flow, avoid swelling, and minimize pressure and contamination along the incision lines.

Question 6

Where are the scars from a facelift?

Accepted Answer

In the past, facelift scars were 'hidden' behind the hairline, but this resulted in the loss of hair-bearing scalp, and a deformity made even worse if the facelift was repeated. It is more common now for incisions to be designed to be hidden along the edge of the hairline and other natural features. The incision used is customized for each patient.

Question 7

Can a facelift tighten sagging jowls?

Accepted Answer

Yes, correction of sagging jowls is the most obvious improvement seen with facelift surgery.

Question 8

Do you need fillers after a facelift?

Accepted Answer

Fillers are not necessary after a facelift, but can be used in the many areas that are not corrected by facelift surgery. They are generally more effective after a facelift because the skin tone has been improved by the surgery. This means the filler can be used specifically to correct volume defecits rather than lift sagging tissues.

Question 9

What is the best age for a facelift?

Accepted Answer

The optimal age range is around 45-55, as you want to perserve what you have already without having an immediate and drastic change that everyone will notice.

Question 10

When will the swelling after a facelift go down?

Accepted Answer

Swelling can be seen for about 10 days after a facelift. It remains for weeks after surgery but this may actually be agreeable in its effect as it fills out the face hiding loose skin or volume defecits.

Question 11

Can a facelift help with acne scars?

Accepted Answer

Acne scars can appear deeper when facial skin ages, and a facelift can restore normal tone that better hides contour irregularities from acne.

Question 12

What is a partial facelift?

Accepted Answer

'Facelift' is a generic word that generally implies an operation in which extra skin is removed and the remaining skin is lifted. Every surgeon does the operation a bit differently, and the operation should be tailored to the needs of the patient. Words like 'partial', 'mini', or 'lunch-time' are often a clue that the operation is shortened and focused on quick-recovery rather than profound and durable results. It's less invasive but wouldn't necessarily cover the extent a full face lift would.

Question 13

How long does facelift last?

Accepted Answer

A facelift can turn back the clock, however it does not stop the clock. You will continue to age, but will always appear younger than you would have had you not had a facelift. For this reason, a facelift might be repeated every 10 years, give or take.

Question 14

Why do breast implants have to be replaced?

Accepted Answer

A saline implant is obvious when it requires replacement, as any leak will result in the breast losing volume. Silicone gel implants (the only silicone-filled implants available since 1999) are not obvious when the shell tears, as the silicone gel remains within the fibrous pocket (capsule) made by your body and volume is preserved. About 20 % of gel implants are found to have a hole at 5 years, MRI over-diagnoses implant holes about 20% of the time (false-positive), and the presence of a torn implant causes no medical problems in the vast majority of patients. Implant manufacturers will pay for a replacement implant if a tear is found (or suspected on MRI). Our advice is to be grateful if your implants are causing you no problems, and leave them alone. If you have hardening, swelling, or mass appearing in an implanted breast, or an illness that defies all explanation, see your plastic surgeon to discuss whether implant replacement is a good idea for you.

Question 15

Why do breast implants hurt?

Accepted Answer

The miracle of surgery is that tissues (including nerves) can be cut/burned/stretched, and that generally any pain experienced after the surgery is gone within a few weeks. Breast implants that develop capsular contracture (a hard wall of fibrous tissue and sometimes calcium) can cause pain because the presence of this hard mass puts pressure on the surrounding tissues. By analogy, a stone in your shoe is not the source of the pain, but when it pushes on the surrounding tissues it causes pain. Another cause of pain can be due to damage to a major sensory nerve to the breast. If you have an areola/nipple that stays numb even months after surgery, this suggests your primary nerve to the breast was damaged and it may be a source of pain if/when it 'wakes up'.

Question 16

Why do breast implants need to be replaced?

Accepted Answer

If you experience swelling or a mass or painful hardening in an implanted breast, you should be seen by a plastic surgeon to discuss management of your implant. If an MRI or ultrasound suggests a torn implant, this presents an opportunity for implant replacement in which the manufacturers warranty would cover the implant cost, even if you are just replacing for cosmetic purposes. A torn cohesive gel implant that is not causing any symptoms does not require replacement. Textured implants have caused some concern as 1/3000 patients may develop a cancer termed ALCL, but if this disease is treated (implant removal and capsulectomy) when early signs (swelling or breast mass) appear, it is curable. If you do not have swelling or mass formation, there is no need to have a textured implant removed, and most women have had excellent experience with these implants.

Question 17

Which breast implants are more expensive?

Accepted Answer

The structured saline-filled implants are most expensive, followed by silicone gel and then saline-filled implants. The differences in cost are not significant, and the additional effort involved in handling a saline implant (smaller incisions, testing and filling the implant) will generally result in total surgery fees comparable to the use of silicone gel implants. The choice of implant should not be based on the relative cost of the implant ($500-$1000 each).

Question 18

Which breast implants cause cancer?

Accepted Answer

Textured implants have been associated with a very rare cancer (anaplastic large cell lymphoma), with ALCL occurring in about 1/3000 patients with textured implants. Whether the implant is causing the cancer is not clear- perhaps the more aggressive healing process around a textured implant is the cause. Whatever the case, use of a textured implant should be considered only if use of a smooth implant will not be successful.

Question 19

What breast implants are safe?

Accepted Answer

It is safest to live with small breasts (or no breast if following mastectomy). If you can accept tiny risks of dissatisfaction (about 95% of patients are happy with their decision to get implants), several types of implants are approved for use by the FDA. Saline-filled implants, round smooth silicone gel implants, and structured silicone implants should be considered safest, and textured implants should be avoided unless there is a significant advantage to their use in your case.

Question 20

Where do breast implants go?

Accepted Answer

In patients with enough padding (2 cm pinch is general rule), it is preferable to put the implant over muscle. Implants put under muscle are actually only under muscle across the top of the implant, which hides the upper edge of the implant in thin people, but has the negatives of dynamic deformity (breasts get deformed when you contract your pectoral muscle) and the implants tend to sit a little too lateral (not close enough to the center) in some patients.

Question 21

When should breast implants be replaced?

Accepted Answer

A saline implant is obvious when it requires replacement, as any leak will result in the breast losing volume. Silicone gel implants (the only silicone-filled implants available since 1999) are not obvious when the shell tears, as the silicone gel remains within the fibrous pocket (capsule) made by your body and volume is preserved. About 20 % of gel implants are found to have a hole at 5 years, MRI over-diagnoses implant holes about 20% of the time, and the presence of a torn implant causes no medical problems in the vast majority of patients. Implant manufacturers will pay for a replacement implant if tear is found (or suspected on MRI). Our advice is to be grateful if your implants are causing you no problems, and leave them alone. If you have hardening, swelling, or mass appearing in an implanted breast, or an illness that defies all explanation, see your plastic surgeon to discuss whether implant replacement is a good idea for you.

Dr. Kreidstein Interviewed by Elevate Magazine

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