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Q&A General

Questions &Answers: Face surgery in general

 

How much improvement can one expect?

This is a crucially important question. We want to see this answer as clearly as possible in advance of making any decisions.

In general, this can be seen in the pictures of the faces that are shown here on this web site and the many others that we can show in the office that are not on this web site. 

But for oneís specific face, the best answer to see the improvement in advance is with drawings.

Looking in the mirror with the doctor and holding the tissues of the face in more attractive positions is the standard traditional way of seeing how much improvement can be obtained in the face. All this is simply done by holding the cheek/neck/eye tissues up and back or in whatever position looks best. 

This technique works well and is always done for each person, and may in fact be most accurate. But it lacks the objectivity, precision and reproducibility of the drawings. 

We answer this question for each person with drawings. The drawings should be of good enough quality that the answer to how good the face can look can be clearly seen. Doing this is much like trying on clothes. You can see how they look on you before buying them. 

And with the drawings, the person can take them home, hang them up on he wall and look at them when in different moods. One can get the opinion of others as to which looks best or how much improvement there is. This makes them, in a way, more objective. We are accustomed to seeing ourselves in photographs. And sometimes it is that appearance in a picture that leads a person to want to look better. 

Then there is the question of how close to the drawings the after surgery appearance is. You can see that for yourself by looking at any of the thousands of photographs of before and after we can show you, then comparing them to the chosen drawings. 

We also have the opinions of hundreds of our patients who have had work done. A majority of patients say that the results equal or exceed the drawings. You may see hundreds of these questionnaires and the summaries of the answers to these questions. 

Anything that can be done with the fingers on the face such as lifting up and back or lifting eyebrows or the corners of the eyes up and back can be done with surgery. So this is a preview of the results. And even without drawings, most doctors look in the mirror with the person and discuss the changes and improvements in the mirror. Often, it is good to see that you and the doctor agree more or less on what is possible and most advantageous. 

The drawings have an advantage over looking in the mirror in that they can take more details into consideration, show more at one time, and are more objective in that they can be studied and critiqued by anyone, anytime, anywhere, even without the subject being present. And, they are much more permanent. In king Tut's tomb, the drawings would have lasted thousands of years. 

There is permanent improvement and temporary improvement. It is a good thing to emphasize and plan for the permanent things of shape and form over the temporary. The face-lift is mostly temporary compared to the many changes that can be made and chosen in drawings that are permanent. We can make many persons appear permanently younger and more attractive without a face-lift. And those things can be explained to each person and shown to him/her in the drawings. 

The amount of improvement is quite different for each person. The best estimate is with drawings. Looking at a lot of the results of a surgeon's works in before and after photographs is a very good way to get a general idea of what can be done. Beware of photo retouching, especially those that are digitally rendered. Seeing actual hard copy film prints, slides and negatives in a doctorís office is much more veritable. 

How long will the improvement last?

Those aspects of the face that are changed in shape, such as the nose, cheeks, chin, eyelids and removal of bags of the eyes are very long lasting or even permanent. 

Those things that are accomplished by tightening and repositioning the skin are much more temporary. Therefore, tightening the skin of the face with a standard face-lift by itself may take 5 to 20 years off the personís appearance in age. One way to express how long it will last is to say if it takes 10 years off, the person will always look 10 years younger than if they had not had it done. And so it will take 10 years for their appearance to catch up to what it was in the beginning before anything was done. 

And so, by that formula, however much younger a person looks in years is how long it will last. But on the other hand, even the tightening up or face lift is permanent in the sense that the person who looks 5 or 10 years younger will always look that much younger no matter how many years go by. 

No operation can permanently prevent aging, but the individual never appears as old as she/he might have if the operation had not been done. The exact duration of improvement can be most accurately predicted with drawings that show the expected result. 

In summary - The improvement is permanent in change of shape and structure, such as of the chin, under the chin, nose, etc. Some looseness of the skin always returns. If a person is made to appear five or ten years younger, they should always appear that much younger than if they had not had the surgery. This effect is cumulative, in that if a person has two or three procedures, each causing them to look five years younger over a period of time, they may look a total of fifteen years younger as a result.

How is the surgery done?

Gentleness is the key to rapid recovery.

The surgery is performed with the patient in a twilight sleep. The patient is given sedatives, tranquilizers and medicines to prevent any feeling of discomfort. Our anesthesia questionnaire shows that more than 94% say they had a pleasant experience.

With the person comfortable and mostly sleeping soundly, the work is done as planned with small sterile instruments made for this purpose. All of the instruments and equipment used are sterilized. 

While surgery is in progress the person is connected to a pulse oximeter, an automatic vital signs monitor, and an electrocardiograph. But most importantly, the person is always under direct observation of the surgeon and his nurses and assistants. 

Where is the operation performed?

It may be done in the federally approved, medicare certified, outpatient surgery center of our office, or in the hospital. Most persons choose the office for more ease, greater privacy and safety and reduced chance of infection, as well as to avoid the added cost of the hospital bill.

We have had an occasional patient have consultation and laboratory work at the hospital both before or sometimes after a surgical procedure. 

For over thirty years of conducting surgery from our outpatient surgery center, we have had a perfect safety record, and there have been no emergencies.

What type of anesthesia is used?

The surgery is performed with the patient in a twilight sleep. The patient is given sedatives, tranquilizers and medicines to prevent any feeling of discomfort. Our anesthesia questionnaire shows that more than 94% say they had a pleasant experience.

The type of anesthesia administered is local anesthesia with sedation. It is administered by the surgeon who has been an American Heart Association approved instructor of Advanced Cardiac Life Support continuously for more than 20 years, along with the help of his assistants. The safety record of surgery with this anesthesia is perfect for more than 30,000 procedures performed over more than thirty years. This record of safety is unsurpassed. 

This type of local anesthesia has a much higher safety record than does general anesthesia. It is widely agreed upon in surgical and medical practice that any surgery which can be done under local anesthesia should, for safety, be done that way. The normal apprehension a patient might feel is allayed by the use of tranquilizers and sedatives. 

With the person comfortable and mostly sleeping soundly, the work is done as planned with small sterile instruments made for this purpose. All of the instruments and equipment used are sterilized. 

While surgery is in progress, the person is connected to a pulse oximeter, an automatic vital signs monitor, and an electrocardiograph. But most importantly, the person is always under direct observation of the surgeon and his nurses and assistants. 

It may be done in the federally approved, medicare certified, outpatient surgery center of our office, or in the hospital. Most persons choose the office for more ease, greater privacy and safety and reduced chance of infection, as well as to avoid the added cost of the hospital bill.

We have had an occasional patient have consultation and laboratory work at the hospital both before or sometimes after a surgical procedure. 

For over thirty years of conducting surgery from our outpatient surgery center, we have had a perfect safety record, and there have been no emergencies.

Is there much swelling or bruising?

There is some bruised appearance in nearly every case. There can be a bruise from just a flu shot or a blood test.  Usually on the face a bruise can be hidden by make-up within a few days or in one or two weeks. It is mostly gone in three weeks. Many procedures can be done without bruising.

Is there much pain?

No pain should be felt during surgery. After surgery there is a feeling of tightness and tenderness of the area for a few days. Our anesthesia questionnaire that is filled out by all patients after surgery over many years is available for your information. It shows that well over 90% were pleased with the experience. 

Will insurance pay for this kind of surgery?

Strictly cosmetic surgery is rarely covered by insurance.

How long does the operation take?

Careful surgery may require several hours. Additionally, one hour of preparation and two hours of observation after surgery are usually required. 

Are bandages worn on the face?

In most cases no bandages are needed. If they are used, they will be removed the second day following surgery. We find that little plastic drains that cannot be felt by the person are much more comfortable than bandages when needed. 

When are the sutures removed, and is this painful?

Some sutures are removed within the first week. Some sutures are removed each time you are seen over a period of one to several weeks. There is no real pain with suture removal. Each suture removed may feel like one hair being plucked from the head and should not even be felt that much. Usually there is no sensation, or just a tickle with suture removal. 

Are there any scars?

Cosmetic surgery should produce no scars and no signs that it was done.  The location of the incisions can be drawn on the patient to show where they will be. Most patients heal well and do not have any visible scars.

We can almost always eliminate any visibility of all scars. 

Must some of the hair be shaved? Is any hair lost?

No hair is shaved and no hair is lost. Very rarely, there is a low forehead hairline that is wished to be set back. 

However, some surgeons still make incisions behind the hairline and routinely remove precious hair. This eventually leads to what is referred to as a bald face, which is a hairline that is pulled too far back, leaving hair loss and a long distance from the hairline to the eyebrows and eyes. Many celebrities who are over forty and up have this condition - and some who have it even deny ever having had surgery. 

How long is the recovery period?

The average recovery is as follows: On the first or second day after surgery any drains inserted post-surgically are usually removed. If any bandage was applied, this is removed on the next day. On the first through fifth day some sutures are loosened or removed and make-up may be applied. Post-op visits to our office are quite frequent in the first two weeks to make you as comfortable as possible during your recovery.

How long before I will be presentable in appearance after face surgery?

After only nose, eyes or cheek surgery the person may look normal in one or two days. The nose and eyelid pictures typically show recovery in only one to three days. A normal appearance may be evident in only three to five days if face, chin, or cheek implants are done. 

Sometimes a bruise develops, and this can last one to three weeks. But if it is only a bruise without swelling, it can usually be covered with makeup and still look good during recovery. 

When combining the peel, nose, face-lift, chin and/or eyelid surgery, usually one to three weeks are required. The patient should expect noticeable signs of surgery in the first week. With proper make-up after the second week, most strangers you meet will not be able to tell any surgery was done. In two to three weeks patients often wish to return to work. Complete healing may require four to six weeks or more.

We have several sets of very informative pictures donated by our patients that show how they progressed through having the face and eyes and other procedures done. You may wish to see them here on the web site under each category of nose, face, eyes, etc. And, we have thousands more in the office. Everyone is welcome to see them. 

 

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 William Roy Morgan, M.D., F.A.C.S  Last modified: January 22, 2015