Joseph A. Mele, III, M.D.
Is it standard procedure to use drains for a facelift? I have had three consultations - one surgeon uses drains, one doesn't, and one uses glue. Please advise.
Most plastic surgeons use either drains or a light compressive dressing or both. Personally, I keep my facelift patients overnight. In the morning, before they go home, the drains are removed and the dressing is replaced. For mini-facelifts, I do not use drains.
I find drains help reduce the initial swelling by removing the small amount of serum that may accumulate between the skin and the deeper structures of the face. Normal output is a few teaspoons over night. This may allow the skin's natural glue to more quickly reattach the skin.
The use of drains can be argued either way. Although I normally use them for all full face lifts, I understand why other board certified plastic surgeons do not, and the use of lack of drains will not effect you long term results.
I am 53 years old and although my neck is tight, it looks very gaunt. When I smile it appears stringy vertically. My face is smooth and without sag, but I have very fine thin skin. For my age I have less than average wrinkles and no visable pores. I cannot see that a neck lift could help me as I feel if anything my skin looks TOO tight and I need more fat to hide the stringiness. What procedure do you suggest is needed to make improvement in my appearance?
When we think of face and neck lifts, we normally think about reducing loose and redundant skin. A quality Facelift and Necklift, however, focuses on more than just the skin.
It sounds like you have visible bands on your neck, not from loose skin, but from the platysma muscle that is underneath the skin. Smiling, and widely showing your teeth, will make the platysma muscle contract. If there is a separation of the muscle down the middle of the neck, this leads to exaggerated vertical bands running up and down the front of the neck.
A platysmaplasty may be just the thing to smooth out the appearance of your neck. Repairing the muscle is like applying a corset to support the tissues beneath the skin. It can reduce the exaggerated banding, while smoothing and supporting the necks normal contours.
I cannot tell you that this is the best procedure for your neck, but it is worth discussing it with a Board Certified Plastic Surgeon in your area.
More information on necklifts, facelifts and even mini-facelifts is available here, on the ASAPS web site, and on my personal websites DrMele.com and SanFranciscoPlasticSurgeryBlog.com. Click on the links below for more details:
Necklift, Facelift (Rhytidectomy) Information
Facelift (Rhytidectomy) compared to the mini-facelift (with before and after pictures).Joseph A. Mele, III, MD, FACS Certified by the American Board of Plastic Surgery and the American Board of Surgery Walnut Creek, CA (925) 943-6353 www.DrMele.com www.SanFranciscoPlasticSurgeryBlog.com www.CirugiaPlasticaSanFrancisco.com www.SanFranciscoBreast.com
I underwent a tummy tuck in 2006. I'm curious as to how I can have my scars revised (scar revision). I'm totally satisfied with the tummy tuck, however I have a 360 degree scar that's visible in a bathing suit (male). Can the scar be totally revised or will there always be a scar around my waist?
The answer to both parts of your question is yes. If the problem is that the scar is too high, it may be possible to lower the scar's position. Scar revision of this sort would mean completely excising the current scar, and some of the skin below the scar. The result is a new scar that is lower on your torso.
My grand daughter is 12 years old and a bit overweight. Presently she is wearing a size 42DDD bra. She complains of having neck pain and lower shoulder pain. The size of her breasts are truly affecting her outlook on life and her personality and causing her to be depressed. I don't think she should have to go through this and wait until she has reached an adult age to have a breast reduction. With parental consent, wouldn’t she be eligible to have the surgery now?
Breast reduction surgery can be a life changing operation. The complaints that your granddaughter has are common for women with large breasts. Pain occurs primarily in the lower neck, upper back and shoulders, but the breasts themselves can also be painful. Constant skin to skin contact beneath the breast can result in a recurrent rash that can be difficult to treat. The benefit of breast reduction surgery is that these types of problems usually improve, and in many cases completely resolve. While the benefits may seem obvious, the risks also need to be discussed in detail with the Board Certified Plastic Surgeon you choose. Here are a few things to consider:
Development of the breast is not complete at age 12. It is best that the breasts are stable in size prior to reduction surgery. There is an increased risk that the procedure will need to be repeated in the future when breast reduction surgery is performed at a young age. In other words, if the breast is still growing, it will likely continue to grow after surgery.
Psychological development in a patient is not complete at age 12. Maturity occurs gradually and faster in some than others. It would be important for the plastic surgeon to evaluate your granddaughter's maturity to see if she is ready to make the decision. This can help not only to determine if she is equipped to handle the surgery and subsequent recovery, but also to minimize the risk of this being a surgery that she regrets in the future.
There is scarring as a result of breast reduction surgery, and this is the big tradeoff. Most patients are very happy to trade in their back and neck pain for scars that are covered by clothing. Moreover, clothing tends to fit better after the surgery. It may be easier for patients who are married and already have had children. Most are in a stable, supportive relationship. They have had a chance to discuss the surgery with their mate prior to having the operation, and they do not have to worry about dating someone new and explaining the scars.
Breast feeding will likely be affected. The most common types of breast reduction surgeries maintain the connection between the nipple and a portion of the remaining breast tissue. This may allow for breast feeding in the future, but breast reduction patients need to accept the fact that breast feeding may not be possible after surgery. Since a significant percentage of the breast is removed, a much smaller amount of breast tissue remains to produce milk.
Other considerations are needed, and additional information is available on the ASAPS web site at www.surgery.org. I have tried to focus in on the unique issues that pertain to breast reduction surgery at an early age. It is not possible to be precise via e-mail. If your granddaughter is seriously considering breast reduction surgery, she will need to make a consultation appointment with a Board Certified Plastic Surgeon. After a brief history and physical examination, the surgeon can provide you with specific information.
It would be important that family be involved, and should attend all doctor’s visits, especially the consultation appointments. You may want to give your granddaughter some privacy during the brief physical examination, but she will probably find it reassuring to have supportive family members around. This can help her ask pertinent questions, and remember the answers. All will get a chance to ask questions and get comfortable with the idea prior to proceeding - this can only help make the experience a good one. Whether the decision is made to proceed or wait, you will have all the information you need to make an informed decision.