It would be nice to predict that exact moment in time when gravity has more control over the way you look than you do.  Then, you could plan ahead how you would deal with the appearance of all those tiny lines around your eyes, the sag in the skin along your chinline, the droop in your eyelids.  But it seems to happen without warning; one morning you look in the mirror and stare sadly at an aging stranger that bears no resemblance to your youthful identity still in your mind. 

Of course, not everyone ages gracefully.  There are many people who go fighting, kicking and screaming every step of the way -- using every single weapon available in medical science and technology.  This arsenal is truly impressive today, and includes everything from sophisticated chemical and acid “peels” to implants to various cosmetic surgery procedures.  The objective is to restore a more youthful appearance and, for most people, to look better without looking significantly different. 

Without commenting on the appropriateness of the obsessive preoccupation with youth in today’s society, it is a basic fact that by the time people reach their 40’s or 50’s -- when they often have both the determination and the financial resources -- they may find themselves in fierce competition with younger, bright, ambitious men and women in the workplace.  They face the dichotomy of welcoming and mentoring the younger rising executives on one hand, and being concerned about grooming and training their replacement on the other. 

Only a few decades ago, plastic or cosmetic surgery was seen as the indulgence of vain, aging dowagers and spoiled young coeds.  Now that the Baby Boomers have past 50, however, thousands of men and women are choosing any of a dozen or so procedures to sculpt, tighten, tuck or resurface all those wrinkles, sagging jowls, frown lines and crow’s feet.  In fact, according to the most recent statistics released by the American Society of Plastic and Reconstructive Surgeons (ASPRS), not only has cosmetic surgery for 51-64 year olds increased 47 percent., but there has also been a 113 percent increase in cosmetic surgery among seniors over 65 between 1996 and 1998.  Perhaps not surprisingly, the most popular procedures are eyelid surgery, facelifts, liposuction and laser skin resurfacing. 

Expectations...Realistic or Not?

People decide upon plastic or cosmetic surgery for a whole variety of personal reasons.  Some want to look more like they “used to;” others simply want a healthier, more youthful appearance.  Some people, however, decide to have a procedure because they believe it will change their life -- make them more attractive to the opposite sex, make people “like” them better, or perhaps for a whole group of reasons they find difficult to articulate.  These surgeries can do a lot of things -- they can improve overall appearance, make people feel better about themselves, and even restore their self-confidence. 

A face-lift, for example, might actually take five or more years off someone’s appearance. But expectations about the outcome can become a minefield. If the surgical candidate believes and expects something that cannot possibly happen, they are destined to view the results as a failure, no matter how technically successful they actually are.  That’s why expectations are the core topic for our pre-surgery consultations. 

If a candidate’s expectations are unreasonable, or if they want the procedure for all the wrong reasons, I am reluctant to schedule the operation.  Look at it this way; if someone expects to get a job because they think the surgery will give them a competitive edge over a young colleague, no matter how excellent the results of the procedure turn out to be, the patient will still be unhappy if they don’t get the job.  These surgeries are just too important to be performed for the wrong reasons that almost guarantee a less than satisfactory outcome. 

The Facelift

Depending upon the objectives to be achieved, the surgery of choice can range from  a “resurfacing” procedure to correct or improve facial scars, wrinkles or blemishes that can be done in the office or an outpatient facility, or a full surgical facelift (rhytidectomy) to remove unwanted, sagging skin and tighten facial and neck muscles.  A facelift can also be done in concert with other facial cosmetic procedures, such as a brow or forehead lift, rhinoplasty (nose surgery), eyelid surgery (blepharoplasty), liposuction, or chin augmentation.  Results will vary patient to patient depending on age, heredity, overall health, bone structure, and skin elasticity as well as other characteristics, and these factors will help select the procedure or procedures, as well. 

During the pre-op conference, based on an exam and a discussion of objectives and expectations, the appropriate procedure and anesthetic are agreed upon, and we cover possible risks and complications, as well.  There are two important pre-surgery instructions -- no aspirin and no smoking -- that can seriously alter the outcome of the surgery. 

Since aspirin and/or aspirin related medications chemically inhibits the body’s ability to form stable blood clots, they are prohibited for two weeks before the surgery.  Smoking can also interfere with healing after surgery, particularly in cases of breast reduction, facelift and tummy tuck -- all of which involve the creation of “skin flaps.”  Smoking constricts blood vessels and decreases blood flow all over the body.  The carbon monoxide in smoke greatly reduces the blood’s ability to carry oxygen which is essential for wound healing and, in the case of a skin flap, the wound may not heal at all.  Research has shown that if you smoke and inhale cigarettes, you are at least twelve times more likely than nonsmokers to heal poorly after a facelift.  Even worse, the whole purpose of the surgery can be negated by unsightly scars.  Of additional concern is the fact that if you have general anesthesia and also smoke, you may develop a hard cough that can cause internal bleeding.  For all these reasons, smoking is strictly prohibited for our cosmetic surgery patients. 

If you cannot give up smoking for one or two weeks before and after the surgery, you may want to rethink your decision to have plastic surgery.  If you are truly committed to improving your appearance and your health, look at it this way: your surgery provides an excellent reason to abandon the habit altogether. 

Surgical styles for performing facelifts have changed over the years.  The procedure used to involve lifting the skin only.  An incision was made around the ears and hairline and the surgeon pulled the skin back, cutting away any excess.  Now, the emphasis is on tightening the underlying structures, as well.  Layers of fat can be trimmed along with the smooth, fibrous connective tissue beneath it, or it can be removed by liposuction.  The new lifts are less likely to produce scars because the skin doesn’t have to be pulled as tightly -- which also avoids that old-fashioned, hollow-cheeked, wide-eyed, “rocket-sled look” --  and the procedure also permits more sculpting of the neck. 

Now facelifts are generally accomplished in an outpatient facility under general anesthetic.  We work through the hairline incisions on one side of the face at a time to separate the skin from underlying fat and muscle, which is pulled gently upward and backward to give a more youthful jawline.  Then, the skin is pulled up and back in the temple area -- in front and back of the ear -- and the excess skin is trimmed off.  If necessary, small fat deposits can be removed from the jawline and from beneath the chin.  Tiny sutures are used to close the incisions and will be removed at the surgeon’s discretion to minimize scarring. The surgery may last up to five hours, depending on whether other procedures are to be done at the same time.  (In about 80 percent of the cases, patients also have eyelid surgery to eliminate “bags” under their eyes and sagging upper eyelids.) 

Following surgery, there are a number of important post-op instructions. Patients are advised to keep their head elevated for the first week, including during sleeping, and are cautioned to remain inactive for the first few days.  A certain amount of swelling and facial bruising will occur and increase for the first 36 hours after surgery, and then slowly decrease over the next several weeks.  Patients can also expect the bruising to drift down onto the chest in the first four or five days -- this is entirely normal, and nothing to cause alarm.  Patients should not, under any circumstances, remove or alter the head dressing. This will be done during an office visit the day after surgery, and again when the stitches are removed. 

We also warn patients to expect a “bad hair day” when the bandages are removed, and suggest they may want to bring along a scarf or hat to cover their hair when they leave the office.  They should also resist the temptation to apply makeup and lotions to their face until cleared to do so, and sunbathing or tanning beds are also out of the question for a while.  Healing takes some time so the full results of the surgery may not be apparent for a few weeks -- be patient. 

Most importantly, we encourage our patients to ask any questions they might have during the healing process, and to let us know at once if any bleeding, unusual swelling, feverishness, or sign of infection occurs.  Complications are very rare, but we don’t want to defeat the purpose of the surgery by risking infection or anything that can cause scarring. 

In summary, there are quite a few weapons in the anti-aging arsenal and, for people who don’t like what they see in the mirror anymore, we offer free telephone consultations to explore what facial cosmetic procedures can do for them.  Remember, everything in life looks better when you do. 

Aesthetic Plastic Surgery Center 17070 Red Oak Drive, Suite 303 Houston, TX 77090 (281) 444-5172 www.mvkellymd.com drkelly@mvkellymd.com

Michael V. Kelly, II, M.D. completed his undergraduate degree at Rice University and earned his Medical Degree at the University of Texas Southwestern. He completed his internship at Hermann Hospital, University of Texas Medical School at Houston, and served as Chief Resident in both Plastic Surgery and General Surgery at that institution. Dr. Kelly served Fellowships with the Maytag Foundation/D. Ralph Millard, University of Miami and the American Cancer Society. For the past decade, he has been active with the Harris County Medical Society, serving as a member of the Executive Board as well as a member of the Board of Trustees of the Houston Academy of Medicine. In 1998, he served as President of the Houston Academy of Medicine. Dr. Kelly is a Life Member of the National Registry of Who’s Who.