Facelift, Rhytidectomy - Potential Risks & Complications
Facelift, or Rhytidectomy, is a surgical procedure to improve visible signs of aging on the face and neck.
As individuals age, the skin and muscles of the face region begin to lose tone. The Facelift cannot stop the process
of aging. It can improve the most visible signs of aging by tightening deeper structures, re-draping the skin of face
and neck, and removing selected areas of fat. A Facelift can be performed alone, or in conjunction with other procedures,
such as a Browlift, Liposuction, Eyelid Surgery, or nasal surgery.
Facelift surgery is individualized for each patient. The best candidates for Facelift surgery have a face and neckline
beginning to sag, but whose skin has elasticity and whose bone structure is well defined.
The following are the Risks and Complications of Rhytidectomy as defined by the American Society of Plastic Surgeons:
Bleeding
It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur,
it may require an emergency treatment to drain the accumulated blood or blood transfusion. Do not take any aspirin or
anti-inflammatory medications for ten days before or after surgery, as this may increase the risk of bleeding. Non-prescription
"herbs" and dietary supplements can increase the risk of surgical bleeding. Also, uncontrolled hypertension can increase the chance
of intra-operative and post-operative bleeding. Hematoma or collection of blood under the skin can occur at any time following surgery.
To reduce this we utilize drains that remove accumulated fluid from under the skin. In case of rare life threatening bleeding,
intra-operative blood transfusions may be required. If blood transfusions are necessary to treat blood loss, there is the risk
of blood-related infections such as hepatitis and HIV (AIDS). Heparin medications that are used to prevent blood clots in veins
can produce bleeding and decreased blood platelets.
Seroma
Fluid accumulations infrequently occur in between the skin and the underlying tissues. Should this problem occur, it may require
additional procedures for drainage of fluid.
Infection
Infection is unusual after surgery. Should an infection occur, additional treatment including antibiotics, hospitalization, or
additional surgery may be necessary.
Change in Skin Sensation
It is common to experience diminished (or loss) of skin sensation in areas that have had surgery for up to 18 months.
Diminished (or complete loss of skin sensation) may not totally resolve after a facelift.
Damage to Deeper Structures
There is the potential for injury to deeper structures including, facial nerves, blood vessels, muscles, and the Parotid or
Salivary Glands. The potential for this to occur varies according to the type of facelift procedure being performed.
Nerve Injury
Injury to sensory nerves resulting in numbness of the face, neck, and the ears is rather normal and expected with any facelift.
The numbness usually and mostly resolves by 18-24 months. Injury to the facial nerve branches, responsible for facial animation,
varies depending on the technique of dissection. The most common injury occurs to the frontal branch of the facial nerve which
is responsible for raising the eyebrow. In majority of patients this is temporary and due to swelling. Injury to the Marginal
Mandibular branch of the facial nerve can result in temporary or prolonged weakness of the corner of the mouth. If this does
not resolve within six months, the nerve can be surgically repaired. Injury to the zygomatic branch of the facial nerve can
result in temporary weakness of the lower eyelid muscle. Painful nerve scarring is very rare. Although the potential for nerve
injuries exist with any facelift, they mostly resolve spontaneously and without any intervention.
Skin Contour Irregularities
Contour irregularities and depressions may occur after facelift. Visible and palpable wrinkling of skin can occur.
Residual skin irregularities at the ends of the incisions or "dog ears" are always a possibility and may require additional
surgery. This may improve with time, or it can be surgically corrected.
Skin Discoloration / Swelling
Some bruising and swelling normally occurs following a facelift. The skin in or near the surgical site can appear either
lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods
of time and, in rare situations, may be permanent.
Skin Sensitivity
Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves
during healing, but in rare situations it may be chronic.
Scarring
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected,
abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than the surrounding
skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and
left side of the body). There is the possibility of visible marks in the skin from sutures. In some cases scars may require
surgical revision or treatment.
Sutures
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke
through the skin, become visible or produce irritation that requires removal.
Fat Necrosis
Fatty tissue found deep in the skin might die. This may produce areas of firmness within the skin. Additional surgery to
remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result
from fat necrosis.
Delayed Healing
Wound disruption or delayed wound healing is possible. Some areas of the face may not heal normally and may take a long time to heal.
Areas of skin may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue.
Smokers have a greater risk of skin loss and wound healing complications.
Hair Loss
Hair loss may occur in areas of the face where the skin was elevated during surgery. The occurrence of this is not predictable.
Asymmetry
The human face is normally asymmetrical. There can be a variation from one side to the other in the results obtained from a
facelift procedure. Additional surgery may be necessary to attempt to revise asymmetry.
Allergic Reactions
In rare cases, local allergies to tape, suture materials and glues, blood products, topical preparations or injected agents have
been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription
medications. Allergic reactions may require additional treatment.
Surgical Anesthesia
Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms
of surgical anesthesia or sedation.
Shock
In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are
performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even
death. If surgical shock occurs, hospitalization and additional treatment would be necessary.
Pain
You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after facelift surgery.
Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after a facelift or forehead lift surgery.
Unsatisfactory Result
Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained.
You may be disappointed with the results of facelift surgery. This would include risks such as asymmetry, unsatisfactory surgical
scar location, unacceptable visible deformities at the ends of the incisions (dog ears), loss of facial movement, poor healing,
wound disruption, and loss of sensation. It may be necessary to perform additional surgery to improve your results.
Cardiac and Pulmonary Complications
Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system.
Pulmonary complications may occur secondarily to blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of
the lungs after general anesthesia. Pulmonary and fat emboli can be life-threatening or fatal in some circumstances. Air travel,
inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that
may result in death. It is important to discuss with your physician any past history of blood clots or swollen legs that may
contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms.
If you experience shortness of breath, chest pains, or unusual heartbeats, seek medical attention immediately. Should any of
these complications occur, you may require hospitalization and additional treatment.
Long-Term Results
Subsequent alterations in facial appearance may occur as the result of aging, weight loss or gain, sun exposure, pregnancy,
menopause, or other circumstances not related to facelift surgery. Facelift surgery does not arrest the aging process or produce
permanent tightening of the face and neck. Future surgery or other treatments may be necessary to maintain the results of a
facelift operation.
Use of Fibrin Sealants "Tissue Glue" During Rhytidectomy Advisory
Fibrin sealants which are produced from heat-treated human blood components to inactivate virus transmission are used to hold
tissue layers together at surgery and to diminish post-operative bruising following a rhytidectomy. This product has been
carefully produced from screened donor blood plasma for hepatitis, syphilis, and human immunodeficiency virus (HIV). These
products have been used safely for many years as sealants in cardiovascular and general surgery. This product is thought to
be of help in diminishing surgical bleeding and by adhering layers of tissue together.
Previous Surgical Scars
The presence of surgical scars from previous facial surgery may limit the amount of skin tightening that can be produced.
Female Patient Information
It is important to inform your plastic surgeon if you use birth control pills, estrogen replacement, or if you believe you may
be pregnant. Many medications including antibiotics may neutralize the preventive effect of birth control pills, allowing for
conception and pregnancy.
Intimate Relations After Surgery
Surgery involves coagulating of blood vessels and increased activity of any kind may open these vessels leading to a bleed, or
hematoma. Activity that increases your pulse or heart rate may cause additional bruising, swelling, and the need for return to
surgery and control bleeding. It is wise to refrain from sexual activity until your physician states it is safe.
Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)
Patients who are currently smoking, use tobacco products, or nicotine products (patch, gum, or nasal spray) are at a greater
risk for significant surgical complications of skin dying, delayed healing, and additional scarring. Individuals exposed to
second-hand smoke are also at potential risk for similar complications attributable to nicotine exposure. Additionally, smoking
may have a significant negative effect on anesthesia and recovery from anesthesia, with coughing and possibly increased bleeding.
Individuals who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of this type
of complication.
Mental Health Disorders and Elective Surgery
It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather
than perfection. Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery and
often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you may have of significant
emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of
elective surgery, effects on mental health cannot be accurately predicted.
Medications
There are many adverse reactions that occur as the result of taking over-the-counter, herbal, and/or prescription medications.
Be sure to check with your physician about any drug interactions that may exist with medications which you are already taking.
If you have an adverse reaction, stop the drugs immediately and call your plastic surgeon for further instructions. If the
reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery,
realize that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not
make any important decisions, and do not drink any alcohol while taking these medications. Be sure to take your prescribed
medication only as directed.
ADDITIONAL SURGERY NECESSARY
There are many variable conditions that may influence the long-term result of a facelift. Secondary surgery may be necessary
to obtain optimal results. Should complications occur, additional surgery or other treatments may be necessary. Even though
risks and complications occur infrequently, the risks cited are particularly associated with facelift surgery. Other complications
and risks can occur but are even more uncommon. The practice of medicine and surgery is not an exact science. Although good
results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. In some
situations, it may not be possible to achieve optimal results with a single surgical procedure.
PATIENT COMPLIANCE
Follow all physician instructions carefully; this is essential for the success of your outcome. It is important that the surgical
incisions are not subjected to excessive force, swelling, abrasion, or motion during the time of healing. Personal and vocational
activity needs to be restricted. Protective dressings and drains should not be removed unless instructed by your plastic surgeon.
Successful post-operative function depends on both surgery and subsequent care. Physical activity that increases your pulse or
heart rate may cause bruising, swelling, fluid accumulation and the need for return to surgery. It is wise to refrain from intimate
physical activities after surgery until your physician states it is safe. It is important that you participate in follow-up care,
return for aftercare, and promote your recovery after surgery.
HEALTH INSURANCE
Most health insurance companies exclude coverage for cosmetic surgical operations such as facelift surgery or any complications
that might occur from surgery. Please carefully review your health insurance subscriber information pamphlet. Most
insurance plans exclude coverage for secondary or revisionary surgery.
FINANCIAL RESPONSIBILITIES
The cost of surgery involves several charges for the services provided. The total includes fees charged by your surgeon, the
cost of surgical supplies, anesthesia, laboratory tests, and possible outpatient hospital charges, depending on where the surgery
is performed. Depending on whether the cost of surgery is covered by an insurance plan, you will be responsible for necessary
co-payments, deductibles, and charges not covered. The fees charged for this procedure do not include any potential future costs
for additional procedures that you elect to have or require in order to revise, optimize, or complete your outcome. Additional
costs may occur should complications develop from the surgery. Secondary surgery or hospital day-surgery charges involved with
revision surgery will also be your responsibility.
Dr. Younai is a Board Certified Plastic & Reconstructive Surgeon with experience in all aspects of
Facial Cosmetic Surgery including Facelift or Rhytidectomy, eyelid surgery or blepharoplasty, neck lift,
forehead or brow lift, rhinoplasty, etc. He is skilled and experienced in all techniques of facial rejuvenation surgery
and strives to create a face that is natural and normal looking. During your consultation he will discuss all details including:
if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative
instructions, recovery course, as well as what to expect after surgery. At that time Dr. Younai will also show you
before-and-after pictures of other patients with facelifts, who might be similar to you.
Dr. Younai receives patients from the Northern as well as the Southern California region. Some of these cities include Beverly
Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.
Dr. Younai performs his surgeries at the Regency Surgery Center which is certified by Medicare, AAAHC,
and AAAASF. This state-of-the-art facility is located in Encino, and near Sherman Oaks, Calabasas, Woodland Hills,
Thousand Oaks, and Westlake Village.
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