Thank you for your question. You’re 47-years-old and you’re contemplating having surgery
that will involve facelift, neck lift, lip lift, lower blepharoplasty and the anticipated
time of the surgery will be 6 hours and you state in your question that you are concerned
about the safety of being under that length of time and that you are getting some push
back from your friends saying that you look fine and so basically the question is it better
to do everything at once or to do them separately.
Well, I can certainly give you some guidance from my perspective as a practicing doctor.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years and all
those procedures you listed are big parts of my practice. And certainly, I have a lot
of experience and opinions about safety and the question of relative risk when it comes
to cosmetic surgery. Now this is my opinion and it’s a personal bias and it is not in
any way necessary indicative of disparaging of other doctors who do things differently.
First, let’s go to the subjective concerns of being a 47-year-old woman and having this
procedure. I think that in addition to your friend, if you go visit 5 more doctors, 10
more doctors, you will get many opinions and you will get everyone’s perspective on what
you need. So ultimately, there is always a question in your mind of whether or not this
is the right time to do the procedures but the key really is what is the desired outcome
and will you get the desired outcome with the approach that has been recommended by
your doctor.
So the first question is will you be under for that long? Well that’s a question you
need to ask your doctor. If I anticipate doing any surgery, I always give estimation of the
time of the preparation, the time of the surgery, the time of the recovery. However, I would
say to you that I would really, for my practice, I don’t do any general anesthesia and the
exception would be for a rhinoplasty operation where there is an issue with the airway and
it really does require general anesthesia. But otherwise, for the procedure you are contemplating,
it is routine for me to do everything under local anesthesia with LITE™ sedation.
The reason I do that is a couple of reasons. One is of course relative safety. In my experience
and in my perspective, local anesthesia with LITE™ sedation is considerably safer than
general anesthesia. The patents are able to avoid a lot of the medical stressors of being
under general anesthesia and their recovery is a lot easier. My patients routinely walk
out of the office feeling good and have their face wrapped after a facelift and they are
smiling and thanking our staff and they are saying goodbye and it is fine. It’s very
much in contrast to the way I learned facelifts in my training back in the early mid 90’s
when I trained. We put everybody under general anesthesia, we put drains, we put a large
wrap, we put people overnight in a hospital or surgery center for overnight stay and that’s
still a valid approach. But for my perspective, I think that local anesthesia with LITE™
sedation makes my life and the patient’s life a lot easier and that’s one bias right
there and there is one difference in my approach.
As far as doing all those procedures together, from my perspective, that’s not my problem
and it is not unusual in our practice do brow lift, upper and lower eyelid blepharoplasty,
facelift, neck lift and doing it all together. It’s not the multiple procedures. It is
really about the time. I feel that with local anesthesia and LITE™ sedation procedures,
I try to keep the procedures less than 4 hours. And certainly, my hands and the type of procedure
I do, that’s kind of where I draw a line and it’s not so much the names of the procedures
because if even if the facelift, the face and neck lift, it can be a short scar lift,
it can be a moderate facelift or it can be extended face and neck lift. Eyelid surgery
can be limited. It can be more involved and it can be a lot additional procedures such
ptosis, canthoplasty, lateral tarsal strip, laser and certainly any focal area in the
face can take up much more time when we are dealing the specialist approach to any problems.
As far as the range is concern of time, it’s going to vary .And last but not least of course,
I would say that at 47 years old, the photos you submitted, I can’t see everything and
without a physical exam. You know when I examine a patient to determine if they are a good
candidate for a facelift, I’ll actually lift the skin up and show them what they can
have done. In our practice, we can offer for a lot of limited procedures where they can
have their eyelids done and we can do something like structural volumizing to improve the
volume in the cheekbones and jawline for somebody in your age wherein and it can make a difference
that can be comparable to a facelift.
So the possible options you have are probably, you can certainly consider if you are getting
a cold feet or anxiety about having the surgery. You can learn more about your surgery, visit
other doctors and just get a balanced perspective. If you have chosen a doctor and you feel you
trust this doctor then this is a discussion with your doctor and decide what your priorities
are. Sometimes my patients will say to me, “I will just do my eyes.” And because
I don’t do general anesthesia, that’s an easy decision because it’s not, I’m
going to say them that, “If you will get general anesthesia, you might just get everything
done together.” In my practice I can do the eyes, I can do the face later. We can
do injectables. We can do a lot of things so there is a lot of flexibility in the approach
that I have which corresponds with the realities of modern lifestyles. For a lot of my patients
which basically people are short on time, we have to work on the realities of people’s
lives and work with those priorities to get the best results as we can. Sometimes, there
are hard deadlines like weddings and graduations, and birthdays and all kinds of things that
have to be factored and not to mentioned busy personal lives.
So discuss this with your doctor and maybe get some additional opinions just to give
you some perspective and see if there is some consistency. And if there are some inconsistencies,
address these with your doctor. I think that it has become my observation and at least
my style to be not just the surgeon who can technically treat an individual’s concern
and also they should be the primary care doctor for beauty so I can be their guide in all
the things that they are concerned about. In our practice, we offer everything from
skin products to lasers to advanced cosmetic surgical procedures so there is not a limitation
in the possible solutions but rather customization in what can best serve in the needs of the
person who is looking to improve their appearance.
So I hope that was helpful, I wish you the best of luck and thank you for your question!