Pre-Consultation Intake and Goal Setting
A high-quality consultation is part detective work, part shared vision. It sets the stage for safety, candidacy, and what “success” will actually mean for you.
Comprehensive medical history and candidacy screening
Comprehensive medical history and candidacy screening
- Your surgeon reviews prior surgeries, anesthesia reactions, bleeding tendencies, scarring patterns, and any wound-healing issues.
- Medications and supplements are checked for bleeding risk and interactions (think anticoagulants, NSAIDs, high-dose vitamin E, fish oil, ginkgo).
- Smoking/nicotine status matters—a lot. Nicotine reduces microcirculation and raises the risk of skin loss; most surgeons require stopping for 4–6 weeks before and after surgery.
- Comorbidities are categorized with ASA classification:
- ASA I: Healthy
- ASA II: Mild systemic disease (e.g., well-controlled hypertension)
- ASA III: Severe systemic disease that’s not incapacitating (e.g., insulin-dependent diabetes)
- Elective facial rejuvenation typically favors ASA I–II; ASA III may be considered with optimization in an accredited facility.
- Screening for sleep apnea, prior VTE, and uncontrolled hypertension informs anesthesia and perioperative planning.
- Photos are taken with controlled lighting, neutral backgrounds, and standardized settings (often an 85–105 mm focal length to reduce distortion).
- Views usually include frontal, right/left lateral, right/left oblique (45°), plus close-ups of the perioral and periorbital areas.
- Images are captured in repose and with expression—neutral face, full smile, pucker, brow raise—and with neck extension to assess how tissues move.
- You’ll pinpoint your priorities—jowls, midface descent, neck laxity, perioral lines, loss of jawline definition.
- Practices may use patient-reported outcomes (PROMs) like FACE-Q to quantify baseline satisfaction and track improvement.
- Together you define “success”: a crisper cervicomental angle, a sharper mandibular border, smoother midface, or a conservative refresh that preserves your identity.
- Your surgeon walks you through the layers of facial aging: skin quality, superficial fat compartments, the SMAS (superficial musculoaponeurotic system), retaining ligaments, and deeper fat/skeletal support.
- You’ll discuss realistic endpoints: a facelift repositions lax tissues and reshapes contour—it doesn’t change skin biology. Adjuncts like resurfacing can improve texture and fine lines.
- Longevity is put in context: results often last 8–12 years, influenced by your biology, lifestyle, and skeletal support.
Technique Selection and Adjunct Procedures
There’s no one-size-fits-all lift. The approach should match the anatomy driving your concerns—period.
Deep-plane rhytidectomy
Deep-plane rhytidectomy
- Indications: significant midface descent, heavier jowls, thicker skin, and a desire for durable midface rejuvenation.
- Why it helps: releases zygomatic and masseteric ligaments and repositions the malar fat pad and jowl as a unit—better nasolabial and cheek improvement without skin tension.
- Trade-offs: technically demanding; swelling can linger longer, but results are often natural and long-lasting.
- Indications: mild-to-moderate jowling and laxity, thinner skin, or a priority on shorter operative time.
- What it does: plication sutures or SMAS flap imbrication restore the jawline and neck definition with less dissection than deep-plane.
- Trade-offs: excellent for lower-face refinement; midface lift is more modest.
- Indications: early laxity, event-driven timelines, or touch-up after a previous comprehensive lift.
- Trade-offs: shorter downtime and incisions—but less neck correction and shorter longevity for more advanced aging.
- In some patients, lateral neck tightening alone is enough.
- Open anterior platysmaplasty via a small submental incision allows release or plication of medial bands and direct treatment of subplatysmal fat.
- Select cases may benefit from partial reduction or suspension of the anterior belly of the digastric or submandibular gland repositioning for a bulky anterior neck—advanced, higher-risk maneuvers that require careful weighing.
- Autologous fat grafting can replenish deflated areas: malar, deep medial cheek, temples, prejowl sulcus, and perioral zones.
- Buccal fat removal is conservative—reserved for clearly bulky, low-set pads and balanced against the risk of long-term hollowing.
- Adjunct energy-based therapies (fractionated CO2/erbium laser, RF microneedling) address fine lines and skin tightening; often staged or applied selectively to protect flap blood supply.
- Facelifts are performed under general anesthesia or deep IV sedation in accredited facilities.
- VTE prophylaxis is risk-adjusted (e.g., Caprini score): sequential compression devices for all; chemoprophylaxis used selectively given bleeding risk in facelift surgery.
- Antibiotic stewardship: a single pre-incision dose (e.g., cefazolin) is standard; extended postoperative antibiotics are avoided unless specific risks exist.
- Tight blood pressure control lowers hematoma risk—the most common early complication, especially in hypertensive males.
Logistics, Recovery Planning, and Next Steps
This is where planning turns into a timeline—with clear expectations before and after surgery.
Personalized surgical plan
Personalized surgical plan
- The operative plan specifies technique (deep-plane vs. SMAS modification), incision design, neck approach, and any volume or resurfacing adjuncts.
- Incisions are mapped: temporal hair-bearing vs. pretrichial; retrotragal vs. pretragal (based on cartilage definition and skin thickness); postauricular sulcus continuation; and occipital hairline design for camouflage.
- Smoking/nicotine cessation for at least 4–6 weeks before and after.
- Medication adjustments: coordinate with your prescribers to pause anticoagulants/antiplatelets when safe; stop non-essential supplements that increase bleeding risk 10–14 days pre-op.
- Skin prep: daily sunscreen; consider retinoids and pigment control (e.g., hydroquinone) for select skin types when appropriate; avoid aggressive peels right before surgery.
- Nutrition: adequate protein and hydration; correct iron or vitamin D deficiencies if present.
- Medical clearance: labs and ECG based on age/ASA status; optimize blood pressure and manage OSA.
- Some surgeons use small drains for 12–48 hours; others use drainless techniques with meticulous hemostasis and tissue sealants.
- Compression: a light facial garment or wraps for the first week; head elevation and cold compresses for the first 48 hours.
- Milestones:
- Day 1–3: peak swelling/bruising; early walking encouraged; blood pressure control is key.
- Day 5–7: remove preauricular sutures; most bruising fades by days 10–14.
- Week 2: back to desk work/light activity; camouflaging makeup per your surgeon’s guidance.
- Weeks 4–6: resume exercise; residual swelling improves; ramp up scar care (silicone, strict sun protection).
- Months 3–6: refinement phase—final contour emerges.
- Complication vigilance:
- Hematoma: sudden swelling, pressure, or pain—call promptly.
- Skin compromise: higher risk in smokers or with overly tight flaps.
- Temporary facial nerve neuropraxia: typically resolves within weeks to months.
- Hypertrophic scars or pigment changes: addressed with lasers, silicone, or steroid as appropriate.
- Clear cost components: surgeon’s fee, anesthesia, facility, garments, implants (e.g., chin), postoperative visits, and any combination procedures.
- Practices may offer bundled pricing for adjuncts (fat grafting, laser) and payment options or financing.
- Timelines: expect 4–8 weeks between consultation and surgery for optimization, with a pre-op visit 1–2 weeks before surgery to finalize consent, prescriptions, and photography.
- Cancellation and rescheduling policies are reviewed—so your deposit and timing are protected.
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