Face Lift Postoperative Recovery

Abstract

The purpose of this paper is to describe what I have studied and experienced, mainly regarding the control and prediction of the postoperative edema; how to achieve an agreeable recovery and give positive support to the patient, who in turn will receive pleasant sensations that neutralize the negative consequences of the surgery.After the skin is lifted, the drainage flow to the flaps is reversed abruptly toward the medial part of the face, where the flap bases are located. The thickness and extension of the flap determines the magnitude of the post-op edema, which is also augmented by medial surgeries (blepharo, rhino) whose trauma obstruct their natural drainage, increasing the congestion and edema. To study the lymphatic drainage, the day before an extended face lift (FL) a woman was infiltrated in the cheek skin with lynfofast (solution of tecmesio) and the absorption was observed by gamma camera. Seven days after the FL she underwent the same study; we observed no absorption by the lymphatic, concluding that a week after surgery, the lymphatic network was still damaged. To study the venous return during surgery, a fine catheter was introduced into the external jugular vein up to the mandibular border to measure the peripheral pressure. Following platysma plication the pressure rose, and again after a simple bandage, but with an elastic bandage it increased even further, diminishing considerably when it was released. Hence, platysma plication and the elastic bandage on the neck augment the venous congestion of the face. There are diseases that produce and can prolong the surgical edema: cardiac, hepatic, and renal insufficiencies, hypothyroidism, malnutrition, etc. According to these factors, the post-op edema can be predicted, the surgeon can choose between a wide dissection or a medial surgery, depending on the social or employment compromises the patient has, or the patient must accept a prolonged recovery if a complex surgery is necessary. Operative measures which prevent extensive edemas are: avoiding transection of the temporal pedicle, or to realizing platysma plication too tight by using strong aspirative drainage instead of elastic bandages. In the post-op, the manual lymphatic drainage is initiated on the third or fifth day, but must be done by a trained professional, in a method contrary to that specified in the books for non-operated individuals. An aesthetician washes the hair and applies decongestive cold tea on the face the second day, and on the fifth, moisturizes the skin and cosmetically conceals any signs of bruising. The psychological support provided by the staff keeps the patient calm and relaxed. Five years experience with this protocol has enabled us to minimize post-op pain. The edema can be predicted with certain consistency (in which surgery there will be more or less edema) and the proper technique can be selected, permitting the patient to choose the best moment for a FL while the surgeon can avoid intra and postoperative measures that increase the edema. After surgery, the patien...

Ritidoplastia: sutura del sistema SMAS-Platisma e importancia de la filosofía de la naturalidad

“…Las complicaciones sufridas en el grupo de estudio estuvieron dentro de los índices aceptables en niveles mundiales para este tipo de procedimiento (1,(11)(12)(13) (Tabla II).…”

“…A las fumadoras se les indicó que debían interrumpir el hábito 30 días antes y 30 días después de la fecha de la cirugía. En todos los casos utilizamos drenajes de succión en el postoperatorio que fueron retirados al día siguiente de la intervención, así como drenaje linfático manual (11).…”

Facelift and Patterns of Lymphatic Drainage

“…3,4 A single patient study proposed a theoretical reversal of lymphatic flow toward the midline after facelift. 5 Also, it has commonly been assumed that deeper facelift dissection causes greater and more prolonged swelling, but that assumption has never been scientifically studied. Identifying the patterns of lymphatic drainage from the cheek before and after rhytidectomy would help to characterize the anatomic structural modifications caused by differing rhytidectomy techniques.…”

Drenagem linfática manual no pós-operatório de enxerto ósseo alveolar: uma nova abordagem para a redução do edema facial

“…Nos indivíduos que passaram por tratamentos tumorais, com ressecções cirúrgicas, esvaziamentos ganglionares e radioterapia (Arieiro et al, 2007), e em algumas cirurgias plásticas (Mottura, 2002) deve ser ressaltado que a DLM é realizada com as mesmas manobras, mas o sentido do fluxo linfático é direcionado aos linfonodos existentes e vias íntegras (Guirro e Guirro, 2004 Frente à literatura, a idade considerada ideal para a realização do EOA secundário é no final da dentadura mista e preferencialmente antes da irrupção do canino permanente, entre 9 e 12 anos. A média da idade encontrada nos pacientes do nosso estudo foi de 12 anos e 11 meses, que ainda se encaixam dentro do período recomendado para o sucesso de todo tratamento ortodôntico.…”

“…Segundo Mottura (2002), uma vez que a drenagem linfática é favorecida pela contração muscular, o paciente é aconselhado a elevar as sobrancelhas e contrair os músculos orbiculares dos olhos e da boca, fechar os olhos com força, movimentar a boca lateralmente e os lábios para cima e para baixo, 4-6 vezes ao dia, após o terceiro dia de cirurgia plástica facial. Estes exercícios também mobilizam o edema das pálpebras, lábios e mento.…”