Cirugía Plástica en Miami
I am 55 years old and will have a midface lift in two weeks. My daughter-in-law's wedding is next month, and I am wondering if I will be healed or should reschedule for afterward
Well if you are having the midface in 2 weeks and your daughter's wedding is in 4 weeks, that leaves you with 2 weeks of recovery for the wedding. I think you should reschedule the surgery until a later time. When patients are thinking of having plastic surgery before an important event, I have them doe the procedure at least six weeks before the event. The only procedures that I will perform on a patient 2 weeks before the event are non-invasive treatments like Botox and fillers, such as Restylane. Although you may be disappointed in that I am recommending that you should not have the midface lift, I do have some good news. The results of a midface can be replicated with facial fillers. Radiesse is a great filler for the cheek area. When injected into the cheeks it gives an amazing lift while giving fullness to the midface. Have the fillers and enjoy your daughter's wedding! Posted by Dr. Bustillo
What do I need to do in order to prepare for my facelift in two weeks? Should I be cleansing or moisturizing my face any specific way?
I think it's fantastic that you are going to have your facelift soon. I think that the preparation before the facelift procedure is very important. There are two basic areas that should be prepared. I recommend all patients to use retinols for the skin. There are various creams that contain retinols. I personally recommend the Environ line, but there are several others. Retinol is vitamin A, which is the most important vitamin for the skin. It acts to thicken the epidermis, increase cell turn over, and repair damaged cells. All of things amount to a very healthy skin. All patients should always be on retinols. The only exceptions are those people that are pregnant and those that are heavily exposed to the sun. If you are currently not on retinol therapy, now is a good time to start. I recommend that you start on a very low dose, to allow your skin to get accustomed to the retinol. Over the next few weeks, you can begin to increase the concentration of retinol you are using. The other preparation I ask patient to begin before surgery is the intake of high dose vitamin C. I ask that the patient begin 2000 mg of vitamin C two weeks before the facelift. In fact, I ask all patients that are going to have plastic surgery to begin this regimen. They continue this for 2 weeks after their cosmetic surgery. In addition, all medications that may interfere with blood clotting, such as aspirin, Motrin, Advil, and others are discontinued. After the facelift, patients are asked to start drinking pineapple juice to help bring down the swelling. When these instructions are followed, the swelling is quickly reduced and recovery is rapid.
Posted by Dr. Bustillo
I have heard that a facelift only treats 2/3 of the face. Why is this, and what parts does it correct versus not?
The facelift procedure is performed to treat the neck, lower face, and depending on the technique, it may also elevate the "midface", or cheeks. The facelift that I perform is named the deep plane facelift. This facelift provides a rejuvenation of the neck by tightening the neck muscles via an incision through the chin. Here the platysma neck muscle is sutured to help elevate the neck. In the lower face, the facial portion of the platysma is elevated and reposition back in its place. This provides a natural, non-pulled look to the lower face. This effaces the jowls and corrects them. In the midface, the malar fat pad, or the “cheek fat” is elevated from the underlying facial muscles and repositioned in higher position. This provides n natural appearing midface elevation. As you can see, the facelift procedure improves the mid and lower face. However, it does not improve the upper 1/3 of the face. The upper 1/3 of the face includes the eyelids and the brows. The eyelids can be improved with an eyelift procedure, or blepharoplasty. The procedure improves the droopy skin in the upper eyelids and the “ bags” in the lower eyelids. This is a separate procedure that can be combined with a facelift procedure and be done together. The brows can be elevated with a browlift procedure. This procedure can be done in several ways. It can be done endoscopically, via small incisions, or open with a larger incision. Each patient is different, and may be a candidate for one browlift technique and not for the other. Your plastic surgeon will help you decide which technique works best for you. Posted by Dr. Bustillo
Will I have bandages on my face following a facelift? If so, for how long will they remain?
The facelift procedure is concluded in the operating table with the placement of a bandage that is placed around the head and neck. The purpose of the bandage is to prevent the formation of hematomas (a collection of blood under the skin) and seromas (a collection of fluid under the skin). The bandage applies a slight gentle pressure on the skin. The minimal pressure is required to help the skin “stick” back down to the underlying tissues. The day after the facelift procedure, I see the patient back in the office. At that time, the bandage is removed. The face and incisions are all checked and they are cleaned. A Velcro adjustable bandage is then placed. This bandage is soft and applies very gentle pressure. It is not uncomfortable and will not cause any discomfort. This bandage then stays on for the following 5 days. It can be removed for eating and brushing teeth, but should remain on for approximately the entire day and night. On the fifth day, the patient returns to the office. On this day, the patient will have the sutures around the ears and chin removed. The bandage is replaced. This bandage should then be worn for approximately 5 more days, but only at night. On the 10th day, the patient returns to the office and the small sutures on the back of the scar inside the hair are removed. From here on down, the swelling and the bruising will quickly resolve. Most patients are able to return to normal activity and work at about 2 weeks after surgery. Any bruising that remains after the 2 week mark is usually minimal and can be concealed with make up if necessary. By enlarge, most patient that undergo the facelift procedure are very happy with the results. Posted by Dr. Bustillo
I am 45, undergoing my first facelift procedure in two weeks. What sorts of dietary and/or exercise precautions should I take before my surgery, and how far in advance?
Patients that are undergoing a facelift procedure should make some dietary and lifestyle changes before the procedure. I ask that all of my patients that are undergoing plastic surgery start changes two weeks before the date of the procedure. At that time, they are asked to stop all medications and vitamins that may interfere with coagulation. A list is given that includes all of the ones to avoid. At that time, 2000 mg of vitamin C a day are begun. The high dose vitamin C helps to decrease the bruising and speed the healing after the facelift surgery. Alcohol, including wine, is stopped 5 days before surgery. Alcohol interferes with the blood clotting and also increases bruising. Exercise is stopped 2 days before surgery. Patients who follow these directions will have the highest possibility that their plastic surgery procedure, such as their facelift, will proceed and with the best possible outcome. These precautions are aimed at allowing the body’s coagulation and anti-inflammatory mechanisms to work best to provide an expedient recovery.
Posted by Dr. Bustillo
I am 49 and will be going in for my facelift consultation next week. Can I expect the procedure itself to take place in the surgeon's office, or will I need to go to an outpatient medical center?
The facelift procedure can be done in several ways. The spectrum ranges from local anesthesia to IV sedation to general anesthesia. Local anesthesia is very safe and can be done in your physician's office. If you are having the procedure done under IV sedation or general anesthesia, you should have the procedure done in a certified facility. A certified facility can be located either in your physician's office or an ambulatory surgical center. If the facility is certified by JHACO, AAAHC, or AAAASF, it means that the facility meets strict criteria and that it is prepared to safely deliver quality patient care. It also means that the facility is prepared to handle the emergencies that may occur if they were to happen. Another important point to consider when having cosmetic surgery, such as a facelift, in an ambulatory surgery center located in a physician's office is the anesthesia provider. The provider should be a MD anesthesiologist. While nurse anesthetists are generally great providers, they need the supervision of a medical doctor, usually an anesthesiologist. When nurse anesthetists provide anesthesia in an outpatient medical center or a hospital, they have the support of medical anesthesiologists at the center. This is certainly a safe situation, where a capable nurse anesthetist has the back up of an medical anesthesiologist. However, if the nurse anesthetist is providing anesthesia in the physician's office alone, she will be without the support of the medical anesthesiologist. This could result in complications associated with anesthesia. In conclusion, I recommend that anyone having a plastic surgery procedure under anesthesia, such as a facelift, that it be done in an accredited facility. If the facility is located in your physician's office, the anesthesia provider should be a medical anesthesiologist. If you are having your facelift surgery in an outpatient medical center, then it is perfectly safe to have the anesthesia provided by a nurse anesthetist. There the nurse anesthetist will have a medical anesthesiologist for back up should an emergency arise.
Posted by Dr. Bustillo
What types of pain medications are prescribed for after my neck lift surgery? Do I need to take any medications beforehand? I want to make sure I am not allergic to any before getting prescriptions.
The neck lift procedure is done under local anesthesia with oral sedation. The procedure itself is not painful and the patient will be able to go home after the surgery. The recovery is about 4 to 5 days. The post-operative period is not painful, and most patients do not take any pain medication afterwards. I give several medications to my patients for use after surgery, it is important for the patient to identify any medication allergies to us during the consultation process. Pain medication, in the form of Tylenol with codeine, is usually sufficient to control any slight discomfort. If the patient is allergic to codeine, then other pain medication such as Celebrex or Percocet, may be given. Antibiotics are also given post-operatively to help prevent any infection. We usually prescribe Keflex, an antibiotic that is typically very easy on the digestive tract. A 5-day course of oral steroid anti-inflammatory medication is given to help the inflammation decrease faster is prescribed as well. Zofran is an anti-nausea medication that is prescribed, to be taken, just in case the patient feels a little nausea. This medication is placed under the tongue and works very well. Again, it is very important for the patient to alert our staff of any allergies to medications before they undergo any plastic surgery procedure.
Posted by Dr. Bustillo
I was informed that I have a "Factor 11 problem" when I was going through my pre-op tests for a Facelift. What does this mean, and are there non-invasive procedures that can help me?
Factor 11 deficiency, also known as Rosenthal Syndrome, can be identified with normal coagulation studies performed during the pre-operative work up. Patients with this coagulation abnormality will have elevated partial thromboplastin time (PTT). The syndrome varies in severity, ranging from mild to severe. I recommend that all patients that have an abnormality, even if slight, to undergo further testing. A hematologist should evaluate patients identified with an elevated PTT. After being diagnosed with factor 11 deficiency, they should be stratified as high or low risk. There are studies that indicate that factor 11 deficiency patients may undergo elective plastic surgery with the use of IV administered fresh frozen plasma, which contains clotting factors. Patients at low risk had fresh frozen plasma available and those in the high-risk category were given fresh frozen plasma were given the clotting factors before cosmetic surgery. All patients that underwent cosmetic surgery did well without any complications. Patients with factor 11 deficiency that wish to undergo plastic surgery should consult with their hematologist and plastic surgeon. While surgery is possible, the patient should weigh all the risks associated with the procedure with the benefits. Surgery with this condition carries significant risks.
Posted by Dr. Bustillo
I am a 32-year-old woman going in for a facelift next week. I have already planned to get Sculptra on the sides of my cheeks for hollowness and tear troughs and am wondering how long after my facelift should I wait to have this done?
First, I wish you luck with your surgery. I am sure that all will go well. The question of injectables after surgery is a very good one. The simple answer is to wait at least six weeks until the majority of the swelling subsides. This allows the physician to accurately see where filling is needed. However, there are several things that I would like to point out. First, Sculptra is not a good filler for the tear trough area. The tear trough area is the area that runs down from the corner of the eye near the nose. In some people, this can be depressed and may have a dark color. Filling this area with a hyaluronic acid filler will fill the groove and provide a smoother contour for the area. The only fillers that should be used here are the hyaluronic acids. The fillers are excellent for the tear trough and achieve a very natural fill in this area. This can be done during the facelift procedure or several weeks after, unless lower blepharoplasty is going to be done in conjunction with the surgery. The second thing I would like point out is that perhaps after the facelift is completed, it is very possible that you may be so happy with the results that you may not need any filling! Wouldn’t that be great? This is my recommendation to my patients that are sometimes set on having fillers done after the facelift. I always tell them to wait and see after the surgery. Most patients are so happy with the facelift result, that they do not feel they need the fillers. Posted by Dr. Bustillo
I am a 43-year-old woman and have been told by my primary care physician that I am prone to keloid scarring. Does this preclude me from being a facelift candidate?
Keloid scarring is actually a rarity. What most people think are keloids are actually hypertrophic scars. What they both have in common is that they are unsightly, but they are actually different. Keloids are depositions of collagen that continue to grow and do not respect the margins of the incision. Hypertrophic scars are unsightly scars that develop just in the incision. Hypertrophic scars usually develop due to poor surgical technique in closing the skin layers together. Patients that develop keloids are not candidates for the facelift procedure, as they can develop keloids in the areas where incisions are made around the ears. On the other hand patients with hypertrophic scars are good candidates for the facelift procedure. This is because a facelift done correctly, with proper closure techniques allowing for no tension on the skin will heal well. The facelift procedure should be performed with attention to replacing the facial muscles back in their place. In this way, the muscles are reposition in a new and higher point in the neck and face. The skin is then re-draped and trimmed. When the facelift is done in this manner, no tension is placed on it. Healing of the incisions should result in a virtually invisible scar.
Posted by Dr. Bustillo