San Diego Facial Plastic Surgery

At the recent meeting of the American Academy of Facial Plastic Surgery in San Diego, CA there was some discussion regarding facelifts and smoking.

Conventional wisdom states that nicotine and facelifting are not good partners. This is because nicotine constricts (makes smaller) the blood vessels supplying the skin. During a facelift, the skin is temporarily "lifted" away from the deeper tissues (including the blood supply) so that it can be redraped following tightening of the deeper tissue. In non-smokers and otherwise healthy patients this temporary separation of the skin causes no harm- there is still plenty of collateral blood flow. In smokers, this collateral blood flow is limited, raising the risk of inadequate blood flow to the skin edges.

Inadequate blood flow carries a certain risk for slow healing, and skin complications. A worst case scenario can be prolonged healing and poor scars that require revision.


Most plastic surgeons attempt to reduce this risk for smokers by encouraging them to quit. Generally two weeks of no smoking prior to a lift, and one week after will put patients in a "safe zone" for healing. Occasionally, patients are unable to quit completely prior to surgery and that is where the patient and surgeon need to sit down and have a frank conversation.


Patients who are "light smokers" (less than 1/2 pack per day) can often be safely treated with a "mini facelift." This involves shorter skin flaps, with less stress on the small blood vessels. However, the surgeon should be highly experienced and skilled in face lift procedures to perform this procedure safely and still achieve a good result for the patient. Most importantly, the patient needs to have realistic expectations and understand that they are still at higher risk than a non-smoker for healing complications. If I feel that my patient doesn't accept this, or doesn't understand the risks of smoking, I will not operate. Also, if I feel I cannot safely give the patient what they want- I will not operate. As with all cosmetic surgery, communication between the plastic surgeon and patient is the key to a happy outcome.

Labels: facelift, mini facelift, plastic surgeon, san diego, smoking

Mini facelifts, and "branded" facelifts (facelifts given the name of their surgeon, or names like "quick lift") have received a lot of attention lately. This is because while there is a huge demand for facial rejuvenation, many potential patients fear long, costly procedures as well as being under anesthesia. One thing branded facelifts may do is help doctors to address these concerns by putting a "friendly face" on the procedure. (This is generally acceptable as long as patients are made aware of any risks- and that a mini lift or branded lift is still surgery!)


While many surgeons have branded their own facelifts, others don't believe in "branded" facelifts stating that "a facelift is a facelift."


I tend to disagree with this, as evidenced by our own "signature mini lift" that we do here at La Jolla Center for Facial Plastic Surgery in San Diego. A proper facelift will always employ some basic principles, regardless of the name or the surgeon-but it is still an expression of the surgeon's esthetic judgement, skill, and experience. Surgical technique and outcome can be quite different in different offices. For example, after performing over 1000 facelifts my own outlook and approach are much different than after my first facelift, or first 50 facelifts.


That said, an experienced surgeon who brands his own "mini" facelift should do so for reasons beyond just marketing a catchy name. The branded procedure should represent something different than a "standard facelift" in that physician's private practice-or be performed in some fundamentally unique way as opposed to other physicians who performs facelifts. A good question to ask the surgeon is: "What is different about this lift from a typical facelift that you or some other surgeon may do?"


Finally, potential patients should not forget that the most important factor in the outcome of any facelift procedure is the quality of the plastic surgeon performing the procedure-not the name of the particular lift.

Labels: branded facelifts, facelift, mini facelift