Enhanced Facelift Rhytidectomy with SMAS

Larry Weinstein, MD FACS, Chief Plastic Surgery, Chester Surgery Center, USA
Abstract

A retrospective review of 218 patients had rhytidectomy with SMAS . Average age 55 over 18 years range of 43 to 83. From 1992 to 2004 average age was 49, In 2017, average age 62. 60 % of patients are done under local with conscious sedation, 40 % under general anesthesia. Patients take Valium 10mg, Emend a long acting antinausea medication and an antibiotic orally with a sip of water 1 hour prior to procedure. 0.5% lidocaine with epi injected to incision lines and fatty areas. 10 minutes elapses while a TCA peel, filler and/or Botox are administered. Skin painted betadine, the hair and ears are soaked with Betadine. Hair is slicked back with Bacitracin ointment . The angle of the head rest is raised to an acute angle to flex the neck as much as possible. Orbicularis oris muscle fascia is grasped with a forceps and a 3-0 ethibond is placed as a suspension suture to the anterior SMAS. Platysma muscle is suspended to the mastoid fascia with a 3-0 Ethibond suture. A 2-0 PDO Quill is placed over the 3-0 Ethibonds and SMAS to bury the Ethibond suture. Any irregularities are trimmed . 3-0 Monocryl subcuticular. Bacitracin is applied to the wounds, gauze and Kerlex Barton’s dressing. Results: There was no postoperative nausea or vomiting. Tylenol postoperatively PRN. Patients had Tylenol PM at night and 5mg Valium for anxiety or tightness. Two small hematomas evacuated with a syringe during a postoperative visit. A seroma over the parotid gland required syringe aspirations till resolved. 3 pixie ears were noted with long term follow up. All patients with conscious sedation reported an excellent operative experience on a post-procedure questionnaire. Conclusion: Emend may help prevent postoperative nausea and vomiting. The 2-0 PDO quill may help SMAS elevation and prevent exposure of permanent Ethibond suture. Elevating the head rest can help elevate the SMAS and skin under no tension intraoperatively .

Biography

LARRY P. WEINSTEIN, M.D., FACS Diplomat American Board Plastic Surgery , Fellow American College Surgeons , SUNY(Brooklyn) Plastic Surgery Clinical Instructor. Attending Plastic Surgeon Morristown Medical Center. Third Prize 1988, Plastic Surgery Educational Foundation Scholarship Contest September 1989, ACS/Volunteer Leadership Award, March 1993, Award Northwest NJ Regional Woman’s Center Centenary College. Alfred Cohen Research Award BVAMC,. In May 2005, American Chinese Medical Association NJ “Plastic Surgery & Facial Rejuvenation”, The ASERF In Chul Song Award-Philanthropic Efforts and Humanitarian, 2012, Madison HS wall of Distinction NYC City Council Citation April 27, 2014, MtFJC Honoree March 10, Plastic Surgery missions India 25 times since 1993.

Posted in Uncategorized on November 21st, 2019

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