Facial plastic surgery and smoking do not mix. First and foremost, smokers have compromised healing due to the effects of nicotine and the hundreds of cancer-causing chemicals found in a single cigarette stick.
While instructions about complete cessation of tobacco products may differ from surgeon to surgeon, the consensus is that three weeks is enough to flush out most of their detrimental effects.
Tobacco products contain nicotine, which is a strong vasoconstrictor, i.e., it causes blood vessels to constrict therefore the nutrient- and oxygen-rich blood flows less efficiently. Ultimately, it takes a longer time for the patients to heal and they become more susceptible to infection and skin necrosis in which the tissue turns black and dies due to lack of oxygen.
Facelift for smokers is particularly risky. In this procedure doctors create skin flaps, which are healthy tissue that is partly detached and moved to create a tighter, more youthful appearance.
But with constricted blood vessels these skin flaps may not receive enough oxygen and nutrients and ultimately “die.” For this reason smokers are more likely to have revisions than non-smokers after facial plastic surgery to address poor scarring.
Also, smoking defeats the inherent purpose of facelift, i.e., to achieve a more youthful appearance, because it significantly accelerates the skin’s aging rate.
Smoking also has detrimental effects on patients having rhinoplasty, or more commonly referred to as nose job. According to California Surgical Institute website, because of the delay healing the grafts and the underlying anatomies of the nose are susceptible to injuries for a longer period of time.
After about two weeks, the grafts and the new contour created by rhinoplasty are more “stable.” But in smokers, the healing process occurs at a much slower pace that they are at an increased risk of inadvertent shifting of the bones due to trauma.
Coughing episode is another common issue with smokers since tobacco disturbs the lining of the lungs and bronchi.
It is important to note that coughing episodes could lead to hematoma (internal bleeding) and persistent swelling, further complicating the patient’s recovery.
Furthermore, a 2005 study has suggested that smokers require 23 percent more pain medications after an operation, and 33 percent more anesthesia during surgery than non-smokers.
There are several neck lift options due to varying anatomies and underlying cause/s of the problem. For instance, some patients are concerned about the appearance of neck bands in which excess fat may be culprit, while others have “turkey wattle” that is typically caused by weak or splayed platysma muscle.
A comprehensive physical is always necessary to determine the best course of action. And during consultation, the patient must also share her motives and cosmetic problems, allowing the surgeon to explain and offer methods that can improve her appearance.
Before-and-After Photos of a Patient Who Have Had Neck Lift Surgery
Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, explains the three most popular neck lift options, which are occasionally performed simultaneously to achieve the best result possible:
1. Double chin and neck band appearance. If these are caused by excess fat beneath the skin, minimal liposuction can create a smoother, more rejuvenated neck contour.
A small round incision, about 1 cm in diameter, is positioned beneath the chin where a microcannula or hollowed tube is used to suction out the fat. However, it is crucial to preserve some fatty cells to maintain the natural contours of the lower face and anticipate soft tissue shrinkage that tends to progress with advancing age.
Over-aggressive liposuction must be avoided at all cost because the platysma muscle in the neck will become prominently visible beneath the skin—immediately after surgery or years afterwards—further contributing to the aged appearance.
2. Loose skin in the neck and jowling. A direct skin excision is needed to contour the lower portion of the face; this is generally accomplished by placing incisions around the ear’s contour that may sometimes reach the nape to achieve more rejuvenating effects.
Oftentimes, this excision-based neck lift is combined with standard facelift in which the incision starts from the temple behind the hairline that curves down and behind the ear, or even the nape if the neck requires contouring as well.
Proper wound closure is imperative to prevent scar migration and poor healing.
3. Weak platysma muscle. Sometimes, the vertical muscle in the neck that has become splayed causes the sagging appearance. To address this problem, a small incision beneath the chin is used to reshape or sometimes even remove a tiny portion of the muscle.
Patients with thin skin and very little fat may choose a non-surgical alternative in the form of Botox, which can be done in 15 minutes.
Plastic surgery for men must take into consideration certain factors such as the masculine beauty ideal, underlying anatomies like skin thickness, ethnicity, and personal goals of each patient.
Inland Empire plastic surgery expert Dr. Tarick Smaili explains what makes plastic surgery for men different from women’s.
(Photo credit: imagerymajestic at FreeDigitalPhotos.net
In facial rejuvenation surgeries such as facelift and brow lift, surgeons follow certain guidelines. For instance, men generally require a more conservative approach than women—i.e., minimal lifting of the forehead area and less work on the lower face—to preserve their masculine appearance.
An over-aggressive brow lift often results in effeminate appearance (high and more arched eyebrow) instead of a masculine brow, which appears lower and “heavier” than women’s.
The same rule applies to body contouring surgeries for men, such as liposuction and pec implants, in which the goal is to recreate the ideal masculine silhouette, or the V-shaped, athletic-looking body.
Men’s skin is generally thicker and more vascularized (more blood vessels), so they are more prone to hematoma or pooling of blood under the skin than women. For this reason, proper dissection is more important than ever when treating male patients during facelift, brow lift, and rhinoplasty (nose job).
To minimize bleeding at the time of surgery and postop hematoma, all patients are required to avoid blood thinners (aspirin and aspirin like products), certain herbal supplements, and tobacco products a few weeks before and after surgery.
Aside from gender-appropriate results, plastic surgery for men must also respect the patient’s ethnicity and his cultural based standard of beauty. This is particularly true of rhinoplasty, eyelid surgery, and other procedures that involve ethnically sensitive areas of the face.
It is important to note that what works for Caucasian patients do not always apply to people of Hispanic, Asian, and African background.
Cosmetic plastic surgery is a highly individualized procedure in which the goal is to make the patient’s happy and possibly improve his body image and self-esteem. For this reason, good communications are of paramount importance to achieve satisfying results.
Meanwhile, anyone who exhibits signs of body dysmorphic disorder, schizophrenia, and other mental issues is a poor candidate for any type of elective surgery.
Plastic surgeries are generally reserved for well-rounded and emotionally stable patients who know how to make an informed decision.
Plastic surgery alternatives offer some benefits such as no or minimal downtime, lower cost, and fewer side effects, as opposed to “nip and tuck” procedures that require more commitment and longer recovery.
The list below explains some of the possible plastic surgery alternatives; however, most of them cannot replicate the exact effects achieved by the “real thing.”
Photo credit: botoxcosmetic.com
* Facelift alternatives. Perhaps Botox is one of the most commonly used non-surgical facial rejuvenation procedures. This injectable drug paralyzes the muscles responsible for the sagging appearance or dynamic wrinkles caused by repetitive facial expression.
Dermal filler injection is another good alternative. It works by plumping up the hollowed skin caused by loss of facial fat or soft tissue atrophy or shrinkage.
Other possible facelift alternatives include medical-grade chemical peels, Thermage, and laser skin resurfacing.
However, these aforementioned treatments provide little to no improvement if there is significant tissue laxity or redundant skin, problems that only a “real” facelift can address, as suggested by Los Angeles plastic surgery experts.
Facelift surgery uses incisions within the ear’s contour and/or behind the hairline (so the scars remain hidden), allowing the surgeons to trim any excess skin and tighten the underlying facial muscles. As a result, its effects can last up to 10 years, as opposed to several months in injectable treatments.
* Liposuction alternatives. Non-surgical alternatives often use laser or ultrasonic waves to penetrate the skin and “liquefy” the fats, which the body will gradually flush out, a process that could take several weeks to months.
Meanwhile, liposuction surgery uses a few incisions measuring 1/4 to 1/8 of an inch, which further contract as they heal that after about a year they are difficult, if not impossible, to detect.
Liposuction is ideal for treating a large surface area, while its non-surgical alternatives are only suitable for limited contouring. Simply put, having surgery is the only way to achieve dramatic improvements.
* Tummy tuck alternatives. A combo procedure that involves non surgical laser liposuction and Thermage—which uses radiofrequency that is known to promote new collagen growth, thus leading to a tighter, smoother skin—might provide good results to patients who require minimal correction.
But as with any non-surgical alternative, the combo procedure is only suitable for patients with very little loose skin. Anyone with a redundant skin can only benefit from tummy tuck, which typically uses a hip-to-hip incision within the lower abdomen and just above the pubic area to hide the scar.
Because tummy tuck involves a large flap of skin, it is only reserved for healthy individuals with no healing problems.
Several variables will determine the ideal neck lift procedure. Nevertheless, it remains imperative to place the scars behind the ears (specifically within the natural skin folds) and/or beneath the chin to hide the surgical stigmata.
Dr. Karan Dhir, one of the leading Beverly Hills plastic surgery experts, has provided simple explanations of the different techniques used in neck lift.
before-and-after photos of a neck lift patient
- Standard technique. In general, it aims to correct the turkey wattle appearance by making around 3 cm incision beneath the chin (and possibly behind the ear if there is some excess skin as well). The idea is to access the muscle called platysma, which is responsible for the sagging neck.
Because the goal is to achieve a smooth right angle under the chin, many patients will need their muscles to be sutured across the midline in what doctors refer to as a “corset approach.”
But for a few patients, cutting or removing some muscle might be indicated to achieve good results from neck lift.
- Skin lift. To remove the excess skin, incisions behind the ears are also needed. Nevertheless, it remains important to tighten and reposition the underlying structure such as the deep muscle and superficial fat to achieve long-lasting results and prevent tension on the wound, which is known to cause poor scarring.
In general, a skin-only lift is not practical because without reshaping the deeper structures the skin will only relax and sag over time.
- As a stand-alone procedure it is rarely performed in older patients because they generally have poor skin elasticity. To achieve good contour, platysma muscle tightening and skin excision are commonly used as well.
Through a small incision beneath the chin (and sometimes behind the ears), doctors are able to correct the double chin appearance. However, it is imperative to leave some fat to cover and hide the underlying muscle.
With over-liposuction, the muscle might show, leading to unnatural results and/or more aged appearance. For this reason, most surgeons will only remove a conservative amount of fat to anticipate further tissue atrophy (or volume loss) caused by aging.
A good number of neck lift patients can benefit from facelift that is performed simultaneously with their surgery. The idea is to achieve a smooth transition between the mid face and neck area, leading to a more rejuvenated countenance.
Other common ancillary procedures include Botox injection, dermal fillers, fat grafting, rhinoplasty (nose job), and chin augmentation via implants.