What Are the Indications of Lower Rhytidectomy?
To realign soft tissue, which has settled over time, and lessen the amount of extra skin present, rhytidectomy is just one of numerous therapeutic options offered to patients with aging. The type of facelift done will depend on the patient's specific anatomy and aesthetic concerns. To set realistic expectations for surgical outcomes, a complete evaluation of the skin's quality, rhytides, scars, fat descent and atrophy, and bone resorption must be made during the preoperative consultation. To ensure the patient and surgeon have the same expectations, facial analysis and photography must be taken with special care to document any facial asymmetries, irregularities in the contours, and hairlines.
What Are the Contraindications of Rhytidectomy?
Wound healing can be hampered by severe medical comorbidities such as type 2 diabetes, immune compromise, the need for steroids, bleeding diatheses, and connective tissue abnormalities. Because smoking negatively affects perfusion and is a significant risk factor for skin flap necrosis. Radiation therapy may have a similar impact, so intensive treatment of these individuals should be avoided. To ensure the best possible recuperation, it is advised that one should stop smoking at least 2 to 4 weeks before surgery and keep it up for a month thereafter.
Some patients may have a history of repeated severe sunburns combined with a predisposition to wound-healing issues. Given that hematoma formation is already one of the more frequent side effects following rhytidectomy, bleeding diatheses, the need for blood thinners and excessive blood pressure can be particularly problematic. Ideally, all prescription drugs and herbal supplements with anticoagulant qualities should be eliminated two weeks before surgery. Any psychiatric history must be evaluated before surgery to ascertain the patient's reasons for requesting surgery. Before considering surgery, patients with body dysmorphic disorder need to be assessed by licensed mental health experts.
What Are the Complications of Rhytidectomy?
Despite thorough preoperative optimization of medical comorbidities and meticulous intraoperative technique, problems in rhytidectomy are possible, as they are in any treatment. Similar to other aesthetic operations, the most frequent unfavorable result is dissatisfaction with the cosmetic results, which various problems, including scars, asymmetry, uneven contours, and an overdone or underdone appearance, can cause. Before surgery, the surgeon should establish a good relationship with the patient to guide them through any postoperative difficulties. This will not only increase patient satisfaction but may also lower the risk of litigation.
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Hematoma:
The most frequent consequence after rhytidectomy, with a reported incidence of 0.2 % to 8 %, is hemorrhage. Major and mild hematomas can both be classified. Major bleeding episodes with signs of subcutaneous mass, discomfort, and ecchymotic skin discoloration frequently happen within 24 hours of surgery; these necessitate surgical intervention to control the hemorrhage. If this happens in the neck, there may be an airway compromise, so the wound must be opened immediately. On the other hand, mild bleeding usually happens gradually and might be brought on by the subdermal plexus seeping. With careful observation and bedside drainage, these episodes are frequently manageable.
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Skin Necrosis:
This is frequently caused by concomitant diseases, including smoking and diabetes, and microvascular damage brought on by seroma or hematoma formation. The risk of skin necrosis will also increase if laser skin resurfaces on the lateral cheek while under the same anesthesia as the rhytidectomy. Eschar development can accompany partial or full-thickness dermis necrosis. Patients with partial-thickness necrosis exhibit desquamation and skin discoloration. With conservative wound treatment, this typically gets better and heals nicely without leaving scars. To increase perfusion, nitro paste or dimethylsulfoxide (DMSO) may be utilized. Full-thickness necrosis will require additional treatment and may prolong the healing process with skin anomalies such as depigmentation, uneven contours, and scarring. Early debridement must be avoided so that wounds can fully manifest themselves.
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Nerve Injury:
Nerve injury has a documented incidence of 0.7 % to 2.5 %, and the best way to prevent it is to understand the relevant anatomy and use careful surgical methods. When doing a face dissection, the surgical landmarks must be kept in mind. Nerves are frequently hurt by forceful retraction and electrocautery, especially when a vessel, such as the face or external jugular vein, is close to a nerve, the marginal mandibular or GAN, even though intraoperative nerve monitors can prevent nerve injuries. If a nerve is cut, rapid microsurgical epineural repair is advised if the injury is discovered during the operation.
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Surgical Site Infection:
Due to the face's abundant blood supply, cellulitis or abscess formation is fortunately a rare consequence. Gram-positive cocci, like Staphylococcus or Streptococcus, are the most prevalent cause of wound infections, and medications that target skin flora usually work to clear them up.
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Scarring:
Even though the incisions used for facelifts are frequently long, their postoperative look can typically be minimized with proper placement. Fortunately, scars are rarely evident in the postauricular region, where they frequently enlarge due to excessive stress during closure. Treatment options for wide, colored, or erythematous scars in the preauricular region include laser resurfacing, steroid injections, and maybe hydroquinone. Avoiding sunlight for the first 12 months following surgery will also aid in minimizing visible scarring. After six to twelve months, silicone sheeting or surgical revision may also help hypertrophic or keloid scars.
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Alopecia:
This is frequently brought on by cutting into the hair follicles, forceful electrocautery, or closure under too much strain. The appearance of the scar may be reduced by beveling the scalpel blade during the incision, either parallel or perpendicular to the hair follicles. The likelihood of post-surgical telogen effluvium, which causes generalized hair loss three months following surgery, should also be discussed with patients by surgeons.
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First Bite Syndrome:
This has been observed after deep plane rhytidectomy, and it could be the result of injury to the postganglionic parasympathetic nerve cells that supply the parotid gland, as could also happen after deep lobe parotidectomy or surgery in the parapharyngeal area.
Conclusion
One of the main methods surgeons use to address the impacts of aging on the face is the rhytidectomy surgery. It is preferable to approach it as an elective aesthetic operation with a coordinated healthcare team to get the best results. Postoperative satisfaction can be increased with communication that emphasizes defining the patient's aesthetic objectives and establishing reasonable expectations. Before the surgery, risk factors for problems should be carefully reduced.
