Preoperative and Postoperative Plan

8.1 Plan for Facelift Surgery

1.Preoperative Assessment

During the initial visit, a consultation form is created by the authors and is used to thoroughly address each point of the first encounter with our client (Table 8.1).

2.Assessment of the Degree of Suitability for Surgery Once the initial consultation has been performed, the patient’s degree of suitability for surgery is assessed. Patients lie within one of three categories:

(A)Not suitable

(B)Suitable, once certain conditions have been met

(C)Suitable

3.Assessment of the Biological Suitability for Surgery Various preoperative tests need to be performed in order that patients can safely undergo surgery. This list serves as an example of which tests may be requested preoperatively as each client will have different tests depending on their individual medical history [1–3].

Baseline Study

(A)Blood tests, such as kidney function, hemoglobin, and clotting factors

(B)Urinalysis

(C)Electrocardiogram

(D)Report from general practitioner or family doctor

A. Erian ( ) and B. Pocock

Pear Tree Cottage, Cambridge Road,

Wimpole 43, SG8 5QD Cambridge, United Kingdom e-mail: plasticsurgeon@anthonyerian.com

4.Analysis of Anatomy

During this stage of the assessment, the patient’s face is analyzed in detail, with the aid of photography. Particular note is made of deficiencies, asymmetries, and abnormalities such as scars. Preoperative photography is valuable in further defining this facial assessment, as well as being extremely useful for medicolegal purposes [4–6]. As well as the photographs, notes are made in the patient’s chart on standard diagrams (Fig. 8.1).

5.Discussion of Surgery

For those patients felt to be suitable for surgery, a full consultation is conducted and the patient is asked what exactly is bothering them with their face and after we agree in principle on the procedure, whether it is surgical or nonsurgical, the procedure is discussed in detail together with the possible complications and show them some examples of preand postoperative cases of similar age and deformity for them to get an idea of the likely outcome of surgery [7–10]. The mental state is assessed, as the authors consider patients not suitable if:

(A)They have unrealistic expectations of surgery.

(B)Suffer from any mental condition, whether it is depression or body dismorphophobia or a body image problem, they should be excluded from surgery.

(C)Very aggressive patients who seem angry about something not related to the surgery.

(D)The deformity is so minute and the patient magnifies its significance and its magnitude. Remember, a millimeter on the face is a mile on the brain in the thinking of those patients.

(E)Patients with relationship difficulties and depression must not undergo surgery until they are stable.

result of nicotine should be excluded and the surgeon should point out the increased risk of bleeding necrosis and infection [11].

(G)Patients with medical conditions that interfere with the anesthetics should be considered carefully and their medication should be reviewed by a physician prior to undergoing surgery [1, 3, 8].

(H)Patients with infectious diseases and sexually transmitted diseases are counseled carefully prior to surgery.

Careful examination is conducted in the presence of a chaperone to identify the clinical problems with the consent of the patient.

Further discussion is carried out. A copy of the consent is given to the patient and this is discussed in detail.

the minimum time to allow clients to reflect on surgery, the patient has time to read this copy of the consent, so that any remaining questions may be answered before the form is signed. As well as discussing consent, the type of anesthesia, the dressings, and the likely postoperative course are discussed.

8.2 Facelift Preoperative Instructions

Before surgery, patients receive a copy of the preoperative instructions. This allows patients to have time to read this information at least 2 weeks before surgery, as well as giving them time to follow the instructions.

Fig. 8.1 Standard diagram for patient analysis. 1 – Brow, 2 – peri-orbital (eye area), 3 – cheek, 4 – upper lip, 5 – chin and jowl area

Along with this, patients also receive a copy of the postoperative instructions and the consent form, so that they may be fully informed and prepared for the operation.

The authors have found that preoperative instructions are best presented in the form of a list. This allows patients to more easily understand the instructions, as they are able to go through the list item by item. As patients have a copy of this at hand, they may even use the list to check off items as they have understood and completed them.

Preoperative Instructions

(A)Your facelift will be performed under twilight anesthesia (intravenous sedation and injection of local anesthetic solution into the tissues). You will not have general anesthesia, and the twilight technique will allow for a speedier recovery. Because you will not have general anesthesia, you will not have many of the side effects such as a sore throat or significant nausea and vomiting. Though you will not remember, the intravenous sedation allows you to obey commands during the operation, which is important, for example, in turning your head.

Because the muscles are not completely paralyzed, the surgery is safer, since nerves can be tested and thereby are less likely to be injured. Due to the large amount of local anesthetic put into the tissues during the operation, there will be very little pain when waking up in the recovery room, and this also helps in a speedier recovery [1, 10, 12, 13].

(B)Please bring with you a pair of sunglasses, a headscarf, and/or a hat to wear upon discharge. This is for your comfort. In addition, plan to wear shirts that open at the front and do not require being pulled over your head [3, 14].

(C)Please do not wear any makeup, lotions, or creams on the day of your surgery. Wash your hair and face on the morning of the operation.

(D)Do not take aspirin or other medicines that may thin your blood, and thus lead to bleeding and bruising complications, for 1 week before your surgery. This includes vitamin E and other herbal/nonmedical preparations, as well as alcohol consumption, which can lead to excessive bruising and bleeding. Please ask the surgeon if you are unsure of what not to take. If you take medicines such as warfarin in order to thin your blood, please consult with the surgeon in order that this is managed properly [3, 15].

(E)Within the week before your operation, do not have you hair bleached, tinted, colored, or permed, as this may affect the skin on your scalp. You will be able to have your hair treated again 6 weeks after surgery, as fresh scars can be sensitive to chemicals used in treating hair.

(F)Do not have your hair cut before surgery. During surgery, your hair will not be cut, and will eventually cover the incisions of your operation. It may be better to have longer hair as this can cover up the scars. There will be postoperative instructions about when you will be able to wash your hair after the operation.

(G)Please write down any questions you may have thought about since the consultation and you will be able to ask these on the day of your operation.

(H)Please expect to stay in the hospital overnight and arrange for someone to pick you up the next day. You will not be able to drive, and a

responsible adult will need to come pick you up. For the first few days following surgery, it may be useful to have someone to help you with everyday activities.

(I)If you smoke, please avoid smoking for as long as possible, but for at least 2 weeks before the operation. The longer you give up smoking the better. Smoking reduces the amount of oxygen in the blood which is likely to cause problems with wound healing [11].

Postoperative Instructions

(A)You will experience swelling of the face, as well as some bruising which may extend into the neck and chest. This is normal and may take 2–3 weeks to disappear completely. Swelling may make your face feel tight. Over the first 3 days, you may apply ice packs (or bags of frozen vegetables, such as peas, covered with a cloth) to your cheeks for about 20 min every hour. Flannels kept in the fridge are also useful as they can be applied directly to the face [3, 14].

(B)Rarely, drains, which are small plastic tubes to allow fluid to escape from the surgery, may be placed at the time of surgery. These will be removed the day after surgery, before you go home [16].

(C)You will feel drowsy following surgery. It is normal to wake up and doze off during the first day.

(D)Eat a diet consisting of soft food for the first 3 days. You will find it difficult to eat food that requires much chewing. Soups and yoghurts are good examples of soft foods. Drinking fluids through a straw is useful as you do not have to open your mouth too widely.

(E)You may wash your hair 3 days after surgery. It is important that the incisions remain dry for 48 h. Do not have a bath for 1 week after surgery.

(F)You should avoid lying flat, and when sleeping, you should be propped up with several pillows. This helps reduce swelling, by allowing gravity to remove fluid from the face. You may, for example, try two pillows under the head and one under the shoulders.

(G)Limit your activities for 2 weeks after surgery, especially bending, straining, and lifting. During the first 2 weeks, activities such as light house

work and gentle walking are fine. Avoid excessive head-turning and any physical exertion. Movements such as these will place strain on the incisions and may cause them to stretch and widen. You may resume activities such as jogging 1 month after surgery [3, 14].

(H)You may return to work when you feel able, though many people allow 2 weeks as most of the bruising and swelling will have disappeared by then.

(I)Please take any medicine that has been prescribed, such as pain killers. If you should have pain that is not relived by the pain killers, please call the surgeon. Do not take aspirin or other medicines that may thin your blood or cause bruising for 1 week after surgery.

(J)The day after surgery, before you are discharged to go home, the surgeon will change your dressings and check the incisions. After you go home, you may remove the dressings in 3 days [17] (Fig. 8.2).

(K)If you should see bleeding coming through the bandages, please call immediately. You will be given the phone numbers of the surgeon, the

Fig. 8.2 Postoperative bandage