Which type of facelift is right for me? [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
There's a lot of facelift buzzwords out there, full, lower, midface, SMAS, deep plane, short scar. What do we need to know about all of these different techniques if we're moving in this direction? How do those things affect the way that we choose a surgeon or decide what we think we need in that process?

Dr. O'Brien (00:21):
Yeah, I would say a lot of surgeons have a couple techniques probably they utilize, depending on what patients do. Some will probably do the same thing every time, but a lot of people will sort of look and say, Hey, this person needs more fat, or this person has a very full face, so I'm going to remove a little bit of fat along the way. And those are some of the different techniques that have to do with a layer of the tissue called the SMAS, SMAS, SMAS. And that's where things like the max lift and those types of things they're talking about how do you address that deeper layer, not the skin. And it's a layer with ligaments, with fat, those kinds of things. And surgeons adopt different techniques, whether it's their training, whether it's just what they see the best results with their own techniques.

Dr. O'Brien (01:09):
And so as long as somebody is addressing all the layers, you're probably getting a good operation. And so it's hard to get caught up with, or as a surgeon, it's tough to sort of hear people get really fixated on a specific technique when it may not be the right technique for them. And so that's where some of the education from during a consultation might come from. As far as short scar, again, that sort of depends on how much, often how much skin you have, whether you're a candidate. Some people, if you try to do a short scar, it all revolves around the incisions, around the ears that happen during a facelift and where they're placed. And depending on where your extra skin is, what the shape of your face is, all of those things. Some people are good candidates for short scars. Some people probably don't get as good a result if they really are insisting on a short scar just because it's tougher to work out the extra skin on that shorter distance. If somebody has a lot of, it may not be the right answer for them. So again, it just comes down to the education. And I think the most important thing is finding a surgeon who does a lot of these, who feels comfortable with them, and you can bring your questions about the different buzzwords or the different techniques and then just then see what they have to say about them in regards to your face.

Eva Sheie (02:30):
Where do you like to hide your incisions?

Dr. O'Brien (02:32):
Most commonly, especially if folks have a lot of extra neck skin, it does require an incision that goes back into the hairline, and that's where a lot of the neck skin is swept kind of behind the ear. And men versus women, there are different concerns. Obviously hair lines change differently between the two genders, and so we have those conversations. And then sometimes folks do need an incision under the chin. There's a little crease that most of us have between our chin button and where the neck skin begins. And if you've got muscle bands or things like that, I will sometimes make an incision under there to kind of address that area.

Eva Sheie (03:10):
How long does facelift surgery take? And then what does the day of surgery look like?

Dr. O'Brien (03:15):
So facelifts take a while. I typically, depending on what all needs to be done, somewhere between four and a half and five hours is a facelift. If you're doing eyelid surgery or something like that in conjunction, it obviously adds onto that. I typically do them first thing in the day because lots of little movements that happen. It's just a very fine, obviously, a fine procedure, fine motor procedure for me. And so I do 'em first thing in the day when I'm fresh and kind of cruise through, and then that gives everybody plenty of time to wake up after surgery and get home, get tucked in while the sun's still shining.

Eva Sheie (03:54):
Then when do you see them for the first time after surgery? Is it the next day or is it, yeah.

Dr. O'Brien (03:58):
The next day they come into the office, they have kind of a padded bandage around over everything, and so that comes off and then, yeah, there's some stitches that typically come out after a week. And then at the two week mark, any little surgical clips in the hairline come out and then people are ready to go at that point looking pretty good.

Eva Sheie (04:21):
Is the neck always included and improved when you do a facelift or is it separate and it's something that you think about in two different categories?

Dr. O'Brien (04:31):
So the neck is pretty much always addressed, even if it's not somebody's primary concern, there's usually some change there as well. Sometimes it is the primary concern, but sometimes it's not. But at all times it's a part of it. Sort of the vectors of pull and tension are a little different depending on what it is that, where the most laxity is or the most change needs to be seen. But it's pretty much always a combo.

Eva Sheie (04:57):
I don't think anyone would complain about their neck looking better.

Dr. O'Brien (05:01):
Not yet, nobody has.

Eva Sheie (05:04):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of the axis, the podcast agency for aesthetics, theaxis.io.