Dr. Sasaki Answers Commonly-Asked Questions

1. When can I exercise after a facelift and/or neck lift procedure?

Facelift and neck lift rejuvenation procedures require appropriate identification of deformities prior their restoration to obtain a natural aesthetic appearance that will be appropriate to the patient’s age. In general, face and neck lifts are indicated for patients with advanced signs of aging. These composite lifts adjust at least three major tissues that gradually result in deepening facial folds, full jowls, wasting and descension of the midface fat, prominence of the platysmal muscle neck bands, and redundancy of skin folds. Depending on the surgical requirements and planned techniques, face and/or neck lift surgeries are artistically challenging because they may require a number of procedures including suspension of the cheek fat pad and/or fat grafting to the deficient midface fat, directional tightening of the muscular planes, and lifting of the face and neck skin. The use of temporary external wrap-dressings or drains are at the surgeon’s discretion and judgement at surgery. Plastic surgeons will always incorporate permanent sutures to secure the transposed deeper muscular planes and both absorbing and permanent sutures to approximate skin edges under minimal tension for a seamless scar.

Dr. Sasaki’s Personal Aftercare Protocol

For over 30 years, my preference has been to avoid any external dressing in the postoperative period, whenever possible. My rationale is that the presence of external dressings 1) conceals any clinically significant collections of fluid or hematomas that may require evacuation, 2) provides insufficient external compression pressure or constraints of movement, and 3) reduces the opportunity for showering and shampooing. Infections along the suture lines are effectively controlled by 1) daily washes with soap and water, 2) topical application of antibiotic creams, and 3) oral antibiotics for a few days. Surgeons may not prescribe oral antibiotics because of 1) lack of evidence-based data for prevention of infections, and 2) reduce the occurrence of antibiotic-resistant bacteria. In neck lifts, I insert one drain that is removed by the 3^rd day after surgery. When possible, I recommend that my patients shower and shampoo the day after surgery for hygienic purposes. The benefit of a drain is to collapse the tissue planes under negative pressure to reduce the accumulation of normal fluid collection (seroma).

Effective management of tissue bleeding and oozing is controlled at surgery. My patients may sleep or sit in any position after surgery. They may resume their usual diets within a few days. Permanent skin sutures are removed by the 10^th day after surgery.

In the first 1-2 weeks, physical activity should be limited to an activity level that is experienced while “walking their dogs.” Since my patients usually experience minimal postoperative pain, they will take only extra-strength Tylenol for a few days. Patients may safely drive within a week when they are physically and emotionally stable and have stopped taking stronger pain medication that may alter reflexes. Prior to that time, a family member or friend is asked to transport the patient to the office.

Uncomplicated healing of the composite tissue planes occurs between three weeks after surgery. Since scar-maturity and stable tissue planes are usually observed by the second and third month, a gradual return to full activity is recommended. Your surgeon will advise you when and how you resume your individualized exercise and activity programs.

2. When should you consider a facelift and/or neck lift?

Facelifts and/or neck lifts are elective procedures. You may express dissatisfaction with your appearance and feel ready for an aesthetic procedure because of your perception or actual observations in the mirror, comments from family or friends, or pressures in the workforce or at home. Plastic surgeons are specialist who are trained to obtain a careful and detailed preoperative analysis in order to formulate a critical, logical and effective operative strategy to correct specific anatomic derangements to achieve consistent and reliable results. Whether it is an isolated deformity in a younger patient or a number of tissue changes in an older patient, your surgeon will help you determine the actual degree of the deformities and how they impact other adjacent structures. It is reasonable to consider having a face or neck lift procedure when these aged findings are significant and affect your well-being and can be realistically accomplished with a natural, aesthetic, and age-appropriate outcome.

3. How much does a facelift and/or neck lift cost?

The cost of a facelift and/or neck lift is based on the complexity of the procedure that is necessary to correct the aged anatomical demands.

4. What is a Silhouette InstaLift™?

Silhouette InstaLift™ represents one of a number of “threading” techniques available to lift facial and neck tissues. The original suture system was designed in the 1990’s as a single nonabsorbable nylon suture that strung a number of absorbable “cog-like cups, facing in the same direction along a section of the suture. The fact that each cog faced in one direction meant that the suture system be passed in only one direction. This original suture was retired from clinical use within 10 years.

At an International Plastic Surgery Meeting in Paris 2017, I was invited to participate in the clinical usage of the newly designed Silhouette InstaLift™ Suture System because of my experience with threading suture techniques since 1995. The current suture system is composed entirely of absorbable material for the suture and the cogs. Two groups of 4-6 cogs faced in opposite directions to hold and elevate the subcutaneous tissue between them. A number of suture systems were positioned at the middle of the subcutaneous fat layer at strategic locations in the face and neck. This system, like other available threading systems, are designed to be used as a closed technique. This means that needles and their attached suture are passed through the skin, within the fat layer, and exiting the skin without a face and/or neck lift exposure. My investigations with the Silhouette InstaLift™ System were focused on the safety and effectiveness of these sutures during “closed” procedures and “open” exposures in face and/or neck lifts.

“Threading” procedures have been developed over 20 years and consist of either absorbable or permanent sutures designed with fixation points of cogs, knots, and barbs and patches. Sutures may be designed for usage as a single linear thread or looped thread. Procedures involve the use of one or more of these sutures to secure the subcutaneous fat. Needless to say, one of the limitations with all suture systems is that the soft subcutaneous fat is the structure used for suture fixation and stabilization. In surgery, the more resistant tissues such as skin or muscle layers are more effective for directional mobilization and fixation. Thus, the effectiveness of threading techniques may be variable and dependent on 1) the thickness, firmness, and distribution of the fatty tissue, and 2) the degree of sagging of skin, fat and muscle, 3) the number of threads and their strategic placement.

In conclusion, “threading” techniques are a part of the number of techniques that a plastic surgeon has available for optimal rejuvenation of the face and neck in primarily younger patients that require a modest repositioning of soft tissues. Ideal candidates should possess a sufficient layer of subcutaneous fat. Poor candidates include patients with minimal fat or too much fat to be effectively suspended by sutures and demonstrate advanced drooping of skin and muscle layers. I continue to used my original Gore-TEX™ looped knotted permanent suture system that was developed in 1995. The system has been used as a “closed” or “opened” technique in over 1000 cases successfully in part because it is sutured to a stable structure rather than floating within the fatty soft tissue.

5. How do you perform a Vampire Facelift?

The Vampire Facelift is a catchy but not optimal technique as red blood cells are not removed from Platelet-rich Plasma (PRP). For the past seven years, I have been a consultant to PRP device companies involved in a number of institutional Review Board Studies for skin rejuvenation.

Platelet particles are normally pinched off a larger cell (megakaryocyte) in our bone marrow, have a normal circulating life span of 8-9 days, and are vital components in the clotting process. Platelets contain a number of different granules that house subcellular protein factors such as growth factors, cytokines and adhesive proteins that communicate and influence other cells to increase blood flow, modulate inflammation and immune-responses, and orchestrate cellular processes that stimulate growth and differentiation of adjacent cells. Clinical researchers and clinicians emphasize that optimal preparations of PRP need to be characterized on the basis of 1) adequate dose of platelet particles, 2) efficiency of platelet yield (˃80%) , 3) purity of product devoid of inflammatory red blood cells and certain white blood cells, and 4) non-activation status of prepared platelets to ensure gradual release its growth factors and other active peptids.

Since platelet particles have a diameter about 2µ, they must penetrate through the skin’s outer (epidermis) and inner layer (dermis) in order to be effective when growth factors are released for rejuvenating effects. Procedures that reduce the skin’s barrier system include microdermabrasion, chemical peels, laser resurfacing, and microneedling to enable passage of the platelet particles. The Federal Drug Administration (FDA) regulates production and usage of biologic products such as PRP. As such, PRP are processed and used under medical practices and research centers for patient and physician safety, limiting transmission of infections, and providing conditions for optimal results.

Dr. Sasaki’s PRP Microneedling Protocol

1. Sterile technique practiced by medical staff and surgeon
2. Patients are monitored and treated in a certified AAAASF operating room
3. Phlebotomy to collect whole blood for preparation of amber-colored PRP with minimal presence of red blood cells, white blood cells, and contaminants
4. Patient’s skin is prepped with an antibacterial solution
5. Microneedling is performed at each anatomic region in order to massage PRP into channels before their closure after one hour
6. The number of passes and selection of needle depths are determined for optimal results
7. Gentle soap washes for 24 hours with resumption of skin care after 48 hours
8. Repeat PRP treatments after 3-6 months, as indicated

To learn more about these procedures, contact our office in Pasadena using the online form or call us directly at (626) 268-4524 to schedule an appointment.