OBJECTIVES: Historically facelift procedures are performed in hospital settings owing to the nature of invasiveness and complexity of the surgery. However, with the normalization of outpatient surgery and surgery center procedures, many patients are looking for a surgery experience away from the hospital. This growth trend is most popular among the liposuction procedures, but more recently has grown to include the facelift population. Our experience in AAAASF surgical facilities performing deep plane facelifts with tumescent anesthesia over the past 2 years and over 100 patients demonstrates that such complex procedures can be performed safely with excellent outcomes and may be the model for the future.
METHODS: Procedures were performed in AAAASF Class A facility under local anesthesia with oral valium and oxycodone for anxiolytic and narcotic control with supplementation by tumescent local solution which includes epinephrine and lidocaine. All patients were screened by the medical team for acceptable level of care within the AAAASF facility by blood pressure assessment and ASA class. Patients were instructed to stop aspirin at least 2 weeks prior to surgery and were administered intravenous antibiotics on the day of the procedure. All patients were allowed to eat and drink their normal meals, including right up to the time of the procedure. All patients were discharged 30 minutes after the end of the procedure.
RESULTS: 100 patients, 91 women and 9 men with the average age of 62 years old underwent deep plane facelift surgery between January 1 2021 and December 31 2022. Complications included 1 hematoma and 5 soft tissue wound infections all of which were managed with wound care and antibiotics. 3 patients had soft tissue ischemia at wound edges which were treated with local wound care and resolved spontaneously. 3 patients had transitory nerve palsy of the depressor angularis oris which resolved with conservative care.
CONCLUSIONS: Deep plane facelift surgery remains the pinnacle of facial rejuvenation based on complexity and technical challenge of surgical intervention.1 Currently only 5% of plastic surgeons who perform facelift do so with the deep plane technique. The major concern appropriately is avoiding facial nerve injury.2 However, our experience demonstrates that the awake patient can provide important and valuable feedback during surgery as facial motor nerves have sensory afferent fibers which enable the patient to share real time information about pain sensation despite adequate local anesthetic. This allows for increased tactile response during surgical release of retaining ligaments.3 Deep plane facelift surgery under tumescent anesthesia may not only be more desirable for the patients but may also allow for augmented feedback for nerve injury avoidance.
References:
1. Jacono AA, Bryant LM, Alemi AS. Optimal Facelift Vector and its Relation to Zygomaticus Major Orientation. Aesthet Surg J. Mar 23 2020;40(4):351-356. doi:10.1093/asj/sjz114
2. Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg. Jun 2004;113(7):2124-41; discussion 2142-4. doi:10.1097/01.prs.0000122410.19952.e7
3. Cakmak O, Emre I. Modified Composite Plane Facelift with Extended Neck Dissection. Facial Plast Surg. Dec 2022;38(6):584-592. doi:10.1055/a-1862-9024