Villar Plastic Surgery

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FACIALS, BOTOX & FILLERS with Dr Villar
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A MACGYVER FACELIFT MADE MY DAY

A HEALTHY 50 yr old woman presented for a facelift complaining of an accentuated roll when she looked slightly down. No previous surgery. Thin and excellent health.

Examination revealed a horseshoe dense crease from one cheek, under the chin, and into the opposite cheek. It was densely adhered to the underlying muscle. Very unusual!

There was an asymmetrical roll of fat, worse on the left than the right. This was tethered to a dense crease in her neck just above the thyroid.

On an otherwise thin neck and face, these two points of fixation caused a dramatic bunching up of the skin and fat in a downward gaze.

This was an interesting challenge with a high chance of disappointment FOR PATIENT AND SURGEON.. We would have to MacGyver this one, and my only hope was that her young elastic skin would be forgiving to my improvisation.

Cosmetic and reconstructive surgery are essentially engineering problems, of form and function.

It became obvious that we had to release the points of fixation. Under the chin was a simple excision and release. But the cheeks were over branches of the submandibular nerve and an excision scar could not be hidden. If the entire horse shoe fixation was excised, it would contract and worsen the deformity. It had to be broken up.

The face had been injected with Marcaine with epinephrine and TXA (tranexamic acid) prior to prepping and draping. This allows time for vasoconstriction of the blood vessels due to the epinephrine. TXA counters the bodies release of natural blood clotting dissolvers (fibrinolytics). This diminishes bleeding and bruising.

To release the cheek adhesions without incisions, we used an 18 gauge needle. The skin is punctured and the needle tip is swung back and forth as a knife cutting the attaching fibers from the muscle fascia with a crunchy sound.

After dealing with the horse shoe fixations, we started the face lift. The skin and subcutaneous fat was lifted off the muscle fascia of the cheeks and neck.

The redundant fat was scissor dissected to an appropriate thickness, then the remaining fat is sucked off the muscle fascia with a flat spatula lipo cannula facing down only, to avoid dimpling of the skin.

It was noticed that there was an unusual amount of fat under the platysma muscle accounting for the majority of the roll deformity. A thin harvester cannula was used to remove and sculpture the neck under the muscle. Removing too much fat under the muscle in the midline can be a disaster!

The neck adhesions had been removed when the neck was dissected across the midline removing the deep creases as well. Deep neck creases are improved by releasing their dense attachments to the Platysma.

The neck muscle was then pulled laterally with absorbable sutures to optimize the neck angle. A SMAS plication was then performed with permanent sutures to pull back the jowls at the muscle level, and this was extended down securing the neck.

Every facelift is different, and you have to think on your feet to draw from experience and intuition. After all surgeries there are the variation and unpredictability of the patient’s healing genetics. Great surgery can heal badly, and bad surgery can heal miraculously? That is why I wake up every day, excited to get to work in the never ending quest for “a better way”

The excess skin was then marked, trimmed and sutured. Care is taken not to pull it upward creating an oriental deformity of the eyelids. Jokingly called the BOCA face-lift.

Tiny 7 French drains are placed bilaterally with bulb suction. This creates negative pressure in the wound, sucking the tissues together, and decreasing the chance of bleeding. If bleeding occurs, it is sucked out.

If a patient calls at night complaining of pain on medications, I go to their home to check them. Facelifts should not hurt, so they probably have a hematoma (blood pooling under the skin). This should be addressed immediately.

All patients are checked the next day to identify and nick problems in the bud.

In this case, I was amazed by the result. It was like hitting a baseball out of the park with your mom and dad watching! Euphoria.

Similar to the feeling I had when Trump won the election and saved America.

So I stopped at Douglas GA to spend the night and visit Tom Reilly who was standing on the tarmack waiting. Tom trained me in aircraft restoration and signed off all my work.

we stopped by his hangar where he is doing work on a B-17. in the main hangar is the B-17 being built for the owner of NAPA auto parts. waiting for Marina to catch up in two hours.