November 22, 1999

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Local people share their experiences

Tips for selecting a plastic surgeon

By MEG H. PARTINGTON / Staff Writer

Plastic surgeons are being asked to turn back time by changing the faces their patients show the world.


The generation before the baby boomers is more inclined to have full face-lifts, says Dr. Donald W. Kress, founder and director of lan Plastic Surgery Center in Frederick, Md. The boomers, however, are saying, "I don't want to age, fix it. They're asking us to stop the aging process," he says, and are requesting less drastic procedures on their eyelids and foreheads.

cont. from lifestyle

The top things that affect aging are smoking, sun exposure and heredity, says Kress, who is certified by American Board of Plastic Surgery.

"The clock goes back anywhere from seven to 12 years but the clock doesn't stop," says Dr. Salvatore DiMercurio, a plastic surgeon at Plastic Surgery and Hand Center in Hagerstown.

The full lift

Complete face-lifts yield the most dramatic results because people's attractive features are unearthed from damaged and excess skin, DiMercurio says.

"The majority of people do want the entire face lifted," says DiMercurio, a board-certified member of American Society of Plastic and Reconstructive Surgeons Inc.

The procedure, which takes two to four hours to complete, generally involves making incisions behind the hairline of the temple, continuing along the front edge of the ear, wrapping around and finishing in the hairline behind the ear.

After the incisions are made, the skin is lifted part of the way across the face to expose the tougher underlayer, Kress explains. That layer is tightened and fat deposits in areas such as under the chin can be removed with suction.

Next, the skin is pulled back into place and trimmed. Small drains, which remove blood, serum and fluid to reduce swelling, bruising and the risk of infection, are placed beneath the cuts, which are then sutured. The drains generally are left in for 24 hours.

Smaller procedures

Sometimes only parts of the face need to be altered to shave off some years.

"Eyes probably are the focus of the face" and therefore have the most effect on a person's appearance, DiMercurio says.

With eyelid surgery, fat, damaged skin and muscle can be removed from the upper and lower eyelids in about an hour. Eyeliner also can be tattooed onto the eyelids so a woman doesn't ever have to apply it again.

Lifting the forehead can remove the look of perpetual exhaustion, DiMercurio says. The procedure involves removal of excess skin from the forehead.

Other options are what Kress calls mini surgeries, which take about an hour to complete. They include temporal lifts, which focus on the eyebrow and temple areas, and upper mini lifts, which focus on the cheek area and parts of the eyelid. There also are S-lifts, which can correct heaviness and sagging along the jaw, and G-sutures, which improve the angle of the neck without removing any skin. Neck lifts are meant to get rid of loose and sagging skin on the neck.

Good candidates

Men and women in good health whose faces and necks have begun to sag but whose skin still has some elasticity are good candidates for face-lifts, according to American Society of Plastic and Reconstructive Surgeons.

Advise your surgeon about medical conditions that could cause problems during or after surgery, including uncontrolled high blood pressure, blood-clotting problems or the tendency to form excessive scars, the society recommends. Tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

Patients also should have realistic expectations, Kress says. Crooked smiles and uneven eyebrows will not be changed by a face-lift, he says.

After the surgery

There will be some swelling or bruising for eight to 10 days after the procedure, Kress says. He recommends sleeping on extra pillows and applying heat and ice as directed by a surgeon.

According to the society, complications that can occur include hematoma - a collection of blood under the skin that must be removed by a surgeon, injury to the nerves that control facial muscles, infection and reactions to anesthesia.

Smokers have more problems with scars and healing, Kress says.

A price to pay

DiMercurio advises those interested in having their faces worked on to make sure they're going to a plastic surgeon. Laws allow anyone with a medical license to perform cosmetic surgery, so someone who knows nothing about plastic surgery could be doing the procedures, he warns.

"If people did their homework, they'd be much better off," DiMercurio says.

The price range for facial procedures is $2,000 to $12,000, depending on how much surgery you want done, DiMercurio says.

Mini face-lifts can last three to five years while a full face-lift can be expected to endure for about a decade, Kress says.

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