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What is a facelift?

A face lift is an operation performed to apply lifting forces to the lower face and neck in the opposite direction to the ageing vectors in order to improve aging changes, and create youthful appearance.

How is a facelift surgery performed?

The facelift is performed under sedation or general anesthesia. A facelift incision begins horizontally beneath the sideburn, and carried on inferiorly in a native preauricular crease in front of the ear. The incision follows a post-tragal course in females, and a pretragal course in men so as not to move bearded skin into the external ear canal. It is carried on to the back of the ear around the lobule and continued for few centimeters superiorly.  It is then curved posteriorly and inferiorly into the hair bearing portion of the scalp behind the ear. After the incision the skin is raised, a thin muscular layer lying underneath the skin called SMAS is incised, dissected and prepared as a flap. Then the SMAS flap is pulled in a direction opposite to the ageing vectors and suspended with sutures to create the youthful appearance. If neccessary, the concurrent liposuction is performed to remove excess subcutaneous fat, and a corset platysmaplasty is performed through a horizontal submental incision Excess skin is excised, and the skin is sutured.

 

 

 

What are the types of facelift surgery:

 

There are mainly two facelift techniques concerned with the depth and extent of dissection. 

 

1. SMAS lift techniques

 

Imbrication and plication of the SMAS are the most common facelift techniques. Plication techniques involve in-folding of SMAS without any SMAS incision, and suture suspension. Imbrication techniques involve a SMAS incision with or without a limited subSMAS dissection, and suture suspension. Ageing changes in the lower face and neck may be successfully treated with SMAS-lift techniques. Since the retaining ligaments of the midface are not released, these techniques can not improve aging changes at the mid facial region and nasolabial folds.

 

2. Extended facelift techniques

 

Extended facelift techniques involve surgical release of retaining ligaments in the midface that prevent the transmission of traction to the malar portion of the facelift dissection. Advancing the subSMAS dissection toward the midface allow repositioning of the ptotic malar fat, restoring the cheek volume, and  diminishing the nasolabial folds. Extended facelifts produce combined, balanced and harmonious rejuvenation of the midface, cheek and lower face without requiring a separate midface lift procedure. There are different extended facelift techniques with similar extended midface dissection, each with some variation.  A deep plane facelift involves undermining of a skin-SMAS flap as a single unit following a more limited subcutaneous dissection. A composite plane facelift, in addition to the deep plane facelift dissection, the lower part of the orbicularis oculi muscle is also dissected and included in the flap. Since deep and composite flap facelifts involve a single unit, they allow excellent blood supply to overlying skin which is important, especially in smokers, to prevent vascular compromise and subsequent skin necrosis.

 

 

 

Does an extended technique (such as deep or composite plane facelift) would have a more superior result than a classical facelift?

 

There are retaining ligaments on the face anchoring the dermis, subcutaneous fat and SMAS to the bony periosteum or deep fascia. The role of these ligaments to support facial soft tissues against forces of gravity. The attenuation of retaining ligaments with aging leads downward displacement of soft tissues, and responsible for many of the stigmata that occur with aging. Inadequate release of these retaining ligamentous attachments during facelift prevent the transmission of traction toward mid face which may lead to an unbalanced, unnatural appearance with unopposed nasolabial folds. Additional attempts to improve untreated nasolabial folds such as fat grafting to malar region are more likely to result with a “stuffed look”, “operated appearance”. Extended techniques such as deep and composite plane facelifts involving the surgical release of mid facial ligaments produce combined, balanced, and harmonious rejuvenation of the midface, cheek, and lower face without requiring a separate midface lift procedure.

 

 

 

Are deep and composite plane facelifts more dangerous than other type of facelifts?

 

Preservation of the facial nerve is crucial in facelift. It is important that the surgeon understands the relationship of the facial nerve to the anchoring ligaments and the anatomy of the SMAS and subSMAS tissue spaces accurately to perform a safe and successful surgery. Actually, extended techniques such as deep and composite plane facelifts while identifying and preserving the anatomy often leads to lower complication rates than blindly working around vital structures.

 

 

 

Which facelift technique does Dr. Ozcan Cakmak prefer, why?

 

Dr. Ozcan Cakmak prefers his modified composite plane facelift technique which is published in one of the most prestigious journals “Aesthetic Surgery Journal” in 2019. His facelift technique produces combined, balanced, and harmonious rejuvenation of the midface, cheek, and lower face without requiring a separate midface lift procedure

 

 

 

What can I expect after surgery?

 

After surgery pain is minimal to moderate and is usually well managed with pain medications. There would be mailed to moderate swelling and the ecchymosis of the skin, which may differ markedly from patient to patient. The ecchymosis will barely be visible after 4-5 days, and most swelling subsides after 5-7 days. Complete healing will take 6-12 months but the major part of this process is most often completed 1-2 weeks after surgery.

 

 

 

Will I have a drain, bandage or dressing after surgery?

 

Yes, you will have a bandage after surgery wrapped around your head to apply light pressure over the face and neck and to minimize the risk of a blood collection under the skin (hematoma). This bandage, and the drains placed behind the ears to prevent blood from collecting under the skin will be removed a day after the surgery.  Removal of the bandage and the drains are typically pain-free. You will be asked use an elastic bandage for the next few days.

 

 

 

Will I need my sutures to be removed?

 

The sutures are taken out 6-7 days after the surgery. The procedure of suture removal is almost always painless.

 

 

 

Will I have any visible scar?

 

There is no such thing as a scarless surgery and any type of incision on the skin will leave a scar. However, facelift incisions are placed either inside of the hair or in natural creases around the ear. Due to effective camouflage, facelift scars are often not visible or barely discernible.

 

 

 

How long does a the facelift result last?

 

It is not possible to stop the effects of aging and after surgery this process continues. In time your face will age and the effects of surgery will decrease. The aging process is extremely variable among people so it is impossible to tell how long the effects of face lift surgery will last, but it is generally expected that the results of surgery last approximately 10-15 years.

 

 

 

How long will I be off from work?

 

You will be asked to refrain from strenuous exercise for 2-3 weeks, but you may start working 7-10 days after surgery.

 

 

 

Can I wear make-up after surgery?

 

You can start wearing make-up after the third day of surgery.

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What is a lower eyelid blepharoplasty?

The lower eyelid blepharoplasty is an operation performed to recreate the a youthful eyelid appearance including re-establishment of the smooth contour at the lower eyelid-cheek junction, elimination of visible fat, effacement of the depressions inherent to their transition, and achievement of even, wrinkle-free skin.

How is a lower blepharoplasty surgery performed?

 

The lower eyelid blepharoplasty can be performed as an outpatient procedure or you may be admitted to the hospital. The operation may be performed under local anesthesia, under sedation or general anesthesia.

 

There are mainly two approaches to treat the lower eyelid:

 

1. Transconjunctival (internal) approach involves an incision on the inside of your lower eyelid. The transconjunctival approach is ideal for young patients that have pseudoherniated fat without excess skin. After the initial incision made inside the lower eyelid, protruding orbital fat is removed or repositioned. Sutures are not necessary for closure.

 

2. The transcutaneous (subcilliary) approach involves an external skin incision placed just under the lower eyelid margin. Transcutaneous approach allows management of excess skin and orbicularis muscle that requires redraping for adequate lid recontouring. It enables broad exposure to extend the dissection for a wide release of retaining ligaments and precise correction of problems such as inferior rim hollowing, malar mounds and festoons. The pseudoherniated fat is often repositioned beyond the infraorbital rim to blend the lower eyelid-cheek junction and prevent hollowness. An orbicularis muscle suspension suture is placed to reinforce the lower eyelid support, and  additional sutures may be used to re-suspend the lower eyelid margin. After final trimming of excess skin, the skin incision is closed with sutures.

 

 

 

What can I expect after lower blepharoplasty?

 

There would be mid to moderate moderate swelling and the ecchymosis of the skin. Cold compresses are frequently applied for the first 48 hours to reduce swelling and ecchymosis. The degree of swelling and ecchymosis differs markedly from patient to patient. Either way the swelling and the ecchymosis both subside within 7-10 days, after which time it is typically hardly notable that you just underwent surgery.

 

 

 

Will I have a bandage or dressing after Lower Blepharoplasty?

 

A bandage is not used after the surgery. A steril strip may be used which is changed or removed after one to three days, and ointment is applied over the suture daily for approximately 1 week in patients with external approach. An eye-drop may be used for approximately 7 days. Artificial tear drops can be prescribed to prevent dryness during the  early postoperative period.

 

 

 

Will I need my sutures to be removed?

 

The skin sutures are removed 5 -7 days after the surgery.

 

 

 

Will I be in pain after the surgery?

 

The lower eyelid blepharoplasty is a minimally invasive procedure. Pain after surgery is typically very mild and well controlled with pain medications. A mild analgesic (non-aspirin containing) is used to control the postoperative discomfort for one to five days.

 

 

 

Will I have any visible scar?

 

There is no such thing as a scarless surgery and any type of incision on the skin will leave a scar. However, subcilliary incision of lower blepharoplasty is very well hidden just below the eyelashes, and often not visible after complete healing.

 

 

 

How long will I be off from work?

 

Generally speaking the recovery period after lower eyelid blepharoplasty is short and you may start doing your daily routines as soon as the first to third day. The swelling and ecchymosis persist rarely longer than few weeks and almost never limits patient mobility.

 

 

 

Can I wear make-up after surgery?

 

You can start wearing make-up 4-5 day after the surgery.

 

 

 

How long can I expect the outcome of surgery to last?

 

It is not possible to stop the effects of aging and after surgery this process continues. In time your face will age and the effects of surgery will decrease. The aging process is extremely variable among people so it is impossible to tell how long the effects of lower blepharoplasty will last, but it is generally expected that the results of surgery last approximately 10-15 years.

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What is an endoscopic brow lift?

The endoscopic brow lift is an operation performed to elevate the forehead skin and the eyebrows. This operation is designed to minimize skin incisions, to hide all scars in the hair bearing skin and to reduce post-surgical healing time.

How is endoscopic brow lift surgery done?

 

Endoscopic brow lift is typically performed under general anesthesia. Five small (three vertical scalp and two temporal) incisions are placed behind the hairline. Shaving of the incision sites in not necessary. The procedure is carried out with an endoscope. The skin is lifted from the underlying bone so the soft tissue connections between the eyebrows and the bone are loosened and the eyebrow can be be sufficiently elevated. The myotomies can be performed through the glabellar muscles to eliminate the frown lines. Once the desired amount of lift is accomplished, the forehead skin is secured in place with special sutures that anchor the forehead skin to the bone of the skull. After the surgery is finished, the incisions are closed with sutures and / or staples.

 

 

 

Do I need an upper blepharoplasty, a browlift, or both?

 

The ideal brow shape and position vary depending on gender, age, culture, ethnicity, orbital shape, eye prominence, facial proportions and current aesthetic trends. With aging, the eyebrow complex becomes ptotic, upper lid skin becomes redundant, which may obscure the supratarsal crease, and lead to temporal hooding. Patients chronically elevate their brows to reduce visual field obstruction from excess upper eyelid skin. The brow position should always be assessed before attempting blepharoplasty: the brow lifting procedure may obviate the need for blepharoplasty. Although brow-lifting can be performed as a single procedure, it is commonly combined with an upper eyelid blepharoplasty to restore younger-looking periorbital and forehead regions. If a forehead lift is indicated at the same time, the brow lift is performed first before an upper lid blepharoplasty, as the amount of upper lid redundancy is significantly reduced after correction of the brow position.

 

 

 

What can I expect after surgery?

 

There would be mild to moderate moderate swelling and the ecchymosis of the skin. Cold compresses are frequently applied for the first 48 hours to reduce swelling and ecchymosis. The degree of swelling and ecchymosis differs markedly from patient to patient. Either way the swelling and the ecchymosis both subside within 7-10 days, after which time it is typically hardly notable that you just underwent surgery.

 

 

 

Will I have a bandage or a drain after surgery?

 

There will be a bandage after surgery wrapped around the head to apply pressure over the forehead and to minimize the risk of a blood collection under the skin (hematoma). The bandage will be removed a day after the surgery. You will use an elastic bandage for the next few days. The drains placed behind the ear to prevent blood from collecting under the skin will be removed a day after the surgery as well. Removal of the both bandage and the drains are pain-free.

 

 

 

Will I need my sutures to be removed?

 

The sutures (or staples) are removed 7-8 days after the surgery.

 

 

 

Will I be in pain after the surgery?

 

The endoscopic brow lift is a minimally invasive procedure. Pain after surgery is typically very mild and well controlled with pain medications. You may need to take pain pills for few days after the surgery.

 

 

 

Will I have any visible scar?

 

Since all incision are placed in hair bearing area, there will be no any visible scar after endoscopic brow lift operation.

 

 

 

How long will I be off from work?

 

Generally speaking the recovery period after endoscopic brow lift is short and you may start doing your daily routines as soon as the first to third day. The swelling and ecchymosis persist rarely longer than 7-10 days and almost never limits patient mobility.

 

 

 

Can I wear make-up after surgery?

 

You can start wearing make-up 2-3 day after the surgery.

 

 

 

How long can I expect the outcome of surgery to last?

 

It is not possible to stop the effects of aging and after surgery this process continues. In time your face will age and the effects of surgery will decrease. The aging process is extremely variable among people so it is impossible to tell how long the effects of endoscopic brow lift will last, but it is generally expected that the results of surgery last approximately 10-15 years.

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What is a rhinoplasty?

A rhinoplasty is a surgical procedure performed to create an aesthetic appearance to the nose while maintaining or improving the breathing through the nose.

How is rhinoplasty surgery performed?

 

A rhinoplasty operation may be performed under general or local anesthesia with sedation. There are two major techniques in rhinoplasty surgery. The first is the open technique in which a small incision is placed on the undersurface of the nose, on the small strip of skin that separates the nostrils. The second is the closed technique where no external incision is placed on the skin. After initial incision, the nose is re-shaped by removing, adding or sculpting the cartilages, bones and soft tissues of your nose. After completing the framework of the nose the skin is re-draped and the incisions will be closed.

 

 

 

Can I see what I will look like after the operation?

 

Computer imaging can give you an idea of what you will look like after surgery. Remember that the actual result may differ somewhat from the computer generated outcome, regardless of the surgeon’s expertise.

 

 

 

Would it be necessary to take cartilage from my ear or rib during rhinoplasty?

 

If you have previously undergone a rhinoplasty, the obtainable cartilage may be sufficient for shaping and reconstructing the nose. If harvesting cartilage either from your ear or you rib cartilage would be required, you will be informed before the surgery.

 

 

 

What can I expect after surgery?

 

There would be mild- moderate swelling and the ecchymosis of the skin while degree differs markedly from patient to patient. A cold mask is placed over the eyes for the first two days to decrease swelling and bruising. Dr. Cakmak does not place any dressing inside the nose to be removed.  However, breathing through the nose would not be possible due to edema at the first few days, which completely resolves within few weeks. There can be an intermittent mild bleeding at the first few days that subsides on its own or with decongestant sprays. You will be asked to apply a saline spray 3-4 times a day to humidify and decrease the crusting inside of the nose. Generally speaking most of the swelling and bruising will subside in 7-10 days although some swelling can persist for up to 2-3 months, and the final appearance will take a year.

 

 

 

Will I have a bandage or dressing after surgery?

 

During surgery at the end of the procedure your surgeon will typically place small strips over your nose and place a splint on these strips. Dr. Cakmak does not prefer any nasal pack or dressing, uses absorbable sutures instead to prevent blood accumulation (hematoma) that do not require removal. The splints on the outside of your nose are removed 7-8 days after the surgery.

 

 

 

Will I need my sutures to be removed?

 

If you have undergone an open rhinoplasty the sutures on the skin will be removed 5-7 days after surgery. If absorbable sutures are used for skin closure these do not have to be removed. The incisions inside of the nose are made from absorbable material and do not need to be removed.

 

 

 

Will I be in pain after the surgery?

 

After surgery pain is minimal to moderate and is well managed with pain medications.

 

 

 

Will I have any visible scar?

 

External incision of open approach rhinoplasty is arranged as very well camouflaged just below the nose, and often not visible after complete healing. Since no external incision is used, there is no scar in internal approach.

 

 

 

How long will I be off from work?

 

Generally speaking the swelling and bruising around your eyes and nose may last up to 7-10 days. You can start working after removal of external splint on on your nose 6-7 days after surgery. The mild swelling may persist rarely longer than few weeks and almost never limits patient mobility.

 

 

 

Can I wear make-up after surgery?

 

You can start wearing make-up 2-3 days after the surgery.

 

 

 

Can I wear glasses?

 

You will be asked to refrain from using glasses for a period between 6 weeks. You may use your contact lenses 2-3 days after the surgery

 

 

 

Can I do sports?

 

You should refrain from strenuous exercise 2-3 weeks after the surgery. You should refrain from contact sports for 6 weeks.

 

 

 

Can I sunbathe?

 

Yes, but only after applying copious amounts of sunscreen on your nose. As direct sunlight may cause edema and discoloration of the skin on your nose. This risk can last a year.

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What is an otoplasty?

 

An otoplasty is a surgical procedure performed to improve the shape of the ears.

 

 

 

How is an otoplasty surgery done?

 

Otoplasty surgery in children is typically performed under general anesthesia. In adults it may be performed either under general anesthesia or local anesthesia with or without sedation. An incision is placed on the back side of the ear. Then sutures are placed to back side of auricle to achieve the desired shape. Then the skin incision is closed with sutures. After one ear is finished, the other ear is operated similarly.

 

 

 

What is the most appropriate age for an otoplasty?

 

After birth the ear cartilages reach their normal age around the age of 5-6 years old. As this coincides with the age at which primary school starts, it is a good age for surgery. There is no upper limit regarding age for otoplasty.

 

 

 

What can I expect after surgery?

 

There will be mild- moderate swelling and bruising of the ears after removal of bandage. The degree of swelling differs markedly from patient to patient. The most of the swelling and bruising subside within 7-8 days, after which time it is typically hardly notable that you just underwent surgery.

 

 

 

Will I have a bandage after surgery?

 

A bandage is wrapped around your head after the operation to apply pressure over the ears and to minimize the risk of blood collection under the skin (hematoma). Removal of the dressing a day after the surgery is typically pain-free. You will be advised to wear a headband regularly for a week, and then only during night for 2-3 months.

 

 

 

Will there be pain after the surgery?

 

Pain after surgery is typically very mild and well controlled with pain medications. You may need to take pain medication for one to five days.

 

 

 

How long will I be off work/ how long will my child be away from school?

 

Generally speaking the recovery period after otoplasty is short and you may start doing your daily routines one to three days after surgery

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What is an endoscopic midface lift?

 

An endoscopic midface lift is a surgical procedure performed to improve the effects of aging on the middle one third of the face (the area between the eyes and the lips), restore the cheek volume, improve the nasalabial folds, and smoothen the lower lid to cheek junction.

 

 

 

How is an endoscopic midface lift surgery performed?

 

Endoscopic midface lift is performed under general anesthesia. An incision is placed in the hair bearing portion of the temple region. Then a flap is formed and extended along the malar bones under direct vision from an endoscope. The flap consisting skin, muscle, and periosteum is completely released, pulled in a vector opposite to the gravity, and anchored with sutures. Then the skin incisions are sutured. The removal of excess lower lid skin through an incision placed just below the eyelashes is often needed as a part of the procedure. The same operation is applied to the other side of the face.

 

 

 

What can I expect after surgery?

 

There would be mild to moderate moderate swelling and the ecchymosis of the skin. Cold compresses are frequently applied for the first 48 hours to reduce swelling and ecchymosis. The degree of swelling and ecchymosis differs markedly from patient to patient. Most swelling subsides after 10-15 days and ecchymosis will barely be visible after 3-5 days. In some patients, complete healing may take 3-4 months due to prolonged edema, but the major part of this process is most often completed 2-3 weeks after surgery. Ice packs to prevent or alleviate swelling and bruising are used for 1-2 days.

 

 

 

Will I have a bandage or a drain after surgery?

 

There will be a bandage after surgery wrapped around the head to apply pressure over the forehead and to minimize the risk of a blood collection under the skin (hematoma). The bandage will be removed a day after the surgery. You will use an elastic bandage for the next few days. The drains placed behind the ear to prevent blood from collecting under the skin will be removed a day after the surgery as well. Removal of the both bandage and the drains are pain-free.

 

 

 

Will I need my sutures to be removed?

 

The sutures (or staples) are removed 7-8 days after the surgery.

 

 

 

Will I be in pain after the surgery?

 

After surgery pain is mild to moderate and is usually well managed with pain medications. You may need to take pain pills for few days after the surgery.

 

 

 

Will I have any visible scars?

 

Since temporal incision is placed in hair bearing area, there will be no any visible scar after endoscopic midface lift operation. The incision to remove excess skin on lower lid is is very well hidden just below the eyelashes, and often not visible after complete healing.

 

 

 

How long will I be off from work?

 

Generally speaking you may start working 10-15 days after surgery. However, the prolonged edema of some cases may take few months to completely disappear.

 

 

 

Can I wear make-up after surgery?

 

You can start wearing make-up 4-5 day after the surgery.

 

 

 

How long can I expect the outcome of surgery to last?

 

It is not possible to stop the effects of aging and after surgery this process continues. In time your face will age and the effects of surgery will decrease. The aging process is extremely variable among people so it is impossible to tell how long the effects of endoscopic midface lift will last, but it is generally expected that the results of surgery last approximately 10-15 years.

 

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What is an upper blepharoplasty?

 

Upper blepharoplasty is an operation performed to bring back the youthful, attractive upper eye appearance involving one or a combination of resection of excess skin, removal of bulging fat and muscle, aesthetic placement of the supratarsal crease, and filling /contouring of a deep upper orbital sulcus with fat injection or transfer.

 

 

 

How is upper blepharoplasty surgery done?

 

Blepharoplasty surgery is most often performed under local anesthesia. Sedation or general anesthesia may be utilized in appropriately selected patients. First, the blepharoplasty incision is measured and marked. Subsequently variable amounts of skin, soft tissue and fat are removed to achieve a pleasing and youthful appearance of the eyelid and to improve the visual field. After the desired amount of excision is accomplished skin incisions are closed with sutures.

 

 

 

Do I need an upper blepharoplasty, a browlift, or both?

 

With aging, the upper lid skin becomes redundant (dermatochalasis), the visibility of the upper eyelid may be effaced ("hooding") due to skin laxity and/or brow ptosis, and lateral hooding may obstruct the visual field. The brow position should always be assessed before attempting blepharoplasty: the brow lifting procedure may obviate the need for blepharoplasty. If a forehead lift is indicated at the same time, the brow lift is performed first before an upper lid blepharoplasty, as the amount of upper lid redundancy is significantly reduced after correction of the brow position.

 

 

 

What can I expect after surgery?

 

There would be mid to moderate moderate swelling and the ecchymosis of the skin. Cold compresses are frequently applied for the first 48 hours to reduce swelling and ecchymosis. The degree of swelling and ecchymosis differs markedly from patient to patient. Either way the swelling and the ecchymosis both subside within 7-10 days, after which time it is typically hardly notable that you just underwent surgery.

 

 

 

Will I have a bandage or dressing after surgery?

 

A bandage is not used after the surgery. A steril strip may be used which is changed or removed after one to three days, and ointment is applied over the suture daily for approximately 1 week in patients with external approach. Artificial tear drops can be prescribed to prevent dryness during the  early postoperative period.

 

 

 

Will I need my sutures to be removed?

 

The skin sutures are removed 5 -7 days after the surgery.

 

 

 

Will I be in pain after the surgery?

 

The upper eyelid blepharoplasty is a minimally invasive procedure. Pain after surgery is typically very mild and well controlled with pain medications. A mild analgesic (non-aspirin containing) is used to control the postoperative discomfort for one to five days.

 

 

 

Will I have any visible scar?

 

There is no such thing as a scarless surgery and any type of incision on the skin will leave a scar. However, the incision of upper blepharoplasty is very well camouflaged by the upper eyelid crease, and often not visible after complete healing.

 

 

 

How long will I be off from work?

 

Generally speaking the recovery period after lower eyelid blepharoplasty is short and you may start doing your daily routines as soon as the first to third day. The swelling and ecchymosis persist rarely longer than few weeks and almost never limits patient mobility.

 

 

 

Can I wear make-up after surgery?

 

You can start wearing make-up 4-5 day after the surgery.

 

 

 

How long can I expect the outcome of surgery to last?

 

It is not possible to stop the effects of aging and after surgery this process continues. In time your face will age and the effects of surgery will decrease. The aging process is extremely variable among people so it is impossible to tell how long the effects of upper blepharoplasty will last, but it is generally expected that the results of surgery last approximately 10-15 years.