Liposuction and facelift: The risks and benefits

Many people used to be put off by plastic surgery because they feared the expensive and extensive surgeries involved in these cosmetic operations. But in recent years, surgeons have developed a host of alternative procedures that make fixing an aging face or an imperfect body a simpler and less expensive process – and they’ve helped fuel a boom in cosmetic surgery. In this column, we’ll take you through two of the most popular plastic surgical procedures today and help you evaluate their risks and benefits.

Facelifts

The classic facelift (rhytidectomy) can help fix a multitude of problems in the lower part of the face in one procedure. As we age, the skin around the nose and mouth may develop deep lines, wrinkles may appear around the eyes, and the jaw line and neck may begin to sag. A facelift can improve these problems by lifting and tightening the skin on the face along with the underlying muscles. There are also non-surgical alternatives you may want to investigate, including having your wrinkles filled, skin resurfacing, or Botox injections. But a facelift isn’t for everyone. It works best on those who still have some elasticity left in their skin. For this reason, it is usually performed on people up to 70 years old, although people older than 70 have successfully had the procedure done. You must be in good health to undergo a facelift as it is a serious surgery and does carry a risk of side effects.

Facelifts can be done in a hospital or out-patient surgery facility – they don’t usually require an overnight stay. They can be under local or general anesthesia. Once you’ve been anesthetized, your doctor will make an incision in your hairline, along the sides of your forehead, temple, and around your ears. He may also cut under your chin if you are having work done on your neck. Then he will loosen the skin from the muscle and tissue underneath. In a classic facelift, he will simply pull the skin back toward your ears, trim the excess, and then stitch it in place at the original incision line.

You may wake up with a bandage wrapped around your face to help minimize swelling and bruising from the procedure. Your doctor will remove it within a day or two, along with some temporary drainage tubes if needed. About five days later, he’ll remove the stitches. Your doctor will give you medication to help control any pain you may feel and you should be able to go home the same day. You will need to rest for about a week after surgery and it may take several weeks after that before you can return to your normal activities.

Like any surgery, a facelift carries certain risks. Because it requires anesthesia, there is a small risk of complications from the medication and procedure. Hematoma, the pooling of blood under the skin, affects about 15 percent of patients, according to some studies. A serious complication is nerve damage, which can cause numbness or partial paralysis of parts of your face. This is usually temporary but can be permanent. It is a rare problem, but it is more likely to happen if you have a procedure in which your doctor lifts more than just the skin and also works on the muscles and tissues beneath it, where the nerves that control facial movement are located.

A facelift can make your face appear tighter and fresher, but it can’t make you look like 25 again. You should see some "before" and "after" pictures of your doctor’s work on other patients your own age to get a sense of what’s possible and realistic for you. You should also know that some doctors are simply more skilled than others. Some surgeons tend to be more aggressive about pulling back the skin and others are less so, and that can affect whether you end up with a natural look or that too-tight, "aging Hollywood" actress look.

And, of course, a facelift can set back the clock a few years temporarily, but it doesn’t stop the aging process, which is determined by your genes and your health habits. Most facelifts are said to last seven to 10 years, but as soon as you heal, your face will go back to normal aging, which means you may require other procedures in the future.

Liposuction

Let’s face it: Diet and exercise is hard work. Many people, even if they’re strict about their regimen, don’t always get the body they want. If you’ve inherited Mom’s thunder thighs or Dad’s pot belly and all the workouts in the world don’t seem to make a difference, then liposuction (lipoplasty) may help you get rid of those unwanted bulges. But it’s also one of the most risky cosmetic procedures. It’s hard to know how risky the surgery is because solid research is hard to come by, but some studies have put the risk of dying of liposuction at anything from three patients in 100,000 to one in 1,000. So carefully weigh the pros and cons of liposuction before you decide to try it.

Liposuction can be done on many parts of the body: the abdomen, thighs, arms, buttocks, upper arms, hips, and even the neck. You are a good candidate for liposuction if you are generally healthy, have a stable weight that does not fluctuate much, and are less than 30 pounds overweight. Liposuction is not for the obese but for those who have flab that accumulates in a specific problem spot. You must also have skin that is still elastic enough to spring back after surgery – otherwise you risk having ridges of extra skin hanging down. Since the skin loses elasticity as you age, in general, younger patients do better than older ones. Know that liposuction won’t take care of cellulite. If you’re trying to lose weight, hold off on surgery – liposuction isn’t meant as a quick and easy weight loss method and the way your weight fluctuates on a diet is likely to cause problems.

Liposuction procedures can vary from small, to remove just a little fat from the neck, to large ones that reshape your entire mid-section. Remember that the larger the surgery, the longer it takes and the riskier the operation tends to be. If your procedure is small, you may have it under local anesthesia, or a local anesthetic combined with a sedative; for larger procedures, you may need general anesthesia.

If your doctor plans to remove more than five liters of fat (5,000 ccs), then your surgery is considered a large-volume procedure and your doctor should have special training to perform that surgery. A new liposuction procedure called ultrasound-assisted liposuction, or UAL, also requires special training.

Typically, liposuction involves injecting the fat to be removed with a solution that makes it easier to withdraw, reduces bruising and blood loss, and provides a local anesthetic. The solution contains salt, the anesthetic lidocaine and the drug epinephrine, which constricts blood vessels. Some people are allergic to lidocaine and this can cause serious complications.

The surgeon will make a small incision just wide enough to pass a hollow tube, about the size of a pen, into the area under the skin where fat collects. You may need multiple incisions, depending on how large an area is being treated. The tube is pushed through the fat, which breaks it up so it can be sucked out through the tube.

The risks of liposuction are rare, but some can be fatal. They include infection, fat or blood clots, puncture wounds in the organs, lidocaine toxicity, fluid imbalance, burns, skin death, nerve damage, pooling of serum, and unsightly skin.

After surgery, you should expect pain, swelling, and bruising. The swelling may last weeks and you may have to wear a compression garment to control it. You will probably need medication and may also need antibiotics to prevent infection. You should be able to return to work in a few days. However, it may take four to six weeks for the swelling to subside and you may not be able to see the benefits of the surgery until then. Bear in mind that you will have to be vigilant about your diet and exercise program in order to maintain the results – the fat will return if you’re not careful.

It is interesting to note that in a study published last year in the New England Journal of Medicine, women who had significant weight loss from liposuction (12 percent of body weight), did not improve their insulin sensitivity, which is a way of tracking a person’s risk for diabetes. Their blood pressure or other measures of increased risk for heart disease also did not improve. If they lost that much weight through diet and exercise, that probably would have been enough to give them some health benefits and reduce their risk factors. It looks like for true health benefits that will reduce one’s obesity risk, there is really no substitute for a healthy lifestyle, which includes eating properly and exercising regularly!