What can I do to help alleviate the ear and throat pain postoperatively?

After a deep plane facelift and/or isolated deep neck lift, patients can experience acute pain in their ears and throat due to nerve irritation, tissue swelling, and surgical manipulation. To help ease this discomfort, the following strategies can be effective:

1. Medications
   - Prescription pain relievers: prescription pain medications, like opioids, are typically prescribed for the first few days post-surgery to manage more intense pain. 
   - Over-the-counter (OTC) pain relievers: following surgery. we instruct patients to schedule acetaminophen (Tylenol) several times daily to help with baseline pain control. 

   - Throat lozenges or sprays: for sore throat relief, soothing lozenges, throat sprays, or saltwater gargles can provide comfort.

2. Cold Compresses
   - Applying cold compresses or ice packs around the jawline, neck, and behind the ears can help reduce swelling and numb the area, providing temporary relief from pain. Avoid applying ice directly to the skin and use cold therapy for 15-20 minutes at a time

3. Head and Neck Elevation
   - Keeping the head and neck elevated especially during the day and while awake, can help reduce swelling and pressure in the surgical area, which in turn can alleviate some of the pain and discomfort in the ears and throat.

4. Hydration and Soothing Foods
   - Staying hydrated can help ease throat discomfort. Drinking warm teas, broths, or cool water can provide soothing relief.
   - Soft, cool foods such as yogurt, smoothies, or applesauce may be easier to swallow if your throat is sore.

5. Gentle Massage
   - In office, we can perform gentle lymphatic drainage massage to help reduce swelling and ease discomfort around the neck and ears. 

6. Avoid Excessive Movement
   - Limiting neck and jaw movement, especially excessive turning or stretching, can help minimize pain in the throat and around the ears. Avoiding activities that strain the neck (like excessive talking and chewing, lifting heavy objects, etc.) is important for allowing proper healing and reducing discomfort.

Why do my ears and throat hurt after surgery?

After a deep plane facelift and/or deep neck lift, it is common for patients to experience discomfort in their ears and throat due to the nature of the surgery and the anatomy involved. Here’s why:

1. Nerve Irritation
   - During the procedure, we work on deeper layers of tissue, including the muscles and connective tissues of the face and neck. This can cause temporary irritation of the sensory nerves that supply the areas around the ears and throat.
   - The great auricular nerve, which provides sensation to the lower part of the ear, often passes through the surgical field. Although the nerve is preserved, it can become irritated or swollen, leading to tenderness, numbness, or discomfort around the ears.
   - Similarly, nerves that supply the throat (ie,glossopharyngeal nerve) can be indirectly affected due to muscle manipulation and swelling, causing a sore throat feeling.

2. Tissue Swelling and Tightness
   - After surgery, swelling occurs in the face and neck as part of the healing process. This swelling can put pressure on surrounding structures, including the ears and throat, causing discomfort.
   - Tightening and repositioning of the skin and deeper tissues can also lead to a feeling of tension, especially around the neck and behind the ears, contributing to ear and throat discomfort.

3. Incision Placement Near the Ears
   - For both a deep plane facelift and an isolated deep neck lift, incisions are made near the ears, often extending behind or near the earlobe. These incisions can lead to tenderness as they heal, making the area around the ears feel sore.

4. Anesthesia and Positioning
   - During surgery, we utilize oxygen to keep you safe. The dry oxygen and the tubes we use to deliver it can contribute to a sore and dry throat, typically in the first 24 to 48 hours.
   - The turning and manipulation of the neck during surgery can also cause some strain or tightness of the neck and the back of the scalp.

5. Muscle Manipulation
   - During the neck lift portion of the procedure, the platysma muscle, which runs from the  jawline to the collarbone, is tightened and repositioned. This can lead to a feeling of tightness or soreness in the throat area as the muscle heals and adjusts to its new position.

Recovery and Pain Relief 
   - The discomfort in the ears and throat usually improves over the course of a few days to weeks as swelling subsides and the tissues heal. See here for ways to ease the pain during recovery.

Anesthesia during surgery: tell me what I need to know.

Our primary goals are to keep you safe and comfortable during surgery. All of our procedures are performed in our private, state-licensed Ambulatory Surgery Center under the direction of our fully committed surgical team.

Anesthetic medications are delivered through an IV, and the depth of sedation can be adjusted as needed. Depending on your health status and procedures being performed, we may opt to deliver oxygen via a small tube in the nose or a small tube that goes into the mouth. You will not be aware of the procedure and won’t remember it afterward. Patients are fully asleep during surgery without any memory and wakefulness during the procedures. Your eyes are closed, you're not awake nor talking, and you have no recollection of the procedure.

Case length may vary from 1 to 6+ hours, depending on which procedure(s) you're undergoing, and rest assured that our Anesthesiologist is at your side the entire time, monitoring your heart rate, blood pressure, and oxygen levels the entire time.

I want surgery but you told me to wait...

For some patients, the juice simply isn't worth the squeeze (yet)...

Some patients come to us very early in the aging process, still looking natural and youthful. At this stage, the signs of aging you're noticing are very minimal and well within the range of what we consider normal for someone of your age and facial structure.

While we understand your desire to stay ahead of the aging process, it’s important to weigh the benefits of surgery against the inherent risks, downtime, and the possibility of very subtle changes that might not yield the significant impact you’re hoping for at this time.

Given a youthful and/or normal anatomic appearance, we sometimes encourage patients to wait on surgery as surgical intervention right now may not offer a noticeable enough improvement to justify the procedure.

We generally recommend revisiting the idea in about 3-5 years when the changes may be more pronounced, and the potential benefit from surgery would be much greater. In the meantime, we can certainly explore non-surgical treatments like injectables or skin treatments to help maintain youthful features. Rest assured, we will be here to guide you whenever the time is right for surgical options in the future.

What's the difference between an isolated deep neck lift (neck only) and a deep plane facelift with neck lift (face and neck)?

An isolated deep neck lift and a deep plane facelift with neck lift both target signs of aging in the lower face and neck, but they differ in scope and the areas they address.

Isolated Deep Neck Lift:
- Focus: primarily targets the neck, particularly issues like excess skin, fat accumulation under the chin (double chin), muscle banding (platysmal bands), and sagging of the neck tissues.
- Procedure: via 3 incisions (one under the chin and one behind each ear, we remove fatty and/or glandular tissues contributing to fullness under the jawline, tighten the muscles in the neck, and redistribute the skin to create more defined contours. 
- Best for: patients who are typically <40 years old, mainly concerned about neck fullness, have good skin elasticity, and lack jowling along the lower part of the face.
- Recovery: we generally recommend patients take ~2 weeks off work/social events with final results appreciable at 8+ months.

Deep Plane Facelift with Neck Lift:
- Focus: a more comprehensive procedure that addresses aging in both the face and neck. It lifts deeper facial structures, repositioning muscles, fat, and skin to rejuvenate the midface, lower face, and neck.
- Procedure: a deep plane lift involves releasing and lifting the deeper layers of the face (SMAS layer) to create a more natural, longer-lasting result. It improves areas like the nasolabial folds, sagging cheeks, jowls, and neck laxity.
- Best For: patients who have aging concerns affecting both the lower face and neck.
- Recovery:  we generally recommend patients take ~2-4 weeks off work/social events with final results appreciable at 8+ months.

What’s the skinny on the GLP-1 weight loss medications and surgery?

There is growing evidence supporting the recommendation to hold GLP-1 receptor agonists (Ozempic, Wegovy, etc) preoperatively due to concerns over delayed gastric emptying, which can increase the risk of regurgitation and pulmonary aspiration during anesthesia.

Safety is our top priority for all patients. We recommend holding all GLP-1 receptor agonist medications for 6 weeks preoperatively.

This ensures the medication is out of your system and your gut motility is normal on the day of surgery. Postoperatively, you may resume the medication whenever you’d like.

For patients with diabetes who need to hold GLP-1 agonists for an extended period, consulting a with your primary care provider or endocrinologist for alternative antidiabetic therapy is advised to manage blood glucose levels effectively during the perioperative period.

I'm curious about PRP and PRF, in combination with other skin treatments. Can you tell me more?

Both microneedling with PRP (Platelet-Rich Plasma) and PRF (Platelet-Rich Fibrin) are advanced skin rejuvenation treatments that involve the use of the patient's own blood components to promote healing and enhance skin appearance. Here's a summary of each treatment and their key differences:

Microneedling with PRP (Platelet-Rich Plasma)

Procedure:

1. Blood Draw: A small amount of the patient’s blood is drawn.

2. Centrifugation: The blood is spun in a centrifuge to separate the plasma, which is rich in platelets and growth factors, from other blood components.

3. Microneedling: A device with fine needles creates tiny punctures in the skin, stimulating the body's natural healing process.

4. Application of PRP: The PRP is applied to the skin, allowing the growth factors to penetrate the microchannels created by the microneedling.

Benefits:

- Stimulates collagen production.

- Enhances skin texture and tone.

- Reduces fine lines and wrinkles.

- Improves skin elasticity and firmness.

- Promotes a quicker healing process due to the growth factors in PRP.

Microneedling with PRF (Platelet-Rich Fibrin)

Procedure:

1. Blood Draw: Similar to PRP, a small amount of blood is drawn.

2. Centrifugation: The blood is spun at a slower speed to separate the fibrin matrix, which is rich in platelets, white blood cells, and growth factors.

3. Microneedling: The same microneedling process is used to create micro-injuries in the skin.

4. Application of PRF: The PRF is applied to the skin, where it forms a gel-like substance that slowly releases growth factors over time.

Benefits:

- Contains a higher concentration of platelets and growth factors compared to PRP.

- Releases growth factors more slowly, which can enhance and prolong the healing and rejuvenation process.

- Includes white blood cells and fibrin, which can further aid in the healing process and improve outcomes.

Key Differences:

1. Centrifugation Speed and Process:

   - PRP is produced by spinning blood at high speeds, which separates the plasma quickly.

   - PRF is produced by spinning blood at a lower speed, which allows for a more natural separation and the inclusion of white blood cells and fibrin.

2. Growth Factor Release:

   - PRP releases growth factors immediately upon application.

   - PRF releases growth factors more slowly over time due to the fibrin matrix, potentially providing longer-lasting benefits.

3. Composition:

   - PRP primarily contains plasma rich in platelets and growth factors.

   - PRF contains platelets, white blood cells, and a fibrin matrix, providing a more comprehensive approach to healing and rejuvenation.

4. Consistency:

   - PRP is a liquid and is easier to apply during and after microneedling.

   - PRF forms a gel-like consistency, which can provide a different application experience and potentially enhanced effects due to prolonged growth factor release.

Clinical Implications:

- PRP: May be preferred for patients looking for quicker results and those who benefit from a higher concentration of growth factors immediately after treatment.

- PRF: May be more suitable for patients looking for sustained release of growth factors and additional healing support from white blood cells and fibrin.

Both treatments aim to improve skin health and appearance, and the choice between them can depend on the specific needs and goals of the patient as well as the clinical expertise and recommendation of their healthcare provider.

How many rhinoplasties can a patient have?

The complexity of any surgery increases as the number of procedures increase – that’s due to scar tissue that forms during the healing phase postoperatively. Scar formation is natural and expected following any surgery. The amount and type of scar formed by each individual, however, varies based on their genetics and overall health status.

The more rhinoplasties a patient has, the more scar formation there is, and the higher their risks are for certain postoperative outcomes – namely, cosmetic imperfections, infection, and tissue ischemia. It’s important to discuss these risks with your surgeon preoperatively, particularly in a revision case.

The other unique aspect of rhinoplasty surgery is the fact that surgeons use cartilage from the nose (typically the septum) to reshape the nose. If a patient has had prior nasal surgery, their bank of available cartilage is likely depleted and their surgeon may need to use cartilage from elsewhere (i.e., ear, rib, or irradiated donor cartilage).

Soooo there’s no strict number of rhinoplasties a patient can have. The important thing to know is that the complexity of the surgery increases and certain risks increase with more nasal surgery.

Thread lifts: how long do they last?

Not long enough. And that’s why I strongly advocate against patient undergoing thread lifts. Not only are their effects short-lasting but they also carry and fairly high risk of skin bunching, infection, scarring, and thread extrusion (where the body pushes the thread towards the skin surface.

Thread lifts were popularized several decades ago, promising to bring along stellar results without the cost, downtime, or invasiveness of surgery. But they failed to yield meaningful results for most patients and that’s why they fizzled out. Fast forward to now and they’re being marketed again by their manufacturers and many non-surgical providers. If you ask most surgeons, they’re not a proponent of thread lift. Their effects don’t last and most patients are relatively unhappy with their results. You’ll really never be able to achieve a surgical result with non-surgical techniques.

Pricing of cosmetic surgeries: how do surgeons’ price their procedures?

Costs of various cosmetic procedures varies widely.

Think of a taco. It costs less than a dollar at Taco Bell and well over $25 at your nearest swanky Tex-Mex restaurant.  Cost is dependent on regionality, market dynamics, environment, and chef expertise. The same can be said for various surgical procedures.

In cosmetic surgery, cost is often dictated by the level of training and experience of your surgeon and their staff, the region of the world they practice in, and the current market. When considering price of a cosmetic procedure, it’s important to inquire about what all is included – surgeon’s fee, anesthesia fee, operating room fee, supplies/materials, medications, postoperative supplies, prescription medications, follow up appointments, etc.

Mother nature and gravity…does a facelift always include a neck lift?

Typically, yes. The term ‘facelift’ is used to describe a surgical procedure that improves the visible signs of aging in the mid-face, lower face, and neck. It is able to address skin sagging, deepening of the fold lines between the nose and the corner of the mouth (nasolabial folds), sagging fat pads, jowls along the jawline, and loose skin and muscle laxity under the chin and within the upper neck region.

Not all facelift techniques are the same. Just as a tailor may approach hemming a dress a bit differently based on that particular dress and their previous experience, one surgeon’s facelifting techniques may vary slightly from their colleague’s.

A concurrent neck lift is often paired with a facelift because the aging process is not isolated to the face – it affects the neck as well. In order to achieve a natural, youthful result throughout the face, jawline, and neck, surgical lifting and tightening is required within both the face and neck regions.

Can you have surgery for a stuffy nose?

A stuffy nose can be addressed during nasal surgery. The important thing for the surgeon and patient to investigate preoperatively is the etiology for the stuffiness. If there is a structural reason for the stuffiness, meaning something physically blocking the normal flow of air, that can usually be surgically addressed during the surgery. Two common examples of structural blockages include: a deviated septum and/or enlarged turbinates.

If the stuffiness comes and goes, it’s more likely to have a non-structural cause. In these patients, medical treatment (rather than surgery) is usually advised. Examples of these types of causes of stuffiness include: allergies, viral illnesses, etc.

Is otoplasty covered by insurance? The grey zone and who determines coverage

Unfortunately, this is not a straightforward answer. More often than not, otoplasty is considered a cosmetic, elective procedure and is therefore not covered by insurance. However, there are instances were insurance may pay for the procedure based on its reasoning.

There are grey areas when it comes to health insurance coverage – there are no fixed rules as to when or if a health insurance company will cover something. The rules change over time and from one company to another. Some may cover a particular procedure while others won’t. The decision is ultimately made by the insurance company and not your surgeon.

If the ear being addressed is considered to be a congenital deformity, it’s more likely that it will be covered by insurance. This is more likely the case in young children.

Will an otoplasty (aka, ear pinning) affect my hearing?

An otoplasty is a surgical procedure intended to alter the size, position, and/or shape of the external ear. It is customized to the individual and involves altering the ear in order to improve its appearance and/or symmetry. During the procedure, cartilage can be reshaped or excised via an incision behind the ear. Varying suture techniques are employed in order to yield the most natural looking external ear.

An otoplasty has no effect on the middle or inner parts of the ear, which are responsible for hearing. In certain rarer scenarios, a patient may require an otoplasty as well as surgery for their hearing. These procedures are staged (performed at different times).

How painful is otoplasty?

Pain varies from individual to individual and is difficult to predict preoperatively. The majority of patients will have some degree of discomfort following the procedure. This is typically treated with Tylenol and occasionally, a patient may require prescription pain medication for the first few days.

Postoperative pain and discomfort are worst in the first 2-3 days after the procedure. Thereafter, pain should slowly improve each day. If pain is worsening and not improving, it’d be appropriate to reach out to your surgeon’s office.

In order to minimize pain, it’s important to follow your surgeon’s instruction in terms of wearing an ear dressing, reducing strenuous activity, and eliminating the potential to bump, hit, or cause inadvertent damage to the area during the healing phase.

Help! How do I get rid of my double chin WITHOUT surgery?

There’s two points to note in this answer.

1. Figuring out what’s contributing to the submental fullness, or ‘double chin.’ Sometimes it’s extra subcutaneous (meaning just under the skin) fat while other times, it’s excess deep fat, enlarged submandibular glands, hypertrophied platysmal and/or digastric muscles, or a combination of the above. Your surgeon is typically able to diagnose the reason for fullness with a physical exam. By knowing which layer(s) of the neck is problematic, you’ll have a target of what to tackle in order to achieve improvement in the fullness.

2. It’s difficult, if not impossible, to achieve surgical results with non-surgical techniques. There are some technologies on the market that use radiofrequency, microneedling, and/or fat dissolving medications to address the most superficial layers of the neck – namely, the skin and layer of fat just beneath the skin. The problem with non-surgical modalities is that they’re not able to target deeper structures in the neck, and thus, often fall short in providing a sculpted neck and jaw line. Surgically, surgeons are able to address each layer of the neck and target the specific area(s) that are contributing to that individual patient’s fullness.

Can you change the shape of the nose without surgery?

You can. The term ‘liquid rhinoplasty’ is a term used for reshaping the nose with non-surgical injectable fillers. When a patient desires minor changes in their nasal appearance and aren’t interested in going under the knife, injection of fillers can subtly raise the nasal tip, smooth a hump along the bridge, and/or camouflage asymmetries. This hyaluronic acid filler dissolves slowly over time and typically lasts 1-2 years after placement.

And while all filler placement carries a small but real risk of vessel occlusion (where filler is inadvertently injected into a blood vessel) which can lead to tissue ischemia and skin loss, the risk of such events is higher when filler is placed in the nose as compared to elsewhere in the face. Also, of note, there have been reports of patients experiencing blindness after liquid rhinoplasties. This is because the blood vessels that feed the nose and eyes are part of a large and concentrated network of vessels confined to a very small area of the face. Therefore, it is crucial to go to a provider with intimate knowledge of nasal anatomy and who has experience operating and placing filler in this area.

Intraoperative sedation - how awake will I be for a blepharoplasty?

If you choose to be. With any cosmetic procedure of the face, there are varying degrees of anesthesia available to you.

On one end of the anesthesia spectrum, you can elect to have only local anesthesia – meaning numbing medication injected in the area to be operated on. You’re completely awake and totally lucid. This type of anesthesia is common for an upper blepharoplasty.

At the other end of the anesthesia spectrum is general anesthesia – where the patient is completely anesthetized, has a breathing tube in their mouth, has zero awareness of what is happening, and experiences no pain. This type of anesthesia is commonly used for rhinoplasty surgery.

In between local anesthesia and general anesthesia, you have varying degrees of conscious sedation – this can be achieved with oral medications, IV medications, or a combination of both. The ultimate goal for anesthesia during cosmetic surgery is to provide a patient the most comfortable experience while also providing them the safest mode of anesthesia. It’s important to ask your surgeon about which type of anesthesia they recommend for the procedure you’re undergoing and who will be administering the anesthesia medications.

At FACE Leawood, we have a board-certified Anesthesiologist that assists with all procedures in which the patient requests sedation.

Planning for recovery: how am I supposed to sleep after an otoplasty?

Each specific surgeon has their own postoperative protocol for every procedure. But generally, following an otoplasty, you will want to sleep in a position that does not disturb, manipulate, or apply pressure to either ear. Lying on your back with the head slightly elevated is what most patients find to work after a bilateral otoplasty, meaning both ears were operated on. This is especially important during the first 2-3 weeks of healing. Thereafter, most patients find it more comfortable to sleep this way, as the ears can remain sore for a several weeks after surgery.

What is a liquid facelift???

A ‘liquid facelift’ is a term popularized for non-surgical facial rejuvenation in which filler is placed in various aspects of the face in order to achieve a more youthful, refreshed look. There is no specific recipe for where and how much filler is injected – the treatment is individualized to the specific patient, their anatomy, and their overall aesthetic goals.

I am not a big fan of the term. Why? Because fillers don’t actually lift the face. I think the term ‘liquid facelift’ is misleading and confusing for patients.

Only surgery can truly lift things. Fillers add volume. It’s my opinion that as individuals age, the best outcomes often come from the result of surgery, judicious volume replacement by way of filler placement, and dedicated attention to the overlying skin.