Complications?

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Facelift by by Dr. BCK Patel MD, FRCS in Salt Lake City and St. George, Utah

We are a tertiary referral center and often see patients from far and wide for second, third and seventh opinions! Complications of cosmetic surgical procedures of the face can be concerning to the surgeon as well as the patient. Most surgeons are skilled enough to correct any undesireable results. However, patients will often want second or third opinions. We also see many patients who want complications and undesireable results corrected. 

IMPORTANT NOT ALL UNACCEPTABLE RESULTS ARE COMPLETELY CORRECTABLE. CERTAINLY, WHEN IT COMES TO LOSS OF TISSUE AFTER REPEATED SURGERIES, AN IMPROVEMENT CAN BE SOUGHT, BUT A COMPLETE CORRECTION MAY NOT BE POSSIBLE

WHAT COMPLICATIONS OF FACIAL COSMETIC SURGERY DO YOU SEE?

The list of the types of patients we see is long. Some of the conditions we see are:

OVER-TIGHT FACE AFTER A FACELIFT

​We have all heard about the joker’s smile look and the over-tight face. Many of us have seen these results on the television screens and on the big screen. These are not easy problems to treat once the overly tight facelift or necklift has been performed. However with a careful review of the operation reports and examination of the patient, we can often improve the “pulled look” appearance.

Pull lines or kite lines which are a complication of a facelift where the vector was incorrect and the patient chose a "rapid lift" procedure with limited incisions
Correction of complications of facelift surgery with the pulled look or wind-swept look with a revision facelift and necklift and fat grafts

Surgical correction of the wind-swept look and correction of the earlobe that is pulled downwards and forwards with loss of the earlobe is complex and much more difficult than doing the facelift and necklift properly in the first place. However, with a combination of revision surgery, scar replacement, fat grafts and lasers, a reasonably nice result can be obtained as seen here.

EARLOBES PULLED DOWN AND STUCK TO THE FACE WITH LOSS OF EARLOBES AND WITH A WIND-SWEPT LOOK

The earlobes pulled down and stuck to the face after a facelift and necklift.

​This is a common problem that we see. It is possible to revise the scars and improve the position of the ear lobe and, in some cases, to even make a new “hanging” earlobe so that the face looks natural.

“I call it my botched facelift: I went to see Dr. Patel but his waiting list was longer than I was willing to wait. I made the mistake I dread every day of going to the next surgeon and having surgery done the following week! I was left with a too-tight pull, I got funny lines I never had, and worse of all, pain in my neck. I finally .”  D. Rock  63 Yrs Old with Fat Droopy Eyes – Salt Lake City, UT recommended for eye lift surgery – Salt Lake City, UT

PULL LINES ON THE FACE AFTER A FACELIFT

Pull lines on the face after a facelift: many patients succumb to the temptation of “weekend facelifts”, quick facelifts, etc. These are done through small incisions which can result in abnormal tension on the facial skin, resulting in “pull lines” which we also call kite lines. In such cases, it is necessary to redo the facelift and neck lift and change the vectors of the tissue repositioning, often with the use of other modalities like fat grafts, lasers, etc. We can improve these pulled faces.

Facelift complication showing the pulled look with kite lines needing revision facelift and neck lift with fat grafts

INADEQUATE IMPROVEMENT OF THE JOWLS, JAWLINE AND NECK AFTER A FACELIFT

Facelift and necklift surgery are precise surgical techniques that depend upon experience, a detailed knowledge of anatomy and a careful study of aging of men and women. A careful preoperative analysis and planning are vital. If and when

quick and template-type facelifts and necklifts are performed, the improvement can be moderate and unsatisfactory. About 30% of our facelifts are revision facelifts performed for patients who are either dissatisfied with their results from surgery elsewhere or where the results have not lasted sufficiently long enough after surgery.

Complications from prior facelift with unacceptable result of jowls, jawline and theneck with residual bands. Repaired with a revision facelift and necklift with nano fat grafts by Dr. BCK Patel MD, FRCS Revision facelift
Complications from prior facelift with unacceptable result of jowls, jawline and theneck with residual bands. Repaired with a revision facelift and necklift with nano fat grafts by Dr. BCK Patel MD, FRCS Revision facelift

BEFORE & AFTER

Revision facelift and neck lift showing a beautiful result with proper planning. Dr. BCK Patel MD, FRCS of Salt Lake City and St. George
Revision facelift and neck lift showing a beautiful result with proper planning. Dr. BCK Patel MD, FRCS of Salt Lake City and St. George

TREATMENT OF SKIN CHANGES: PORES, VESSELS, PIGMENT SPOTS, WRINKLES, LINES, SCARS, ETC

Some surgeons will perform very nice facelifts and necklifts but ignore the canvas of the face: the skin. A beautiful face demands beautiful skin as well as excellent underlying anatomical structures. We often see patients where the skin has been neglected: here we can achieve a lot of improvement using a combination of lasers, peels, pulsed light lasers, radiofrequency lasers, injection radiofrequency and other non-surgical techniques. 

BEFORE & AFTER

Revision facelift and neck lift showing a beautiful result with proper planning. Dr. BCK Patel MD, FRCS of Salt Lake City and St. George
“I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm.”  D. Gull Highly recommended for eye lift surgery – Salt Lake City, UT

BADLY PLACED SCARS AFTER A FACELIFT AND NECKLIFT

The designing of the incisions is a very precise technique and is not the same in men and in women and, indeed, is not same from one face to another. We often see scars that are obvious and very anterior to the ear or hairline. In others, the scars are too wide and distort the ear or the face. In such cases, we carry out scar revisions of various kinds to improve and hide as much as possible the old scars and reduce the size and improve the location. 

facelift-complications-scars-copy_orig
Lip fat augmentation to create fuller lips by Dr. BCK Patel MD, FRCS

ASYMMETRY AFTER FACELIFTS AND NECKLIFTS

We sometimes see patients who have a different result between the right and left sides of the face after a facelift and necklift. There are many reasons for this outcome, including underlying anatomical and bony differences between the two sides, different tissue placements, different incision placements, inadequate tissue volume replacement (fat grafts) and facial nerve and muscle problems. In some cases these can be improved, but one needs to see and examine the patients to obtain a detailed understanding of the underlying causes. 
Liplift by Dr. BCK Patel MD, FRCS

surgical reduction of the depressor angularis oris muscle may be used, but botox can achieve the same result, albeit on a more temporary basis.

Liplift by Dr. BCK Patel MD, FRCS

improvement in the melolabial folds and the angle of the mouth using the lifting surgical technique together with surgical weakening of the depressor angulari soris and fat augmentation of the mesolabial folds.

Liplift by Dr. BCK Patel MD, FRCS

Surgical markings for angular lift and weakening of the depressor angularis oris muscle.

FACIAL SCARS

We often see patients with unacceptable scars from trauma, surgery, tumour resection, reconstructive surgery, and other reasons. Depending upon the age, site, depth and relative relations, proper scar revision is planned using a combination of techniques, including lases, Z-plasty, W-plasty, geometric broken line scar revision, fat grafts, dermabrasion, microneedling, radiofrequency, vascular lasers and collagen remodeling lasers, among other techniques.
Nasal scr treated with Z-plasty
Keloids after facelift surgery needing resection and repair
Severe trauma to the face reconstructed with tissue rearrangement and lasers by Dr. BCK Patel MD, FRCS

ASYMMETRIC EYELIDS AND BROWS

After endoscopic browlift surgery and upper blepharoplasty, some degree of asymmetry is to be expected as none of us have the two sides look exactly the same. However, if the difference is very noticeable, it can be a problem. There are many reasons for this to occur, including failure to position the brows properly, failure to correct underlying ptosis of the eyelids, failure to design skin creases that match, failure to address the fatty tissue of the upper eyelid fat pads, too much removal of fat from eyelids and brows and misplacement of eyelid incisions, among other causes! As we talk to one another by looking at our eyes, designing eyelid surgery has to be the most fussy and accurate
​of all plastic surgery procedures.
Bilateral upper lid retraction which can be a complication of bilateral over aggressive ptosis repair
Right upper eyelid retraction after ptosis repair leading to lagophthalmos and corneal exposure
Cicatricial lower eyelif retraction with inferior scleral show after traditional transcutaneous lower blepharoplasty corrected with skin recruitment using adjacent tissue rearrangement by Dr. BCK Patel MD, FRCS

UNABLE TO CLOSE EYELIDS AFTER UPPER AND/OR LOWER EYELID SURGERY

Cicatricial lower eyelif retraction with inferior scleral show after traditional transcutaneous lower blepharoplasty corrected with skin recruitment using adjacent tissue rearrangement by Dr. BCK Patel MD, FRCS
Repair of right upper eyelid ptosis by Dr. BCK Patel MD, FRCS
Cicatricial lower eyelid retraction and ectropion after traditional transcutaneoud lower blepharoplasty corrected by tissue rearrangement by Dr. BCK Patel MD
This is a very common problem we see when the surgeon may have been over-zealous with the resection of tissues, or, not infrequently, the patient has asked the surgeon “to remove as much as he or she can” during the surgery, which is always a mistake. Again, proper planning with an assessment of the position of the eyeballs (proptosis, enophthalmos, etc), corneal health, laxity of tendons, looseness of eyelid tissues, ptosis or retraction, canthal dystopia, muscle tone, skin condition, degree of sun damage, etc, etc, etc are all factors that careful surgeons take into account. If you come to see us with the inability to close your eyelids after surgery, it is important for you to come with your preoperative photographs, and all your operation reports and clinical notes so we can examine you and assess your condition as well as what was done. Correction of this problem may involve one of myriad techniques and it may not
​be possible to completely correct the problems.

LOWER EYELIDS PULLED DOWN AND AWAY FROM THE EYEBALL AFTER LOWER BLEPHAROPLASTY

Cicatricial lower eyelid retraction and ectropion after traditional transcutaneoud lower blepharoplasty corrected by tissue rearrangement by Dr. BCK Patel MD
Again, this is a not uncommon problem we see. In some instances, we can correct this with a minor procedure and some conservative treatment. In other cases, a more detailed procedure or procedures may be necessary. ​
 

ABNORMAL INCISIONS AND SCARS AFTER BLEPHAROPLASTY AND ASYMMETRIC RESULTS

Designing skin creases and placement of incisions when performing upper and lower blepharoplasty is the secret to hiding the incisions. No surgeon can create invisible incisions but with proper design, we can hide them well enough to not be noticeable by anyone except by the patient and by us! When the scars are not well places, revision may be possible but not with perfect results in every case. Again, it is important for you to bring your pre-surgical photographs and operation and clinical notes with you
 

MISPLACED IMPLANTS IN THE FACE

Misplaced implants in the face can be cheek, chin or other implants. Implants on the face should be inserted conservatively and with the smallest size possible to give a nice result, so as to avoid the “operated look.” Sterility is also vital to avoid the risk of infection of the face and the implanted areas. Here, we often need to completely remove the implants, allow the tissues to recover from the surgical trauma and then carry out further reconstruction, often with tissue repositioning and with fat grafts. Replacement implants are only used occasionally in such cases. ​

​Facial plastic surgery gone bad
 
Complications from cosmetic surgery repaired by Dr. BCK Patel using the Hammock Lift to correct cheek ptosis and ectropion
Complications from cosmetic surgery repaired by Dr. BCK Patel using the Hammock Lift to correct cheek ptosis and ectropion

BEFORE & AFTER

Complications from cosmetic surgery repaired by Dr. BCK Patel using the Hammock Lift to correct cheek ptosis and ectropion

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FAQs

Facelifts are performed in an operating theatre for the sake of sterility and your comfort. We have a team of anesthesiologists and nurses who are trained to specifically look after patients undergoing these procedures.
 
 
General anesthesia is best for facelifts, although in some instances, sedation anesthesia may also be used.
 

With a 3-D procedure, there are several layer of sutures, accurately placed to give the lifting, tightening and filling, without leaving any tell-tale pull-lines. Some are slow dissolving sutures, others are more permanent. The skin sutures are generally removed between 7 and 14 days. ​

Lasers will be used to treat peri-oral lines, “sleep lines” on the cheeks and other skin irregularities. The advantage of using all the skills and modalities available to us, rather than performing quick or weekend or one-hour facelifts is that it allows us to give you a remarkable improvement not only in the structure and appearance of the face, but also the health and smoothness of the skin as seen here:
 
Facelift surgery can take between 3 and 5 hours of surgery time, depending upon the planned procedures, patient’s face-type, age and other factors. ​
 
Bruising and swelling are de rigeur! However, significant long-lasting complications are rare.
Bleeding is not common as we pay close attention to proper hemostasis. On rare occasions, a small hematoma may collect.
​
Everyone will experience some numbness in the face: this resolves over weeks to months. This occurs because of the dissection of the face. This is not a complication.
Because of the dissection and repositioning of the tissues, it is common for there to be small differences in the smile between the right and left sides: this is usually only noticeable to the patient and to Dr. Patel! It recovers over a few weeks.

All faces have asymmetry and there will be some degree of asymmetry. This is to be expected.
Permanent weakness of nerves and muscles is rare.
The scars are usually very well hidden. However, some patients may have a tendency to cause hypertrophic scarring: in such cases, certain lasers and treatments will help. By-and-large, scars are rarely a problem. With Caucasian skin, pinkness of scars is to be expected for several weeks. With darker skin, some hyperpigmentation may occur. 
 
Bruising around the jawline and upper neck is common for the first two weeks. The face itself usually will not get much bruising, but may be pink from any laser work. Swelling is to be expected because of the extent of the surgery: the swelling abates over about two weeks. ​
 
Only if insurance will buy you a Rolls Royce (Phantom, of course). ​
 
A sensation of firmness will be there because of the swelling: this is present for the first few days. Most patients do not need prescription pain medication after the first two to three days. ​
 
We will provide you with a special neck dressing which you will wear as much as you can for the first couple of weeks. You will also apply a moisturizer (any brand will do) to the face as healing skin and lasered skin requires moisturizer. Icing the face also helps for the first two to three days. Many of our patients will ice the face for longer as it feels good. You may be up-and-about the day after surgery. Gentle exercise (treadmill and stationary bicycle) may be commenced by day 3. More vigorous exercise like skiing and tennis may be resumed by about day 10. ​
 
Ideally, you should be within about 3 – 5 pounds of your desired weight. Whereas I can create the most beautiful angles and curves in slim patients, if you are able to get close to your ideal weight, we can wonders as can be seen in this patient who lost some weight before her surgery and is absolutely chuffed at her result:
 

In the first few days, everyone will experience some degree of dryness and blurry vision. You will also feel that your lids look a little tight on the outer corner where you will also feel some of the deeper sutures if you put your finger there: this is of no concern. The tightness and the bumps under the skin settle over a few weeks.
More serious complications which are very rare include excessive bleeding, hemorrhage and loss of vision. 

BROWSE TREATMENTS

Browlift
Lower Blepharoplasty
Midface Lift
Lip Lines
Skin Resurfacing

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    Contact Info

    ​Dr. BCK Patel MD, FRCS
    ​1025E 3300S
    Salt Lake City, Utah 84106, USA

    (801) 413-3599 (phone/text)
    E-Mail: bckpatelmd@gmail.com
    bckpatel.info

    Dr. BCK Patel MD, FRCS
    617 E Riverside Dr Suite 101
    ​Saint George, UT 84790, USA
    (435) 215-0014
    ​E: drbckpatel@gmail.com

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