Ask Dr. Manchester

How is skin elasticity determined?

Sunday, January 10th, 2010

Question:
I have read that the elasticity of my skin can have bearing on the outcome of my facelift. How is the elasticity determined?

Answer:
Elasticity is not determined. It is a fact and is different in each individual. Think of skin as being similar to a pair elastic panty hose. Brand new it has a great deal of stretch and i.e. elasticity. This panty hose, if washed in warm water every day for six months and dried with heat for six months would lose its elasticity after six months. You could alter it but you would not have the flexibility of a new pair. Our skin acts in a similar way. Flexibility is determined by how much sum you received as a young person (it takes about 45 years to see the full effect but can be seen much sooner in some individuals. Skin thickness also determines flexibility.

What are the long-term effects of a facelift?

Saturday, January 9th, 2010

Question:
I am a 41 year old woman planning a facelift, which will be my first ever surgical procedure! I am wondering, what are the long-term effects of a facelift on the quality of my skin and my circulation?

Answer:
If you are having your surgery by a well trained surgeon, there should be no long term effect on skin quality or circulation.

The one effect that will be achieved is that you will always look younger than your stated age and your peers. There is no downside to a facelift unless your surgery is substandard. Some surgeons have a tendency of pulling their patients too tight or change the direction of the normal skin pull. I would advise you to look at photographs and meet a recent postoperative patient to obtain a “feel” as to what you should expect.

Minimize scarring after a breast reduction procedure?

Friday, January 8th, 2010

Question:
What can my surgeon do to minimize scarring after a breast reduction procedure? I am 35 and very interested in getting this done but am worried about embarrassing scar tissue.

Answer:
The skin closure is the most important factor in determining whether you will achieve good thin scars that will fade with time. Most surgeons remove their sutures after 10 days and use absorbable sutures to close their wounds. In breast reduction, the surgery is done backwards in that the incisions are under the breast and thus all of the weight of the breast is pushing down onto the incision. Absorbable sutures are absorbed by inflammation. This reaction to the sutures creates a red hard scar that lasts for a prolonged time and promotes scar tissue formation. Early removal of sutures also allows the wounds and scars to spread. Incisions and thus scars are not at 100% tensile strength until they are 7 weeks old.

I like to use nonreactive, non-absorbable sutures for my breasts reductions. I close my wounds with deep Nylon interrupted sutures and I use a Prolene running subcuticular suture for the skin. I leave the prolene skin suture in place till the patient shows some skin reaction to it which is usually at 6 to 7 weeks following surgery. In this way. the wound has gained most of its tensile strength and will not spread or pull apart. Scars turn white within 4 to 5 months and mature quicker that the standard methods.

I am planning on having a facelift…

Wednesday, January 6th, 2010

Question:
I am planning on having a facelift and I am also doing Invisaligns®. Is it safe to have the facelift within a week of my Invisaligns®?

Answer:
A simple answer is Yes. Invisaligns® are clear plastic aligners that are designed to move your teeth similar to braces without the unsightly hardware. Impressions are made of your teeth and then a series of molds i.e. aligners are made to slowly move your teeth into position. These are changed every three. There is no surgery involved and no tension is applied to the mouth or skin of the face. Your dentist will be able to replace your Invisaligns® every three weeks without hurting the incisions of a facelif

Correct a mouth drooping at the corners…

Tuesday, January 5th, 2010

Question:
I am 67 years old and am wondering what the most natural-looking way would be to correct a mouth drooping at the corners.

Answer:
This is a very difficult problem and the treatment depends on severity. Some patients complain that the drooping causes drooling when drinking liquids. If this is the case support needs to be given to the ligament (modiolus anguli oris) that circles the mouth. This modiolus is a ligamentous structure that circles the mouth and is used by the muscles that animate the mouth and face. The muscles that move the mouth in smiling and kissing all attach and are anchored to this structure. Mild cases of drooling or drooping, can be improved with the injection of tissue fillers in to bulk up this area. I have used this on patients with strokes or who are too old to have surgery. The fillers bulk up the lower lip and close off the corner of the mouth as well as elevates the lower lip.

In a healthy patient, an extensive facelift with dissections carried out to the corners (commissures) of the mouth. Sutures are placed in the modiolus or commissure at the lateral side of the mouth and then elevate and sewn into the superficial fascia of the cheek. The muscle that runs around the mouth is the orbicularis oris and it is what is pulled upward and posteriorly and sutured to the superficial fascia of the cheek. This surgery is performed under general anesthesia and is individualized for each patient as to how tight and high the pull will be.

Minor cases can be treated with a simple facelift.

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