Consultation & Physical Exam for Neck Rejuvenation
 Health History
All cosmetic surgery consultations
begin with a thorough health history. This is especially
true if general anesthesia is being used, but also applies
to local anesthesia. Neck Lifts are usually done
under general anesthesia. Prior to meeting with Dr. Cruise you will be given a health history questionnaire
to fill out in the waiting area. There are five areas
of your health you will be asked about. Be sure to
answer it with detail so that your surgery and anesthesia
can be optimized for you.
1) General Health
General health problems are important
to discuss so that your surgery is as safe as possible. Be
sure to mention any chronic illness. Of particular
concern are: high blood pressure, diabetes, heart problems,
liver and kidney disease, stroke, cancer, bleeding problems,
and wound healing problems.
What will Dr. Cruise do if I
have medical problems?
In short, he will make sure your
health is optimized as much as possible to ensure your
safety. This may mean referring you to your private
physician.
If you have a health problem
or are over 50 years of age you can often save yourself
time by getting a letter from your private physician prior
to your cosmetic consultation stating what the health
problem is, how it is being treated, and whether or not
you are able to tolerate general anesthesia safely.
If you are seeing any specialist
(i.e. cardiologist, kidney doctor, psychiatrist, etc.)
be sure to bring a letter from them stating that you are
able to tolerate surgery.
If you are not able to tolerate general
anesthesia it may be possible for your neck lift to be
done under local anesthesia. This must be discussed
with Dr. Cruise.
Be sure to let Dr. Cruise know
if you have ever had a blood clot.
2) Past Surgical History
On your questionnaire you will be
asked about previous surgeries. Be
sure to identify any problems you may have had with anesthesia. Of
particular concern are previous cosmetic surgeries especially
if you do not like the result and are interested in revision.
3) Medications
Be sure to list all medications you
take including aspirin and over-the-counter medications. These
are important as they may increase bleeding and affect
your surgery. It is extremely important to stop taking
aspirin and aspirin containing products at least 10 days
before surgery. Tylenol is a good alternative. Here
is a partial list of aspirin containing products and
other products to be avoided prior to surgery.
4) Allergies to Medications
Information about medications that
cause allergies is very important so that these medications
can be avoided. Of particular importance is the reaction
you had, especially if you had trouble breathing. Be
sure to include this information! Nausea is not an
allergy but it is important to mention as well.
5) Smoking, Drinking and
Drug Use
These three will certainly affect
your surgery and MUST be mentioned so that your surgery
can be optimized. Smoking causes a profound decrease
in wound healing and will lead to worse scarring and a
less favorable result. With
large procedures such as a face lift, neck lift, tummy
tuck, and breast lift smoking must be stopped at least
3 weeks before and after surgery. Otherwise, the
results could be disastrous leading to non-healing wounds,
poor scarring, and/or infection. With smaller
procedures such as eyelid surgery, nose surgery, breast
augmentation, and liposuction smoking will hurt the overall
result but this may or may not be noticeable. In
this case smoking cessation is strongly advised but is
not mandatory.
Neck lifting involves elevating the
neck skin. This puts a strain on the blood supply
to the skin. Normally, this is not a problem but
it may be in smokers. Smoking significantly decreases
blood supply to the skin and can cause skin slough. The
last thing you want after going through a neck lift is
a large scar from poor healing caused by smoking.
Physical
Exam
The key to the neck physical exam is
to determine exactly what is causing the problem. Below
is a typical sequence that an experienced plastic surgeon
such as Dr. Cruise uses to evaluate the neck and what can
be done to correct problems.
Chin
The importance of the chin in relation
to the neck has already been outlined. See the section
on chin augmentation for more information. With aging, some people develop
a droopy chin otherwise know as witch's chin. This
can be corrected or markedly improved during neck lifting. There
are several ways to address the problem but they all involve
removing the hanging fibro/fatty tissue that hangs below the
ideal chin level. This can be done through a small incision
just below the chin. Notice in the above Before and After
pictures the improvement of the droopy chin. The addition
of a chin implant greatly helps improve droopiness. Usually,
as is the case above, this is not necessary. Fat removal in
combination with a properly performed neck lift will obtain
the desired improvement.
Neck
Hanging skin below the neck is probably the most common
complaint. During your consultation, your plastic surgeon
will palpate the tissue to determine if the cause is excess
skin, fat, or muscle. Most commonly, it is a combination
of all 3, therefore, all 3 must be addressed.
1. Muscle
This muscle is called the platysma and extends from above
the jaw line to the clavicle. It is responsible for
skin tightening. Men flex this muscle to tighten their
skin when they shave. This is the deepest layer, therefore,
during a neck lift it must be addressed first. With
aging, this muscle becomes lax and separates into bands
under the chin. These bands are excised through a small
incision just under the chin. They are sutured together
in the midline to create a smooth, continuous neckline. If necessary, the muscle is then tightened laterally through
an incision behind the ears. Alternatively, the platysma
muscle can be suspended into proper position by a suture
that extends from one ear to the other. |
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