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KSL Channel 5 Video Salt Lake City - Cosmetic Surgery Media Utah

Dr. Bitner has been an invited and featured guest on KSL Channel 5. He has discussed the latest and most recent advancements in surgical hair restoration and facial rejuvenation. Most recently, Dr. Bitner’s dialogue involved presenting the Rapid-Recovery Mini-Lift. It is important for patients to understand the major differences between all the face-lifting and facial rejuvenation options. Please click below for links to the interviews.

Below is the full transcript of the discussion Dr. Bitner had about facial rejuvenation on KSL Studio 5.

Question #1: A Face Lift removes extra skin only?

FICTION- In the early days of facial rejuvenation, extra skin only was removed. The results were initially excellent, the recovery time was short and complications were few. Unfortunately, the results were short-lived and within a year, the skin laxity had recurred.

However, in the 1970′s, Dr. Skoog described a layer deep to the fatty tissue layer called the SMAS (superficial musculo-aponeurotic system) layer. This layer is a strong connective tissue layer made of fat, collagen, and muscle. When this layer is repositioned up and back, the results can produce natural, youthful and long-lasting results. The modern-day SMAS facelift is designed to rejuvenate the lower two-thirds of the face including the cheeks, jowls and neck. Since the initial description, a dizzying number of names have been assigned to different approaches, all of which effect the SMAS layer in some fashion or another.

There are two important principles that must be observed to produce results that are natural, undetectable and long-lasting. First, the incisions must be carefully placed in inconspicuous locations. Being off by even a millimeter can leave the scar detectible. Incisions around the ear should be placed behind the temple hairline, behind the notch of cartilage in the ear, where the ear lobe joins the cheek and back behind the ear. Great care should be taken to avoid distortion or pulling on the ear lobe. Secondly, the SMAS layer should be pulled up and back. Manipulation of the SMAS produces the foundation for the final result, but excessive manipulation will cause prolonged bruising and swelling. A balance must be achieved that maximizes results while minimizing swelling and bruising.

Question #2: The “Speedy, Rapid, Light-As-A-Feather, etc…” Lift are updated versions of the facelift?

FICTION- The assigned names to minor variations in face lifting is a marketing technique. The intent is the make the patient feel that they are getting the full effects of facial rejuvenation while avoiding the down-time. This is the goal of all face lift surgeons whether they have assigned their technique a name or not. Buyer beware. In fact, the ASPS and the AAFPRS have forbidden their members from assigning monikers to their facelift techniques. The Academy feels that this style of advertising is misleading to the consumers. Generally, someone who has assigned a specific name to their facelift technique is a “cosmetic surgeon” whose training may or may not be verified.

I divide facelifts into three general categories: #1 an extended, long-flap, deep-plane or sub-periosteal facelift, #2 a traditional facelift and #3 the mini-facelift. The extended long-flap facelift can produce incredible “smoothening” of facial wrinkles, ironing out everything. However, the results can be leave the patient with an un-natural, wind-swept look and is rarely indicated. The traditional facelift uses incisions that are well hidden, short elevation of the SMAS layer with imbrication. The results are completely natural and will fix more extensive cases of facial aging. Roughly, this procedure is designed for someone aged 55 and above. Finally, the mini-lift uses shorter incisions, less SMAS manipulation, less bruising and a quicker recovery. This procedure is designed for less severe facial aging, usually age 45-55 or 60. A facelift by any other name is still a facelift.

Question #3: The laser facelift is an excellent non-surgical alternative to a traditional face lift?

FICTION- Laser skin resurfacing, chemical peels and other methods of resurfacing can help in facial rejuvenation, but do not treat the same things that a surgical face lift treats. Skin resurfacing helps with skin texture, sun damage and fine lines and wrinkles. Surgery helps correct sags and bulges. Both resurfacing and surgery are tools that should be part of the facial plastic surgeon’s armamentarium. However, the right tool needs to be selected for the patient concern. A laser can not produce the results that are obtained with a face lift, and a face lift doesn’t improve sun damage and skin texture. Generally, those who advertise “laser facelifts” are non-surgeons hoping their single tool is the answer for all aspects of facial rejuvenation.

Question #4: A face lift can be safely done in the office with local anesthesia and sedation?

FACT- While a facelift is definitely a surgery, most of the time, it can be performed in an office-based surgical suite with gentle IV sedation. Numbing medicine is injected into the surgical area and a nurse can administer the sedation. An office suite, should be certified by an ambulatory surgery group such as AAAASF or AAAHC. This ensures that the procedure can be done safely and adheres to accepted standards of sterility. An office setting provides privacy and better patient comfort than a hospital or surgery center. While general anesthesia can be given, usually IV sedation helps the patient forget most of the operation and remain totally comfortable throughout.

Question #5: Using photo imaging, you can show before-and-after photos, even before any surgery is done?

FACT- Photo imaging is an excellent tool used to aid in patient-physician communication. Essentially, a photo is taken and “photoshopped” to show how the person will look after the surgery. As long as the surgeon and the imager have an understanding of one another’s limitations, the results can be strikingly accurate to true “after” results. This helps in many ways. First, and foremost, the surgeon and patient can better communicate what they are hoping to achieve with the operation. It helps a surgeon show what can be accomplished with an operation and helps the patient communicate what they are wanting with the operation. Imaging also helps the patient get a reasonable understanding of what the surgery will look like on their own photo. While photo-imaging is not meant to serve as a guarantee for expected results, it is a valuable tool. The imaged results are usually very similar to the actual results obtained.

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John Bitner MD
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