There are quite a few risks of Rhytidectomy. First and foremost there could be an allergic reaction to the anesthetic. The most common are complications are due to hemostasis [1 : stoppage or sluggishness of blood flow] or "overextensive undermining of flaps". Although extremely rare, it is possible to bleed post-operatively resulting in another surgery to control and drain the collected blood. Another possibility is hematoma (a collection of blood, some report 8.5% but usually is in the 5% range), seroma (a collection of the watery portion of the blood) and thrombosis (abnormal clotting). Loss of sensitivity is common, although temporary. Permanent sensation loss in the cheek or chin area or in general, can and may happen. There is also a risk of excessive scarring or inner scar tissue.
Although greatly feared, nerve injury is rare - 0.4% and 2.6%. Out of the nerves of the face, the frontal branch [: a branch of the ophthalmic nerve supplying the forehead, scalp, and adjoining parts] is most commonly injured. The reason it is vulnerable to injury during dissection is due to its path over the zygomatic arch [: the arch of bone that extends along the front or side of the skull beneath the orbit and that is formed by the union of the temporal process of the zygomatic bone (English translation: cheek bone) in front with the zygomatic process of the temporal bone behind] The mandibular branch [: the one of the three major branches or divisions of the trigeminal nerve that supplies sensory fibers to the lower jaw, the floor of the mouth, the anterior two-thirds of the tongue, and the lower teeth and motor fibers to the muscles of mastication] can be injured during dissection below the platysma (neck muscle) at the mandibular angle (angle of the jaw). There is the possibility of buccal [1 : of, relating to, near, involving, or supplying a cheek <the ~ branch of the facial nerve>] injury which can happen when deep dissection is carried out medially in the mid-face section. The greater auricular nerve is injured more than the facial nerve due to the postauricular [: located or occurring behind the auricle of the ear <a ~ incision>] flap [: a piece of tissue partly severed from its place of origin for use in surgical grafting] being elevated off of the adherent subcutaneous tissues.
As far as hematoma is concerned, "The pathophysiology [: the physiology of abnormal states; specif : the functional changes that accompany a particular syndrome or disease; in English this translates to the "reason" or "cause"] behind this problem is that the flaps are separated from the deep tissues, limiting the blood supply. Additionally, tension is placed on the flap as the skin expands to accommodate the underlying volume. Skin necrosis routinely follows unrecognized hematomas. Expanding hematomas must be addressed by opening the incisions and obtaining hemostasis [1 : stoppage or sluggishness of blood flow]. Smaller ones may disappear with serial evacuations. Meticulous hemostasis, judicious flap dissection, and attention to postoperative pain are the best defense against this common complication." source: Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96
If too much skin is removed or if inadequate incisions are placed, a rhytidectomy patient can suffer greatly. You see, excessive tension can widen scars (as talked about in the Temporal lift) Hypertrophic scarring is possible, especially in individuals who are prone to such (ethnic patients). If this happens these scars can be treated with repeat injections of triamcinolone [: a glucocorticoid drug used esp. in treating psoriasis and allergic skin and respiratory disorders, such as Kenalog or Kenocort:] every month. These injections help calm down inflamed tissue and break up the excess collagen causing the excessive scarring.
Another possibility is tissue necrosis (skin death) or skin sloughing [: dead tissue separating from living tissue; esp : a mass of dead tissue separating from an ulcer] . Topical and oral antibiotics will help but the necrotic tissue must be debrided [: the surgical removal of lacerated, devitalized, or contaminated tissue]. Many forms of debridement exist but the most common is manual with an acidic pack. The least common being maggot therapy debridement [: use of sterile maggots from the blue bottle fly].
A very common after effect is Alopecia [: loss of hair, wool, or feathers : BALDNESS] along the incision lines and even hair of the head in general or facial hair, such as eyelashes or eyebrows sometimes because of the anesthesia and medications such as antibiotics and pain relievers. Only about 1% (source: Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96) report permanent Alopecia. T his may be from individual bodily reactions, circumstances or excessive tension. Sometimes a scar excision is suitable, sometimes this will only create further tension.
Another major risk is facial weakness or paralysis. This can be from necrotic muscle tissue or surgeon area in detaching the flap of muscle for too long of a period of time and then the flap is traumatized. Resulting in necrosis at worst, as well as dysfunction. Another is attached earlobe, also called Pixie Ear Deformity [:drawn down or attached earlobe due to excessive rotation of the flap and auricular regions].
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08-21-2007, 11:32 PM
What are the Risks & Complications Of Rhytidectomy?
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