HISTORY: The patient is a (XX)-year-old Asian female who presents for a followup consultation for a lower facelift and possible dermabrasion of her upper lip. She has previously been seen several times in the past regarding consultation regarding an upper and lower blepharoplasty as well as a lower facelift. The patient states that she underwent an upper and lower blepharoplasty by Dr. John Doe four years ago. She is not 100% happy with the results, and she complains about visible scarring of the upper eyelids as well as residual darkness under her eyes. The patient continues with her previous concerns regarding laxity of her lower face and neck region. She complains about jowling as well. Now, the patient also complains about marionette lines and wrinkles of her upper lip.
PHYSICAL EXAMINATION: The patient has facial aging, which is appropriate for her age. There is mild ptosis of the eyebrows with wrinkles of her forehead and glabella. There are also crow’s feet wrinkles present. There is minimal dermatochalasis of the bilateral upper eyelids with well-healed upper blepharoplasty scars. There are well-healed subciliary scars of her lower eyelids as well with minimal fat herniation and minimal excess skin. There is some wrinkling of the lower eyelids consistent with her age. There is moderate midface volume loss with deep nasolabial folds, downturned corners of the mouth, and significantly deep marionette lines. There is jowling bilaterally with severe lower face and neck laxity with platysmal banding. Overall skin tone is poor.
RECOMMENDATIONS:
1. Lower facelift: The patient was explained about scars in particular and the fact that the scars are permanent, lengthy, and can hypertrophy. We informed her that this surgery will help to improve the laxity of the lower face and neck region, including her jowls. We emphasized to the patient, however, that the surgery is limited in the improvement that it can make in actual wrinkles. We informed her that the nasolabial folds will be unchanged postoperatively and that her marionette lines would be only modestly improved. These would likely necessitate filler injections as well as a possible corner mouth lift for optimal improvement of the downturned corners of the mouth. We emphasized to the patient as well that the platysmal bands will be improved but not eradicated.
2. Upper lip dermabrasion: The patient has several fine and a few deep lines of her upper lip. There are two deep vertical wrinkles on the right side of her upper lip which, we emphasized to the patient, will be present postoperatively. We informed the patient that we could perform some dermabrasion of the upper lip to help soften all of the lines but emphasized to the patient that this is not like an eraser where all of the lines will be completely removed. We emphasized to the patient especially the two deeper lines on the right side of her upper lip will be present postoperatively. The patient has voiced an understanding of this. We also discussed the possible complications including, but not limited to, bleeding, infection, skin necrosis, DVT, and pulmonary embolism. We discussed with the patient that she would likely have residual nasolabial folds and marionette lines postoperatively as well as some perioral wrinkles. The patient has voiced understanding of all of the above.
