Nembutal

Miami -- He's been retired for seven years, but plastic surgeon Lawrence B. Robbins, M.D., of Miami is still asked to share some of his operating tips learned during a 28-year career.

That career included performing 3,000 facelifts with very few complications over the years. In addition to performing surgery, he spent his career teaching cosmetic techniques as past president of the American Society for Aesthetic Plastic Surgery and as a clinical associate professor of plastic surgery at the University of Miami School of Medicine. He developed a postgraduate fellowship in cosmetic surgery in 1974 that trained 50 fellows. Stanford University put him on staff as an assistant professor and sent residents to him for three months of training in cosmetic surgery.

Nearly perfect record

Dr. Robbins says his patients had no permanent facial nerve injuries, almost no infections and fewer than a dozen hematomas in nearly three decades.

He built one of the first Medicare-certified, state-licensed ambulatory surgical centers for plastic surgery in South Florida. Dr. Robbins says a successful facelift starts well before a patient ever sees an operating room.

"It is important for the surgeon to be aware of a patient's profile--that leads to getting a satisfactory result for the doctor and the patient" Dr. Robbins tells Cosmetic Surgery Times.

"By profile, I mean the physician needs to make sure the patient is in good physical and mental health, and has an awareness and understanding of the surgery they're going to undertake--and doesn't have unrealistic expectations about what can and can't be done.

"To this end, it's very important for the physician to establish a rapport with the patient in the consultation room--not a treatment room--so the patient feels comfortable and is at ease, and the doctor gets to know what the patient actually expects of the surgery."

Patient tools

Dr. Robbins says it's also vital for the patient to know what will actually happen during surgery. He uses a simple tool to give the patient a little extra information.

"I kept two mirrors in the consultation room. One was a straight-view mirror; the other was a reversal mirror--it reverses how you see yourself so that you see yourself as other people see you," he says.

That provides the patient with a completely different view of themselves.

"Looking at their familiar reflection, they may never have noticed that one eyebrow was higher than the other or that one eye was round, the other oval" he explains.

"I made patients look at themselves in the straight mirror and tell me what they didn't like on their face from the hairline down. Then I pulled out the reversal mirror and had them look at themselves again."

Dr. Robbins says that's the first time most people notice the asymmetry of their faces. If the surgeon doesn't alert the patient to asymmetries prior to surgery, Dr. Robbins says, they will be noticed afterward, and patients will tend to focus on those differences if they've never seen them before.

"Uninformed patients can end up being very unhappy with great results when those asymmetries are suddenly noticed after surgery."

Absolute criteria

He also had a set of absolute criteria patients had to meet before he would perform surgery: They couldn't smoke for at least one month and could take no aspirin or aspirin-related compounds for two weeks, and every patient had a medical clearance by a physician with appropriate lab tests.

Technically, for Dr. Robbins, simplicity was often the key to a successful facelift. First, he never used an anesthesiologist.

"I did all of my facial surgery under local anesthesia; I never put a patient to sleep--never. We gave minimal pre-op sedation--morphine and Nembutal (Ovation). A small dose of intravenous Versed (Hoffman-LaRoche) was given during the installation of the local; vital signs were closely monitored during the entire procedure. Patients were comfortable and safety was controlled."

Undermining

He says the surgeon needs to widely undermine the face, and he offers several simple tips to get good results:

* Pull the brow up and back--not directly upward, because that's what creates the surprised look.

* Maintain the normal anatomy of the patient's face, including the natural sideburn on both men and women.

* Bring the incision into the tragus to hide the scar--but don't put tension on the tragus, because that would expose the ear canal.

* Create a lobule that does not give an attached appearance.

* Bring the posterior scar onto the concha.

* Hide the remaining scar by following the hairline.

"You want to redrape the skin--not pull the skin or lift it," he advises. "You want to separate it from the underlying tissue. The fat has been pulled down by the skin--and by gravity. So now you can pull it back to where it used to be, and refill the hollows that developed in the cheeks and correct the jowl to recreate the original contour."

Neck approach

His approach to the neck was to detach the skin and fat from the muscle and remove the fat in one piece, then to properly treat the platysma muscle.

He says the key to avoiding nerve damage is to keep the entire operation above the nerves in a superficial plane.

While Dr. Robbins performed his surgery in his ambulatory center, facelift patients generally spent the night in a local hospital--through an arrangement for a flat fee of $350 to make sure complications could be easily treated --then went home after the dressing was changed the next day.

Only problem

Dr. Robbins says the only real complaint he ever heard was that he used very tight bandages the first night, but he explains that that avoided other common problems of facelift patients.

"We had very little discoloration, very little swelling and hematomas were rare," he says.

COPYRIGHT 2005 Advanstar Communications, Inc.
COPYRIGHT 2005 Gale Group