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Surgeon's facelift techniques withstand test of time

Article-Surgeon's facelift techniques withstand test of time

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 post-graduate 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.

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