Hewlett, N.Y. — In an industry where assisting recovery from facelifts and other procedures is becoming a business in itself, a facelift completed with only local anesthesia and minimal or no sedation and that dramatically decreases recuperation time offers the possibility of altering the current state of plastic surgery.
"Ask any patient considering a facelift what scares them, and in the top five answers they always say the anesthesia and the length of recovery time following surgery," says Zachary Gerut, M.D., F.A.C.S. "In the past two years, I've completed over 300 facelifts without general anesthesia or deep sedation — and, of these patients, only five took more than a week to recover — most were back to their normal work or social schedule in just four days."Virtual volume
Success from Dr. Gerut's facelift approach is reliant upon several departures from the norm including the tumescent volume instilled prior to surgery.
The current formula used for pre-surgical injection consists of 1 liter sterile saline combined with 1 ampule of adrenaline, 15 cc of lidocaine and 15 cc of marcaine.
"I don't expect everyone to be instantly able to operate on a face that's swollen to two or three times its normal size with a liter of fluid, but the end result is proof that this approach offers optimal results over the regular facelift," says Dr. Gerut, who is in solo private practice in Hewlett, Long Island, N.Y., and assistant clinical professor of Plastic Surgery at Montefiore-Albert Einstein Medical Center in New York City.
"For 10 years or more, I've been injecting increasing amounts of facial tumescence prior to surgery in order to reach the point where the procedure can be completed with minimal sedation or only local anesthesia. While it's more difficult for the surgeon to operate and to picture the end result when the face is so swollen, the recovery is dramatically different."
Without the use of general anesthesia or deep sedation, Dr. Gerut performs a standard facelift, including a submental incision, midline platysma plication, pre- and postauricular incisions, lateral platysma plication, as well as completing a SMAS procedure.
"With the use of the tumescent technique I am also able to perform blepharoplasty, cheek and chin implants, tip rhinoplasty and central forehead lifts," Dr. Gerut says.
While most patients are lightly sedated, they are easily awakened during the facelift procedure — a request that more patients are making due to what Dr. Gerut terms the somewhat irrational but unfortunately pervasive fear of "going under" as well as to prevent post-op bleeding, bruising and swelling that the tumescent technique accomplishes. The results and the quick recovery from Dr. Gerut's approach have gained national media coverage on major television networks such as NBC, CBS and ABC.
"There's a demand for this approach and there's no reason why my colleagues cannot offer it," Dr. Gerut says. "It's important to expand our knowledge from journals and conferences, but it's also important to learn from patients."
Although unique in its avoidance of anesthesia, facelifts and other cosmetic procedures performed with the tumescent technique are fully monitored by his anesthesia staff, according to Dr. Gerut.
"It may be difficult for the plastic surgeon to learn to operate on a patient who is awake and moving and has a massively swollen face, but there are patients from all over the country and abroad that are coming to me for this approach," Dr. Gerut says.