Unique challenges exist when performing facelifts in elderly patients, but surgeons stress that painting all senior citizens with the same brush is inappropriate. In fact, plastic surgeon Graeme J. Southwick, M.D., of Melbourne, Australia, says the term "elderly" leaves significant room for interpretation.
"The dictionary defines elderly as 'having lived for relatively many years,'" says Dr. Southwick, who says that 35 percent of his entire facelift population comprises patients over the age of 60. "In Australia, from 2010 to 2050 it is expected that the number of people in the 65 to 84 age (range) will more than double, so elderly facelifting will be commonplace."
San Francisco plastic surgeon Timothy J. Marten, M.D., says a patient's chronological age isn't nearly as significant as their overall physical and mental condition. "Patients age differently, and this affects how I approach them," he says. For example, "A frail patient with limited mobility, poor posture, fragile skin, thin fine hair and multiple medical problems who long ago gave up regular exercise and has a limited social circle of similar friends is not the same as one of the same chronological age who is in good health, exercises regularly, has elegant posture, good skin, thick hair, gets around easily, is engaged in a long list of activities and keeps busy with a wide and diverse circle of friends," he says. The former patient should be approached with extra care and will be accepting of a more limited surgical plan, whereas surgical decision making is less constrained in the latter patient, who likely still desires the best possible outcome that can be achieved, according to Dr. Marten.Both surgeons stress that while taking a medical history is always important, making a detailed assessment of the elderly patient's heath is even more crucial.
"Elderly patients have more medical problems, more cardiovascular problems and more neck arthritis, so more care is required in neck movements during surgery," Dr. Southwick says.
Adds Dr. Marten, "You have to make sure that the patient is medically up for the procedure."