Dr Ross Farhadieh Talks Faces – Facelifts, necklifts and more!

Something that’s close to my heart is facelifts, necklifts, and all things face (yeah that’s because I want one!) so- today we get the in’s and out’s from Specialist Plastic Surgeon Dr Ross Farhadieh who is based in Sydney and practices in Canberra as well.

Trish Hammond: Good morning, podcasters. Today and we’re going to have a fantastic podcast with Dr. Ross Farhadieh. He is based in Sydney. He also practises in Canberra, as well. Welcome, Dr. Farhadieh! How are you?

Ross Farhadieh: I’m well! Thanks for having me on, Trish. How are you?

Trish Hammond: Thank you so much. I’m doing great. Thank you so much for taking the time to join us here today.

Ross Farhadieh: A pleasure.

Trish Hammond: We’re going to have a talk about something that’s close to my heart, and a lot of other ladies out … And men, actually, out there as well. We’re going to talk about faces, and facelifts, and what happens as we age, and the different techniques that you use.

The first question I was going to ask you is, is face lifts and neck lifts, is that a procedure that you do a lot of?

Ross Farhadieh: Yeah. It’s an area that I’ve done sub-specialty training in. Both reconstructive as well as cosmetic because it’s something I’ve always been interested in. I increasingly do lots of necklifts, face lifts, and total facial rejuvenations.

Trish Hammond: If someone were to come for … I wouldn’t want a whole face lift, but there’s so many ladies out there that we’ve been speaking to at the moment. They’ve lost a heap of weight and what they want is from the jowls down. Is that called a lower neck lift?

Ross Farhadieh: Yeah. It’s a very common area that women and men, in fact, become concerned about as we age. The lower face and the upper neck tend to loosen up in our late 30s and early 40s. Certainly when we’ve lost a lot of weight, it becomes more prominent.

In general, to address these, we often not only do a neck lift, but in order to make sure that everything blends in harmoniously, you need to address the lower face as well. Otherwise, you’ll end up addressing the neck only and the rest of the face will look a different age and a different shape. It will become very obviously disharmonious.

In general, my approach is … Especially given the fact that the incisions are the same, is to address the lower face and the neck at the same time so that we have a harmonious appearance in that regions.

Trish Hammond: Okay. Yeah. So basically, the lower neck lift covers from the jowls down so that it doesn’t look weird.

Ross Farhadieh: No. That’s the idea. So, the lower face and the neck come together.

Trish Hammond: Alright. What about a whole face lift? Are there different types that you do?

Ross Farhadieh: Yeah. Classically, face lifts used to be done by just excision of skin. Sometime in the 1970s, we discovered that we could re-suspend the ligaments and go under plane called the SMAS plane, which allowed us to have longer lasting, more natural results. There are variations of this technique: High SMAS, the lateral SMASectomy, the extended SMAS technique, so techniques are available.

What I generally do is what’s called a composite SMAS technique, which combines both of these and doesn’t undermine the skin as much, which means that the results are more natural in terms of appearance. Post operative swelling is a lot less. The skin undermining is a lot less. Patients tend to recover quicker. This involves addressing different areas of the face from the apple of the cheek when it’s sunk down, to the lower face, to the mid face, as well as the neck where required.

Trish Hammond: Okay, because I know that people are always frightened of having that stretched look, but that … That’s not really done, these days, is it? It’s all about exactly what you said. Just making sure that the face is in proportion and not the skin just being stretched.

Ross Farhadieh: In principle, that’s the idea. You still, from time to time, see people who’ve had surgery where they look very stretched and artificial. The art of practising facial rejuvenation surgery is to make patients look refreshed and natural, as opposed to a stretched outcome. This is, in fact, what we do.

Trish Hammond: Yeah. Yeah. Awesome. If someone was to have a face lift or a neck lift, it’s obviously just day surgery. Is that right? Or do you stay in overnight?

Ross Farhadieh: In general, patients stay overnight from their neck lift and face lift. I see them the next day to make sure everything is fine and then they go home. From time to time, if the procedure hasn’t had a bit mess involved and it’s not as extended, then they can go home that day, at the end of the day.

Trish Hammond: Okay. Okay. Is there any after care on their part? Do you have to lay sleeping up? Are there any rules?

Ross Farhadieh: Yeah, there’s a sequence of these. We’ve actually created lots of pamphlets that describes exactly what you should expect and what the outcome should be so that you can go through all of those. In general, we recommend that people don’t sleep flat, that they have a couple of pillows under their back just to stop the swelling. And that they take it easy for the first couple of days. Certainly, for the first couple of days, they’re going to feel a bit bruised and a little bit swollen.,

Trish Hammond: Yeah, of course.

Ross Farhadieh: In general, we find that people, by the time they’ve gotten to a week, most of the swelling has settled down. In fact, they’re very much ready to integrate back into society and go back about their normal business.

Trish Hammond: Would you reckon a week? You think a week?

Ross Farhadieh: Yeah, a week to 10 days …

Trish Hammond: Okay.

Ross Farhadieh: Is not unreasonable. If you’re going to be in close quarters, it’s probably safer to think about two weeks. As I said, increasingly, swelling is less of a problem than it used to be.

Trish Hammond: Okay. Why is that? I’ve seen some people just after surgery and it’s like, “Oh my god!” You can’t go anywhere and you wouldn’t want anyone to see you.

Ross Farhadieh: Part of it is related to technique. Those people who still practise extended SMAS and high SMAS and that, or SMASectomy where they do significant amount of undermining of the skin, will find that patients are more swollen. Whereas, those who do a composite face lift technique will find that because there isn’t as much skin undermining, that the patients are less likely to be as bruised for as protracted period of time.

Also, some of this is related to our after care. In times going by, we’ve started using short bursts of steroid tablets. These steroids dampen the immune response for that early postoperative period and therefore, their edema becomes less of a problem for the patients.

Trish Hammond: Okay. Is there anything they shouldn’t do before surgery? I know you shouldn’t take fish oil and …

Ross Farhadieh: In general, anything that causes bleeding or things of the blood. Aspirin, fish oil, are things to be avoided. Perhaps the most important thing to avoid is smoking. There is good evidence that people who smoke prior to surgery and certainly post operatively are 10 times more likely to lose parts of the skin flap, which has been undermined. They’re more likely to end up with wound healing complications.

Trish Hammond: Oh, wow. Yeah, okay. So smoking is a big thing for sure.

Ross Farhadieh: Yes. I basically don’t operate on patients who are currently smoking.

Trish Hammond: Do you test them at all? Do you just take their word for it?

Ross Farhadieh: No, I trust my patients. I take their word for it. We discuss giving up … Stopping four to six weeks beforehand and for to six weeks afterwards.

Trish Hammond: Yeah. Yeah. Okay. I know you do your surgeries in Sydney and in Canberra. Which hospitals in Sydney do you operate from? For the face lift?

Ross Farhadieh: I operate in two parts of the city. I operate both in the eastern suburbs and then a number of various hospitals including Bondi Junction Private. I also operate in the northwestern area of Sydney in Hospital for Specialist Surgery. There’s a number of other institutions that I at. In Canberra, I operate both in Calvary Bruce as well as the National Capitol Hospital.

Trish Hammond: Okay, so there are a few options for patients as well.

Ross Farhadieh: Yeah.

Trish Hammond: Another thing that I’ve got down from a patient. What are any possible complications that can happen after a face lift?

Ross Farhadieh: One of the issues … I have a long discussion with all of our patients about complication profiles of all the surgery that we offer, and provide them with documents and pamphlets that gives them a good idea after our consultation as to what they look like. This is born out of my academic background and doing research and publishing in this field.

In general, the way to think about complications is general as well as specific. General complications can be related to bleeding, infection, anaesthetic complications. In general, post operative bleeding in face lifts, across large series of studies done by people who do face lifts a lot, is about in order of one to two percent. It is definitely more in men than it is in women. This is born out of the literature.

Perhaps the most important complication in face lift surgery is nerve damage to the facial nerve. Again, in large series of studies, the largest of which is 1000 patients in London, with two common face lift surgeons performing those consecutive face lifts … Their recorded number of major facial nerve injuries was in order of one percent. That means that the nerve that supplies the muscles of a small area of the face might be affected by the technique of surgery. This is not something that I have experience myself, but obviously, this is born out of the literature. The way around this is obviously to be as meticulous as possible and to take as much care as possible.

Slight bruising to the nerve, which causes mild asymmetry for a period of four to six weeks, is not that unusual. It can be as high as 10 percent in clinical studies.

In general, the surgery is very safe. It’s a lot more reliable than it used to be. It is something that, done in a perfect hand, should not result in any major complications.

Trish Hammond: Okay. Say for someone like me. My husband is always about, “Oh, I don’t care what you have done, but don’t ever touch the face.” Of course, I’m not going to listen to him. I’m going to, at some point, have a face lift. If I wanted to do that without him or anyone else knowing, I could actually come to Sydney, book myself a week … Stay with my daughter for a week, have my face lift, come back home, and I would look refreshed? Or would I probably …

Ross Farhadieh: Yeah, so that’s …

Trish Hammond: Still need a little bit longer?

Ross Farhadieh: That’s generally the idea. One of the things that I generally do is that I show my patients … We have quite a few people who come from interstate who come to visit us. We ask them to stay five to seven days postoperatively so we can see them during that time period and make sure everything is gone. While I’m at it, that there are no issues.

In general, we go through the sequence of photographs so they can see what patients look like at a week, what they look like at a month, what they look like at three months, what they can expect to look like at six months and so forth. You can, in fact, see that even though there are subtle differences, by the time you reach two to four weeks, you wouldn’t know. If you knew the person, you’d probably say that they looked refreshed.

One of the ladies that we operated on, she was 72 years old. She had a full facial rejuvenation, eyelids, her full face and neck done. She said that everybody kept saying that she looked really like she was rested and she looked refreshed and she looked fantastic. If you put a picture side to side, she looks 25 years younger.

Trish Hammond: Yeah.

Ross Farhadieh: People who saw her, because of the natural results, did not comment on the fact that she had had surgery. The scars are very well hidden.

Trish Hammond: Yeah.

Ross Farhadieh: We do short scar face lift surgery these days.

Trish Hammond: What about someone with short hair? I’m actually growing my hair at the moment because …

Ross Farhadieh: Yes.

Trish Hammond: I’m planning on having this done.

Ross Farhadieh: Yes.

Trish Hammond: Is short hair a problem?

Ross Farhadieh: Classically, with long extended face lift scars, it would be more obvious. Increasingly with short scar face lift surgery, really by the time you reach two to three weeks, the scars are not noticeable. They’re camouflaged well. They’re hidden in the right spots. They extend from the front of your ear to just behind your ear. Most people don’t notice this.

Trish Hammond: Yeah.

Ross Farhadieh: Even with short hair.

Trish Hammond: Yeah. Yeah. That’s really good to hear. How long would it take? How long are you under? How long is the actual operation?

Ross Farhadieh: Obviously these things are dependent both on the patient and as well as the operator and the technique that is used. For the composite high SMAS technique that I use, we would be looking at something in order of four to six hours in most of our patients. If we do a total facial rejuvenation that includes eyelids and the neck and so forth, it’s generally an all day affair.

Trish Hammond: Okay. Oh, it’s a big deal. Yeah. It’s not …

Ross Farhadieh: It is.

Trish Hammond: Finish off in an hour and move the next …

Ross Farhadieh: That’s right. No.

Trish Hammond: That’s something I was going to ask you about is multiple procedures. Say for example, you needed your eyelids done and a rhino … You could do it all at once if you wanted to?

Ross Farhadieh: With the exception of the nose …

Trish Hammond: Okay.

Ross Farhadieh: Which I don’t think should be done at the same time. In general, I suggest that if people are considering all of those areas to be done, that they consider doing them at the same time so there is no piecemeal surgery. That most things are addressed at the same time so that you end up refitting the of those areas together.

Trish Hammond: Okay. There’s absolutely no item numbers for this surgery, is there?

Ross Farhadieh: I’m afraid not.

Trish Hammond: Damn!

Ross Farhadieh: That’s right. That’s, in fact, one of their drawbacks of this surgery because if you’re driven by an outstanding technique and you want to be meticulous and you want to take your time to make sure that the patient ends up with the best results, it does mean that the surgery takes a little bit long. It is not a McDonald’s approach to face lift surgery.

Trish Hammond: Yeah.

Ross Farhadieh: Which means that those hours that the patient spends on the table have to be paid for. Because there’s no item number, no insurer covers that time period in the hospital.

Trish Hammond: Yeah. Absolutely. No, totally. I get it, because I’ve heard how much even the hospitals … Without the doctor’s fees … I know it’s not cheap. It’s …

Ross Farhadieh: No.

Trish Hammond: Your face. It’s your face.

Ross Farhadieh: Yes.

Trish Hammond: You know. Really.

Ross Farhadieh: It’s the only one you’ve got, right?

Trish Hammond: Exactly.

Ross Farhadieh: Your body and your face are your only permanent facets in life.

Trish Hammond: Exactly.

Ross Farhadieh: They’re worth investing in, if that’s what you want to do.

Trish Hammond: Exactly. I’m going to ask you one more thing. Actually, two more things to ask you. First of all, what about weight? What about if someone …

Ross Farhadieh: Yeah!

Trish Hammond: Kind of loses weight after they’ve had a face lift?

Ross Farhadieh: Good question. Good question. One of the things we’ll discuss is that ideally, what you want to do in all aesthetic surgery, is to have stable weight. One which you’re going to maintain for at least six months. This is the weight that you’re going to want to be afterwards as well. Any surgery that rearranges any part of your body will be effected by you losing weight or gaining weight. Those subcutaneous compartments will accordingly deflate or inflate.

It doesn’t mean that the results will be particularly adversely effected, but it is something that you need to be mindful of. For example, if you’ve had a lower face lift and neck lift done and you’ve got a really chiselled jaw, and then you go and pack on 20 – 30 kilogrammes, that jaw is going to be less likely a chiselled jaw. That’s just natural. That’s a byproduct of what happens to our bodies.

Trish Hammond: Yeah. So you want to be a stable weight and don’t mess around with … You want to be where you’re going to be …

Ross Farhadieh: Your normal weight.

Trish Hammond: Yeah.

Ross Farhadieh: Yes.

Trish Hammond: I haven’t got one of those yet, but hopefully soon.

Ross Farhadieh: None of us do, I don’t think.

Trish Hammond: I’m going to ask one more question. Because I’m actually planning on having this done in the next couple of years … I’ve had Anti-wrinkle injections, I’ve had some fillers. Now I’m detoxing, for one of the better word.

Ross Farhadieh: Yes.

Trish Hammond: I’m going cold turkey.

Ross Farhadieh: Yes.

Trish Hammond: I don’t know if that’s the right thing or not. I’m not going to have anything done. I’m figuring that if I’m going to …

Ross Farhadieh: Yeah.

Trish Hammond: Have a face lift, I want to have no fillers, or …

Ross Farhadieh: In my view, and this is a point of conjecture, but certainly fillers for people who are considering having facial surgery done, should’ve been stopped six to nine months beforehand. Botulinum Toxin, so Anti-wrinkle injections or Anti-wrinkle injectionss or an actual fat dermabrasion or micro-needling, they’re not things that need to be stopped.

In fact, increasingly, we often consider doing some skin treatment before we do the face lift. That in itself doesn’t need to be stopped. Certainly, hyaluronic acid, any of the injectables that we use as fillers, are things that should be stopped. As part of this process, I reckon any injectable patients with their own fat. I do some fat transfers that gives a more youthful appearance and the stem cells from their fat cells gives them a more youthful skin look as well as a fuller lip and a fuller cheek. Part of the ageing process is, in fact, atrophy of the subcutaneous fat compartments.

Trish Hammond: Yeah. You do that during the surgery?

Ross Farhadieh: Yes.

Trish Hammond: Okay.

Ross Farhadieh: As part of the face lift surgery.

Trish Hammond: Oh, great!

Ross Farhadieh: Where indicated, I do it as part of the face lift surgery. We do some stuff … We put some stuff in their lips, occasionally we’ll put some stuff in the brow. We’ll put some stuff in the cheek.

Trish Hammond: Okay. Okay. So you do that during the surgery. When you mention skin treatment before, like what?

Ross Farhadieh: Micro-needling. Micro dermabrasion. Some minimal laser therapy. There are things that can be considered having have done prior to having surgery. Not immediately prior to surgery, but four to six weeks prior to surgery.

Trish Hammond: Okay, so just so the skin is its premium before surgery.

Ross Farhadieh: Yeah, that’s right. That’s right

Trish Hammond: Great! Well that’s good! One last question.

Ross Farhadieh: Yeah?

Trish Hammond: I don’t know how long ago. I think its been a year or a year and a half ago, I had some filler. It’s permanent filler in my jowls because they were going to see if it’s worth injecting filler in the jowls. Anyway. It’s something that I’m not happy that I had done. It’s given me a bit of a square jaw. If I was having a face lift, is that something that you would … Could you shave it … It’s still there, and I think it’ll be there forever. Is that something you’d shave down?

Ross Farhadieh: It depends on where it is. Certainly if it’s an anomaly that bothers you. There are some people who are not happy about the structure support of their face. In bone work, or structural support work, or shaving it off, or trimming it off, or adding to it because some people have to add to their jaws, and we consider putting chin implants in so they look like they have a fuller jaw, there are things that can be considered as part of your facial rejuvenation surgery.

Trish Hammond: Okay. Oh good, so you can do that while you’re … Get it all done … Yeah … Have it …

Ross Farhadieh: Yeah.

Trish Hammond: Of course, makes sense. Do it while you’re there. Alright!

Ross Farhadieh: Sure.

Trish Hammond: That’s been awesome. I have no more questions. I think I’ve had every single question that anybody could possibly want to know asked.

Ross Farhadieh: Great. Thank you for your time.

Trish Hammond:

Thank you so much! I really appreciate it. Ladies and gentleman, if you’re looking for a facelift. Dr. Ross Farhadieh practises as I said in Sydney and in Canberra. You can either Google him or, or drop us an email to [email protected]. Thank you so much!

You can find Dr Ross Farhadieh at Panthea Clinics, phone 1300 03 03 71.