Each patient is entirely different and requires a unique, individualized approach. The surgeon must thoroughly discuss the patients concerns and expectations. In addition, a full medical history and physical exam must be performed. A careful bleeding history should be taken to rule out need for hematologic consultation. A full list of medications, including over the counter and herbal supplements, must be obtained as many drugs can increase the risk of bleeding with surgery.
All patients should be photographed preoperatively. Standard photographic views include: frontal, right and left oblique, and right and left lateral. The reliability and consistency of the photographer is essential to the preoperative consultation. During the initial aesthetic consultation, each patient is evaluated for signs of facial aging, as well as intrinsic anatomic imbalances. A thorough facial analysis should be performed, and the surgeon should be prepared to diagnose photoaging of the skin, volume loss, bony abnormalities, and soft tissue deformities. Specifically, the signs of facial aging identified in patients who proceed to facelift surgery are jowling, neck laxity (with or without platysmal diastases), and midface descent. Patients are given options for treatment and counseled on expected outcomes. The surgeon must be certain that the patient has realistic expectations. The full surgical plan is discussed, including proposed areas of incisions and the reasoning behind placement of these incisions. Patients should also be counseled on all the risks of the surgery, which are discussed later.