Facelift, Home, Neck Lift

Facelift & Necklift for Patient with Cushing’s Disease from Chronic Steroid Use.

I had the opportunity to meet a patient with the initials S.T. who is 55 years old and has chronic renal disease and therefore has been on chronic steroid therapy as well as other immune suppressing medication such as Myfortic and Remicade. One of the dreaded side effects of these medications is that the person’s face will became overly puffy and swollen in a very aggressive way such that there is significant distortion to the face.�
This is called “Cushing’s syndrome” or “Cushingoid Face”.  S.T. has suffered that problem and it has been devastating to her as it is for most people who suffer from it.  It is common teaching that a person who is on steroids cannot have elective surgery because steroids can also inhibit the body’s ability to heal well, thereby increasing the risk of healing problems following surgery.  This also pertains to the use of any immune suppressing medications like those mentioned above. I have had a lot patient’s who are on these medications for arthritis or lupus or any other number of over active immune system related disorders.  With help from their rheumatologists I have safely operated on at least 10 people like this over the last several years. Prior to 3 years ago, I would simply decline to operate on these patients because I was taught that it wasn’t safe to do surgery on them). However, all of these patients were able to be off of all medications at the time of surgery and stay off their medications for 1 week after the surgery.  I have never operated on anyone who was on their steroids during the surgery and the early post operative period.  S.T. was not able to be off of her prednisone even for one day because of her kidney disease but she desperately wanted to look normal and therefore wanted the surgery.  I spent a lot of time discussing this with her nephrologist who is very close with her as they have had a doctor patient relationship for many years.  The nephrologist wanted S.T. to have the surgery to improve her quality of life.  Based on S.T.’s desires and her motivation do this surgery and be very compliant with post operative care I decided to do her surgery for her.  I did a facelift and I used a very safe technique called the Deep Plane Facelift.  This facelift technique puts minimal tension on the superficial skin layer and most of the tension is on the deeper layers.  This makes this the safest facelift technique for any patient who may have an issue with healing like S.T.  Her nephrologist was involved in managing her kidney medications on a daily basis which included prednisone on the surgery day and every day afterwards. S.T.’s post operative healing course was perfectly normal without any problems at all.  The results outstanding and she is so happy that she was able to have this surgery.  S.T. and her husband feel that we were able to give her the appearance that she used to have before she suffered Cushing’s syndrome.  I am very proud of S.T.’s courage and motivation to go through with this surgery and I will be more willing to take on patients with these types of problems in the future.