I would like to introduce you to a novel new product for patients recovering from surgery on the face or neck, where a flap of skin was elevated off the underlying supportive tissues, and has a tendency to either develop fluid or blood under that flap, or worse yet, where the skin gets swollen because the lymphatic fluid is getting backed up because the delicate lymphatics were interrupted.
It is helpful to know a bit about my background and my impetus for this work. I am now a retired general surgeon with 40 years of practical experience in problem-solving, and in dealing with a variety of procedures where something like this would have been helpful to recommend to my own patients. Also, and maybe even more importantly, I have been through a facial rejuvenation procedure and have developed this product because of the difficulties I personally had, and the lack of devices that would have made it a much less miserable procedure to recover from. I developed a prototype shortly after the first month of recovery, so I was still able to glean some benefits, but certainly not as many as would have been possible had it been available from the start.
Allow me to start with the science behind this innovative device.
Before opting to go through the operation, I went to three different Plastic Surgeon’s and also read up extensively on the operation. The messages that I heard repeatedly is that after the operation, I would not be able to do ANYTHING that might increase the pressure in the veins or lymphatics of my face. That is, I was told that I couldn’t lift anything over 10 pounds, that I wouldn’t be able to bend over, and that I would have to sleep with my head elevated 45° or more or sleep in a lounge chair. I was also told to put ice on my face.
Personally having a large repertoire of operations that general surgeons perform on the face, I was familiar with exactly how hard it is to compress the scalp, the brow or the face. It is also difficult to provide cold compresses to the skin of these regions. A comfortable modality to do that, simply does not exist. A hands-free device that will keep it applied to the face without personally holding it without having to constantly be adjusted would be a welcome adjunct.
In my years of clinical practice, I had encountered several similar problems by treating chronic venous stasis in the legs. The increased vascular “back pressure“ can result in swelling that progresses to blistering vesicles. These blisters then tend to break down and subsequently form ulcers, resulting in pain, and even infections. It is a well-known and established treatment plan that you must FIRST decrease the pressure. This is generally done through compressive, circumferential wraps. Once healed, the legs can stay healthy with appropriately fitted graduated compression stockings. Below, I have captured some photos to help you understand the concept better.
The science behind this is also well established. The pathogenesis of how interstitial edema leads to the compromise of the micro circulation, (preventing the transport of oxygen and nutrients from the capillaries to skin cells) is replete in the surgical literature. DECREASED LYMPHATIC DRAINAGE -> INTERSTITIAL/MICRO VASCULAR EDEMA-> POTENTIAL SEROMA/HEMATOMA-> INCREASED DIFFUSION DISTANCE IN IMPAIRED NUTRIENT/OXYGEN-> INFLAMMATORY CHANGES AND POTENTIAL SKIN DAMAGE/ULCERATION. Compression then causes the reverse to occur. REDUCTION OF INTERSTITIAL EDEMA-> DECREASE IN THE PERI-CAPILLARY FLUID “HALO“-> IMPROVEMENT IN CAPILLARY FLOW, AND TISSUE EXCHANGE-> LESS PAIN, FASTER HEALING.* The connection between interstitial edema and seroma formation after facelift surgery has been established by several investigators. The disruption in lymphatics is much more likely given that the dead space created in this operation allows the fluid to leave the interstitium and flow into the dead space creating seromas. In the same way, blood from the disrupted capillaries gets into this space causing hematoma. See MEAD, and LAWRENCE.*
Compression, especially graduated compression, not only prevents the swelling of the interstitial space, but also decompresses it. It is not simply the swelling from inflammatory mediators, but probably more importantly, the temporary lymphatic dysfunction. A meta-analysis review incorporating 12 publications directly measured blood flow, tissue oxygenation, oxygen saturation, hemoglobin levels and flap circumference. This paper found that with compression, blood flow and tissue oxygenation increased, and flap circumference (edema) decreased.* In another meta-analysis, early compression of 30 to 35 mmHg did NOT reduce pedicle flow velocity nor flow volume, yet provided reduction in edema. In other words, it not only does not compromise a flap circulation, but actually improves the various aspects in micro-circulation. Facelift postoperative recovery results in a postoperative anatomy of dysfunctional lymphatics that I have already addressed. In addition, the elevation of facial skin changes the direction of lymphatic drainage. These changes demonstrate a change in flow towards the medial portions where vascularity remains intact. Many Plastic Surgeons are reluctant to apply any pressure to freshly elevated flaps. Some degree of necrosis frequently occurs to precarious zones behind the ear. Pressure that is too high, unevenly distributed or concentrated over a vascular particle could theoretically compromise perfusion. But that appears to be unfounded since moderate and carefully controlled compression has proven not only to be safe and actually beneficial. The MASQUE has been designed to provide graduated compression postoperatively, which will decrease the painful swelling, dreadful complications of skin necrosis, and the common fluid collections that can occur as a result of the procedure.
My desire is that you will recommend this to your patients, see these improved results, and feel comfortable, recommending it routinely.
The science behind this is also well established. The pathogenesis of how interstitial edema leads to the compromise of the micro circulation, (preventing the transport of oxygen and nutrients from the capillaries to skin cells) is replete in the surgical literature. DECREASED LYMPHATIC DRAINAGE -> INTERSTITIAL/MICRO VASCULAR EDEMA-> POTENTIAL SEROMA/HEMATOMA-> INCREASED DIFFUSION DISTANCE IN IMPAIRED NUTRIENT/OXYGEN-> INFLAMMATORY CHANGES AND POTENTIAL SKIN DAMAGE/ULCERATION. Compression then causes the reverse to occur. REDUCTION OF INTERSTITIAL EDEMA-> DECREASE IN THE PERI-CAPILLARY FLUID “HALO“-> IMPROVEMENT IN CAPILLARY FLOW, AND TISSUE EXCHANGE-> LESS PAIN, FASTER HEALING.* The connection between interstitial edema and seroma formation after facelift surgery has been established by several investigators. The disruption in lymphatics is much more likely given that the dead space created in this operation allows the fluid to leave the interstitium and flow into the dead space creating seromas. In the same way, blood from the disrupted capillaries gets into this space causing hematoma. See MEAD, and LAWRENCE.*
Compression, especially graduated compression, not only prevents the swelling of the interstitial space, but also decompresses it. It is not simply the swelling from inflammatory mediators, but probably more importantly, the temporary lymphatic dysfunction. A meta-analysis review incorporating 12 publications directly measured blood flow, tissue oxygenation, oxygen saturation, hemoglobin levels and flap circumference. This paper found that with compression, blood flow and tissue oxygenation increased, and flap circumference (edema) decreased.* In another meta-analysis, early compression of 30 to 35 mmHg did NOT reduce pedicle flow velocity nor flow volume, yet provided reduction in edema. In other words, it not only does not compromise a flap circulation, but actually improves the various aspects in micro-circulation. Facelift postoperative recovery results in a postoperative anatomy of dysfunctional lymphatics that I have already addressed. In addition, the elevation of facial skin changes the direction of lymphatic drainage. These changes demonstrate a change in flow towards the medial portions where vascularity remains intact. Many Plastic Surgeons are reluctant to apply any pressure to freshly elevated flaps. Some degree of necrosis frequently occurs to precarious zones behind the ear. Pressure that is too high, unevenly distributed or concentrated over a vascular particle could theoretically compromise perfusion. But that appears to be unfounded since moderate and carefully controlled compression has proven not only to be safe and actually beneficial. The MASQUE has been designed to provide graduated compression postoperatively, which will decrease the painful swelling, dreadful complications of skin necrosis, and the common fluid collections that can occur as a result of the procedure.
My desire is that you will recommend this to your patients, see these improved results, and feel comfortable, recommending it routinely.
INITIAL ENCOUNTER
APPLICATION OF IMPREGNATED COMPRESSIVE WRAPPINGS. (Different patient)
4 WEEK PROGRESS SHOWING DEREASED EDEMA, NO WEEPING
8 WEEK PROGRESS WITH UNCER HEALING AND EDEMA MAINTENANCE
SEROMA
SEROMANEEDLEASPIRATION
POST-AURICULAR SKIN NECROSIS