Facial Rejuvenation

With age comes wisdom and with wisdom comes wrinkles. Facial cosmetic surgery turns the clock back, but the aging process does continue inexorably forward. This surgery redirects and resupports as it removes the looseness which develops with age. We are an eye-contact society; we wish our eyes to sparkle while the rest of our face blends nicely into the background. This is approached through a menu of tissue alterations, addressing the forehead, face, eyelids and neck, either individually or in combination. Each of these areas also has a variety of procedures to specifically individualize the improvement based on need. The goal is to choose the procedure best suited to the patient's needs, desires and financial considerations. After surgery, one should follow a lifestyle directed toward delaying the aging process to prolong the effect of their new correction. Exercise, diet, stress reduction, limiting sun exposure and no smoking are all basic foundations to a good long-term result.

What you get is more than what you see. Removal of external excess skin is further enhanced by maneuvers designed for tightening neck muscles, removal of bulging eyelid fat, tailoring overactive eyelid and eyebrow musculature and resuspending facial support structures. Laser resurfacing adds another dimension to the long-term success of these procedures.

Blepharoplasty (Eyelid Surgery, Eyelid Lift)

Eyelid surgery, also called an eyelid lift or blepharoplasty, can rejuvenate puffy, sagging or tired-looking eyes by removing excess fat, skin and muscle from the upper and/or lower eyelids. Eyelid surgery may be performed for cosmetic reasons to improve sight by lifting droopy eyelids out of the patient's field of vision.

What can eyelid surgery do for me?

Blepharoplasty is ideal for the correction of:

• Loose, sagging and/or folded upper eyelids that may limit vision
• Puffy fat deposits in the upper eyelids
• Under-eye bags
• Sagging lower eyelids that may show the white of the eyes below the iris
• Excess skin in the lower eyelids
• Fine wrinkles in the lower eyelids

What won't blepharoplasty correct?

Blepharoplasty cannot raise the eyebrows or reduce the appearance of deep wrinkles, crow's feet or dark circles under the eyes. however, eyelid lifts can be combined with other procedures such as brow lifts and corrugator muscle modification (for vertical frown lines) to enhance a more youthful appearance.

Incisions are made along the eyelids in inconspicuous places; in the natural creases of the upper lids for upper eyelid blepharoplasty and just below the lash line on the lower lids for lower eyelid blepharoplasty. If no skin needs to be removed, the surgeon will likely perform a transconjunctival blepharoplasty, where the incision is made inside the lower eyelid and there are no visible scars.

Bruising, swelling and a sense of tightness in the eyelids are temporary and should subside within 2-4 weeks. Most patients can resume activities in 5 days, after sutures are removed, and return to work in about 10 day. Bright light and environmental sensitivity normally abates after a month or two. Contact lens wearing may ne resumed when irritation subsides after a couple of weeks.

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Facelift (Rhytidectomy)

In time, gravity, sun exposure, and the stresses of daily life take their toll on our faces and necks. Deep creases appear beside the mouth, the jaw line slackens and becomes jowly, and the neck develops loose folds and fat deposits. Facelifts counteract these signs of aging by tightening muscle, removing fat, and trimming excess skin, giving your face a fresher, youthful look. After surgery, some patients look 10-15 years younger.

What can a facelift do for me?

Facelifts, technically known as rhytidectomies (literally, "removal of wrinkles"), rejuvenate the mid- to lower face and neck. Facelifts are most effective for patients who want to correct:

• Midface sagging
• Deep creases under the eyes
• Deep creases between the nose and mouth (nasolabial folds)
• Jowls due to loss of muscle
• Sagging areas of fat
• Loose skin and fat under the chin and jaw

What won't a facelift correct?

Facelifts can produce a dramatic improvement in appearance for patients with the problems mentioned above. However, facelifts do not stop the aging process; in time, signs of aging will gradually appear once again.

It just turns the clock back, allowing aging to progress more gracefully. Facelifts can be performed in conjunction with browlift and eyelid surgery when appropriate.

Am I a good candidate for a facelift?

The best candidates for rhytidectomy:

• Wish to improve one or more of the signs of aging indicated above
• Are men or women whose faces have begun to sag, but whose skin still has some elasticity
• Are generally healthy
• Do not smoke
• Have realistic expectations
• Are considering a facelift for personal reasons, not because someone else is pressuring them to do so

• Traditional Facelift

  The "full" facelift for rejuvenating the face, jowls and neck, including fat sculpting, lifting and repositioning of muscle and deeper tissues, and skin trimming and redraping. The incision begins at the temples and travels down to the front of the ear, around the earlobe, and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin.

• Limited-incision Facelift

  For limited rejuvenation around the eyes and mouth, including nasolabial folds an other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip as well.

• Neck lift

  A neck lift concentrates on jowls, loose skin on the neck, and fat under the chin. The incision is made around the ear lobe and behind the ear to the lower scalp.
  
  However, neck prominences, such as "turkey gobbler deformity," may require only an incision under the chin.

What is recovery from facelift like?

After your facelift, your head may be wrapped up like a human Q-tip for a short period of time.

At first, you may experience swelling, numbness, bruising, and a feeling of tightness or tension in the face and neck. Your face may look uneven or distorted, and your facial muscles may feel stiff. Most of these usually resolve within 3-6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy or itchy in time.

Many patients return to work by the third week. Camouflage cosmetics can be used to minimize the appearance of bruising.

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Lateral Foreheadplasty or Browlift

This procedure, whether as an adjunctive procedure or as a stand alone maneuver, provides a significant improvement of eyebrow ptosis or droop, without giving a startled appearance or the "I've just seen a ghost" look.

Incisions are placed within the temporal hair bearing scalp, and tension or stretch is placed on deeper structures to avoid stressing the hair follicles. Normally, no scalp skin has to be removed. This procedure is of fairly short duration and down time afterwards minimal.

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Rhinoplasty

Rhinoplasty, or corrective nasal surgery, is designed to reshape, reduce or augment a person's nose to achieve facial harmony and enhance self-confidence. Though often performed as a cosmetic procedure, rhinoplasty may also be a reconstructive endeavor for correction of deformity from previous injury or birth defect.

More than any other facial feature, teenagers are most keenly aware of their noses. Its there in the mirror everyday, front and center. The embarrassment of a big or distorted nose extends into adulthood, distracting from an otherwise glowing personality. Rhinoplasty or "nose job" was originally designed for reduction of nasal hump and projection, and straightening deviation. The operation today is directed toward both appearance and strength. Providing cartilage support of the nasal tip is extremely important for long lasting results, as important as size, shape and position.

Specific Features addressed include:

• Balance the size of the nose with the other facial features
• Modify the width of the nose at the bridge
• Improve the nasal profile, including removing humps or depressions
• Contour a nasal tip that is too large, "boxy", drooping or upturned
• Change the angle between the nose and the mouth
• Narrow and reshape the nostrils
• Correct asymmetry or deviation

Rhinoplasty is best planned for after completion of facial growth, normally age 15 for girls and a few years later for boys. After surgery, as swelling resolves over several months, the nose will continue to improve in size and shape. A good rhinoplasty should not bring attention to itself, but rather allow the nose to blend naturally with the other facial structures.

Will I like the results of my nose surgery?

Patients with realistic goals for rhinoplasty are generally very happy with the new shape of their nose. The exact results depend on the patient's nasal bone and cartilage structure, facial shape, skin thickness and age.

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