Facial Rejuvenation

face and neck lift | brow lift | rhinoplasty
eyelid surgery | collagen | botox

Face and Neck Lift

Surgery to rejuvenate the face and neck can profoundly influence one's appearance and restore self-confidence. Face and neck lifting procedures ideally should be individualized for each patient's own findings and complaints. Not any one technique can nor should address every issue.

The Surgery
Surgery can be performed under local anesthesia with sedation. It may be performed as an outpatient procedure. I use anesthesiologists to provide the anesthesia sedation. Skin laxity, muscle laxity, and facial and neck fat distributions are addressed.

After the Surgery
Following surgery a cotton filled elastic supports the tissues for several days. Once this is removed, a simple elastic neck strap supports the healing tissues and aids in readherence. Bruising and discomfort are generally minimal to moderate and resolve over one to two weeks.

Health Concerns
As with any cosmetic procedure, complications are uncommon, but include bleeding, infection, delay of healing, lumpiness, slight asymmetries, numbness, and muscle weakness. Scars are well concealed and heal rapidly-generally fading quicker than scars elsewhere on the body. Return to activities start around seven to ten days after surgery.

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Brow Lift (Forehead Lift)

Before and After Click To Enlarge

Surgeryto rejuvenate the brow is one of the least utilized often overlooked option for facial rejuvenation. The procedure is surprisingly pain free with rapid recovery and little risk. Benefits can be dramatic when the forehead lines and lateral eyebrow droop or hooding is corrected.

 

The Surgery
Surgery begins with an incision through the hair near the top of the scalp. No hair is cut. The scalp soft tissues are undermined and the forehead muscles are selectively divided or removed. The skin and scalp is then pulled back and inset in a more youthful location that eliminates the sagging corners of the eyebrows which have weighed down the eyelids.

After the Surgery
A cotton elastic dressing is placed for one day. Patients then are free to gently wash their scalp. Immediately their hair covers the incisions. Recovery is quick. Patients return to work in five days and resume exercise in less than three weeks.

Health Concerns
As with any cosmetic procedure, complications are uncommon but include bleeding, infection, delay of healing, nerve injury, and alopecia (hair loss). Scars generally heal more rapidly on the scalp than in other body locations.

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Rhinoplasty

Before and After Click To Enlarge

Surgery to reshape the nose is a common cosmetic procedure that can have profound results on a person's appearance and self-confidence. Rhinoplasty can accomplish any number of changes, including size augmentation or reduction, a narrowing of the nostrils, changes in the bridge or tip of the nose, or an alteration to the angle of the nose and upper lip. Regardless of the specific purpose, surgery to reshape the nose creates a more contoured and shapely nose.

The Surgery
The surgeon begins by making an incision, either from within the nose or across the columella (the vertical strip separating the nostrils). The skin is then separated from the underlying framework (the bone and cartilage) of the nose and sculpted to the desired shape and size. Finally, the surgeon reattaches the skin to the new contoured framework, and stitches the incision. Surgery usually lasts no longer than an hour or two and is performed on an outpatient basis.

After the Surgery
Following surgery, a splint is applied to the nose to maintain the new shape. The surgeon may also decide to place nasal packs or soft plastic splints in the nostrils to stabilize the septum (the dividing wall between the air passages). Patients can experience some swelling and bruising to the eyes and nose; although medication greatly reduces any discomfort you may experience. Stitches are usually self-dissolving and patients can return to work in seven to ten days. Patients who wear eyeglasses must have them specially fitted to the head for up to seven weeks.

Health Concerns
As with any cosmetic surgical procedure, complications are rare, but may include infection, nosebleeds, or a reaction to the anesthesia. In certain cases, small burst blood vessels may appear as tiny red spots on the skin's surface (a minor but permanent condition). Minor scarring may occur if the surgeon makes the incision across the columella. To maximize the success of surgery and minimize the risk of complication, always follow your doctor's instructions for surgical preparation and postoperative care.

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Eyelid Surgery

Before and After Click To Enlarge	Before and After Click To Enlarge

The area surrounding the eyes is one of the first to show the signs of aging. Eyelid surgery, or blepharoplasty, corrects for sagging upper eyelids and for the bags that form just below the eyes. Eyelid surgery can wash away years of aging, giving your eyes a smoother, more natural and youthful appearance.

The Surgery
The surgeon begins by making incisions along the natural creases of the upper lid, and/or directly under the lower eyelashes. The skin is then separated from the underlying tissue and the excess fat, skin, and muscle are extracted. The surgeon then replaces and stitches the skin, leaving it smooth and tight. Blepharoplasty lasts anywhere from one to three hours and is usually performed on an outpatient basis.

Alternative Approaches
In some cases, a surgeon may opt for transconjunctival blepharoplasty. The surgeon makes several incisions on the lower eyelid and removes pockets of fat, but no skin. This procedure is ideal for patients with less skin excess under the eyes, and leaves no visible scar.

After Surgery
Following surgery, the eyelids are rubbed lightly with ointment. There are no bandages. The eyes will feel tight and sore, although medication alleviates much of this discomfort. The head should be kept elevated for several days. Application of a cold compress minimizes swelling and bruising. The sutures are removed within a week of the surgery. Most patients can return to work in seven days, but must take care to protect the eyes from harmful contact and irritants.

Health Concerns
As with any cosmetic surgery procedure, complications are rare, but include a reaction to the anesthesia and infection. More minor complications include temporarily blurred vision and a slight disparity in the healing and/or scarring of the two eyes. Once the sutures are removed, tiny whiteheads may appear around the eyelids, but can be removed easily by your surgeon. To maximize the success of surgery and minimize the risk of complication, always follow your doctor's instructions for surgical preparation and postoperative care.

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Non Surgical Facial Restorative Procedures

Collagen

When we are young, our skin is soft and elastic, free from the facial lines and tissue damage that time, injury, and disease can cause. This youthful looking skin is due, in a large part, to collagen, the fibrous protein that forms the underlying support layer beneath the skin. Over time, the skin's network of collagen begins to weaken, causing the skin to lose its elasticity. Collagen injections have been used for decades to refill depressions and lines in the skin. Collagen Replacement Therapy is a safe, nonsurgical treatment that can even out facial lines and scars, as well as improve the look of specific parts of the body.

The Treatment Process
Patients are first given a skin test to detect for a possible allergic reaction to the collagen injection. The test involves the physician injecting a small amount of collagen into an inconspicuous location. This testing period takes approximately a week. If no reaction is determined (this is the case roughly 97% of the time), the patient returns to the office, where the physician reviews the medical record and outlines the basics of the treatment.

The treatment is nothing more than an injection(s) of collagen into a specific area. Some patients find the injections slightly uncomfortable; especially those performed on the lips or around the nose. The injection is typically no more painful than a normal shot. Some types of collagen contain a small amount of lidocaine, which helps to numb the "injection" area. Most treatments last 30 minutes and can be accomplished during a lunch hour.

Following the Treatment
Immediately after the treatment there may be some temporary bruising, puffiness, or tenderness. This is normal and gradually subsides in a few days. Patients can resume their day-to-day activities almost immediately following the injection. The longevity of a collagen injection varies, lasting anywhere from several months to one year. Just like naturally occurring collagen, collagen injections gradually wear away and patients can choose to have "touch up" treatments.

Health Concerns
In very rare cases, a shallow scar can form at the injection site. If you experience prolonged redness, swelling, itching, and firmness at the injection site, contact your physician immediately. Individuals with a history of allergy to other bovine collagen products; patients with other severe allergies; or those who are sensitive to lidocaine should not undergo collagen injections.

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Botox

No matter how well skin is preserved and pampered, everyone eventually develops facial wrinkles. Fortunately, there are a number of options available to remove the lines that accompany aging. Botox is perhaps the easiest of all these options. Botox is an extremely quick approach to soften or remove the natural wrinkles between the eyes (frown lines), on the forehead, at the sides of the eyes (crow's feet), or at the base of the nose (glabellar frown lines).

What is Botox
Botox is a purified protein toxin that is derived from a specific form of bacteria. It was originally utilized as a remedy for neck and facial spasms, but in the last decade it has been used effectively to remove facial wrinkles.

How Botox is used
Each day, the muscles between the eyes (frown lines) or on the outside of the eyes (crow's feet) contract many times. Over time, these muscle contractions create virtual "creases" or wrinkles in the skin. To remove these wrinkles, Botox is injected through a very small needle into the muscles that cause these contractions. The Botox essentially impedes the nerve impulse from reaching these muscles. Gradually, the muscles relax and the facial wrinkles soften or disappear. Patients may experience a slight discomfort when the needle is inserted and the Botox injected, but this only lasts approximately 5-7 seconds. The entire treatment is performed in the physician's office and lasts 10 to 15 minutes.

Once the Botox Treatment is complete
In the majority of cases, patients return to their normal routines the same day. The muscles relax within a few days of the Botox injection, causing wrinkles to either lessen or to disappear completely. The muscles remain in a relaxed state for 3 to 5 months. Further treatment is necessary to erase returning wrinkles. After several treatments, the length of time that Botox is effective can increase, sometimes lasting up to 8 months.

Health Concerns
Botox has been used to diminish facial wrinkles for a number of years and exhibits very few side effects. Although it causes a temporary paralysis of the muscle, it does not affect the nerve, so no numbness in the face occurs. Immediately after the treatment, Botox can spread slightly and possibly lead to a temporary drooping of surrounding muscles. As such, patients should avoid rubbing the treated area for 10-15 hours following surgery. If drooping does occur, the surrounding muscles typically return to normal within a couple of weeks. In very rare instances, a blood vessel may burst, causing a temporary black and blue area. Patients who are pregnant or have been diagnosed with a neurological disease should refrain from having this procedure performed.

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