Plastic and cosmetics surgery face procedures
- Face lift
- Neck lift
- Brow Lift
- Blepharoplasty (eyelid surgery)
- Rhinoplasty (nose surgery)
- Otoplasty (ear surgery)
- Wrinkle treatments
Face lift
A facelift is one of the most effective ways to regain a fresh and youthful look. If your face does not look as young as you feel, you may be a candidate for a facelift.
When to do a facelift: – The majority of patients who undergo this procedure are between 40 and 60, although the procedure can be performed at any age if indicated. Face lifting can be repeated periodically if necessary. There are several conditions that are particularly improved after a facelift:
- A poorly defined jaw line
- Deep wrinkles in the face
- Sagging of skin near the cheeks or jaw line
- Loose skin and fatty deposits around the neck
Adjunctive procedures: – There are several other procedures that improve facial appearance and can be performed at the same time as the facelift:
- Brow lifting to improve tired appearing eyes or forehead wrinkles
- Eyelid surgery to remove excess skin and fat from eyelids
- Skin treatments or laser surgery to improve fine wrinkles in the face
- Collagen or fat injections to soften wrinkles or augment lips
- Botox injection to improve wrinkles
How is the surgery done? – A facelift is commonly performed under general anesthesia or local anesthesia with sedation. Incisions are made above the hairline in the temple and extend down in front of the ear and around the ear to the lower scalp. The scars, once healed are well hidden in natural creases. The skin and other tissues of the face and neck are separated, tightened, and re-sutured to achieve the desired result. The muscle in the neck may also be tightened. A soft bandage is placed around the face after the procedure.
How long is the recovery period? – Patients are advised to rest with their head elevated for the first 24 hours after surgery. Pain is usually well controlled with prescribed medications. The swelling in the face usually peaks within the first several days and then gradually subsides over one to two weeks. The bandage will be changed within the first week and any external sutures will be removed. Makeup can be worn to conceal any discoloration. Patients usually return to light activity within a few days. Patients can begin strenuous exercise after 4-6 weeks.
How long does a facelift last? It is difficult to predict exactly how long the results of a facelift will last, although patients are usually pleased with their appearance for many years after surgery.
Neck lift
Your neck can age differently than your face. If you've lost a lot of weight, your neck may be taking its time to catch up. For others, it's a matter of genetics. A neck lift is actually a set of procedures used to enhance the appearance of your neck:
- Cervicoplasty is the procedure used to remove excess skin
- Platysmaplasty removes or alters neck muscles
- Your surgeon also can perform neck liposuction, which removes excess fat. In some cases, Botox injections may be the answer to your problems if you have fullness or "bands."
How a neck lift is done: – Typically, the procedure will last 2-3 hours. Of course, if you are having a neck lift in conjunction with liposuction, facelift, brow lift or other surgeries, the time will vary accordingly. Your exact procedure will depend on your desired results and your own personal circumstances. In order to undergo a neck lift, you must be in good general health, both physically and mentally.
What do you dislike about your neck? – Be honest with yourself! You're putting a lot of time and effort into researching the surgery, so make sure you get the results you want. You also should write down your thoughts on what you'd like to correct and have that with you at the time of your pre-operative consultation.
Here are some of the most common concerns:
Turkey Wattle: – Weakened or loose neck muscles if you have weakened or loose neck muscles, this may cause the "turkey wattle" or appearance of neck "bands."
To correct this, your surgeon may recommend platysmaplasty surgery. The surgeon makes incisions under your chin and/or behind your ears to access the platysma (neck muscle) and manipulate it accordingly. Sometimes, that may even mean removing some muscle. Your surgeon may also use permanent sutures to hold the tissue in place.
You and your surgeon will discuss what type of anesthesia to use, depending on your level of comfort. If you want to remain asleep during the procedure, you should request general anesthesia. Otherwise, your surgeon can use local anesthesia with sedation. It's up to you, however, to make that determination.
Instead of surgery or in addition to it, Botox injections can relax parts of the platysma that are responsible for the "band" appearance or look of fullness. The injections are completed on an outpatient basis and typically can be completed within 15 minutes.
Excess fat – During liposuction, your surgeon will make a small incision below the chin and remove the excess fat. If you are undergoing multiple procedures during your neck lift, it is very common for plastic surgeons to begin with liposuction. If this is the only procedure you'll need, you should plan to spend up to an hour undergoing the operation. You will be able to determine this with your doctor during your pre-operative consultation. Your incisions will be stitched and bandaged. It's very important to follow your doctor's instructions on properly caring for the stitches and bandage in the days following surgery.
Too much skin – Just like the platysmaplasty, your surgeon will make similar incisions for a cervicoplasty, trimming parts of the skin and lifting it into place. It will be secured with tissue glue or stitches. The cervicoplasty can be completed in about 2-4 hours, depending on the complexity of your procedure. Again, your anesthesia will depend on your own personal comfort level. Your surgeon will fit you with a compression bandage that you will have to wear for at least one week, unless instructed otherwise. It's important to follow his or her instructions to ensure proper recovery.
How should I prepare for a neck lift?
- During your consultation, your surgeon will instruct you on what medications to avoid prior to your surgery. Certain medications and vitamins thin your blood and can cause increased bleeding.
- If you are a smoker, you will need to quit at least 4 weeks before the surgery and 4 weeks after. You cannot just plan to cut down. You must not smoke for this time period to ensure proper healing.
- This is no time for a diet: make sure that you eat properly because this will help your body heal.
- Make sure you wear loose, comfortable clothing on the day of surgery. You should especially plan to wear a button-down blouse or shirt that does not have to be pulled over your neck or head.
- You should plan to take at least 1 week off from work to recover. However, your doctor can determine this based on your personal situation.
- If you are having platysmaplasty, cervicoplasty, or a combination of any of the procedures we've discussed here, you should plan on having a home recovery area set up before you undergo surgery.
Your home recovery area should include:
- Ice packs
- Gauze and towels
- Thermometer
- Supply of comfortable, loose clothing (preferably button down shirts or blouses that do not have to be pulled over your neck and head)
- Petroleum jelly and antibacterial ointment for incision sites
- Telephone within reaching distance of where you'll be lying or sitting most of the time
- Supply of pillows which will allow you to keep your head in a comfortable position
- Someone who can stay with you at least the first 24 hours after surgery
Recovery takes time and it's important that you're patient with the process. Most people can return to work in 10-14 days.
If you participate in other sports or are physically active, you will have to wait at least three weeks, if not longer, to resume those activities. Don't rush! It's not worth it. You've put a lot of time and energy into making this happen, so make it worthwhile.
What are the complications and side effects of neck lift surgery? – You will have swelling and bruising that can last for several days. You may feel tightness or tingling, and different sensations including burning or pulling. You also will experience numbness. These are all very normal in the first few weeks following surgery and should not be cause for concern.
As with any surgery, you run the risk of infection. Please keep a watchful eye on your temperature. At the first sign of a fever, contact your doctor. If you have unusual discharge from the incision site, such as pus, contact your doctor immediately. Although it's very rare, you could have an allergic reaction to the anesthesia. That's why it's very important to disclose any drug allergies to your doctor in a pre-operative consultation.
Does insurance cover this procedure? – Insurance carriers are all different, but one thing is the same: They typically agree NOT to cover elective, cosmetic surgery. If your procedures will in any way correct a medical condition, it's important that you express this to your insurance carrier. Your surgeon can write a letter detailing your case.
Brow lift
A brow lift is also known as a forehead lift, an endobrow lift, an open brow lift, or a temporal lift. The procedure cosmetically corrects sagging in the forehead skin, upper eyelids and eyebrows.
Here's how: The surgeon will maneuver tissues and remove segments of muscles and skin that are responsible for wrinkles or deep frown. Sometimes, this procedure is performed in conjunction with a facelift or reshaping of the nose.
Think about it. You want your facial features to have the same contoured appearance. If you only have the work done on your forehead, other areas will appear more aged. If you are interested in learning about other procedures, you can discuss the options with your surgeon.
There are two methods to lift your forehead and eyebrow areas:
- The classic lift
- Endoscopic lift
The classic lift involves one continuous incision, beginning at the level of your ears and going up around your hairline. Depending on where your hairline is, the surgeon will move the incision line to avoid a visible scar. For instance, if you are a man who is balding, the surgeon can make the incision mid-scalp, so the scar can be hidden in the remaining hair. Here's how the endoscopic lift differs: Instead of making one continuous incision, your surgeon will make a few shorter incisions in the scalp. He or she will insert a scope (small camera on the end of a thin tube) into one of the incisions in order to view the tissues and muscles from a screen. At the same time, he or she will use another device inserted in another incision to make the necessary alterations.
In this procedure, small absorbable anchors are used to secure the offending tissue once it's altered appropriately. Those anchors are tiny, but mighty. They'll keep your tissue under control for years. Because the incisions are smaller, this procedure is less invasive. You will experience minimal scarring and shortened recovery time.
Eyelid surgery (blepharoplasty)
Drooping upper eyelids, lower lid puffiness, and dark circles can make you appear tired, angry or unhappy. If your eyes are making you look tired or older than you feel, then eyelid surgery (blepharoplasty) may be right for you. Eyelid surgery can remove excess skin and fat from the upper and lower lids, and can tighten the lower lid. The result is a younger, smoother, more alert and rested appearance.
Who is a candidate for surgery? – Most patients have eyelid surgery to minimize the effects of aging. Others may require surgery because drooping upper eyelid skin impedes their vision. This is one instance where insurance may cover the costs of surgery.
Are there limitations to the surgery? – There are other cosmetic problems that contribute to the overall appearance of the eyes. These may not be corrected by eyelid surgery alone. For example, a sagging brow may require a forehead lift. Fine wrinkles (crow's feet) around the eyes can be improved with chemical peels or laser resurfacing. Also, bleaching agents can be used to lighten the appearance of dark circles.
How is the surgery performed? Eyelid surgery is usually performed using local anesthetic supplemented by sedation. The incisions are well hidden in the natural creases of the eyelids. Any excess skin, fat, and hypertrophied muscle is removed. Very fine sutures are used to close the incisions.
What can I expect after surgery? – There is some swelling and bruising around the eyes following surgery. Ice is applied to the area for 24 hours to reduce swelling. Patients typically do not experience much pain following the procedure. They can resume day-to-day activities within a short time. The swelling and bruising subsides over the first week and patients can begin applying makeup at that time. Exercise can be resumed after several weeks.
Nose surgery (rhinoplasty)
Using micro-incisions, our surgeons can beautify your nose and correct breathing difficulties. By reshaping the cartilage and the nasal bones, a balanced look can be achieved for a more attractive appearance.
Is nasal surgery very painful? – There is some discomfort following surgery, but this is well controlled with medications.
What is the recovery like? – The surgery is an outpatient procedure. Most patients only require a small bandage. The swelling resolves within one to two weeks. Patients typically return to normal activities within a few weeks.
Will my insurance cover rhinoplasty? – Insurance does not usually cover the cost of surgery that is purely for cosmetic reasons. Surgery to correct or improve nasal function or surgery to correct a deformity or injury may be covered. We try our best to be your advocate to obtain insurance coverage for legitimate functional problems of the nose.
Can I combine a cosmetic procedure with one covered by my insurance? – A cosmetic improvement can be performed at the same time as functional nasal surgery. There is usually an additional fee for the cosmetic portion. We can give you more information regarding your particular situation following a consultation.
Otoplasty (ear surgery)
Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears. For the most part, the operation is done on children between the ages of seven and14. Ears are almost fully grown by age seven, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.
If you're considering ear surgery for yourself or your child, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything you don't understand about the procedure.
All surgery carries some uncertainty and risk. – When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle.
Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.
Planning for surgery. – Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome.
In the initial meeting, your surgeon will evaluate your child's condition, or yours if you are considering surgery for yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery.
Where will the surgery will be performed? – Ear surgery is usually performed as an outpatient procedure in a hospital, a doctor's office-based surgical facility, or a freestanding surgery center. Occasionally, your doctor may recommend that the procedure be done as an inpatient procedure, in which case you can plan on staying overnight in the hospital.
What types of anesthesia are used? If your child is young, your surgeon may recommend general anesthesia, so the child will sleep through the operation. For older children or adults, the surgeon may prefer to use local anesthesia, combined with a sedative, so you or your child will be awake but relaxed.
What is the procedure like? – Ear surgery usually takes about 2-3 hours, although complicated procedures may take longer. The technique will depend on the problem.
With one of the more common techniques, the surgeon makes a small incision in the back of the ear to expose the ear cartilage. He or she will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, the surgeon will remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete.
Another technique involves a similar incision in the back of the ear. Skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without removing cartilage.
In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.
What is the recovery like? – Adults and children are usually up and around within a few hours of surgery, although you may prefer to stay overnight in the hospital with a child until all the effects of general anesthesia wear off.
The patient's head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication. Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Be sure to follow your surgeon's directions for wearing this dressing, especially at night.
Stitches are usually removed, or will dissolve, in about a week.
Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery. Children can go back to school after 7 days or so, if they're careful about playground activity. You may want to ask your child's teacher to keep an eye on the child for a few weeks.
Other ear problems – Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include: "lop ear," when the tip seems to fold down and forward; "cupped ear," which is usually a very small ear; and "shell ear," when the curve in the outer rim, as well as the natural folds and creases, are missing. Surgery can also improve large or stretched earlobes, or lobes with large creases and wrinkles. Surgeons can even build new ears for those who were born without them or who lost them through injury.
Sometimes, however, the correction can leave a scar that's worse than the original problem. Ask your surgeon about the effectiveness of surgery for your specific case.
More natural-looking ears – Most patients, young and old alike, are thrilled with the results of ear surgery. But keep in mind, the goal is improvement, not perfection. Don't expect both ears to match perfect symmetry is both unlikely and unnatural in ears. If you've discussed the procedure and your expectations with the surgeon before the operation, chances are, you'll be quite pleased with the result.
Wrinkle treatments
- Chemical peels ? TLA peels, glycolic acid
- Dermabrasion
- Botox injection: What to expect
Is it just aging? Too much sun? Too much stress? In general, how skin ages and wrinkles is a complex process. It isn't just about cellular changes, collagen depletion, hormone loss, damage caused by free radicals, and so on; it's a combination of many factors.
The anatomy of the wrinkle – The lines that appear between your brows (glabellar lines) actually result from muscle movement and the passage of time. You may have heard the expression "wearing your emotions on your sleeve," but in reality you wear them on your face. If you're angry or annoyed, for example, you knit your brows together. Underneath your skin, your facial muscles contract, cause a pleating of the overlying skin, and then, as anyone can see, you're frowning.
After years of crinkling and wrinkling, those glabellar lines start to linger longer and can become more pronounced. For women, whose faces tend to be more animated than men's, and whose skin is typically more delicate, these lines may appear exaggerated and more permanent.
Fortunately, there is a way to temporarily reduce moderate to severe glabellar lines. Treatment with Botox Cosmetic can visibly smooth and soften moderate to severe frown lines between your brows. An improvement can be seen within days and may last up to 4 months, although results may vary. In clinical trials, nearly 90% of men and women surveyed rated the improvement in the appearance of frown lines between their brows as moderate to better 1 month after treatment.
Fat grafting or fat transfer is the procedure to remove surplus fat cells with meticulous extraction methods and to re-implant where needed - to the lips, nasolabials (mouth to nose folds), under eyes, cheeks, chin, temples, etc. This is a very exciting procedure as it is not incredibly invasive - but does create a moderate amount of swelling - and returns a youthful look.
This procedure can also augment the cheeks, chin, jawline with your autologous tissue to further enhance your look. Or quite simply restore your under eye fat or to fill areas where fat has been lost due to aging, trauma, disease or sickness.
How well does it work? – Well that is controversial and results differ from surgeon to surgeon. It has been argued by some surgeons that it does not, in fact work, although time and time again there are patients who rave about facial rejuvenation or augmentation through autologous fact grafting. Bottom line, if performed correctly, yes, it can last quite a long time. However, there are many variables:
- fat cell removal techniques
- handling techniques after removal
- spinning/emulsions/serums/etc.
- re-implantation techniques
- patient's metabolism
- patient aftercare of treatment area
- vascular (blood vessel formation to the fat cell)
Are you a candidate for fat grafting? – When we age our underlying collagen and elastin begin to break down and wrinkles emerge. This along with facial fat loss, brings about a haggard, hollow or even skeletal look. If you are not overly skinny, with a major metabolism and have a little extra fat somewhere on your body to spare you may be a good candidate.
First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery. Although attempts can be made if a patient has lipodystrophy, it is often the case that the fat does not remain and injectable fillers may be a viable option.
Communication is crucial in reaching one's goals. You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are. Discuss your goals with your surgeon so that you may reach an understanding with what can realistically be achieved.
You must be mentally and emotionally stable to undergo a cosmetic procedure. This is an operation which requires patience and stability in dealing with the healing period. There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue. Please consider this before committing to a procedure.
What areas are usually treated? – Almost all areas of the face and body can be treated but there are the usual requested treatment sites:
- Correction of "hollow" eyes, visible vessels resulting in dark circles, as well as visible tear troughs
- Correction after aggressive removal of under eye fat pads from lower blepharoplasty
- Temple areas
- Upper malar
- Sub malar
- Chin
- Lips
- Jaw line
- Forehead
- Glabella
- Facial scars
- Lower cheek after aggressive buccal fat extraction or natural loss
- Area between upper lip and nose
- Bridge of the nose and lateral fat pads
- Buttocks, hips
- Sternum
- Outer brow
- And anywhere else fat is needed or wanted
The laser treatment of various vascular lesions utilizes the principle of selective thermolysis. The energy of the lasers is targeted at the vessels or at times more specifically at the contents of the vessels that comprise the lesion. Thus, in a non-invasive manner, selective destruction of the lesions is accomplished, while minimizing collateral damage to the surrounding skin. Vascular lesions vary in the size, the composition, the color, and the location of the vessels. These qualities serve to impart unique characteristics, which allow the laser surgeon to select the best-suited laser or lasers to treat the particular lesion.
There are 2 main types of lesions:
- Telangiectasias: – These are small diameter, linear blood vessels that occur on the surface of the skin. Some people may refer to them as "broken blood vessels". Common areas where these lesions occur are the face and cheeks, particularly on the sides of the nose and around the nostrils. Telangiectasias are common in people with sun-damaged skin and also in people with rosacea. Nasal vessels tend to be more resistant to treatment and may require multiple treatments. Pulsed-dye lasers have been used effectively for the treatment of telangiectasias.
- Flushing and facial redness: – These are components of rosacea that can be treated with a pulsed-dye laser. Multiple treatments are usually required. The newer vascular lasers can be modified so that the pulse of light is on for longer which results in reduced bruising after the treatment. Experience shows particularly with the pulsed dye laser that those who are treated more aggressively and bruise may indeed respond better
Is anesthesia needed? – Laser treatment of vascular lesions can be mild to moderately uncomfortable. Most experience only a brief stinging sensation with each laser treatment and are able to tolerate the procedure without medication. The need for anesthesia when treating vascular lesions is dependent on the pain threshold of the patient and the size of the lesion.
How many treatments are necessary? – Multiple treatments are generally necessary to obtain satisfactory results in the treatment of vascular lesions, the exact number is difficult to predict Telangiectasias may clear after one treatment, particularly the smaller vessels, the larger vessels may require a second treatment. Nasal telangiectasias may require several treatments, the interval between treatments is 4 to 6 weeks.
What are the complications? – Fortunately, the complications in treating vascular lesions are rare in the hands of experienced and skilled physicians. Bruising is the most common reaction. This is particularly true of the pulsed dye lasers and the bruising usually resolves in 7-10 days. Mild crusting develops in about 20% and this usually resolves in 5-7 days. A certain degree of pain, swelling and redness is possible, although these symptoms resolve in 24 to 48 hours after treatment.
Pigment alteration – postinflammatory hyperpigmentation, or darkening of the skin in the treated area may occur. This effect is usually temporary. Strict sun avoidance is recommended. Hyperpigmentation or lightening of the treated area is rare and usually transient.
Infection – Bacterial infections are rare and occur when the superficial skin is injured, cooling the skin either through cryogen spray, contact cooling, or various cooling gels, lessens the incidence of skin injury. Antibiotic treatment may be prescribed if infection develops, but generally good wound care is sufficient to prevent infection.
Scarring is rare with the pulsed dye lasers.
Who is a candidate for laser treatment of vascular lesions? – Almost any patient with one of the vascular lesions described above is a candidate for laser treatment. Many physicians will not treat patients with a recent history of isotretinoin (Accutane) use due to the risk atypical scarring. In patients undergoing their first laser treatment for vascular lesions, a test area can be treated to assure the appropriate dosage and tissue response.
Where are lasers used? – Laser treatments can be performed on virtually any skin surface. Care must be taken to protect the patient's eyes from the laser light. Goggles or metal eye shields must be used.
Objectives of therapy:
- Safe and effective improvement in the appearance of the skin involved with the vascular lesion
- Total removal of the vascular lesion, while desirable, is not always possible
- Fading or lightening of a vascular lesion is reasonable expectation, complete resolution of some lesions is possible
- Multiple treatments may be necessary to achieve the desired response
Preoperative care:
- Patients should avoid excessive tanning
- Anesthetic cream application 30-60 minutes prior to treatment (if necessary)
- Immediately prior to treatment, all creams and cosmetics need to be removed from the skin
