Wednesday, November 11, 2009


I am constantly asked about minimally invasive procedures with short scars, "thread lifts", "barbed sutures", mini-lifts, etc. Most of these procedures can be done in a short period of time, produce little bruising and swelling, and involve minimal "down-time". It sounds great, and certainly if these procedures would work, I would be signing up immediately. In most cases, these procedures do not produce results that last for more than a few months. These procedures are advertised extensively, mostly by non-board certified plastic surgeons because they can be done in an office setting with very little surgical training.
In order to get excellent and long lasting results with facial rejuvenation, more extensive surgery is needed. The Neck Lift is a common procedure that addresses the laxity in the lower face and neck. One of the more distressing aspects of aging that can be noticed even in the 30 and 40 year old age group, is laxity in the lower face, jowls, loss of definition of the jaw line and sagging in the neck. Pertinent points related to the neck lift involve the following:
(a) Excess fat in the neck is removed
(b) The muscle laxity in the neck and the deeper loose tissues in the face are tightened. This deeper tightening of tissues is critical in getting a natural and long-lasting result.
(c) A natural and conservative re-draping and removal of neck and facial skin.
(d) Incisions under the chin, in front of and behind the ears, and extending into the posterior hairline
(e) Be prepared for at least 2 weeks of bruising and swelling before you are back to work and social activities
(f) Numbness in the face and neck and tightness in the neck will resolve but may take several months.
(g) Heavy and prominent nasal labial folds (the folds running from the corner of the nose to the corner of the lip) are difficult, if not impossible, to correct. Although short-term improvement may be noted, it is difficult to achieve long lasting improvement no matter what technique is used.

The facelift is an extension of the above procedure into the mid face and temporal region.

Forehead lifting addresses the upper third of the face and can be done in several variations. The traditional forehead lift achieves four goals: elevation of sagging eyebrows, improving heavy creases between the eyebrows (glabella wrinkles), improves transverse forehead wrinkles, and some tightening of the excess upper eyelid skin. Be prepared for 2 weeks of "down-time" and prolonged numbness (maybe even permanent) in the forehead and extending into the scalp.

Eyelid Surgery addresses excess skin, excess fat and muscle laxity in the upper eyelids (Upper Blepharoplasty) and excess fat (puffiness) in the lower eyelids (Lower Blepharoplasty). We are limited as to how much we can improve wrinkles in the lower eyelids with this technique. If we try to pull the skin too tight and remove too much skin to try to achieve eradication of all wrinkling, this will produce too much tension on the lower eyelids and cause a pulling down (ectropion). A better technique for excessive lower eyelid wrinkling is laser resurfacing. Be prepared for 2 weeks of "down-time" and even longer to achieve the optimal result in terms of swelling around the eyes. I recommend a pre-operative visit to an opthalmologist prior to eyelid surgery to rule out any underlying eye disease.

Facial Resurfacing falls into four categories:
(1) Dermabrasion (Sanding): A diamond burr is used to "sand" away the outer layers of the skin
(2) Chemical Peeling: A chemical acid is applied to the skin to burn away the outer layers. Depending on the type of acid used will depend on the depth of the peel. Common acids include Glycolic Acid ("light peels"), Trichloracetic Acid -T.C.A. (medium depth peel) and Phenol Acid(Deep peel).
(3) Laser Resurfacing: Uses laser energy to remove the outer layers of skin. There are a variety of lasers available for facial resurfacing. Depending on the skin type and degree of sun damage and wrinkling dictates the laser of choice.
(4) Radiofrequency (R.F.): Uses radiofrequency energy to treat the skin surface. This may be helpful in certain cases of red and pigmentary skin problems.

In summary, facial rejuvenation continues to be popular in many age groups to address the affects of genetics, sun damage and aging tissues. My philosophy is to address the most problematic areas and the areas that concern the patient. A "shot-gun" approach addressing the entire face is usually not necessary in the typical patient.