FACIAL REJUVENATION...
Our face is our calling card.
Nowhere does aging leave its imprint more noticeably than on the face. The appearance of aging does not always correlate with our own inner feelings and well being.
Many factors contribute to the aging face including heredity, stress, sun exposure, inadequate diet, alcohol consumption and smoking. Gravity and the unrelenting aging process add to those factors, sometimes dramatically. This can change not only the way you look, but also the shape of your face. You start looking tired and older, despite the fact that you don't feel old!!
Plastic surgery can "turn the clock back" by enhancing your facial appearance and creating a more fresh, youthful look.
There are three categories of patients seeking treatment:
1) Those that need lifting procedures for their sagging and excess skin...
2) Those that only need to address their skin quality with Peels, Laser or Microdermabrasion...or a Minimally Invasive Treatment such as Fat Transfer, Soft Tissue Fillers or Botox.
3) Those that need both.
Therefore, the facial analysis can be divided in four major areas:
1) The forehead and eyes
2) The midface
3) The neck
4) The facial skin
Facial rejuvenation surgery may involve procedures to reduce signs of aging in the lower neck, the midface area, as well as the eyelids, eyebrow and forehead regions. Multiple facial procedures may be performed at the same time.
The good news is that most of these procedures do not require general anesthesia and therefore can be performed under local anesthesia or under IV sedation resulting in less complications and problems.
PROCEDURES:
REFRESHING TECHNIQUES
These improve your facial appearance without the need of a total facelift. Early sagging in the neck can be improved with Laser Liposuction, external ultrasound-assisted liposuction and/or early platysma banding ( the two cords in the neck which are made by the platysma muscle) or with Botox injections (off-label). If the neck banding is more severe, a platysmaplasty may be necessary, which is a neck tightening procedure (the platysma muscle is fashioned into a corset) performed through a small incision hidden beneath the chin. Your skin quality and fine wrinkles can be helped with a skin care program specifically designed for you with or without microdermabrasion or deep chemical peels. The latter peels are quite effective and are employed in improving some of the deeper wrinkles. One of the first signs of aging is observed in the eyes and in the latter case, eyelid surgery may sometimes be required to correct the bagginess and the excess skin. Also fillers such as Restylane, Juvederm, Radiesse, etc. ( see "Soft Tissue Fillers" under Lasers and Other Treatments ) or better yet your own body Fat Injections can complement your result thus avoiding or at least postponing the need of more extensive surgical procedures. The so called "weekend lifts" are discussed below under endoscopic facelifts and are not recommended.
EARLY FACELIFTING ( SHORT SCAR FACELIFT )
If you are less then 50-60 years old, the early facelift can help maintain that youthful and healthy look in your later years thereby prolonging the time for a second facelift. The reason is that in the early facelift the underlying tissues are somewhat more elastic, fuller and more pliable with a better surface skin tone. In selected patients a vertical suspension short scar facelift can be performed. This avoids the scars behind your ears thereby most people would not know you had a facelift and also permits you to wear your hair up off the face or in a ponytail. The advantages are obviously no more scars behind your ears, lesser discomfort, fewer complications and a more rapid recovery but sometimes you may have to accept a lesser improvement especially if you are 60 or older. The most important thing to know is that this procedure is usually performed under local anesthesia and you should not confuse it with all of those advertised procedures such as Thread Lift, FeatherLift, WeekenderLift, etc. The latter simply do not work and you would unwisely be spending your money. The short scar facelift is not unlike the classical facelift. When Dr. Herve` Gentile performs the short scar facelift he separates the skin and fat from the underlying muscles. He determines where fat can be trimmed in your neck and fat added to improve the contour of your face. Dr. Herve` Gentile then tightens the underlying muscles as a separate layer and pulls back and removes the excess skin. Recovery is much shorter since you are not put to sleep and generally you are presentable in a little more then one week.
The short scar facelift addresses only the sagginess of the skin and the deeper tissues but usually the other two components of aging also need attention,...the skin and the loss of fat and volume. Dr. Gentile's treatment philosophy is to do fat transfer grafting in conjunction with your short scar facelift to restore the lost volume, thereby bringing back some of your youthfulness. Your results will be enhanced by this combo, especially after you have been started on skin care treatments to improve the quality of your skin and preserve your attained fresh and natural look.
If you need to only address the midface (the sagginess of your cheeks ) endoscopic techniques can be used resulting in very small and hidden incisions behind the hairline above your ears and sometimes in the gum-line inside the mouth.
SKIN REJUVENATION
Your skin can be improved with a number of
products such as Retin-A, Kinerase, Gentle Derm Care, Obagi and Obagi Nu-Derm skin creams and
lotions and a variety of procedures such as superficial or deep Chemical
Peels, Obagi Blue
Peel and Microdermabrasion. Currently we only recommend Obagi and
Obagi Nu- Derm as these products have demonstrated to offer better results. We do not recommend and we do not offer the Therma-Cool
and other similar Light skin tightening procedures as recent studies have shown the
results to be minimal or non-existing.
( see also Microdermabrasion, Facial Peels,
Skin Care Treatments under Laser and Other Treatments)
EYELID SURGERY (BLEPHAROPLASTY)
Your eyes are the first to show the signs of aging and eyelid surgery can make a big difference in the way you look. The procedure consists of removing excess skin and fatty bags from under and over your eyes and is performed in our surgical office suite under local anesthesia. The scars will blend unto the natural eyelid folds and lines and will heal very quickly, since the lid skin is very thin, becoming barely noticeable after a few months. A transconjunctival approach is sometimes used in the lower eyelid to remove fat bulges, which results in a hidden scar behind your eyelid. For patients with significant lower eyelid redundancy or eye prominence a lateral canthoplasty is sometimes performed through the same incisions. A canthoplasty repositions the lateral angle of your lid to a higher position thereby tilting the outside of your eyes upwards ( almond shape eye ). You can reduce swelling and bruising by applying cold compresses to the eyes while discomfort and pain, if any, can be controlled by medication. Recovery is quick and most patients are presentable in four days (make-up is allowed after three days). Expect your eyes to feel tight and pulling for at least a week after surgery, but do remember that it is normal and natural to have a few remaining wrinkles when your lids are open which are the result of functional winking. Sunglasses are also recommended since your eyes for a while will be more sensitive to the light. You may receive comments on your improved appearance but generally speaking nobody will know why, even if you have a new sparkle in your eyes.
FACELIFT (RHYTIDECTOMY)
When someone thinks of plastic surgery they think of a facelift. Unfortunately it is also thought of as unnatural, plastic and hollywoodian. There is nothing further from the truth, since not only it can turn your clock back between eight and twelve years without anyone knowing it (unless you tell them) but it provides you with a natural, refreshed and healthy look. The goal is to try and make you look as good as you used to.
The procedure usually takes about two to three hours and is performed in our own office surgical suite, preferably under local anesthesia with IV sedation. The facelift consists of removing fat from the neck and jowls, sometimes with ultrasound or laser assisted liposuction, tightening of the facial muscles and redraping the excess skin excised from the cheek and neck. It can also improve the sagging of the lateral corners of the mouth. A facelift will not remove the lines around the mouth and the permanent wrinkles in extensively sun damaged individuals who present a cobblestone-type skin appearance. Since every face is not alike, other asymmetries may need to be addressed at the time of your consultation.
A minimal-incision
facelift ( the short scar facelift ) with the incision in the hairline of the
temple and in front and inside of the ear
is the now the preferred method used by Dr. Herve Gentile.
This avoids scarring behind the ears, which can be noticeable when the
hair is pulled back and also results in a more painful recovery. It is not the gold standard but the results can be as
good as a regular facelift, especially in younger women and men and if there is not a lot of sagginess in the neck.
The skin of your temple, cheek and neck will be
separated from the sagging facial muscles, which will be tightened.
All the excess skin
and fat is removed and the resultant incisions are sutured under tension.
Most of your
scars will be hidden in your hair or the skin creases of your ear.
Your tissues will
resist their new location and therefore it is normal for you to experience a feeling of
tightness. You will also experience swelling and bruising which subsides in 10-14 days,
some numbness especially around the ear which is usually temporary and some discomfort easily
controlled by medication. A tight facial garment will be fitted to your face to reduce
swelling complications. If you are a smoker it is imperative to stop smoking at least
six weeks before the facelift and you must be honest about it, since complications
develop more frequently in smokers. You will be provided with all the care possible to
speed up your recovery, but remember that healing is slower than in other procedures.
You
can return to some of your activities in about 2 weeks.
You must have somebody with you the first
night and if you are from out of town, we will provide your accommodations.
To preserve
your new look longer and healthier you will need to avoid the sun or limit its exposure
using sunscreens and blocks and refrain from smoking.
ENDOSCOPIC FACELIFT
This procedure is ideal for carefully
selected individuals who do not have a significant amount of skin sagging and desire to
refresh their face. Usually a specially designed lighted instrument or an endoscope, which
is a tiny tube with a camera attached, is passed through small incisions and is used to
visualize the area to be treated. The involved muscles over your facial bones are then tightened and suspended
resulting in a smoother overlying skin. It is indicated especially for midface rejuvenation (
midface lift ) and upper face rejuvenation (eyebrow/forehead lift ).
The
endoscopic midface lift should not be confused with the various publicized
weekend facelifts "the thread lift, the feather lift,
etc. " which consist of suturing and suspending only your
skin and advertised as producing minimal to no swelling. These weekend
facelifts do not last at all, weeks to a few months in the best of
cases, and in many instances there is no visible improvement at all since the
skin will be pulled down by the muscle to which it is attached (see also FAQ).
MIDFACE LIFT
The midface lift corrects the sagginess and looseness of the lower eyelids and the falling off of the cheeks. It is specially designed for the younger patient seeking to address the earliest signs of aging which occur around the eyes and cheeks. The incisions are small and hidden in the hair above your ears (rarely a separate incision in the gum-line is required). The procedure takes about 2 hours and recuperation is similar to the classical facelift with most patients returning to work in 10-14 days. It is often combined with an eyebrow lift or a classical facelift.
FOREHEAD/BROWLIFT
The forehead lift corrects and
improves the deep wrinkles in your upper third of the face and the horizontal
and vertical frown lines in the middle between your eyebrows.
Consequently it eliminates the sagging and drooping eyebrows giving you that
tired and sad look and the heavy excess skin of the upper lids since a
forehead lift always incorporates an eyebrow lift. The procedure
is performed in our office surgical suite under local with IV sedation or
general anesthesia and the incisions are usually placed and hidden behind the
hairline. Botox is usually injected 10 days before to
prevent the brow from contracting downwards. We use the new COAPT
system for fixation of the brow in lieu of the old fashioned metal screw.
If you have very thin skin you may actually feel the Coapt implant underneath,
but, since it is self absorbable, it will disappear in approximately 8-12
months. This operation takes about 2 hours and addresses
both the skin and the underlying muscle.
While a browlift is a more limited procedure since it elevates only the brows it is the one most frequently performed. In a Forehead lift intervention on the deep muscles is performed in different ways to weaken and eradicate the frown lines and wrinkles. Then both the skin and muscle are lifted and tightened. This can help provide a more lasting result and it can prevent frown and worry lines from coming back. Your sad and tired appearance may disappear and your face will look brighter and refreshed, but remember, the results last an average of five to twelve years. The procedure is most of the times performed endoscopically (Endoscopic Forehead Lift ) through multiple smaller incisions and it is otherwise similar except that less excess skin can be removed. After surgery you will experience bruising, swelling and discomfort for about a week and numbness in the scalp which is almost always temporary. You may wash your hair the day after surgery and usually you can return to work after the first week.
TOTAL FACIAL REJUVENATION
Total facial rejuvenation is a combination of multiple procedures that permit you to achieve that natural and youthful look you want. It consists of eyelid tucks, facelift, forehead/browlift, sometimes in combination with lip lift/augmentation, fat injections, cheek/chin augmentation and addresses all of your facial features and structures together in one setting. Often peels or microdermabrasions are performed later in a second setting to balance your new appearance. This creates a more harmonious look by giving you a smoother, fresher and a better tone skin.
SECONDARY LIFT
These procedures are designed to restore your natural facial harmony after your first lift. This results in a more youthful you.
ANCILLARY PROCEDURES
Lip Lift/Augmentation, Facial Fat Injections/Grafting, Cheek/Chin Augmentation, and Nose Reshaping (Rhinoplasty) all help redefine and can be considered complimentary to the facial rejuvenation procedures. Chemical Peels, Skin Care and Microdermabrasion also complement your results. Please check them out under Facial Redefinition and Lasers and Other Treatments.
LASERS FOR THE FACE...
Laser surgery is one of the most exciting and requested cosmetic procedures because lasers have many applications today. But one of the fallacies about lasers is that they can do everything with less bruising and swelling. They can be used to tighten your neck, remove unwanted hair and treat spider veins in the face and legs as well as other pigmented lesions. The laser is an extremely precise surgical tool in which a beam of light is generated to vaporize the surface of the skin or shoot a light beam through the skin without affecting it to treat spider veins and unwanted hair. For example the goal of skin resurfacing ( Erbium, Fraxel, etc.) is to soften or eliminate wrinkles and possibly rejuvenate the skin but since the light energy is converted to heat it can produce some unwanted effects. There are other modalities which offer much better results and are less expensive than skin resurfacing and therefore Dr. Herve` Gentile does not recommend it. Lasers has also been used to treat hypertrophic scars and acne but again despite the media hype they offer minimal improvement.
Dr. Herve` Gentile recommends laser hair and spider vein removal and in selected patients laser liposuction of the neck as this results in tightening of the skin and the underlying soft tissues. Although this modality is available for men and women of all ages, the ideal candidate for laser hair has fair skin and for laser liposuction of the neck some fat in addition to the minimal skin looseness. In addition all people, both with fair and darker skins, are candidates for Microdermabrasion, Obagi Blue Peel and Obagi Skin Care treatments. For severe wrinkles of the face and specially around the mouth a deep Facial Peel sometimes in combination with a lift will offer the most improvement even compared to skin resurfacing. Remember that if you need skin retightening or correction of significant neck sagginess laser face is not for you. No Laser can perform a Facelift.
PHOTOGRAPHS
