Facial Rejuvenation

The division's plastic surgeons are well respected in the area of facial cosmetic surgery. Because cosmetic surgery is such a personal and intimate choice, physicians make it a point to personally get to know each patient and spend time listening and guiding them through the process — from initial visit to post-operative care. The surgeons will discuss a variety of available options and outcomes during several personal consultations and, together, doctor and patient will decide on the best procedure.

The following are some of the facial cosmetic procedures performed by the division's plastic surgeons:

Facelift (rhytidectomy)
Some of the first signs of aging occur on the face. While changes may occur gradually, there may come a time when one looks in the mirror and does not see the he or she they used to see. A facelift can help restore a youthful appearance. It smoothes the loose skin on the face and neck, tightens underlying tissues and removes excess fat. As a result, the face will appear firmer and fresher.

Facelifts are most commonly performed on patients in their 40's through 60's. However, patients in their 70's and 80's will also benefit from the procedure. Signs that a patient may be a good candidate are:

• A deep line running from the corner of the nose to the corner of the mouth.
• Loss of a well-defined jawline.
• Deep wrinkles in the cheeks and sagging skin near the cheekbones.
• Loose skin, wrinkles, or excess fatty tissue in the neck.

Techniques for facelifts vary depending on the patient's features, the surgeon's preferences and the desired results.  The procedure may be performed on an outpatient basis or require a short hospital stay generally one night, depending on what the surgeon thinks is best.

Typically, the incision is hidden in the natural contour of the ear and then extends around the earlobe and back into the hairline. Following surgery, the incisions are easily concealed by hair or with makeup. Working through these incisions, the plastic surgeon frees the skin from its underlyingtissues and pulls it upward and back. The excess skin is then removed. In some cases, the deeper tissues may also be repositioned to restore a more youthful contour to the face. If necessary, an incision under the chin allows the surgeon to remove fatty tissue in that area and smooth the cord-like structures of the underlying muscle in the neck.

The plastic surgeon may explain additional procedures that can be performed with a facelift. For example, a facelift is often combined with: a brow or forehead lift, eyelid surgery, nose reshaping, liposuction of the face and neck, neck lift and skin treatments.

Brow or Forehead Lift
Some of the most visible signs of aging are drooping eyebrows, "hooding" over the eyes, forehead furrows and frown lines. In a brow lift, also known as a forehead lift, the muscles and skin that cause the problems are altered or removed to smooth the forehead, raise the upper eyelids and minimize frown lines. The lift is a relatively simple procedure with results lasting from five to 10 years or longer. It is usually an outpatient procedure and can be done alone or in conjunction with other procedures, such as facelift, eyelid surgery or nose reshaping.

Men and women of any age may be good candidates for a forehead lift. While the procedure is most commonly performed on people in their forties to sixties to slow the visible effects of aging, it can also help people with inherited conditions, such as droopy brow or furrowed lines above the nose. To see how a forehead lift might improve one's appearance, look into a mirror and place the palms of the hands at the outer edges of the eyes above the eyebrows. Then gently draw the skin upward to raise the brow and forehead area. This is generally what a brow lift would do.

To perform a brow lift, the surgical team begins by tying the patient's hair with rubber bands in front of and behind the incision area. The patient's head will not be shaved, although hair immediately in front of the incision line may need to be trimmed. For most patients, the incision will start at about the level of their ears and run across the top of their forehead. If he or she has a high or receding hairline, the surgeon may make the incision just at the hairline to avoid making the forehead appear even higher. By wearing hair down on the forehead, most scars will not be noticeable.

Eyelid Surgery (blepharoplasty)
As people age, the eyelid skin stretches, muscles weaken and fat accumulates around the eyes causing "bags" above and below. Eyelid surgery can take years off a patient's appearance by removing fat from the upper and lower eyelids. It corrects drooping upper lids and puffy bags below the eyes - features that make one look older and more tired than he or she feels. Most patients are 35 or older, but if droopy, baggy eyelids are a genetic family trait, he or she may decide to have the procedure at a younger age.

Eyelid surgery is usually done on an outpatient basis and generally takes one to three hours. In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids — in the creases of your upper lids and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures, leaving nearly invisible scars. If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may perform a transconjunctival blepharoplasty. In this procedure, the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.

Surgery of the Nose (rhinoplasty) and Nasal Tip Reconstruction
Rhinoplasty is one of the most common plastic surgery procedures. It can reduce or increase the size of the nose, change the shape of the tip or bridge, narrow the span of the nostrils, or change the angle between the nose and upper lip. It can also correct a birth defect or injury or help relieve some breathing problems. Men and women in good physical health are good candidates for the procedure. Many surgeons prefer not to operate on teenagers until after they've completed their growth spurt — around 14 or 15 for girls and a little older for boys.

Rhinoplasties are usually done on an outpatient basis, but complex procedures may require a short inpatient stay. A typical procedure usually takes one or two hours. During the surgery, the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The skin is then redraped over the new framework. Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an "open" procedure for more complicated cases. Here, a small incision is made across the columella, the vertical strip of tissue separating the nostrils. Following surgery, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in the nostrils to stabilize the septum, the dividing wall between the air passages.

Liposuction of the Face and Neck
Suction-assisted lipectomy, or liposuction, is a technique to remove unwanted fat deposits from specific areas of the body, including the chin, jaw, neck and cheeks. The best candidates for liposuction are of relatively normal weight but have pockets of excess fat in specific areas. Suction lipectomy is not recommended if the patient has had recent surgery on the spot to be sculpted or if the patient has poor blood circulation in the areas to be treated. Those who have heart or lung disease are also not good candidates for this procedure.

Liposuction of the face and neck is usually performed on an outpatient basis. The procedure generally takes from 30 minutes to two hours, depending on the area and amount being suctioned. To begin the procedure, the surgeon makes a small incision just large enough to allow the insertion of a hollow tube called a cannula. The opposite end of the cannula is attached to a machine that creates a strong vacuum. The surgeon manipulates the cannula deep within the fat layers under the skin, breaking up the fat and suctioning it out.

Neck Lift
With time, the skin on our necks tends to lose some elasticity, adding years to our appearance. A neck lift will reshape and tighten the neck to give it the appearance of length and elegance. Restoring the graceful line of the neck can provide a younger, more toned look while making you feel better about yourself.

Surgery of the Ear (Otoplasty)
Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears. Usually, the procedure is done on children between the ages of 4 and 14. Ears are almost fully grown by age four 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.

Ear surgery usually takes about two to three hours, although complicated procedures may take longer. During 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. 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. Ear surgery is usually performed as an outpatient procedure, but occasionally the doctor may recommend it be done as an inpatient one. In this case, the hospital stay is usually only overnight.