The goal of a browlift is to restore the brow to a youthful height at or above the bony rim of the eye. For women, this shape is a gentle arch toward the outer portion of the brow. For men, it appears straighter across. This can help reinvigorate the tired appearing eyes to a more rested and vitalized look. There are many approaches to elevating the brow, but most commonly an endoscopic or minimally invasive approach is performed. Small incisions are hidden in the hairline and can vary from 3 to 5 incisions depending on the amount of elevation needed and the preference of the surgeon.
Many women and men who are concerned about the sagging of their brow and upper lids are good candidates. If there is a concern about balding or a receding hairline, other types of incisions and techniques can be used to minimize raising the hairline further back. It is common that patients, who present with heavy upper eyelids, are greatly benefited from having both the brow elevated via a browlift, and an upper lid surgery to give the greatest improvement.
Dressings will vary based on surgeon preference but typically absorbable suture or staples are used for closure. Gauze may or may not be used. Swelling may occur around the brow and upper lid/lower lid region, as gravity tends to pull the swelling downward. Patients are back to normal activity within 2-3 weeks.
Fortunately, complications are rare, but can include injury to sensory and motor nerves in the forehead. Also, premature decent of the elevated brow may occur if inadequate elevation is achieved at the time of surgery.
The aging face is often accompanied with loss of volume and fullness in the cheeks. Cheek implants can replace volume lost to age or simply help in those individuals with weak cheeks. Patients who have used injectable soft tissue fillers to plump their cheeks temporarily may like a more permanent solution offered by the cheek implant. It is placed though small incisions inside the mouth or can be placed during a face-lift or lower eyelid surgery. Whether you have never really had full cheeks, or you’ve simply lost fullness with age, cheek implants can help give you the look you want.
Recovery from the procedure is one to two weeks. The risks and complications are swelling, bleeding, infection, pain, loss of sensation and asymmetry. In the hands of an experienced surgeon this risks are minimized. Your surgeon will review the recovery as well as possible risks and complications with you during your consultation.
Chin implants are great for patients who need better facial harmony. Most often, chin implants work well for people with small, atrophic chins, or large noses. Making a chin look stronger can help balance other prominent features on the face. Thus, it is often paired with a rhinoplasty. Chin implants come in all shapes an sizes and can be made from a variety of substances from formed silicone, to porus polyethylene, better known as Medpor. Route for implantation is from an external approach beneath the chin, or from an intraoral approach. There is less chance for infection from the external approach beneath the chin, but the intraoral approach doesn’t have a scar on the skin. It is best to discuss which approach to use with your chosen Cosmetic Surgeon.
You are a good candidate for a chin implant (genioplasty) if you have a small chin that is out of balance with your other facial features. It is the perfect adjunct for a patient with a long nose.
Dressings can include supportive tape and a light dressing along the incision if the external approach is used.
Potential complications include malposition of the implant, infection, and possible nerve injury to the sensory portion of the chin and lower lip.
Ear Pinning Surgery (Otoplasty)
Surgery for prominent ears is a good operation for both children and adults. At a young age, children may be teased for having “prominent” or “mouse” ears. A successful surgery can give a great confidence boost to the developing child. An incision is made behind the ear, hidden in the crease. Next, the cartilage is exposed from behind and sutures are placed to increase the bend in the ear, bringing them closer to the head. The bowl of the ear may also be decreased and weakened which helps keep the ears closer to the head post operatively.
Good candidates include children and adult who are bothered by the shape of their ear and for those who feel like their ears stick out too much.
The post operative course and instructions will depend on your surgeon, but often patient are instructed to wear a headband, which keeps the ears close to the head while they heal, for approximately 1 week full time. Then patients are transitioned to a part time headband for another 2-4 weeks.
Complications include possibility of infection, bleeding, exposure of the suture, and recurrence of the prominent shape. Fortunately, these potential complications are uncommon.
Facelifts are operations that improve the contour of the jawline. They can also rejuvenate the corners of the mouth and neck. These operations are great for individuals who have excess skin laxity. The incisions are made both in front of and behind the ears. They may be extended into the hairline above or in front of the sideburns, and also extended into the hairline behind the ear in down into the neck.
Often times, an incision is made beneath the chin, which allows your surgeon to address the neck and lax muscle at the same time as the traditional facelift. Skin only facelift give a wind tunnel appearance, and should be avoided. Most other facelift operations suspend the tissue beneath the skin, and give a much more natural appearance. The goal is to turn back the clock 10-15 years.
The dressing you may have after the operation will depend on your surgeon, but typically some type of pressure dressing is applied for at least a few days. You may or may not have a passive or suction type drain, which helps your body remove excess fluid that may build up after the operation.
Complications include possible infection, blood collection under the skin called a hematoma, nerve injury which may affect movement in the face, undesirable scarring, and change in sensation of the earlobes.
Fat grafting is a popular procedure to rejuvenate the face with a resultant natural look. As one ages facial fat volume is lost. This loss of volume leads to deflation of the face leading to jowls, sagging jawline and a hollowed aged appearance.
Facial fat grafting involves placing small amounts of fat into strategic areas of the face through small microcannulas (tubes). Fat is collected (harvested) via liposuction from another part of the body where fat is more plentiful. The placement of fat can effectively reestablish facial volume. The rejuvenating effects may last up to 5 years or more.
Patients with mild to moderate deflation of the face are excellent candidates for facial fat grafting. Typically jowls, flattened cheeks, and hollows under the eyes are improved. Patients who have had a previous face-lift are benefited by fat grafting as well.
The procedure can be performed under local anesthesia and combined with other facial cosmetic procedures. There is minimal physical downtime although swelling may be present up to a week. Post op care includes gentle facial washing and placement of an antibacterial ointment on the fat insertion sites.
Minor complications may include bruising and prolonged swelling. Occasionally the transferred fat my not survive as much as desired. Rare complications may include bleeding, infection or persistent area unwanted fat placement.
Fat grafting of the face is a safe, minimal downtime technique to restore a natural more vibrant appearance.
Also known as sliding genioplasty is a surgery done to reshape the contours of the chin either by reduction or augmentation using own native bone. Augmentation genioplasty is done by making an incision on the mucosal side of lower lip to expose the bone of the chin, then a thin saw is used separate the bottom portion of chin bone from the remainder of the jaw bone and moving it in the desired direction to improve or reduce chin projection, it can also be used to correct asymmetry, shorten or lengthen the chin. The bone is repositioned in the new position with plates and screws. Genioplasty is a good alternative to chin implants.
Individuals with small, large, wide, narrow or asymmetric chin are good candidates for genioplasty.
Genioplasty can be done under local anesthesia with IV sedation, or general anesthesia in outpatient setting. Most patients recover in 10-14 days. A chinstrap is usually used to support in the postoperative period to support the chin for 10-14 days.
Genioplasty is a safe procedure however minor complications are not uncommon such as numbness or tingling of lip and chin, delayed bone or wound healing, hardware exposure.
Many consider lips the most sensual part of the face. Youthful lips are typically full with a classic cupid bow upper lip and plump slightly larger lower lip. The outline of the lips is distinct. With aging the lips deflate and vertical fine lines develop along the border.
Lips may be enhanced by typically by two techniques.
Fillers can be injected directly into the lip to restore volume. The majority of commercial fillers are a synthesized biologic gel called hyaluronic acid. These fillers may last from 6-12 months. Ice, topical anesthesia and dental nerve blocks can be performed to ensure a comfortable procedure.
The advantages of filler are little to no downtime, immediate visible results with minimal side effects. There is usually some slight swelling and possibly some bruising that should resolve quickly.
Those patients seeking a more permanent form of lip augmentation may benefit from lip implants. At this time most cosmetic surgeons use tapered silicone implants. With a dental nerve block and local anesthesia is utilized the implants are placed through tiny incisions at the sides of the mouth where the upper and lower lips merge. This incision heals well with little to no scar visible. The result is a permanent enhancement of the lips.
Post lip implant one can expect swelling and bruising from 3-7 days. One may need to limit vigorous exercise but can usually return to daily routines immediately except for the cosmetic downtime. Rare complications may include numbness or infection. As with any procedure involving the mouth if a patient has a history of herpes outbreaks they should have antiviral prophylaxis pre and post op. If the patient wants the implant removed it can be easily be performed under local anesthesia.
A rhinopasty operation is meant to change the appearance of the nose. Some patient may have a functional issue breathing through their nose and this can be addressed at the same time as the cosmetic portion. Depending on the experience of your surgeon, he or she will either choose to perform the operation through and open or a closed approach. With the open approach, a small incision is made at the base of the nose. The remaining incisions are made on the inside of the nose. With the closed approach, all the incisions are made on the inside.
Good candidates are those patient who want to make reasonable changes to the cosmetic appearance of their nose. Drastic changes can often cause unwanted complications and compromise nasal breathing. A rhinoplasty that creates a better look but sacrifices the ability to breathe through the nose is a failed operation. Morphing of images prior to surgery is a great tool that facilitates the surgeon’s understanding about the patient’s desires. These images are not meant to be an actual representation of the outcome.
Dressings after a rhinoplasty typically include tape on the nose and possibly a cast if the nasal bones were broken. Inside the nose may be packing to help prevent oozing.
Complications may include noticeable deformities, collapse of the nasal dorsum, and unhappiness with the cosmetic result. Fortunately, infections are rare. It is not uncommon that if the bones are broken, the patient may feel some irregularities, but they shouldn’t be visable.
Also known as Orthognathic surgery, which is needed when the jaws don’t meet correctly and/or teeth don’t seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions a misaligned jaw. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly. Orthognathic surgery corrects overbite, underbite and open bite deformities, it can also be used to correct facial asymmetry, enhance or narrow the jaws. The surgery can also be used to correct deformities resulting from trauma, growth disturbances and sleep apnea, resulting not only in better aesthetics but also improvement in jaws function.
Orthognathic surgery usually requires extensive per surgical planning requiring dental models, CT scan and presurgical orthodontic treatment. Teeth will be aligned prior to surgery, mock-surgery is done on a software using 3D printing technology to simulate the final outcome and plan the desired movements to align both upper and lower jaws with skull and the rest of the facial bone.
Surgery can be done on the upper jaw only, lower jaw only, upper and lower jaw together and often combined with genioplasty, cheek implants, rhinoplasty and neck liposuction, depending on level of jaw malposition or asymmetry. The upper jaw is separated from the base of the skull and moved in the desired direction to meet with lower jaw in the correct bite and fixated on the new position with Mini plates and screws, the lower jaw segmented in a specific area to allow for movement of the tooth bearing segment without disturbing the jaw joint(TMJ) and placed into the new position with plates and screws.
Recovery from the procedure ranges from 3-6 weeks depending on the extent of surgery, patients are required to consume soft non-chew diet during recovery.
Possible risks include numbness or tingling sensation of the lips, TMJ pain, delayed wound or bone healing and hardware failure.
Necklift (Cervical Rhytidectomy)
The goal of a necklift is to improve the contour of the neck. This is typically done through an incision beneath the chin to gain access to the midline of the neck. Incisions may or may not also be made around the ears in similar fashion to facelift incisions. Improvements of the neck may include removing excess deposits of fat, tightening lax muscles underlying the skin, and removing excess skin. Necklifts are often thought to improve the jowl region, but this is a facelift, which can be done in conjunction with a necklift. Other procedures paired with necklifting often include. Liposuction, which helps to further improve the neck contour and jawline.
Good candidates include those with excess skin in their neck without corresponding drooping of the lower face. Also patients with submental fat deposits, lacking a well-defined jaw, can benefit from necklifting.
Dressings typically include some type of pressure dressing and may or may not include a drain. Patients typically feel “tight” after necklifting, but this sensation improves after a few weeks.
Recovery for necklifts is typically 2-3 weeks. By this time much of the bruising and swelling has resolved. Patients that have liposuction performed with the necklifts, may stay a bit more swollen for a longer duration. Typically results from liposuction take 2-3 months to see.
Possible complications include infection, bleeding, hematoma (rapid collection of blood under skin), breakdown of skin around the incisions, and nerve damage. All patient are advised to avoid any type of blood thinner at least 7 days prior to surgery. Patients who are smokers are at increased risk of complication secondary to the effect smoking has on wound healing.
Upperlid Surgery (Upper Blepharoplasty)
Upper lid surgery is used to treat excess skin of the upper lid in addition to fat herniation of the upper lid fat pads. Sometimes, the upper lid skin excess becomes heavy enough that it weighs down the lids, causing a decrease in peripheral vision. If this occurs, sometimes this procedure can be covered by medical insurance. The mild fat protrusion in the upper lid fat pads can also cause some undesired bulging, and can be removed at the time of surgery. This procedure can be done under local anesthesia, with twilight anesthesia, or under general anesthesia depending on surgeon and patient preference.
Patients with isolated upper lid excess and/or fat protrusion are good candidates for blepharoplasty. Often the upper brow is heavy as well, and is the root cause for excess skin of the upper lids. Thus, both a brow lift and upper blepharoplasty are often done together for optimum results. Patient with a history of dry eyes should be wary of any upper or lower lid surgery, as this may exacerbate their underlying problem.
Dressings vary but typically a topical ointment is applied to the eyelids. Rarely is an occlusive type dressing applied over the incision. Cool packs can help with swelling after the procedure.
Possible complications include bleeding, infection, uneven height of the new upper lid crease, abnormal scarring, and dry eyes.