There's been huge progress made in facial rejuvenation techniques since the days of the old stretched-out sort of facelift. We can now have a customized combination of procedures, some done at the same time, some done at different times.
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The three facial areas
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In today's approach to facial aging, the face is thought of as having 3 treatable areas:
· Upper face (the brow and upper eyelids)
· Mid face (lower eyelids, cheeks and nose)
· Lower face (jawline, mouth and neck)
SMAS facelifts
The term "Sub-Muscular Aponeurotic System" refers to the layers under the skin that consist of muscle and collagen (connective tissue). In a modern facelift, these are tightened as well as the skin, to create a firmer and more youthful-looking result. At the same time, liposuction can be used to remove excess fat.
Facelifts work on the cheeks, jawline and neck. An incision called the "S" incision is made on each side. It runs partly inside the hairline and partly in front of the ear.
A facelift takes between 2 and 3 hours to perform and can be done under general anesthesia or local with IV sedation. It can be done in a hospital or a doctor's surgical office.
Recovery is usually rather quick, with not much pain, although a pain medication will be prescribed if needed. The swelling subsides within days and the bruising fades in a few weeks.
The pinkness in the scars fades after a few months, leaving a narrow white line, most of which can be hidden by hair or makeup. Although the results are not permanent, they do last many years and most people don't feel the need for any further work for about 8 to 15 years or so.
Browlifts
As we age, the force of gravity pulls downward on our face and this droop can affect the eyebrows, which in turn affect the upper eyelids, pulling them downward and creating a tired look to the face.
Aging also brings crow's feet at the corners of the eyes and of course, frown wrinkles. And some of us have eyebrows that are positioned low over the eyes, just from our genetics.
A brow lift (forehead lift) takes 1 to 2 hours to perform and can be done in several ways.
Coronal procedure (the traditional browlift)
From an incision behind the hairline running over the top of the head ("coronal" means "like a crown"; think of Coronation), the skin is gently pulled upwards, the eyebrows along with it, and set into a new position. At the same time, excess fat and skin can be removed. If necessary, a corrugator excision can be performed at the same time, where the muscles which create frown lines can be modified or released to smooth the forehead. Then the incision is closed with sutures or clips and some cosmetic surgeons will apply a dressing and bandage.
This type of brow lift raises the hairline and heightens the forehead.
Endoscopic browlift
An endoscope is a very narrow, flexible, hollow tube with a light at the end. It's connected to a television monitor and the plastic surgeon uses this TV picture to guide his actions. Endoscopes are used for many surgeries now, but the endoscopic brow lift was the first one to be accepted widely. Endoscopic surgeries are much less invasive and stressful than traditional surgeries.
The endoscopic brow lift calls for several small incisions in the scalp (3 to 5, depending on what exactly is to be done), each an inch long or less. Through one of these, the cosmetic surgeon will insert an endoscope. Through another of the incisions, he inserts surgical instruments and carefully lifts the forehead skin to a new position. The eyebrows are lifted at the same time, giving the eyes a wider look.
As with the traditional brow lift, the plastic surgeon then closes the incision and usually dresses it, using a bandage to hold the dressings in place.
In this type of browlift, no skin is removed. So this is not the procedure of choice for a person with many horizontal brow wrinkles. But the small incisions leave very small scars, which makes it good for men whose hair is too thin to cover scars.
Temporal brow lift
The temporal browlift (also called a lateral lift or lateral brow lift) is a variation of the endoscopic brow lift. In this procedure, the small incisions are located a little further to the sides, nearer the temples, and the new position of the skin and underlying tissues has a slightly more slanted angle. It also lifts the cheeks a little, giving a more youthful line to the cheekbones.
Excess skin is removed, which lifts the outer ends of the eyebrows slightly, but doesn't lift the center ends. Crow's feet are also removed with this method. It can be done at the same time as an endoscopic brow lift and / or a facelift.
Corrugator muscle excision
The corrugator muscle is the one which squeezes the eyebrows together, forming frown wrinkles as we age. A corrugator excision is often performed along with a browlift and involves modifying or removing part of the corrugator muscle so that frown lines will not re-develop.
Direct browlift
This is a method for raising the eyebrows without affecting the hairline or working on frown lines or crow's feet. The incisions are right along the tops of the eyebrows and raise only the eyebrows themselves. The resulting scars are barely visible against the hair of the eyebrows.
Laser surgery
In conjunction with any of the above facial rejuvenation procedures, people often have laser surgery.
What is a laser?
A laser is a focused beam of light which can be precisely controlled by the cosmetic surgeon for resurfacing the skin. Lasers are very effective at removing such things as moles, fine wrinkles, spider veins, port wine stains, or mild scarring.
The beam can remove the upper layer of skin, the epidermis, leaving the next layer, the dermis, exposed and pink.
Then the laser power is lowered and the laser used to heat the dermis gently. This stimulates it to produce collagen fibers. (Collagen is a protein that's common in the body, and is produced any time the skin's integrity is damaged.) As the collagen heals the treated area, new skin grows which is softer and less wrinkled.
Laser resurfacing is done with a local anesthetic and if needed, also a sedative. Depending on what other procedures you're having done at the same time, a general anesthetic may be used.
The procedure takes anything from several minutes to an hour or more, according to how large an area is being treated.
Recovering from laser resurfacing
Afterwards, there'll be swelling and discomfort for perhaps a week or so, and there could be some oozing for a couple of weeks. The skin may be pink or red for several months as it regrows and recovers.
You'll need to avoid direct sunlight, and if you have to be outdoors, use a sunblock with an SPF of 25 or more. Also avoid moving your facial muscles as much as possible and use a moisturizer at least twice a day to keep your skin hydrated and supple.
Finding a good cosmetic surgeon
Since cosmetic surgery has become so popular in the last 10 years or so, some doctors have taken short cut training to take advantage of this at a disservice to the general public. You want a properly trained and experienced surgeon, not one who might gain his basic experience on you! Choose a plastic surgeon who's certified by the American Board of Plastic Surgery (ABPS), and one who's a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS).
While you should by all means listen to your friends and acquaintances who may have had cosmetic surgery and want to recommend their doctor to you you should do your homework too, and check the doctor's credentials.
Some questions to ask when interviewing plastic surgeons
· Do you have hospital privileges, and if so, which hospitals?
· Can you do the procedure in the hospital if I want to?
· If you do surgery in other facilities, are they accredited?
· How many breast reductions have you done?
· Can I speak to some of your previous patients about their experience with it?
Facial rejuvenation, including facelift, browlift, and laser surgery
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Oct 21, 2011 18:45:46
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