Facial Plastic Surgery

The brow lift and endoscopic brow lift are two surgical procedures that can reduce signs of aging in the upper third of your face.  While both procedures have similar aesthetic goals, the endoscopic technique is a less invasive method that many plastic surgeons are now performing on a regular basis.

The brow lift is an effective procedure for rejuvenation of the forehead and eye area, an important part of your facial appearance.  By gently lifting the underlying tissues of the brow, the brow lift can correct age-related issues such as:

• Lines and furrows
• Asymmetric brow
• Glabellar lines
• Crow’s feet
• Excess eyelid skin

If wrinkles and lines are localized in the forehead, a brow lift is usually done as a single procedure.  In other cases, the patient will benefit from facelift surgery or eyelid surgery during the same procedure.

ARE YOU A CANDIDATE FOR BROW LIFT SURGERY?

You might find that as you grow older, changes occur in your forehead and around your eyes.  The brows gradually descend, resulting in visible lines and creases on multiple areas of the forehead.  Loose skin seems to collect on the eyelids, making you appear tired or unhappy.  Problems such as these are indications for a brow lift or endoscopic brow lift.  Through surgery, your provider gently elevates the brows to restore their natural arch and create a smoother forehead.

WHAT TO EXPECT DURING YOUR SURGERY

A brow lift will typically require about 1 to 2 hours total operating time.  General anesthesia is an option, but local anesthesia has become a common choice with the less invasive brow lift techniques.
Your face is cleansed thoroughly and the hair is tied back and/or trimmed.  After anesthesia is administered, the doctor makes 4 or 5 small incisions behind your hairline.  The surgical endoscope, a small viewing instrument, is used to see your underlying tissues during surgery.  The tissues of the forehead are lifted or partially removed and the shape of the brow is altered to exhibit a smoother appearance.  By gently elevating the brow, the area around your eyes is also opened up. To maintain the results as you heal, your provider fixates the brow and closes the incisions with sutures.

AFTER BROW LIFT SURGERY: HOW LONG DOES RECOVERY TAKE?

Recovery time varies, but the endoscopic technique will typically require less downtime than a traditional brow lift.  Expect to rest for at least 7 days before returning to your normal routine.  Some nausea, numbness, mild swelling and discomfort is normal, but should be nearly resolved after 3 weeks.  Pain medications can help you manage discomfort as you recover from your brow lift.  If it’s necessary to remove staples or fixation devices, you’ll need to return for follow-up appointments after 1 week and 2 weeks, respectively.

POSSIBLE COMPLICATIONS

All surgery, including the brow lift, carries some uncertainty and risk.  Possible adverse events or complications that can occur with this procedure include nerve damage, scarring, alopecia along scar edges, loss of sensation along incision line, itching, infection, bleeding, asymmetry, overcorrection, and unsatisfactory results.

Cheek augmentation – using a facial implant or an injectable filler – is offered by Wilmington Health for the treatment of sunken or recessed cheeks caused by aging or caused by inadequate underlying bone structure.  This procedure is often combined with a facelift to enhance the projection of your cheekbones.

ARE YOU A CANDIDATE FOR CHEEK AUGMENTATION?

When you are young, it’s common to exhibit a healthy fullness in the cheeks, making your face appear round or heart-shaped.  When volume in this area decreases over time, that youthful appearance can become diminished.  With cheek augmentation, your provider can increase the projection and volume in your cheeks to restore your youthful facial appearance.

In some younger patients, the underlying structure of the facial bones does not project sufficiently, leading to a sunken cheek area earlier in life.  These cases may also be appropriate for correction with cheek augmentation.

The basic indications for cheek augmentation are as follows.  You may be a candidate if you:

• Exhibit a hollow appearance in the mid-face
• Have a cheekbone structure that lacks projection
• Lost weight and now exhibit wrinkles and flattened cheeks

ENHANCING FACIAL VOLUME WITH CHEEK AUGMENTATION: HOW IT WORKS

While taking your preferences and conditions into consideration, your provider may recommend cheek augmentation with a malar implant or an injectable wrinkle filler.  Although both methods can provide long-lasting results, the implant is considered a permanent solution to this cosmetic problem.

INJECTABLE FILLERS

Wrinkle fillers such as Juvederm, Restylane, Radiesse, and other products are provided at our practice, and your provider can recommend the best product for your cheek augmentation procedure.  Using a topic anesthetic or dental block to control discomfort, the filler is injected beneath the skin of your cheeks to a specific depth.  The doctor may then massage the area briefly to ensure a smooth result.  Cheek augmentation with a dermal filler can last 6 months to a few years, depending on the product chosen.

MALAR IMPLANTS

Malar implants are specially designed prosthetics made of silastic, a firm silicone rubber that is used in a variety of medical applications.  The implants are available in many shapes and sizes to match your facial structure.  When performed as a single procedure, cheek augmentation requires an incision in the upper lip or in the lower eyelid.  When performed in conjunction with a facelift, it can be inserted using a different method.  Within the tissue of your cheeks, your provider forms a pocket for the implant and secures it into place with screws or sutures.

POST-OP: WHAT TO EXPECT AFTER CHEEK AUGMENTATION

You’ll be able to see the results (increased cheek projection) immediately after surgery.  However, it can take some time for the swelling to fully subside and the long-term results to be realized.  After about 3-4 weeks, you should be close to seeing the final results of your cheek augmentation.

The chin is an important aspect of one’s appearance.  Along with the nose and forehead, it plays a vital role in balancing the facial features.  Most people agree that a chin should be prominent but proportional in relation to other aspects of your face.

Chin surgery is intended to correct a facial imbalance caused by a weak or inadequate chin.  This surgery takes several forms including sliding genioplasty and chin augmentation, i.e. alloplastic mentoplasty.  Using an anatomically shaped facial implant, a plastic surgeon can increase projection of your chin to balance your facial features.

ARE YOU A CANDIDATE FOR CHIN SURGERY?

If you’re a candidate for chin surgery / augmentation, you probably have a chin that is not proportional.  This means that your chin is not necessarily small, but relatively small. Such a condition can make your nose or forehead appear more prominent.

The medical term for this condition is microgenia, characterized by inadequate underlying bone structure in the chin.  If you are bothered by this condition, you may be an ideal candidate for chin surgery.  Patients must be psychologically stable and capable of understanding the risks, benefits and limitations of cosmetic surgery.  Patients who present severe microgenia or dental problems may not be good candidates for chin surgery.

HOW IT WORKS: ALLOPLASTIC MENTOPLASTY

The doctor will examine your face, head, neck and jaw to determine if you are a suitable candidate for chin surgery.  If you proceed with surgery, the doctor will give you instructions on using facial cleanser or antibacterial mouthwash, depending on the planned incision site.

Local and/or general anesthesia can be used during chin surgery, depending on the circumstances and your plastic surgeon’s preference.  There are also two different incision methods for placement of a chin implant: the intraoral incision (in the mouth) and below the chin.  There are special considerations for each incision.  The intraoral incision leaves no visible scar but carries a higher risk of infection.  An incision below the chin leaves a small but permanent scar.

After performing the incision, the surgeon creates a pocket for the implant, selects an implant of proper size and shape, and then secures it in place in front of your jawbone.  Soft sutures are used to close the incision, followed by wound dressing.

WHAT TO EXPECT AFTER CHIN SURGERY

You will receive post-operative instructions that should be closely followed.  These may include steps to elevate your head, eat a soft diet, avoid contact with the incisions/chin, and practie good oral hygiene.  You may also be prescribed antibiotics and pain medications.  After about 7-10 days, the sutures will be removed in a follow-up appointment.

POSSIBLE SIDE EFFECTS / RISKS

Like all surgical procedures, chin surgery has some uncertainty and risk.  Complications are relatively rare but can occur. Possible complications include but are not limited to bleeding, infection, implant malposition or mobility, and nerve injury.  Ask your provider for more information if you are concerned about complications.

Dermabrasion is a precise method of mechanical skin abrasion.  Using a special dermabrader device, your provider can correct skin texture problems that negatively affect your appearance.  As one of many techniques in skin resurfacing, dermabrasion can be performed alone or in conjunction with procedures such as laser skin resurfacing or a chemical peel.

ARE YOU A CANDIDATE FOR DERMABRASION?

Dermabrasion can treat large areas such as the face or chest, or it can be performed as a “spot treatment.”  Before undergoing this procedure, it’s very important to identify the areas you want to correct and communicate those goals with your provider.  A wide variety of skin problems can be treated.  The following are some of the common dermabrasion treatment indications:

• Scars (deep acne scars or surgical scars)
• Mohs defects
• Lesions
• Deep wrinkles or folds
• Unwanted tattoos

There are also contraindications for certain patients.  Those prone to keloids or hypertrophic scars might be advised to skip dermabrasion.  You should also notify your provider if you have a history of lichen planus, hyperpigmentation, hypopigmentation, or psoriasis.

WHAT TO EXPECT DURING YOUR DERMABRASION TREATMENT

A dermabrasion device is basically an electric motor that can be fitted with different abrasive tips for resurfacing your skin. Your provider will choose the proper abrasive tip for your treatment, while also choosing a proper technique with varying rotation speed, movement and pressure.  With smooth, precise movements, the doctor passes the dermabrader over your skin, contouring the area while scraping away irregularities.  If you receive a full face treatment, the application may extend slightly below the chin to mask any differences in pigmentation after the procedure.

POST-OP: AFTER YOUR DERMABRASION

The area will first be wrapped in gauze and topical anesthetic, followed by ice.  When you are discharged, the treated area will be wrapped in a semi-permeable dressing, along with gauze, tape and possibly netting.  These will require regular replacement during your recovery.  Pain medications will help you manage discomfort during this time.

Healing time is about 1 to 2 weeks.  As your body’s healing mechanisms are stimulated, an increase in collagen production occurs.  When your skin heals, you should see a noticeable improvement in texture and a reduction of the targeted skin irregularities.

POSSIBLE SIDE EFFECTS

Possible adverse events occurring after dermabrasion include but are not limited to the following:

• Bacterial or viral infections, which may be managed with antibiotic or antiviral medications
• Post operative hyperpigmentation,
• Post operative hypopigmentation
• Residual scarring, which is more likely with delayed healing
• Acne outbreaks or Milia, which may be managed with traditional therapies

Blepharoplasty is a common procedure that corrects cosmetic issues of the upper and lower eyelids.  When excess skin and fat collect around your eyelids, your face may appear aged, tired, or unhappy.  Blepharoplasty is designed to correct this problem. There are several variations in technique, including procedures designed to address the same conditions on patients of Asian descent.

ARE YOU A CANDIDATE FOR EYELID SURGERY?

Most people who choose this procedure are over the age of 35. They often have a hereditary predisposition for baggy eyelids and have a strong desire to correct it. If you exhibit conditions of the eyelid such as the following, you may be a good candidate for eyelid surgery:

• Excess eyelid skin (dermatochalasis)
• Bags above or below the eyes
• Drooping upper eyelids
• Stretched skin around the eyes

If you are bothered by these conditions, we encourage you to schedule a consultation with your provider. You may also want to check with your opthalmologist to prepare for your consultation. If you have thyroid problems, Graves disease, dry eyes, high blood pressure, diabetes or other medical problems related to the eyes, blepharoplasty may not be recommended for you.

WHAT TO EXPECT DURING EYELID SURGERY

Surgery requires approximately 1 to 3 hours under local anesthesia. Because it is an outpatient procedure, you will not need to stay overnight in a hospital or surgery center. The doctor places incisions in the natural creases of the upper eyelid, or just above the lower eyelashes. The skin is meticulously separated from the muscle and fat before the excess eyelid tissue is trimmed or repositioned. The incisions are then closed with fine sutures.

RECOVERING FROM EYELID SURGERY: WHAT TO EXPECT

You should expect about 7-10 days of downtime after your blepharoplasty procedure. Immediately after surgery, your provider will lubricate your eyes and apply a bandage. Your eyelids will likely feel sore or tight as the effects of anesthesia wear off. Prescription pain medications are usually prescribed to manage discomfort during recovery.

When you are sent home, the doctor will give you post-operative instructions that should be closely followed. This may include steps to keep your head elevated and use cold compresses to reduce swelling and bruising. You will need to postpone use of contact lenses for about 2 weeks after your eyelid surgery.  Exercise may need to be postponed as long as 3 weeks.

POSSIBLE SIDE EFFECTS / COMPLICATIONS

All surgery, including blepharoplasty, carries a risk of complications or adverse events. Bruising is a common side effect after eyelid surgery, which often endures for 2 weeks or longer. You may experience excessive tear production, sensitivity to light and temporary blurriness of vision.

Complications such as infection, bleeding, swelling, scarring, asymmetry, difficulty closing eyes, pulling down of the lower lids and blindness are rare but possible.

Platysmaplasty is a type of facelift named after a prominent neck muscle (the platysma) that travels from the chest to several points of your neck. This muscle, along with other tissues, can become lax over time. Neck lift surgery or another procedure in neck contouring can correct the sagging tissues that reside below your chin that hide the natural, angular transition from your neck to your face.

ARE YOU A CANDIDATE FOR A NECK LIFT?

If you exhibit conditions such as the following, you should schedule a consultation to discuss the options in neck contouring:

• Jowls
• Neck bands
• Neck fat or fat below the chin
• Sagging or crepey skin on the neck

These conditions are very common and they make a negative impact on one’s appearance.  Contrastingly, the desirable aesthetic characteristics in this area include a well-defined jaw line, strong chin, absence of neck fat, smooth skin, no platysmal folds, and a long narrow neck.

The goals of neck contouring are designed to meet or at least approach these aesthetic goals.  Procedures such as platysmaplasty and neck liposuction can create a sharper cervicomental angle with a visible depression beneath the hyoid bone, thereby creating the appearance of a longer, slimmer neck.  They can also enhance definition of the transition from your jaw to your neck, restoring the sharp angles that you probably had during youth.  Other areas such as the chin can be enhanced and the presence of heavy jowls can be improved.

HOW NECK CONTOURING WORKS

Neck contouring is an individualized procedure, so certain patients may benefit from a less extensive procedure. For example, neck liposuction alone may be sufficient for young patients who have good skin tone.

Typical neck lift procedures require techniques similar to a facelift, combined with liposuction to remove excess neck fat. The surgeon makes an incision near the earlobe, extending it around to the hairline.  One or two small incisions are also made below the chin to remove fat with liposuction. The platysma muscle and digastric muscles may be remodeled or partially removed, while excess skin is trimmed.  The incisions are then closed with sutures.

WHAT TO EXPECT AFTER NECK CONTOURING

Your provider will send you home with special post-operative instructions, which you should closely follow. These instructions may include a list of medications to avoid (such as aspirin or vitamin E) and steps to ensure a smoother recovery.

You may need to elevate your head when resting, using pillows to avoid turning during sleep. An elastic compression garment is usually worn for a few weeks, which you may be able to hide with a scarf or high-necked garment. You can usually shower and wash your hair the day after surgery, but you’ll need to avoid rigorous exercise, bending and lifting for about 2 weeks. The results are not immediately clear after a neck lift. It takes some time for the swelling to subside, so it may be as long as 3 weeks before you can appreciate the aesthetic improvement in your neck.

POSSIBLE COMPLICATIONS

The risk of complications may vary depending on the technique chosen for your neck contouring procedure. Possible adverse events include but are not limited to hematoma, seroma, temporary loss of sensation, prominence of platysmal bands, and unsatisfactory aesthetic outcome. If you are concerned about side effects, ask your provider for more information during your consultation.

Liposuction can be performed on the neck area when patients present stubborn fat deposits below their chin, lower face and on the neck. This is a very common problem that affects people of all ages.  Unfortunately, when fat accumulates near the neck, the angular shape of your chin and jaw is lost. With liposuction, your provider can sculpt this area and remove unwanted fat, thereby restoring the natural lines of your lower face and improving your appearance.

With new liposuction techniques, plastic surgeons can provide more precise results and shorter recovery times. While no liposuction procedure can replace dieting and exercise, it can remove persistent areas of neck fat that do not go away after traditional weight-loss methods have been tried.

ARE YOU A CANDIDATE FOR NECK CONTOURING?

The best candidates for neck liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in the neck. Furthermore, candidates should also be:

• Physically healthy
• Psychologically stable
• Realistic in their expectations

While your age is not a major consideration for this procedure, older patients are more likely to have poor skin elasticity and therefore may not achieve the same results as a younger patient with tighter skin.

Due to increased risks, those with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the neck are not considered good candidates.

HOW NECK LIPOSUCTION SURGERY WORKS

During neck liposuction, your provider removes localized deposits of neck fat to sculpt your neck area and lower face. Through a tiny incision, he inserts a narrow tube or cannula to vacuum the fat layer that lies beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out.

RISKS AND COMPLICATIONS TO BE AWARE OF

Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the plastic surgeon is adequately trained.  However, it’s important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees.

The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the vital organs; and unfavorable drug reactions.

The scars from neck liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance are not uncommon after liposuction. The skin surface may be irregular, asymmetric or even baggy, especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended.

WHAT HAPPENS AFTER NECK CONTOURING

After surgery, you may experience some fluid drainage from the incisions. A small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and promote skin contraction, you may be fitted with a snug elastic garment to wear over the neck for several days. Your provider may also prescribe antibiotics to prevent infection.

You might not look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days.

It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.

RETURNING TO NORMAL

Healing is a gradual process. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days.

Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more. Your provider will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.

Plastic and reconstructive surgeons can perform many procedures that improve the shape and position of the ear. One of the most common of those surgeries is otoplasty, which corrects protruding ears on children and adults. People commonly refer to otoplasty as “ear pinning surgery.”

INDICATIONS FOR OTOPLASTY / EAR SURGERY

Otoplasty is usually done at an early age to prevent or end teasing by a child’s peers. The normalizing of the child’s appearance can have a positive effect on his or her self-esteem. When the ears have fully developed (often as early as age 4) the child can undergo the procedure. If you are an adult and believe that your ears are out of proportion, otoplasty may be beneficial for you as well.

Otoplasty can correct conditions such as:

• Large or protruding ears
• Ears out of proportion

There are many other congenital conditions or defects that may affect one’s ears. Cupped ears, lop ear, or shell ear are all documented conditions that may be improved through surgery. Otoplasty however, is specifically intended to address ears that significantly protrude out from one’s head.

HOW OTOPLASTY SURGERY IS DONE

Otoplasty is done as an outpatient procedure with about 2 to 3 hours of operating time. Local anesthesia is common for adults and adolescents, while young children may need general anesthesia to remain still during surgery. Your provider makes a precise incision in the back of each ear, where he folds or removes cartilage. Sutures are then placed to hold the ears in the new position and close the incisions. The ears will appear more proportional as they reside closer to the patient’s head.

RECOVERY AFTER OTOPLASTY

Recovery time with ear surgery is typically 1 week or shorter. Kids typically return to school after a week and adults can be back to work in about 5 days. You’ll be sent home with instructions from your provider, which should be closely followed to ensure you minimize the chance of complications and obtain satisfying results. Watch young children closely to be sure they are protecting the ears and do not upset their results.

After surgery, the doctor wraps the patient’s head in a bandage, followed by a light head dressing after a few days. Stitches may need to be removed during a follow-appointment, which should be scheduled about 1 week after surgery.

POSSIBLE SIDE EFFECTS / COMPLICATIONS

Possible adverse events include but are not limited to infection, formation of scar tissue, or a blood clot on the ear, which may dissolve or it can be extracted. Ask us about these risks if you are concerned or need more details.

Rhinoplasty is a word derived from the Greek terms for nose (rhino) and shape or reform (plasty). This is a common procedure performed by plastic surgeons, which can correct a wide variety of nasal characteristics that make a patient’s face appear unbalanced. A subtle change made with rhinoplasty can make a dramatic difference in a person’s appearance.

Each patient’s nose is unique, so there’s no one-size-fits-all rhinoplasty technique that can satisfy every patient. There are however, general aesthetic goals that most surgeons aim to provide during rhinoplasty:

• Balanced nasal projection and width
• Proper angle between nostrils and lips
• Relatively narrow nasal tip
• Straight nasal dorsum
• Small dip between dorsum and tip

ARE YOU A CANDIDATE FOR RHINOPLASTY?

A good candidate for rhinoplasty is bothered by the appearance of his or her nose, to the extent that it causes problems with self-image and confidence. You may feel that your nose is out of proportion with the rest of your facial features, causing others to give undue attention to your nose. In such cases, rhinoplasty may change your nose and improve your quality of life. If you’re considering rhinoplasty, you should be healthy and not be using any illegal drugs or nasal medications.

You should also have realistic expectations about the procedure. During a consultation, your provider will discuss the expected results and related risks so you fully understand the surgery before proceeding. It’s common to take time and formulate the aesthetic goals of your surgery, sometimes using photographs to analyze the angles of your nose and decide how it might be improved.

HOW RHINOPLASTY ALTERS THE SHAPE AND PROPORTION OF YOUR NOSE

Whether your nose is large, small, bumpy, droopy, crooked, wide, narrow, short or long, a rhinoplasty procedure can be designed to bring your nose into balance. A typical operation requires about 1 to 3 hours of operating time under local anesthesia and intravenous sedation.

Plastic surgeons use two basic variations in surgical technique: the open rhinoplasty and the closed rhinoplasty. In the former, all incisions are made inside your nose; in the latter, the skin is lifted from the underlying structure to obtain a clear view of the cartilage and bone. To reshape your nose, the cartilage and bone of your nose is reduced, augmented or refined. Once the reshaping is complete, absorbable sutures are placed within your nose and nasal packing is inserted, sometimes with a nasal splint.

WHAT HAPPENS AFTER RHINOPLASTY SURGERY

During the first week of recovery, you will likely need pain medications to control discomfort. The nasal packing can usually be removed within the first week, but swelling takes longer to fully subside. Most patients return to their normal routine in about 1 to 2 weeks. During the weeks that follow your surgery, it’s very important to avoid activities that could cause an impact upon your nose.

As the swelling clears and you see the changes in your nose, it may be somewhat difficult to adjust to your new appearance. This definitely varies from patient to patient, especially among patients of different age groups.

POSSIBLE COMPLICATIONS

Possible adverse outcomes and events include but are not limited to unsatisfying results (which may require revision surgery) nasal obstruction, bleeding and sinus infection. Ask your provider for more information if you are concerned about complications from rhinoplasty.

ALTERNATIVES

There are a few alternative procedures and techniques that may provide benefit similar to those of rhinoplasty. A procedure called septoplasty is designed to improve breathing problems in the nose without altering shape.  For aesthetic changes, a chin implant can often balance a nose that appears prominent. There are even non-surgical options that plastic surgeons have used such as Radiesse dermal filler for contouring of the nasal area.