Facial Procedures


Friday, May 9th, 2014

As a general rule most plastic surgeons agree that starting early is better.  But keep the procedures minimal and more frequent.  This will help to maintain a NATURAL look.  Find a plastic surgeon who will help you keep the procedures reasonable and appropriate.  Use your own good judgement too.  Stay away from “cosmetic or aesthetic” doctors who have little training, experience, or judgement and are not real plastic surgeons.  Stick to board certified plastic surgeons. The best source for fully trained, board certified, ethical plastic surgeons is the American Society of Plastic Surgeons -  www.plasticsurgery.org.

Chronological age is not as important as your physiological age.  People develop the stigmata of aging at different times and at different rates.  Fortunately, today, we have many different options to maintain a youthful appearance.   Patients in their 20’s and 30’s should be using sunblock, a good skin care program, and possibly doing laser treatments. Botox and/or fillers may be helpful, but be conservative.

For most people, from 40 years on, the skin begins to sag, sun damage is more apparent, pigmentation irregularities occur, there are volume shifts and volume loss.  When these factors first become apparent it is time consider more aggressive maintenance and correction.  Because botox, fillers, and lasers are simple and quick they are common treatments in my office for patient who are 40+ years old.  Again it is important to avoid being overdone.  In my opinion, fillers do NOT cause significant lifting unless they are overdone leading to a “balloon” look.   For sagging and drooping, lifting procedures are best.  Ultherapy (ultrasound) is a non-surgical office procedure to tighten and lift.  It is great for minimal to moderate sagging.

I am doing many more “mini face lifts”, neck lifts, and fat injections in patients in their 40‘s and 50’s than ever before.  Although I still do “full” face lifts,  this is usually in older patients who have not done any maintenance.  Consider two 45 year old patients- one doing nothing for 15 years and then having a full face lift, the other having 2-3 mini lifts during this same 15 year period. In my opinion it is better to do 2 or 3 mini lifts over 15 years, than wait until everything is severely sagging and be forced to do a full face lift.  Obviously,  if you do multiple mini procedures you will look better during the 15 years. In  addition, at the end of the 15 years,  the patient doing minimal maintenance procedures will have a better and more natural look.

Mini lifts are very simple procedures that involve less surgery and minimal down time (usually 2-3 days).  A mini lift is performed with local anesthesia or sedation.  There are many options regarding the components of the min lift  and possible additional procedures.  I tailor my recommendations to the individual’s particular problems and preferences.  My priorities are safety, keeping a natural look, and maximal improvement, in that order.


Revitalize your face and neck

Thursday, March 7th, 2013

Many patients ask me “what can I do to make my face and neck look better?”  Of course this is a very general question so I try to organize their thinking and my response.  I usually divide my assessment into three catagories:  skin surface problems, sagging or drooping issues, and volume disorders.

Skin surface problems include: sun damage, pigmentation, fine line and wrinkles, surface irregularities, acne scars, and red spots.  “Resurfacing” is required for these conditions and is usually done with lasers, dermabrasion, peels, and skin care products.  These treatments do not significantly tighten the skin or tissues.

Sagging and drooping is usually evident in the following areas: jowls, cheeks, eyebrows, eyelids, and the neck.  As we all know, unfortunately, drooping is a major part of the aging process.  These conditions are best treated by surgical lifting procedures (e.g.-face lift, brow lift, neck lift, eyelift).  Surgical procedures will result in the most significant improvement.  There are also some non-surgical lifting techniques using ultrasound (e.g.-Ulthera) or radiofrequency (e.g.- Thermage) to stimulate contraction (tightening) of the tissue.  The non-surgical lifts will result in much less lift but are less expensive and have less down time.

Recently, the significance of volume loss in the face has been recognized as a vital cosmetic issue.  Aging causes downward movement of facial fat.  Cheek fat will descend causing puffiness along the jaw (jowls), cheek depressions, and indents under the eyes (tear troughs).  The fold from the edge of the nostril to the corner of the mouth (Nasolabial Fold) will deepen.  Folds at the edge of the mouth will deepen.  These conditions can be treated with fillers that are injected to replace lost volume.  There are commercially available fillers (e.g. Restlylane, Juvderm, Radiesse) that can be injected in the office in just a few minutes.  These fillers last 6 months to one year.  Your own fat can also be used.  This is a slightly more complex and expensive procedure but usually lasts quite a bit longer (2-5 years or more).

In some cases, volume may need to be removed, particularly in the neck.  Usually liposuction is used for this.

Of course each patient has different combination and severity of problems.  If this sounds a bit complex and confusing -  it is to the untrained individual.  The exact nature of each person’s issues needs to be assessed during a consultation by a legitimate BOARD CERTIFIED PLASTIC SURGEON.  A PLASTIC SURGEON who has the training and experience to do all of these treatments is the best doctor to determine the options that are appropriate for you.