Facial Aesthetic Surgery

Correction of the Aging Face & Neck

Visible signs of aging of the face and neck can be treated in a number of different ways, including plastic surgery, laser surgery, skin resurfacing, topical skin care, and injection of Botox and fillers such as Juvederm. The following 3 charts are just intended to provide a guide for the patient to the multitude of procedures that are available for rejuvenation of the aging face. This includes from the time of the earliest signs of aging and environmental damage to later decades of life with more extensive changes of the aging process.

It is our belief that the most natural rejuvenation of the aging face and neck can be best achieved by finding the proper blend of:

surgical procedures
fillers and injectables
laser resurfacing techniques for each patient on an individual basis
daily skin care, including sun avoidance and topical agents as prescribed by your physician

Many patients begin to show evidence of their age by the presence of wrinkles, lines around the mouth and eyes, and deepening of the nasolabial folds. For these patients, the improvement they seek can often be achieved with injectables and fillers. Two examples of these fillers and injectables include Botox and the non-animal derived hyaluronic gels, such as Juvederm or Restylane.

For those patients whose main problem is structural as evidenced by sagging skin and unsightly accumulations of fat, for example, surgical correction is usually the required procedure for proper rejuvenation.

There are those patients who, even after their injections and surgical procedures such as a facelift, still do not see the rejuvenations they were seeking when they look in the mirror. The reason for this is that their skin has aged with the rest of the structures of their face but has not been properly addressed. This occurs even when the patient has undergone a skilled surgery and has been injected with a multitude of fillers. These patients require a laser resurfacing of their skin to improve its pigmentation and texture, reduce wrinkles, and aid in tightening of the skin.

Furthermore, some patients who seek face-lift consultations are, in fact, better candidates for treatment by non-ablative and ablative skin resurfacing, fractional skin resurfacing or plasma skin resurfacing. For this reason, we have extensively incorporated into our plastic surgery practice, more so than most plastic surgeons, these laser, light, and plasma procedures. These procedures are discussed elsewhere in this website and in more detail in our other web site www.lasersandplasticsurgery.com.

Clearly, a full understanding of the ideal blend of procedures necessary to maximize their rejuvenation cannot, for most patients, realistically be achieved without consultation with a plastic surgeon. This plastic surgeon should be, in my opinion, an expert and experienced in all these modalities:

injection of fillers and Botox
lasers
surgical rejuvenation

We hope, nevertheless, that the patient seeking information about these procedures will be able to use this website and its sister site as a guide to help them before, during and after their consultation.

Signs In The Mirror

1st Stage

SIGN OF AGING	TREATMENT
Laxity of Skin around the Jawline and Corners of the Mouth, Appearance of Fine Lines and Thinning of Lip	Minilift
Accumulation of Fat in the Neck and Under the Chin	Liposuction or Laser Liposuction
Deepening of the Nasolabial fold (line between the corner of the mouth and the outer corner of the nostril)	Mini-Lift Laser or Plasma for Skin Tightening
Wrinkles at the corners of the eye (Crow's Feet) and adjacent to the nasolabial fold and frown lines start to appear between eyebrows and along forehead.	Botox, Non-ablative Laser Resurfacing, Fractional Resurfacing, Plasma Skin Resurfacing
Mild textural and pigmentation changes in the skin	Non-ablative Laser Resurfacing, Fractional Resurfacing, Plasma Skin Resurfacing and microdermabrasion

2nd Stage

SIGN OF AGING	TREATMENT
Increased Laxity of Skin at Jaw and Corners of the Mouth as well as redundant skin along cheek and neck.	Facelift
Progressive loss of definition of mandible with fat accumulation in the neck.	Liposuction or Laser Lipolysis with possible tightening of skin and muscle in the neck
Early vertical bands appear in the central portion of the neck (platysmal bands). Nasolabial fold becomes deeper, lines of animation of forehead and adjacent to the eye become longer and increase in number	Surgical Correction of Bands with hyaluronic gel injection to nasolabial folds and botox to forehead. Possible subperiosteal midface lift.
Eyebrow starts to sag below lower edge of forehead	Endoscopic Brow Lift or Temporal Brow Lift
More wrinkles and frown lines increase in number and deepen both on the face and on the neck	Botox, Hyaluronic Gel, Non-ablative Laser Resurfacing, Fractional Resurfacing, Plasma Skin Resurfacing
Pores increase in size (especially in "T-Zone")	Glycolic Peels, Non-ablative Laser Resurfacing, Fractional Resurfacing, Plasma Skin Resurfacing
Areas of hyperpigmentation (brown spots) increase in size and number	Non-ablative Laser Resurfacing, Fractional Resurfacing, Plasma Skin Resurfacing, glycolic peels and microdermabrasion
Small capillaries appear more prominent around nostril, top of nose and along cheeks	Laser ablation

3rd Stage

SIGN OF AGING	TREATMENT*
Significant Laxity of Skin of Cheek, along mandible, under chin and neck	Face lift with liposuction of neck and tightening of muscles of neck and fascial layers of cheek
Edges of mandible barely or not discernible with prominent fat deposits beneath chin	Face lift with liposuction of neck and tightening of muscles of neck and fascial layers of cheek
Significant platysmal bands and prominent lines along entire face including nasolabial fold, forehead, and crow's feet	Face lift with liposuction of neck and tightening of muscles of neck and fascial layers of cheek with possible subperiosteal midface lift and hyaluronic gel injection
Eyebrows are completely below bottom edge of frontal bone	Endoscopic or Temporal Brow lift
Wrinkles, Lines, Folds, Brown Spots, and Spider Veins are extensive and prominent in color	Non-ablative Laser Resurfacing, Fractional Resurfacing, Plasma Skin Resurfacing

Face Lift Surgery

There are now almost as many different types of face lifts, or rhytidectomies, as there are movies to see in a large multiplex cinema. These multiple options benefit the patient in the various stages of the aging process. Some of these types of rhytidectomies, or names they are known by, are:

The Standard Facelift
The Facelift with tightening of the muscles (platysma) and/or SMAS ( a fascial layer of tissue also known as the sub muscular aponeurotic system) of the face and neck
The Minilift
Deep Face Lifts
Subperiosteal Facelifts
Midface Subperiosteal Facelifts
Short Incision Facelifts
“S”-lift
Endoscopic Facelifts

Most surgeons will, in addition, perform liposuction of the neck and under the chin at the time of the face lift surgery. The placement of the incision for the same face lift procedure can also vary from surgeon to surgeon. The trends in face lift surgery today include limiting the size of the incision, placing incisions in locations that are less visible, supporting the underlying tissues as well as the skin, and, perhaps, starting these rejuvenation procedures at an earlier age with less extensive procedures, thus creating a more natural look.

For example, the classic location of the scar for a facelift at one time was several millimeters in front of the ear. Today, most surgeons will place the incision "inside," or along the edge, of the tragus (fleshy protrusion at front of ear). A younger patient with early signs of aging may benefit from a minilift procedure where the incision is only along the edge of the ear as described above and extends minimally above the ear. Patients with deepening of the nasolabial fold, descent of the cheek, and ptosis (or dropping) of the lateral eyebrow below the rim of the orbital bone may get significant improvement from the limited incision temporal brow lift, the endoscopic brow lift or the subperiosteal midface lift.

The minilift and limited incision facelifts permit the patient, in most instances, to return to work relatively soon after the procedure. The deep plane and subperiosteal procedures, on the other hand, require long periods of time for all the swelling to resolve.

Most facelift procedures can be performed as an outpatient under a local anesthesia with sedation by a board certified anesthesiologist. With this type of anesthesia, it is as if the patients are asleep but do not require the placement of a breathing tube as required for general anesthesia.

Patients can usually return to work one week after all the procedures with the exception of the deep plane and subperiosteal procedures. Aerobic exercise is limited for the first 3 weeks after the procedures.

Face lift procedures are contraindicated or prohibited in smokers. The patient must stop smoking at least 14 days prior to the procedures. Procedures that are often done at the same time as the face lift include upper and lower eyelid surgery (blepharoplasty), laser or plasma resurfacing, and rhinoplasty ("nose job").

The treatments listed are not intended to be complete or comprehensive. The specific risks and the suitability of these procedures for a given individual can be determined only after a personal consultation. Please email us at infoplstc@RothausMD.com or call us at 212.737.0770 to schedule a consultation.

Eyelid Rejuvenation Surgery

The changes of the aging eyelids may include:

an excess of skin and appearance of wrinkles
ptosis (descent) of the upper eyelid itself
prominence of the fat pads around the eye

The procedures for aesthetic correction of the eyelid, or blepharoplasty, include:

removal of excess skin from the upper eyelid through an incision in the fold
rejuvenation of the lower eyelid with an incision under the lashes
removal of the bags only from the lower eyelid with an incision inside the lid (transconjunctival blepharoplasty)
ablative, non-ablative, fractional, or plasma skin resurfacing (see www.lasersandplasticsurgery.com)

These procedures are most commonly performed as an outpatient with local anesthesia supplemented by intravenous sedation administered by a board certified anesthesiologist. Sutures are removed within 3 to 5 days. Most patients can return to work in one week and resume aerobic activities within 3 weeks.

Rhinoplasty

The rhinoplasty, or nose job, is the surgical procedure for reshaping of the nose. Patients who desire such an aesthetic change in their nose must wait until they are at least 15 to 16 years of age. Of course, any patient under the age of 18 must have parental consent.

Many older patients, however, also desire a rhinoplasty procedure. Some of these patients have always desired an alteration in the shape of their nose. Others see a change in their nose, especially at the tip, with aging and wish to have a restoration of its more youthful profile.

The rhinoplasty was classically performed through incisions that were all placed inside the nose-just beyond the nostrils. Recently, in some hands, an "open" rhinoplasty has become a commonly performed procedure. The disadvantage of the open rhinoplasty is that the patient is left with scars on the outside of the nose and may experience a longer period of edema or swelling of the tip. The rhinoplasty is generally performed as an outpatient procedure under a local anesthesia with intravenous sedation by a board-certified anesthesiologist. Patients will generally require tape and a splint on the outside of the nose for a period of approximately 4- 5 days. Patients can return to work or school after one week, but must limit exercise for 3 weeks.

Otoplasty

The "pinning" back of the prominent ears is called an otoplasty. This procedure can be done as early as five years of age. In teenage and adult patients, this procedure is often done as an outpatient procedure under local anesthesia with or without intravenous sedation. The incision for the otoplasty is entirely behind the ear. Patients generally are required to wear a compression dressing around the head for several days. After the dressing is removed, some sort of protective headband is worn, especially at night, for several weeks afterwards.

For additional information on Laser Aesthetic Procedures, go to www.lasersandplasticsurgery.com.

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