Facial Aesthetic Surgery

Correction of the Agin 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, and skin resurfacing.

Signs in the Mirror

1st Stage

SIGN OF AGING	TREATMENT
Laxity of Skin around the Jawline and Corners of the Mouth	Minilift
Accumulation of Fat in the Neck and Under the Chin	Liposuction
Deepening of the Nasolabial fold (line between the corner of the mouth and the outer corner of the nostril)	Fat Injection, Collagen, Goretex
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, Nonablative Laser Resurfacing
Mild textural and pigmentation changes in the skin	Nonablative Laser 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 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 autologous fat injection to nasolabial folds and botox to forehead. Possible subperiosteal midface lift.
Eyebrow starts to sag below lower edge of forehead	Endoscopic Brow Lift
More wrinkles and frown lines increase in number and deepen	Botox, CoolTouch Laser, Fat Injection, Collagen
Pores increase in size (especially in "T-Zone")	Glycolic Peels and Nonablative laser resurfacing
Areas of hyperpigmentation (brown spots) increase in size and number	Nonablative laser 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 autologous fat injection.
Eyebrows are completely below bottom edge of frontal bone	Coronal Brow lift
Brown Spots and Spider Veins are extensive and prominent in color	Laser ablation

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 are:

1. The Standard Facelift
2. The Facelift with tightening of the muscles (Platysma) and or Fascia (SMAS or Submuscular aponeurotic system) of the Face and Neck
3. The Minilift
4. Deep Face Lifts
5. Subperiosteal Facelifts
6. Midface Subperiosteal Facelifts
7. Short Incision Facelifts
8. 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 classical 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 in front of the hair and extends minimally above the ear. Patients with deepening of the nasolabial fold and a drooping of the cheek may get significant improvement from the subperiosteal midface lift where the incision is placed under the lashes of the lower eyelid. 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 out-patient under a local anesthesia with sedation by a board certified anesthesiologist. Patients can usually return to work one week after all the procedures except 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 resurfacing (CO2 and Erbium), and rhinoplasty ("nose job").

EYELID REJUVENATION SURGERY

The changes of the aging eyelids include an excess of skin and appearance of wrinkles, drooping of the upper eyelid itself, and prominence of the fat pads around the eye. The procedures for aesthetic correction of the eyelid or blepharoplasty include:

1. removal of excess skin from the upper eyelid through an incision in the fold
2. rejuvenation of the lower eyelid with an incision under the lashes
3. removal of the bags only from the lower eyelid with an incision inside the lid (transconjunctival blepharoplasty)
4. ablative laser resurfacing using the CO2 and Erbium lasers.

These procedures are most commonly performed as an outpatient with local anesthesia supplement 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 approximately at least 15 to 16 years of age. Of course, any patient under the age of 18 must have parental consent as well. 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 scars on the outside of the nose. The rhinoplasty is generally performed as on out-patient 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 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 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.

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 info@rothausmd.com or call us at 212.737.0770 to schedule a consultation.

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