- Facelift & Neck Lift - Eyelid Surgery - Forehead Lift -
- Rhinoplasty (Nose Surgery) - Chin Implant - Cheek Implants - Ear Surgery -
Loss of skin elasticity of the face and neck occurs sooner or later in all individuals. Some have a genetic advantage which delays the effects of aging, others are less fortunate, but the process is inexorable.
I have seen the evolution of surgical techniques from the simple to the most complicated, and have experience with all of them. The bottom line is that to provide a natural non-surgical look, excess skin must be excised, fat repositioned and removed if excessive, facial and muscular layers tightened, and overlying skin redraped naturally with incisions in inconspicuous places. It goes without saying that the expected recovery time should be reasonable.
Whether this is done with limited incisions or more extensive ones, adding liposculpture under the chin or simply some trimming, minor undermining or a greater dissection depends on the actual physical presentation and individual goals.
At the present time, I see no reason to perform face lift procedures that require months for swelling to subside. In almost all cases, however, I favor a technique which lifts the skin in a vertical direction, and the underlying tissue more laterally. These two vectors are counteractive to the effects of gravity, and are consistent with quality results that in my practice allow a return to most usual activities in 12 to 14 days.
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Eyelids that become saggy, puffy, and bulgy from fat bags are unsightly, associated with a tired worried look, and can be a source of great concern.
Fat bags of the lower lids may occur at an early age, and particularly in young females with a genetic predisposition. One of the most frequently requested procedures in my practice is blepharoplasty, which I presently perform almost exclusively with a laser. This technique provides a safer and shorter recovery period than the cold steel (scalpel) technique, is associated with less swelling, bruising, and tenderness, and produces consistent quality results without changing the shape of the eyelids.
When the outside corners of the lower eyelids are lax, either from ordinary aging or previous surgery, tightening (canthopexy) can be performed either alone or combined with regular blepharoplasty. In many instances the lower lids, and "crows feet" areas are associated with wrinkles that are caused from sun damage as well as aging, and the tightening effect may be enhanced by laser resurfacing.
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Much of our facial expression is reflected by the appearance of the brow. Patients frequently complain about being asked why they are angry, or looking overly concerned and worried when this is entirely not the case. Furrowing in between the eyebrows, and deep wrinkles and contractions at the forehead may be present in youth, or develop and worsen with aging.
My method of choice is to perform an open forehead rejuvenation which treats the eyebrows as one unit, and permits precise corrections of asymmetry and unevenness. When performed alone, there are no visible incisions of the face, and recovery is shorter than that for a facelift. The surgery can also be done endoscopically, and I often combine it with eyelid, face, and neck surgery.
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|Nose Surgery (Rhinoplasty) and Chin Implants
Rhinoplasty or nasal cosmetic surgery is one of the most common cosmetic procedures. I believe the goals should be not only to remove a hump, narrow a tip, change the angle at the mouth, or reshape nostrils, but to treat the entire nose as a unit and make alterations that fit the face as a whole. Nothing is more unnatural than a nose that is simply wrong for the face even if it is perfectly sculpted.
Chin implants are often done with rhinoplasty when there is a recession to balance the facial features. Although the nose is the most prominent feature of the face, the chin can sometimes be the most important. A chin that is too small will make the nose look larger, give a droopy appearance to the lower lip, and cause the neck to look older because of a shortened distance to the cervical crease.
It is not uncommon in my practice to do a chin implant alone for someone who thinks their nose is too big, when in fact the nose is just fine, but unbalanced because of a weak chin.
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Whether or not we notice it consciously, full cheeks are often a part of how one judges a person's face. Cheek implants can have a major impact on the appearance and self-confidence of patients whose cheeks have thinned or flattened due to age, illness or other causes. Implant sizes and shapes are tailored to each patient's desired appearance, and can be inserted through the mouth with no visible scars on the face. The surgery can be done as a single procedure, or combined with others such as with a chin implant, the two together extremely effective in rejuvenating the face with minimal incisional surgery.
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Ear surgery for children or adults can set prominent ears back closer to the head and reduce the size of large ears. Surgery may also be helpful for "lop ear," "cupped ear" and "shell ear," large or stretched earlobes, and lobes with creases and wrinkles. The procedure may be performed in a hospital, office-based facility or an outpatient surgery center under general or local anesthesia. Correcting unattractive earlobes that have been pulled down by heavy earrings is an easy addition to face lift surgery.
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