FACIAL PLASTIC SURGERY
Facial Plastic Surgery is all about plastic surgery of the face: face lifts, forehead lifts, neck lifts, “eye jobs,” “nose jobs,” and any other procedure performed in and around the face. About 40 percent of my practice is plastic surgery of the face. People often infer from the amount of photos on my website that I perform mostly breast work – I have an endless supply of before and after photos for breast procedures. Don’t let the volume of before and after photos deceive you; most of my patients who benefit from facial plastic surgery prefer not to have their faces on my website.
Ear, Nose and Throat doctors (ENT’s) frequently call themselves “Facial Plastic Surgeons.” As I have said many times before, there is no patent on the term “plastic surgeon” and anyone can call themselves one, but don’t be fooled. it’s important, if not critical, for all patients considering any form of plastic surgery to check with the American Board of Plastic Surgery to make sure you are considering a “true” or “real” board certified plastic surgeon. Don’t be one of those patients that I see in the office who is shocked when I tell them that their previous doctor is not a Board Certified Plastic Surgeon, as they may have been led to believe.
Facial plastic surgery has been making a comeback lately as the results from non-invasive procedures (like lasers) have been somewhat of a letdown. “Weekend” lifts, “Thread” lifts, and other heavily marketed and promoted procedures have offered short-term gains at best, and are quite expensive. These non-invasive alternatives are typically offered by non-plastic surgeons, as any plastic surgeon who cares about his/her reputation will not take part in these charades.
Patients have even been turned off by some unnatural results and occasional “alien” appearances after facial plastic surgery has been taken to extremes. Tabloids constantly make fun of bizarre outcomes from some plastic surgery procedures and many celebrities have fallen victim to “plastic surgery gone wrong.”
The new “revolution” in facial plastic surgery is “surgery done right!” This simply refers to results that appear beautiful, natural, and lasting. However, you can only expect these results when your surgeon is experienced and has a knack for selecting procedures that work best in the individual patient. Your surgeon must have that “gift” for producing results that look harmonious, non-operated, and age appropriate.
By combining surgery with non-surgical alternatives such as fillers, Botox and acid peels, facial plastic surgery outcomes have essentially been revolutionized. Re-suspending loose tissues, plumping hollow areas of the face, and softening deep wrinkles all work synergistically to provide for the most natural and youthful outcome. It’s actually possible to look beautiful without looking artificial or “operated.” Keep them guessing—“Did he/she have plastic surgery?”
There are many ways to achieve natural, beautiful results when it comes to facial rejuvenation. Your surgeon first has to choose the right procedure(s), and then perform the procedure(s) very well. Surgical experience cannot be underestimated. For instance, not all face lifts are the same. Less can be less for some, and more can be more for others. Sometimes a combination of simple procedures focused on the problem area(s) is all that is needed for a beautiful outcome that avoids the telltale signs of plastic surgery.
Further details of facial procedures are addressed elsewhere on my website. Below, I have broken the face down into specific areas and I discuss the typical aging changes and the most common rejuvenation alternatives.
Forehead
Deep or active wrinkles of the forehead skin are a sure sign of age. Frown lines between the eyes and crow’s feet on the outside of the eyes are also a sign of age that are usually and easily improved with Botox and fillers alone. They will, however, require regular treatments every four months or so. Low eyebrows can make the eyes appear sad and slit-like. Being “bright-eyed and bushy-tailed” is not usually associated with heavy, low eyebrows.
An endoscopic brow lift is a permanent way to elevate the eyebrows and smooth the wrinkles of the forehead. The muscles that cause the deep creases between the eyes are also reduced. Frequent use of Botox may not be needed anymore between the eyes. The incisions from this procedure are small and in the hair of the scalp—nothing for anyone to see. It’s very difficult, if not impossible to over-elevate the brows when the endoscopic technique is used in the right patient.
Eyebrows frame the eyes. Having good eyebrows is critical to beautiful eyes. Use makeup appropriately and consider permanent eyebrow and lash liner treatments from Dr. Boysen if you need the benefits.
Eyes
The eyes are critical to facial rejuvenation because this is how the world sees you. Person to person communication occurs through the eyes. Beautiful, unobstructed eyes are the goal of all of these rejuvenation procedures.
A blepharoplasty, or eyelid lift, is a procedure that reduces skin excess and bulging fat, if present, on the eyelids. Conservative treatments are always in order because the eyes don’t tolerate overly aggressive treatments. Simple skin removal works beautifully. Fat, when in excess, should be contoured and not eliminated (it’s always preferable to have fuller, plumper tissues around the eyes—look at any teenager). Light acid peels around the eyes can also help to soften the creases and make the skin color even.
A combination of an endoscopic brow lift and blepharoplasty may be needed when all components addressed through each procedure would benefit from treatment. Fillers and Botox can also work quite well around the eyes. The two alone are particularly suitable for younger patients, and in patients with more advanced aging, provide maximal benefit when combined with surgical procedures.
Nose
The nose is the center of the face. A nose that is too large may take away from facial symmetry and beauty. An unrefined nose may lack delicate features and be a distraction to others. The most common, straight-forward treatments offered for the nose through a rhinoplasty are usually hump reductions and procedures that enhance the appearance of the nasal tip.
Secondary rhinoplasty refers to a procedure that is performed after one has already been done before. This is not uncommon in my practice, and usually is offered to patients whose noses were either overdone or inexpertly manipulated so that the nose appears unnatural, artificial, and uncomplimentary. If breathing has been compromised from previous surgery, this will be addressed at the time of secondary rhinoplasty.
Lips
Deep lip lines and creases around the mouth are very undesirable to most, as this is a sure sign of age. These issues can be addressed with fillers, as well as acid, laser, or dermabrasion treatments.
Women frequently appreciate fuller, more beautifully shaped lips. Fillers are the easy option to enhance lips and are performed within minutes. Newer, silicone lip implants have worked beautifully since their appearance on the market in 2008. Implants are not used to change the shape of your lips as much as it simply makes your lips larger and fuller. Excellent lip enhancement is the rule when the best size and placement of the lip implants is chosen.
Teeth
I can’t say enough about good teeth. White and straight is the rule. Never underestimate the benefit of nice choppers. A visit with an experienced and qualified dentist can be worth every penny. A great simile is worth millions!
Chin
A weak chin can affect facial balance and symmetry more than most people think. It will also affect the appearance of the neck, as the lack of bony support can result in fullness below the chin and a full neck angle. A well placed chin implant is a very powerful procedure, improving both facial and neck appearance.
The incision from the procedure is beneath the chin and is well hidden. Choosing the correct size implant and performing the procedure with skill is important. Computer imaging helps in this area quite well to see what you would look like before the procedure.
Cheeks, Nasolabial folds and jowl
I combine these areas because they all address possible face lifting procedures. Each area, when treated alone, can be addressed in the following ways. Fatty jowls can be improved with liposuction in many cases. Nasolabial folds that are deep can be improved with fillers, or even grafts of tissue. Cheek implants are a nice option when the cheek bones are underdeveloped. Deep wrinkles around the cheeks respond well to acid treatments or lasers.
When a few or all of these areas need to be addressed, a “mini” facelift or a regular facelift are great options. A “mini” facelift offers slight improvement. A regular facelift is powerful as it offers much more improvement with the same scars! The facelift procedure is still the gold standard in terms of facial rejuvenation—all procedures that profess to offer the same results are simply untrue.
Facial Skin
Your skin is the foundation or canvas for beauty. Healthy, smooth, evenly textured skin is an essential component of facial rejuvenation. Texas sun can take its toll on your skin. Acid peels, lasers, and medical grade skin care products like Obagi can work wonders on sun damaged, wrinkled, and blotchy skin. Never overlook the benefits of radiant, healthy looking skin when you are considering facial rejuvenation.
Neck
The neck is a very common concern to many people. One of the greatest advances in neck rejuvenation is the anterior neck lift. Basically, this procedure is performed through an incision beneath the chin. There are no scars in the hairline behind the ear. Improvements to the neck are made by creating a nice neck angle in combination with flattening the area beneath the chin itself. Improved definition of the jaw bone through neck rejuvenation also better separates the neck from the face. A more improved, more youthful profile is evident.
Liposuction alone in younger patients with good skin can be a wonderful and simple method to improve the neck. A full neck lift is usually reserved for those with advanced aging and poor, sun damaged skin.
Given all the available options from the article above, it becomes quite apparent that the best outcomes are derived from proper and appropriate selection of procedures that provide for the most natural, desirable outcomes. Although we would all hope that non-surgical methods achieve the same goals, this is simply not a reality. Non-surgical treatments can buy you some time, and enhance the young and beautiful, but for the rest of us, the heavy lifting comes with plastic surgery.
Robert Caridi, M.D.
