Archive for the ‘Forehead | Brow Lift’ Category
Facial cosmetic surgery is a very personal and monumental decision. Universally, all patients want the best outcomes. In today’s corporatized America, with heavily influential marketing spin, pharmaceutical companies, medical device companies, and even practitioners promote a less is more mentality to push products and services that often over promise and under deliver on the results. In no way can skin creams, injectables, or lasers deliver the types of results once can achieve with surgery. In a similar manner, minimally invasive sounding surgeries are in no way a substitute for time tested peer reviewed procedures that provide quality long lasting results.
Unfortunately not every person will achieve acceptable results with Botox or injectable fillers such as Juvederm, Restylane, and Radiesse. These products have their place in facial aesthetic practices, in properly selected patients, but in general should be viewed as temporary treatments with less impressive results when compared to surgery. Their primary advantage is that they have minimal social while providing a benefit. Botox is being used more and more as a preventative cosmetic medicine that delays wrinkle formation. Fillers camouflage initial signs of aging, but ultimately putting too much filler in a face, the liquid facelift, can alter ones appearance creating an artificial overinflated appearance. Using filler to augment facial structures can be useful to patients wanting to get a general idea of the appearance prior to permanent surgical procedures such as lip and cheek enhancements procedures. Creams reverse the signs of photo aging and contribute to collagen formation and production but are limited in their effectiveness. Lasers are an excellent option to delay the signs of aging and treat sun induced skin photoaging, but in no way can they tighten skin like facial cosmetic surgeries such as a facelift.
Surgical procedures are the best option for impressive endurable results. Rhinoplasty can dramatically affect ones facial appearance in a way that almost no other cosmetic surgery can. The nose can cause undue and unnecessary attention drawing attention away from other attractive facial features. Aging face surgery has many layers of effectiveness based on the surgical techniques used and how they are applied. In general, minimally invasive techniques can produce an artificial appearance and or short-term results. When considering aging face surgery most sophisticated patients are looking for surgeries that will last as long as possible with the most dramatic natural appearing results. There are no shortcuts to achieving optimal results and when applied, shortcut techniques frequently under deliver on the surgical results end.
Becoming an informed patient who understands the benefits of finding the right intervention or surgery for the right patient will ultimately save one time and money over the long haul. Getting things done right the first time is of paramount importance to achieving optimal outcomes with a high degree of patient satisfaction, while avoiding problems and bad outcomes.
Posted by: Benjamin C. Stong MD
Healing following Facelift surgery is of significant interest to patients and practitioners. Millions of dollars are spent on marketing every year, promising less healing and down time, and subsequently, a faster return to daily activities. Practitioners advertise minimally invasive surgical techniques and use prescription pharmaceuticals and homeopathic remedies to facilitate healing following surgery. Bromelain and Arnica Montana (A. Montana) are the two most common homeopathic treatments offered following facelift surgery; they are supposed to reduce swelling and bruising, respectively. One of the most conclusive studies on A. Montana demonstrated no difference in the degree of bruising between the group taking A. Montana and the group receiving a placebo pill following facelift surgery. However, this study did validate an objective computer model to assess bruising, with a superior ability to discriminate subtle color changes over the human eye and eliminating the inherent, subjective bias of visual analog scales and ranking schemes. This allowed the medical community to objectively study the effect of therapies on bruising following surgery, and in particular facelift surgery procedures.
Hyperbaric oxygen (HBO) therapy has been popularized in the main stream media through several celebrities for its anti-aging effects. In the scientific literature it has been demonstrated to hasten wound healing by promoting free radical scavengers, reducing cell damage, and increasing the oxygen delivery and blood supply to wound beds. For years, hyperbaric oxygen therapy has been used to facilitate healing in chronic, non-healing wounds. Ultimately, the common pathway in hyperbaric oxygen therapy is more rapid wound healing. A new, unique application for HBO therapy is to assist healing in facelift surgery.
We performed a prospective, controlled study on thirteen patients undergoing face lift surgery with six electing to undergo HBO therapy immediately before and after their face lift. Seven patients were entered into the control group and received no therapy. Any additional confounding factors were equal and accounted for. Statistical Analysis, digital photography and the previously validated objective computer model were used to assess the resolution of bruising postoperatively. The result was a statistically significant decrease in the degree of bruising in the HBO group over the control group on postoperative days 7 and 10, with a 35% and 30% reduction, respectively. There were no complications associated with the treatment group.
This is the first report of the benefit of HBO therapy on wound healing in cosmetic surgery. To date there has been no more compelling evidence for a particular adjunctive therapy to facilitate healing, with many of the current treatments having little scientific evidence supporting their use. The validated computer model in this study provides the scientific community an excellent resource to objectively measure the resolution of bruising and healing following surgery. Additionally, a larger number of patients enrolled in this study would empower the degree of effect on bruising and most likely become statistically significant sooner in the postoperative course.
When patients are choosing to undergo facelift surgery, they should educate themselves on therapies that do and do not work. This can often be difficult due to the current directed marketing strategies making promises that often go unfulfilled. What the patient truly needs is a consultation with a facial plastic surgeon in order to decipher and discuss the information. Hyperbaric oxygen therapy offers patients a statistically validated and scientifically studied adjunctive therapy to recover faster, following facelift surgery. HBO in otherwise healthy patient’s is a safe, innocuous therapy with little downside. Although it can potentially increase the overall cost associated with the surgery, it does offer patients seeking the most rapid recovery from facelifts a further treatment modality to employ in order to return to daily activities faster. Due to the proven benefits, HBO should be included in the discussion with patients undergoing facelift surgery as a potentially beneficial therapy in the healing process and may be applicable to other plastic surgery procedures such as the midface lift.
Posted by: Benjamin C. Stong MD
Atlanta, GA
A facelift is a procedure designed to restore the neck and the lower third of the face, evolving tremendously over the previous 40 years. The deep plane facelift went through several developmental stages and today serves as one of the very best facelift techniques to provide patients with a long term correction of the jaw line and excess skin and fat in the neck. Early facelift pioneers discovered the SMAS (muscular) layer of the face and its importance in facelift surgery. Releasing the SMAS layer allowed aggressive re-suspension of the facial soft tissues, correcting the jowls and defining of the jaw line. Next the “Bi-planer” facelift lifted and contoured the neck to remove the excess skin and fat in addition to releasing and suspending the SMAS layer. The “tri-planer” facelift was then developed, to mobilize the tissues of the midface below eyelids and treat the nasolabial folds. This technique resulted in a less than satisfactory midface correction. Finally, Hamra refined this technique into the Deep Plane Facelift, releasing the suspensory ligaments just below the midface resulting in a correction of the midfacial drop and a softening of the nasolabial folds in addition to the correction of the jaw line and neck. This offered a unique facelift procedure, because it was much more comprehensive than any technique previously described. Today many of the best facelift surgeons use a variation of this technique.
The deep plane face lift can now be combined with mini facelift incisions to provide the maximum amount of correction available with a single facelift procedure while using the smallest incisions. Many patients falsely believe that the “Deep Plane” facelift will result in longer healing times. In truth, there is actually less bruising and risk of hematoma than with other techniques. With the deep plane facelift the correction in the midface and nasolabial folds is less permanent than the correction of the neck and jaw line. It is not as effective as a separate endoscopic temporal midface lift as a midface lift procedure. Surgeons who perform the deep plane facelift have had specialized training in the technique because it requires an intricate knowledge of the anatomy of the soft tissues of the face and the facial nerve to achieve optimal outcomes and avoid complications.
When consulting about facelift surgery, the overall expenses in addition to the healing period are foremost considerations. Most informed patients are seeking to have a procedure that will offer the longest term and most complete correction, thereby decreasing the overall cost from unnecessary revision surgeries. The deep plane facelift is currently one of two “gold standard” procedures, to correct the aging jaw line and neck, the other being an extended Sub-SMAS facelift. It is the only procedure to offer a correction of the midfacial soft tissue drop and the nasolabial folds with a single procedure.
Facelifts are often combined with other procedures, including: upper and lower eyelid blepharoplasty and brow lifts for a “full facelift” surgery. In addition, a skin rejuvenation plan is important to add to surgical procedures to attain superior results. Laser surgery and medical grade skin care products are often combined to offer the state of the art in skin rejuvenation therapy. Consultation with an expert facial plastic surgeon is critical to developing a strategy to restore and preserve ones youth and beauty.
Benjamin C. Stong MD
Atlanta, GA
The upper eyelids and brow should be considered together for rejuvenation of the upper third of the face. The upper eyelid is one of the first areas of the face to show signs of aging, with excess skin. If left long enough, the redundant skin can obstruct a patient’s peripheral vision. Patients often complain of heaviness of the upper eyelid with outside observers commenting that the patient looks tired. Along with redundant skin, the upper eyelid can have bulging of the fat pads that surround the eye. The excess fat should be removed during upper eyelid blepharoplasty (eyelid lift).
The brow descends with age due to laxity in the supporting structures. The lateral, or outer portion of the brow, descends at an accelerated rate when compared to the central portion of the brow because of differences in attachment to the underlying soft tissue and bone. This results in a more rapid accumulation of redundant skin on the outer portion of the upper eyelid, which is termed “lateral hooding.” When determining the correct brow lift procedure, the surgeon should determine if the effects of aging on the brow include primarily the lateral brow or the more central portions of the brow. If there is a significant discrepancy in aging of the central and lateral brow, with the lateral brow primarily affected, a lateral temporal brow lift may be indicated. With this procedure an incision is placed in the hair overlying the temple and the brow is elevated in an upward and outward direction to restore its natural arch and youthfulness.
Often times patients do not seek consultation until the effects of aging are more advanced with the central brow having dropped significantly, as well. In this instance a total brow rejuvenation procedure should be performed, with several options currently being used. The most state-of-the-art brow lift procedure is the endoscopic brow lift whereby the brow is lifted using tiny incisions in the scalp and telescopes to release the brow and reposition it in an elevated position. There is controversy as to the effectiveness of this procedure. Over time, it has become apparent that in experienced hands it is an equally effective, less invasive procedure.
The trichophytic brow lift, an open technique, camouflages the incision by placing it in the hairline mirroring the entire length and carrying the incision down into the hair tuft over the temples. This is an effective technique that is still commonly used today by many surgeons. The primary consideration is whether the patient is willing to tolerate a much longer incision and more invasive procedure. Other types of brow lifts still used today, although less commonly, include: the coronal, direct, and midbrow lift with specific indications for each technique. The direct and midbrow lift place incisions in the forehead skin and are typically indicated for facial paralysis and older, male brow lifts respectively. The coronal brow lift approach places a large incision in the central scalp from ear to ear and is almost never indicated for rejuvenation procedures, but rather as an approach to facial trauma and head and neck procedures. The coronal brow lift incision may be indicated to reverse a previously over pulled brow procedure that has resulted in a “surprised look.”
When considering the upper eyelid and brow as a unit, one must restore brow position prior to removing upper eyelid skin to prevent “lagopthalmos,” or eyelid retraction, and dry eye. If the brow is at an appropriate height with a youthful arch, the upper eyelids may be addressed without a simultaneous brow lift. When a low brow position and redundant eyelid skin occur together, a brow lift should accompany an upper eyelid blepharoplasty with the brow lift performed first to prevent negative outcomes.
When patients present with primary concerns about their upper eyelids, the brow must be assessed at the same time in order to get optimal results. When a low brow is not corrected at the same time as the upper eyelid blepharoplasty, a future brow lift procedure can have a much higher complication rate and may preclude the procedure all together. Finding a surgeon who is familiar with the many brow lift techniques and assesses the brow and eyelids together as a complex, is important to avoid complications and deliver optimal results.
Post provided by: Blepharoplasty | Eyelid Lift Atlanta GA | Benjamin C. Stong MD