Face Procedures - Center for Plastic Surgery

Upper Facial Rejuvenation

The upper 1/3 of the face consists primarily of the forehead, the upper eyelids, and the lower eyelids. Signs of aging can occur individually in any one of these components or in any combination. Goals of surgical rejuvenation are to restore a youthful appearance and balance without surgical stigmata (ie, a natural appearance).

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At the Center for Plastic Surgery several different operative procedures are available for Facial and Neck rejuvenation depending on patient desires and existing anatomy. Our goal is to produce a totally natural unoperated appearance.

Miniface and necklifts address primarily the jowl and neck region.

Procedure: Via incisions placed under the chin and around the ears, soft tissue and skin are reposition to give a youthful contour to the jowls and neck.

Operative Time: 3-5 Hours

Anesthesia: Local with IV sedation or General.

Recovery: Generally 10 days to 2 weeks for acceptable appearance at social distances

Risks: Although rare, bleeding, infection, contour irregularities, nerve injury, and visible scarring have been reported.

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Full face and neck lifts give all of the benefit of mini face lifts (see above) and additionally elevate the cheek to a more youthful position as well as lessen the Nasolabial folds (NLF- the sometimes deep groove between the lower nose and corner of the mouth).

Procedure: Similar to incision of mini facelift, however the incision also extends around the sideburn and occasionally into the scalp behind the ear.

Operative Time: 5-6 Hours

Anesthesia: Usually local with sedation. General anesthesia optional.

Recovery: Generally 2 weeks for acceptable appearance at social distances.

Risks: Although rare, bleeding, infection, contour irregularities, nerve injury, visible scarring, and loss of hair around incisions have been reported.

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Mid facelift is indicated for those wishing a more youthful position of the cheek without a cheek implant.

Procedure: Via a small incision in the upper Buccal recess (within the mouth between the upper lip and teeth) and a small incision in the front scalp the entire cheek tissue is repositioned to its natural youthful higher position.

Operative Time: 1-1 1/2 Hours

Anesthesia: Usually local with sedation. General anesthesia optional.

Recovery: Generally 1 week for acceptable appearance at social distances.

Risks: Although rare, asymmetry, temporary or permanent loss of sensation, weakness, as well as infections or bleeding have been reported.

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Extended face lift is the combination of a full face lift (see above) and a mid face lift (see above). For persons with marked facial aging, extended facelifts produce the most dramatic natural result.

Procedure: See full facelift and midfacelift above.

Operative Time: 6-7 hours

Anesthesia: Local with IV sedation or general

Recovery: Generally 2 weeks for acceptable appearance at social distances.

Risks: Although rare, bleeding, infection, contour irregularities, asymmetry, nerve injury, visible scarring, and loss of hair around incisions have been reported..

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Limited incision necklift is an excellent procedure for those whose aging is primarily isolated to the neck and have relatively good skin tone.

Procedure: Via a small incision under the chin excess fat is removed, muscles tightened, and soft tissue sculpted to improve neck contour.

Operative Time: 1 1/2 to 2 hours

Anesthesia: Local with IV sedation, General optional.

Recovery: Generally 10 days to 2 weeks for acceptable appearance at social distances.

Risks: Infection, bleeding, and contour irregularities have been reported.

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Neck Z-plasty is indicated for older male patients who wish improvement in neck appearance and wish to avoid a Face/Neck lift.

Procedure: Excess skin and fat are excised directly from the front of the neck and then muscles tightened. The skin is then closed in a "Z" pattern which makes the scar less conspicuous.

Operative Time: 1 1/2 to 2 Hours

Anesthesia: Local with sedation or General.

Recovery: Generally 2 weeks for acceptable appearance at social distances.

Risks: Infection, bleeding, and visible scarring have been reported.

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Buccal Fat excision proves beneficial for those with full or "Chubby" cheeks.

Procedure: Through small incisions on the inside of the mouth, Fat is removed from the cheek creating a more sculpted appearance to the face.

Operative Time: 1 to 1 1/2 Hour

Anesthesia: Local with Sedation, General Anesthesia optional

Recovery: Generally 3 to 5 days for acceptable appearance at social distances.

Risks: Although rare nerve injuries resulting in temporary or permanent facial weakness have been reported.

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The most common sign of aging in the forehead is that of eyebrow descent. The outer 1/3 to ½ of the eyebrow is most commonly affected.

Procedure – although several techniques, including the coronal (long incision) approach and the endoscopic approach have been described, I currently favor the limited incision approach. This approach allows stable elevation of the outer 1/3 to ½ of the eyebrow with no visible scarring providing a natural and youthful appearing brow. Forehead wrinkles also usually improve after the lift.

Operative Time – 1 to 1- ½ hour

Anesthesia – Usually local with IV sedation, General optional

Recovery – Generally 3 to 7 day’s acceptable appearance at social distances.

Risks – although extremely rare, there have been reports of nerve injury resulting in decreased sensation or movement of the brow and slight hair loss.

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Upper Eyelids
The most common signs of aging in the upper eyelids are loose skin and excess “Fat Pockets”, resulting in a sad or tired appearance.

Procedure – Upper Blepharoplasty is the medical term used to describe upper eyelid rejuvenation. Excess skin and fat are removed via an incision in the natural crease. Muscles resulting in frown lines between the brows can also be modified to diminish the lines.

Anesthesia – Usually local with IV sedation. General optional

Recovery – Generally 7-10 days acceptable appearance at social distance.

Risks – although rare, dry eye syndrome or the inability to completely close the lids has been reported.

Lower Eyelids
The most common signs of aging in the lower eyelids are loose skin, excess “bulging” fat, and droopiness.

Procedure – Lower Blepharoplasty is the medical term used to describe lower eyelid rejuvenation. Apparent excess fat is repositioned and or removed and redundant skin excised. The lower eyelid is usually also tightened ( canthopexy) to correct or prevent future droopiness. Incisions are made on the inside of the lid, the outside or combination depending on the degree of aging.

Operative Time – 1 ½ to 2 hours

Anesthesia – Local with IV sedation. General optional

Recovery – Generally 10-14 days acceptable appearance at social distances.

•Risks – Although rare, dry eye syndrome, visual disturbances, round eye appearance, droopy eyelid (ectropion) have been reported.

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Rhinoplasty or Nasal (nose) contouring is an operative procedure intended to permanently alter the shape of the nose. The changes can be subtle or dramatic. The closed or open approach can be utilized. In the closed method all incisions are placed inside of the nose, there are no visible external scars. In the open technique incisions are placed both inside the nose and also on the outside surface in well-hid locations. The closed and open approaches both have advantages and disadvantages. I currently use each approach approximately 50% of the time.

Rhinoplasty ranges from relatively minor changes such as skin modifications to change the shape of the nostrils to more dramatic changes that modify the cartilaginous and bony framework of the nose. The specific procedure for a given person depends on that person’s specific nasal characteristics and goals.

Operative Time - 30 Minutes to 4 hours (Depending upon the extent of the proposed procedure)

Anesthesia - Local with IV sedation or General Anesthesia

Recovery - 2 weeks acceptable appearance at social distance. May take 9-12 months to realize the final result.

Risks- Prolonged swelling, visible scarring, and asymmetry have been reported. Although rare, prolonged difficulty with breathing and loss of smell can occur.

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Chemical Peels

Chemical peels are a technique that utilizes various solutions to remove the damaged outer layers of the skin revealing the youthful underlying skin. Although superficial to deep peeling can be performed, at the Center for Plastic Surgery we perform only superficial and medium depth peels as the complication rates with the deeper peels markedly increases.

We offer various strength Glycolic Peels, Lactic Peels, Salicylic Peels, Jessners Peels and Trichloracetic Acid (TCA) peels. In general, the Glycolic Peels provide for a relatively superficial effect with little to no downtime. The TCA peels provide for a superficial to medium depth effect and require several days downtime. For our TCA peels we utilize the Obagi Blue procedure, one of the safest and most effective TCA methods. Lactic peels are indicated for sensitive, dry or sun damage skin. Whereas salicylic peels prove beneficial for oily, acne prove, or aging skin. Also offered are Glyco-Blend (Baker's) and Lactic-Blend (Morgan's) peels.

Procedure: 20 min to 1 hour

Anesthesia: Lighter peels- none. Medium depth- IV Sedation

Recovery: Light peels-none. Medium depth –3-10 days

Risks: Although extremely rare hypopigmentation, hyperpigmentation, and scarring have been reported.

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Fat transfer is a technique whereby fat is removed from areas of the body with relative excess (donor area) and transferred to an area of relative lack of volume (recipient area). Fat can be transferred FROM almost any area TO almost any area of the face and body. Once transferred, the result is usually permanent, although more than one session may be required to achieve the desired volume. Interestingly, the transferred fat takes on the characteristics of the area it is transferred to…i.e. if transferred to the lips, the lips look and feel entirely natural.

The most common donor sites are the abdomen, hips, and inner or outer thighs. The most common recipient areas are the lips, the upper cheek, chin, the brow roll, and the buttocks as well as contour depressions after liposuction.

Operation Time - ½ to 2 hours, depending on areas treated

Anesthesia - Usually local with sedation

Recovery - 5-10 days to appear acceptable from social distances

Risks - Although rare, irregularities and contour abnormalities have been reported

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Professional Topical Skin Care Products

Through years of experience, at The Center for Plastic Surgery we’ve done the work for you! We’ve selected the best products from the best product lines and have made them available with professional skin specialist consultation. Products lines carried include Jan Marini, MD Forte, and Obagi. We can provide unique combinations for unique results in skin rejuvenation.

All products stand alone for home use, or can be used in combination with office based chemical peeling, ElOS or other treatment modalities.

Call today for more information.

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Although not as popular as in previous years, the CO2 laser still produces near incomparable reduction in wrinkles and skin tightening amongst non-excisional surgical techniques. However, compared to newer techniques (see ELOS) there is considerable down time and risks are somewhat greater. Still, for those with marked wrinkles, laxity, and sun- damaged skin the results of CO2 laser resurfacing are hard to surpass.

Today I rarely use the CO2 laser because of the prolonged downtime as well as the relatively high potential for hypopigmentation (loss or color) amongst other side effects/complications. The technique utilizes a highly sophisticated laser that selectively removes the outer layers of the skin, allowing new skin to regenerate creating a marked improvement in skin texture, decreased wrinkles, and improved tone.

Operative Time: 1 to 1 ½ hours

Anesthesia: usually local with IV sedation, General optional

Recovery: 10 to 14 days for acceptable social appearance

Risks: increased or decreased skin color, prolonged redness, and scarring occasionally occur.

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At the Center for Plastic Surgery we have offered Botox® for facial enhancement for nearly a decade. You may ask,”How does Botox® work?” By decreasing the activity of the underlying muscles that cause frown lines, Botox® indirectly produces smoother skin with diminished wrinkles and furrows. It can also be strategically placed to result in aesthetic repositioning of facial features such as brow elevation or elimination of a “Gummy” smile. Because of its unique properties Botox® can be used in combination with skin care products, soft tissue fillers, and ElOS, amongst others to produce quite dramatic and natural results.

Call today and learn more about the unique results possible with Botox®!

Procedure Time: 10-20 minutes

Anesthesia: Usually none. Topical and cooling optional.

Recovery: Usually no down time.

Risks: Although rare, temporary droopy eyelids, bruising, and allergic reactions have been reported.

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At the Center for Plastic Surgery we provide a wide assortment of soft tissue fillers that create consistent and reliable results. Our selections range from the true and tested collagen based products such as Cosmoplast® to the more recently introduce Hyluronic based products including Juvéderm®, and Restylane®. All of these products can stand on their own or be used in unique combinations depending on client desires and features. Various facial regions can be enhanced such as the brow-roll, the high-cheek, and the lips or the products can simply be used to decrease the appearance of wrinkles and various furrows such as laugh lines. More recently both Sculptra® and Radiesse® have been added to our product line and procedure even longer lasting results.

Call today to find which products might be best for you!

Procedure Time:15 minutes to 30 minutes

Anesthesia: Usually none. Topical and cooling optional

Recovery: Several days of mild swelling

Risks: Although rare, temporary bruising, allergic reactions, irregularities have been reported.

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Contour threads offers a minimally invasive method for brow, cheek, jowl and neck lifting. The technique offers subtle, natural looking results with less down-time when compared to traditional surgical techniques. Today I rarely use contour threads as questions regarding longevity of results remain. Of note, contour threads were recently voluntarily removed from the market

Call today for more information, or to arrange a physician consultation!

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The Center for Plastic Surgery, P.C. now offers Vibraderm, the newest, most advanced technology for performing microdermabrasion. The system can be utilized from head to toe providing instant improvement in skin texture and appearance-All with no downtime.

Call today for more information, or to arrange a complimentary consult!

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Utilizing the ELOS system unsightly veins can be diminished and removed with no down time. Elos vein removal utilizes a unique combination of laser light and radiofrequency to safely ablate veins of various size.

Procedure Time: 15 to 60 minutes

Anesthesia: Topical cream

Recovery: No down time

Risks: Complications are extremely rare although superficial blistering, hypopigmentation (light color), hyperpigmentation (dark color), and scaring have been reported.

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Utilizing the Galaxy ElOS system, aging and sun-damaged skin can be beautifully rejuvenated with no downtime! ElOS uses a unique combination of radio frequency (RF), intense pulse light (IPL), diode laser, and infrared light to safely rejuvenate the skin. ElOS safely treats rosacea, spider veins, skin imperfections, uneven skin tones, and age spots, wrinkles and skin laxity all with no downtime.

Procedure Time: 60-90 minutes

Anesthesia: Topical cream

Recovery: No down time

Risks: Complications are extremely rare although superficial blistering has been reported.

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