Youthful Reflections

Hello.  Thank you for your question.  Aging of the face is a complex process that involves progressive loss of facial fat and bone volume and progressive laxity of skin and and supporting connective tissue that leads to sagging in the most dependent areas, including the neck, jawline, marionette lines and nasolabial folds.  Each individual is unique in the progression of these aging changes with some demonstrating more laxity than volume loss, while vice versa for others.  Therefore, management for facial rejuvenation must be individualized for each patient.  Depending on the degree of aging changes, this may involve a facelift to address the laxity in the lower face and neck, midface volume restoration using grafted fat, fillers or implants, or a combination of both.  I would encourage you to seek a consultation with a board-certified Facial Plastic Surgeon or Plastic Surgeon who has extensive experience and expertise in facial rejuvenation, and allow them to assess your individual anatomy, concerns and goals, in order to determine the best treatment plan for you.  I wish you the best in achieving your aesthetic goals.

Hello.  Thank you for your question.  Upper and lower blepharoplasty procedures can safely be performed using local anesthesia alone or in combination with oral or IV sedation.  It is my opinion that general anesthesia is not necessary for these procedures, but is certainly also an option.  The ideal anesthesia recommendation for each individual patient should be made by the primary surgeon in consultation with the patient.  The most common local anesthetic for blepharoplasty procedures is lidocaine with epinephrine.  Xylocaine is simply a brand name for the generic lidocaine.  They are exactly the same thing.  I will commonly do blepharoplasty procedures using some light oral sedation using a benzodiazepine medication, such as valium or ativan, to help alleviate patient anxiety.  IV sedation can also be utilized to achieve a deeper level of sedation.  The choice of medications for IV sedation would be determined by the anesthesia provider performing the sedation in consultation with the patient.  I would encourage you to seek a consultation with a board-certified Facial Plastic Surgeon, or Plastic Surgeon, who has extensive experience and expertise in facial rejuvenation and allow them to assess your individual anatomy, concerns and goals, in order to determine the best treatment plan for you.  I wish you the best in achieving your aesthetic goals.

Hello.  Thank you for your question.  There are multiple techniques available for lifting the brow and/or forehead.  The choice of technique depends on the anatomy and goals of the individual patient and the experience of the physician.  If you are simply wanting to tighten the skin and improve forehead wrinkles without significant elevation of the brow, this can be best accomplished by performing a pretrichial subcutaneous forehead lift.  With this technique, the incision is made in an irregular pattern within the edge of the frontal hairline, and the dissection is performed within the subcutaneous layer of the forehead to allow the skin of the forehead to be separated from the underlying muscle.  The skin is then re-draped over the forehead and excess skin is then removed.  The incision is then closed within the frontal hairline.  This can significantly improve forehead wrinkles.  However, the skin will adhere back to the underlying muscle and over time the forehead wrinkles will likely begin to recur with repeated facial expressions that raise the brow.  Therefore, Botox injections will still likely be needed to prevent recurrence of the forehead wrinkles over time.  I would encourage you to seek a consultation with a board-certified Facial Plastic Surgeon, or Plastic Surgeon, who has extensive experience and expertise in facial rejuvenation and allow them to assess your individual anatomy, concerns and goals, in order to determine the best treatment plan for you.  I wish you the best in achieving your aesthetic goals.

Hello.  Thank you for your question.  Rejuvenation of the area under the eyes can be accomplished using various techniques, depending on the anatomy of the individual patient and the experience of the treating physician.  The factors that lead to aging changes of the under-eye region of the face must be understood, in order to understand the treatment options.  Some people develop bulging of fat from around the globe of the eye into the lower eyelid as they age that can lead to the appearance of "bags" under the eye.  Others may develop laxity of skin and muscle of the lower eyelids that can contribute to the appearance of these under-eye "bags".  In addition, most people tend to lose volume in the upper part of the cheek with age that results in hollowing below the lower eyelid, resulting in a valley under the eye referred to as the tear trough.  Each of these aging changes may occur individually, or they may occur in varying combinations.  Treatment of aging changes involving the lower eyelids and upper cheek must take into consideration each of these factors to achieve optimal results.

The volume loss in the upper cheek that causes the tear trough can be corrected by adding volume to that area using fillers, fat grafting, or fat repositioning from the lower eyelid.  For younger patients who don't have much bulging fat into the lower eyelids, then a small amount of filler injected into the tear troughs can provide a very nice result.  If someone has bulging fat into the lower eyelid, then lower lid blepharoplasty with fat repositioning into the tear trough can result in significant improvement of the lower eyelid bags and tear trough.  For patients who have under-eye bags with laxity of skin and muscle, but only a small amount of bulging fat, then there may not be enough fat in the lower eyelids for repositioning during lower lid blepharoplasty, and fat grafting from another site may be needed to fill in the tear trough.  An experienced facial rejuvenation surgeon  will likely use all of these techniques, depending on the individual needs of each patient.  

I would encourage you to seek a consultation with a board-certified Facial Plastic Surgeon, or Plastic Surgeon, who has extensive experience and expertise in facial rejuvenation and allow them to assess your individual anatomy, concerns and goals, in order to determine the best treatment plan for you.  Look at their before and after pictures to be certain that they can actually achieve the kind of results that you seek.  If a surgeon does not have a lot of before and after pictures for the procedures that are recommended, then they may not be the best physician for you.  Also, look at their patient reviews to see what their other patients say about the work they do.  If you have done these things and feel comfortable with the surgeon, then I would suggest that you proceed with their recommendations, as they have the experience and expertise to determine how they can achieve the best results for you.  I wish you the best in achieving your aesthetic goals.

Hello.  Thank you for your question.  I would suggest following the recommendations of your primary surgeon, as they know your case and medical history, and should be making recommendations in your best interest based on their experience.  Swelling is absolutely expected following facelift, and can vary from one patient to another.  The swelling usually reaches it's peak around postoperative day 3 or 4, and will then diminish fairly quickly over the following 2 weeks, with some mild residual swelling that will diminish more gradually over several months.  For most patients, the visibly apparent swelling that others will notice typically resolves in about 10 - 14 days, such that patients may feel comfortable getting back out in public.  I do not routinely prescribe steroids after facelift.  Earlier in my career, I would prescribe a Medrol dose pack after facelift surgery.  However, I stopped doing that several years ago and saw no significant difference in recovery for my patients.  Therefore, I see no advantage to prescribing steroids, in general, as steroids do have the potential for undesirable side effects, especially in older patients.  Having said that, in a case of excessive swelling in a patient with no contraindication to steroids, I would not hesitate to prescribe a short course, such as a Medrol dose pack, in hopes that it might potentially speed up resolution of the soft tissue swelling.  I hope this information is helpful.  I wish you the best in your recovery and achieving your aesthetic goals.