Corrective Eyelid Surgery
Eyelids, like other face and neck areas, may develop wrinkles and bulges from either heredity or aging. Pouches, both at the inner part of the upper lids and in the lower lids, are generally due to increased pressure caused by accumulations of fat above and below the eyes. Such excess fat and excess skin are removed in the eyelid procedure. Upper lid correction is performed at the same time as lower lid surgery. The operation takes about one and a half hours and is usually performed under monitored sedation supplemented with local anesthesia in our office surgical suite. Patients generally experience early return to daily routine.
There is usually little or no pain in the postoperative period. Each operation is followed by varying degrees of swelling and discoloration, which usually subside within ten days. By this time, too, the thread-thin upper eyelid skin scars can be camouflaged by makeup. The lower eyelid procedure is performed with thread like incisions. The upper eyelid incision line gradually blends in well with the surrounding skin and, after several weeks, becomes perceptible only on close scrutiny. Corrective surgery of aging eyelids is frequently performed in combination with face lift, nasal, or eyebrow surgery.
Corrects the “Droopy” Look
Generally, a small incision is made in the front scalp area. Drooping eyebrows are frequently one of the first signs of aging. Sometimes excess skin hanging from the upper eyelid may be partially due to a low eyebrow. This may also cause the upper lids to bulge and descend until they seem to lie on the eyelashes themselves. Any of the procedures that correct sagging eyebrows may be performed under sedation anesthesia in the office surgical suite. Patients may return home with few restrictions on activities.
The Face Lift
The face lift both improves wrinkling caused by loose skin and lifts or tightens the fatty face and neck tissues, which tend to sag increasingly with advancing years.
It has become the second most popular cosmetic operation because, as life spans increase due to medical advances combined with better nutrition and exercise, many aging men and women find that they look older than they feel.
The operation may be done for two reasons:
- to slow the advance of aging, helping relatively young individuals, say forty or younger, appear to stay young; or
- to help one who is already well wrinkled to appear younger.
The amount of improvement from surgery depends on the degree of wrinkling. If wrinkling is significant, results may be dramatic. If sagging is just starting and the operation is an attempt to keep the patient looking young, the improvement may be more subtle, causing friends to remark that the patient looks “less tired” and “more alive.”
The greatest benefit of the face lift—one that justifies the procedure being performed on patients in their forties as part of a preventive maintenance program—is that the patient can maintain a youthful appearance for the rest of his or her life simply by having periodic “tuck-ups” every few years, as is done by Hollywood personalities. These relatively minor procedures are usually followed by very little swelling and discoloration. However, they cannot be done without the initial face lift.
In the majority of cases, the face lift result will last from six to ten years. Although no operation can permanently prevent aging, the individual never looks as old as he or she might have if the operation had not been done. The actual duration of improvement cannot be predicted accurately, but depends upon the skin condition of each patient. If the skin’s degenerative process is very rapid (often a result of tobacco, alcohol, or excessive sun exposure), wrinkling and sagging will occur more quickly.
The face lift operation is performed in our office surgical suite under “twilight” anesthetic, supplemented with local anesthesia along the incision lines. Patients generally go home the same day.
Hair is never cut or shaved in the temporal region or behind the ear in preparation for surgery. The procedure consists of redraping and tightening facial tissue and removing excess skin. A pressure dressing is applied after surgery. Hair may be washed two days later. Staples in the hairline are removed seven or eight days after surgery. Stitches along the ear-facial line are removed after four or five days. Hair usually covers the resulting thread-thin scars immediately.
In some people, fat gradually develops below the chin to make a “double chin.” This mound of fat obliterates the ideal chin-neck line and contributes to the appearance of aging. Other people have “turkey gobbler” necks, consisting of fat and loose skin that runs from the chin to the base of the neck.
Most double chins may be effectively improved or eliminated with supplemental liposuction. A short incision is made in the crease below the chin, excess fat is removed, and the skin of the upper neck is tightened. There is negligible postoperative discomfort, and the scar becomes obscured.
When supplemental liposuction alone is insufficient, a face lift may also be performed. This is particularly appropriate for sagging jowls or a “turkey gobbler” neck. The face may seem tight for a while after the bandages are removed, but it softens with time. The face does not, however, appear “stretched” or “plasticized.” In a short time, the scars become inconspicuous except on close scrutiny.
Finally, it should be understood that the face lift operation will not eliminate small vertical creases about the lips, bulging or excess eyelid skin, or horizontal forehead creases. These areas require separate procedures that may be combined with the face lift.
Cosmetic Surgery for the Nose
Rhinoplasty attempts to correct deformities and breathing difficulties of the nose. The surgeon reshapes and arranges bone and cartilage, removing any excess and occasionally augmenting the nasal structure with additional cartilage as necessary. There are many cases in which breathing difficulty occurs as the nose becomes progressively more disfigured because of aging or previous trauma. Some patients also have deformities inside the nose that impair breathing, cause headaches, or create sinus trouble that cannot be satisfactorily corrected without simultaneously straightening the external nose.
The surgical work is performed on the inside of the nose, and frequently a small incision is made on the outside of the nostril divider, which essentially leaves no scar. However, in the infrequent case when the nostril must be reduced, an incision is made where the nostrils join the upper lip area. This incision is placed in a natural fold so the scar becomes practically invisible in a few weeks.
Rhinoplasties are usually performed because people want to look better. They would like the shape and size of their nose to be in harmony with the rest of their features. People in business or fashion, for example, are motivated by economic or career considerations. Breathing difficulties that accompany cosmetic deformities are corrected during the same surgery. Such surgery is therefore functional as well as cosmetic.
Surgery for the nose is performed in our office surgical suite, or hospital outpatient surgery and patients go home the same day. Actual surgery takes from two to three hours, and additional time is needed for preparation. General anesthesia is utilized and the patient is monitored at all times during and after the procedure. Following surgery, a small Teflon “cast” is applied with underlying tape to the nose. Rarely is packing inside the nose used. Ice compresses are applied to the eyes for a short time after surgery in order to reduce any swelling and discoloration. Upon discharge, patients receive easy-to-follow instructions for home care. Patients are advised to be up and out of bed the day after surgery, resting no more than three hours in bed.
The dressing on the nose is removed in our office about five to seven days after surgery. When the cast is removed, the nose may appear at first to have a slightly exaggerated “turn-up,” the result of bandages and swelling. Three to five days after cast removal, the nose begins to approximate its eventual shape, and any swelling becomes barely discernible.
At the end of one week, most swelling and discoloration around the eyes have disappeared in ninety percent of our patients. Some slight swelling of the nose, which the patient feels more than can be seen, is present, but it steadily diminishes over a few weeks. This swelling may be more noticeable in the morning and becomes less so as the day progresses. The thicker the skin, the longer it takes for the nose to attain its final shape. It may be about a year before the last one or two percent of swelling is gone. This does not usually bother the patient or detract from the improved appearance.
Since surgery is frequently performed on the septum (the partition in the middle of the nose), there may be minimal nasal blockage for a few days after surgery owing to crusts and swelling. However, no intranasal packing is used after surgery.
After the nasal dressing is removed, patients visit the office a few times during a two-month period so that our staff can monitor progress. During this time, patients must be careful to avoid injury to the nose, to protect it from prolonged exposure to direct sunlight, and to refrain from wearing eyeglasses, which may cause pressure on the sides of the nose. Eyeglasses can be suspended from the forehead with a piece of clear adhesive tape. Patients may gently clean the outside of the nose and use cosmetics.
To avoid strain, patients are advised not to lift heavy objects for at least two weeks after the operation. There is usually minimal postoperative discomfort, and most patients require a minimal pain medication.
Limiting factors in rhinoplasty include the facial contour and shape; skin texture and thickness; inclination of the chin, lips, and forehead; and the depth of the angle between the forehead and the nose; the patient’s height; and the skin’s healing potential.
It is technically difficult to correct some noses that have been severely injured in contact sports or accidents. We try to make the correction in one operation and succeed in the vast majority of cases, but sometimes a short additional procedure is required.
Cosmetic Surgery for the Chin
Very often correction of a receding chin is recommended in connection with nose surgery. A receding chin, particularly when accompanied by a slanting forehead, causes the face to look as though it tapers to a point if only a nasal cosmetic procedure is done.
The surgery, done under general or intravenous sedation, is performed upon patients of adolescent age and older. Chin surgery is generally done in the office surgical suite. A minimal external scar beneath the chin is placed in a natural fold and becomes a barely noticeable line. The chin implant used is of an extended type, which contours the jaw line for enhanced cosmetic appearance.
Cosmetic Surgery for the Ears
Otoplasty is the procedure used to “pin back” or reposition protruding ears closer to the head. Local anesthetic is used for adults and teenagers, while a general anesthetic is preferred for youngsters, usually older than age 6. This procedure is performed in our office surgical facility and patients go home the same day with very little post-operative pain.