A full range of elegant techniques are available to rejuvenate the face when the aging effects of sun exposure and gravity have taken their toll. Certainly the trend in plastic surgery is to begin smaller rejuvenation procedures at a younger age. Waiting until the skin is wrinkled and sagging is not ideal, but better late than never. We will work with you to determine which procedures would be most beneficial for you.

FACELIFT
A facelift will rejuvenate the lower face and neck. The incision is well hidden in front of the ears and behind the ears (standard incision) or just in front of the ears (short scar facelift). Facelift is a term that describes a variety of techniques which are customized for each individual patient. All involve tightening of the deep layers of tissue (SMAS) and removal of excess skin. How exactly that is accomplished varies from patient to patient depending on individual anatomy. Liposuction of the neck and tightening of the neck muscles (platysma), limited skin resurfacing and fat or other filler injections are commonly performed at the time of a facelift. Combinations of procedures including facelift, blepharoplasty and browlift are frequently performed at the same time.

MINI-FACELIFT (MINIMAL INCISION FACELIFT)
This procedure is performed through a shorter incision (hidden in front of the ear) rather than a traditional facelift incision. This allows tightening of the face above the jaw line. A mini-facelift is especially useful in the younger patient with early signs of aging.

MID-FACELIFT
Also referred to as Vertical Cheek Lift or Cheek Lift. This involves an incision hidden in the scalp plus an incision either within the mouth or the lower lids. The mid-facelift raises the bulk of the cheek which is suspended in a higher position. The mid-facelift is very different from a traditional facelift. It does not remove skin; rather, it repositions the cheeks vertically and softens the lower lid-cheek junction. It is sometimes employed with a traditional facelift or alone in the younger patient with minimal neck excess.

BROWLIFT or FOREHEAD LIFT
The browlift raises the forehead and eyebrows creating a tighter, more youthful look. The type of incision will depend on the amount of lift required. A coronal incision (behind the hairline, across the crown) is required for more severe drooping of the brow. An endoscopic lift can be performed when less lift is required. The endoscopic lift uses several small incisions behind the hairline and employs an endoscope to raise the forehead and eyebrows. A temporal lift (or lateral browlift) is sometimes performed for the patient who has drooping of the outer forehead and eyebrows. For patients with a very high forehead, an incision is made at the forehead hairline to avoid a further increase in forehead height.

EYELID SURGERY (BLEPHAROPLASTY)
A blepharoplasty is available for both upper and lower eyelids to reduce excess skin and bagginess. For the upper eyelids, blepharoplasty generally involves removal of excess skin (hooding) and reduction of prominent fat pads.

The anatomy of the lower lids is more complex and several techniques may be employed depending on individual anatomy. The traditional blepharoplasty involves a well hidden incision just below the lash line. Excess fat and skin are removed. For those patients who have significant dark circles and prominence of the lid-cheek junction, a more modern technique is employed. A lower lid blepharoplasty with fat transposition retains the fat usually discarded. The fat is repositioned to fill in the thin skinned valley responsible for dark circles. The fat fills that valley on a permanent basis.

For patients who already have had their lower lid fat removed or have naturally occurring dark circle, we commonly fill the dark circle/valley with Restylane® injections. This works quite nicely and lasts about 6-12 months.

For patients with true fat excess and no skin excess, a transconjunctival blepharoplasty may be performed. This involves an internal incision with no external scar.

Blepharoplasty improves the contour of the eyelids. For textural problems such as crepey wrinkling, chemical peel or laser resurfacing plus BOTOX® Cosmetic are commonly performed.

FACIAL IMPLANTS
A variety of implants are available to augment the contour of the existing bone structure. Common implants include cheek, chin and pre-jowl implants.

RHINOPLASTY
Structure of the nose can be modified to improve a noticeable hump, drooping of the tip, excessive length or width.

LIP ENHANCEMENT
Enhancement of the lips for wrinkles or enlargement can be performed with a variety of materials. Please see 'Non-Surgical Treatments' and 'Skin Resurfacing'.

SKIN RESURFACING
Skin resurfacing techniques include chemical peels, dermabrasion or laser resurfacing. These techniques can help with the skin’s textural problems, including deeper wrinkles. These require regeneration of the skin after resurfacing with 7-14 day downtime. These should be distinguished from the lighter chemical peels and microdermabrasion which are performed by an aesthetician and are much milder and require little or no downtime.

NON-SURGICAL TREATMENTS
For BOTOX® Cosmetic, Fillers, Restylane®, JUVÉDERM™ Injectable Gel, Radiesse®, Fraxel®, IPL®, FotoFacial™, etc, see section devoted to ‘Non-Surgical Treatments’..