Facial Cosmetic Surgery
Facial cosmetic surgery can be some of the most challenging, but at the same time, the most rewarding surgeries we perform. Plastic surgery training exposes a surgeon to all forms of facial cosmetic as well as reconstructive procedures. A strong foundation in cleft lip and palate surgery, facial trauma and tumors or malignancies of the face, is crucial to being able to provide optimal cosmetic results. Equally as important as the surgeons training and experience, is their ability to understand their patient’s desires and expectations of the facial cosmetic procedures they are considering. At Sweetgrass Plastic Surgery in Charleston we will work closely with you to ensure that we understand your expectations and devise a surgical plan that will provide you with the best cosmetic results possible. Thank you for considering Sweetgrass Plastic Surgery.
Anytime a patient is in my office and I ask them what bothers them about their face, nearly everyone grabs for their neck and the redundant skin that increasingly hangs from the chin region as we age. In addition, most are unhappy with their jowls, or lower cheek area along the jaw line. The other specific complaint I hear is that patients are told they look mad because of the slight frown appearance they have as a result of the down ward turn of the corner of their lips as they age. The SMILE technique was described by mentor, Dr. John Robinson nearly forty years ago. The objective of this procedure is to re-suspend the soft tissue structures of the face which descend as we age, resect loose skin and address the fat deposits which occur throughout the neck region with aging. In addition, the technique will cause a slight upward cant to the lateral aspect of the patient’s mouth and lips, giving them a happier more pleasant overall appearance. This technique has stood the test of time, producing long term high quality outcomes and a countless number of extremely satisfied patients over several decades. I consider myself fortunate to have had the opportunity to train under the direction of Dr. Robinson and learn the SMILE facelift technique.
Facelift or rhytidectomy is a surgical approach to facial rejuvenation and correction of facial aging. It is important to consider that the signs associated with facial aging are a result of multiple issues occurring over time. First, as skin ages, it loses its elastin property; as a result it has less resiliency or ability to contract. In addition the underlying subcutaneous tissue and fat descends, mainly in the infra orbital region and the nasolabial fold region, along the jaw line and in the central neck region. Finally hollowing or atrophy of the facial fat occurs over time.
The SMILE facelift is designed to address the specific issues associated with facial aging. The procedure uses a combination of techniques to ensure that your face is restored to a natural, more youthful and pleasant appearance.
The SMILE facelift allows for:
- Resection of redundant and loose skin
- Tightening of the subcutaneous SMAS laterally and the platysma muscles in the central neck region
- Suspension of the subcutaneous tissue and fat using a uniquely designed SMILE probe
- Liposuction of the chin and neck region as needed
The use of adjunctive fat grafting in combination the SMILE procedure is very effective in achieving the optimal clinical outcome. Transfer of fat to the tear troughs, nasolabial folds or lips is permanent; therefore, you do not have to undergo repeated injections as is the case with traditional highly expensive fillers.
After a facelift, there is bruising and swelling present for the first one to three weeks. A small amount of residual swelling may persist for up to 8 weeks. By three months the swelling has subsided and your final result is clear. The surgery takes on average 3 hours and is done as an outpatient procedure. In some circumstances local anesthetic is an option. Post operatively you will be asked to wear a head and neck wrap for compression.
The most common complaint I hear today from patients is how they are unhappy with their neck. Most complaints specifically focus on the redundant, loose hanging skin that develops in most people as they age. Often referred as the “turkey gobbler” by some patients, this area of unwanted tissue can be dramatically improved by a combined approach which targets, loose redundant skin, excess fat deposits as well as separation of the platysma muscle. By addressing each of these factors, the overall combined effect is a significant improvement in the appearance and contour of the neck. This procedure is done as an outpatient, usually taking less than 2 hours to perform.
Eye Rejuvenation (Blepharoplasty)
When asked by a patient what is the one thing I can do to most improve the overall appearance of my face? This procedure is always my first answer. Eye lid surgery is quick, easy to recover from and has minimal risk with virtually no down time. Yet, the results are subtle but substantial in that patients look more rested and awake.
Redundant skin of both the upper and lower eyelids may be addressed with a blepharoplasty. The procedure involves the excision of redundant skin and possibly the underlying fat pads, as well as a small portion of the orbicularis muscle. Traditionally the upper eyelid procedure is performed via a transcutaneous (through the skin) incision. The lower eyelid procedure may be performed through a transcutaneous or transconjunctival (through the inner lining of the lower eye lid). The approach is determined based on the amount of redundant skin present and the laxity of the lower eyelid.
This simple and safe procedure, which may be done under local anesthetic, has a dramatic improvement in the overall appearance of the patient. While subtle, patients look well rested, less tired and happier without the baggy appearance of their eyelids.
Facial aging can lead to descent of the eyebrows. There are various ways to address this issue; first direct incision via an upper blepharoplasty incision and direct pexy of the eyebrow in a more youthful position is an option. More invasive techniques such as the endoscopic brow left and the coronal brow lift are options which address more dramatic brow ptosis. Each approach has benefits and draw backs, which can be reviewed and discussed during a consultation. The position of the eye brow can have a dramatic effect on the appearance of the upper eyelid. Thus, it is important to determine if the upper eye lid fullness is a result of brow ptosis or due to redundant skin and prominent fat pads of the upper lid. By accurately determining the etiology of the excess tissue we can determine the best surgical approach and optimize the cosmetic outcome.
There are two options when considering the use of injectable fillers. One is the use of retail products the other is the use of your own fat. It is dependent on the clinical scenario and application as well as the patients expectations and desired outcomes as to which approach is best. When considering using your own fat (fat grafting) it is important to remember that between 40 and 70% of the fat which is transferred will take, as a result we have to over fill at the time of the procedure. The advantage to fat grafting is that once the fat has incorporated into the surrounding tissue it is permanent. When using manufactured fillers, there is period of time in which the filler is absorbed by your body and as a result require repeated injections. The advantage of manufactured fillers is that there is no need for anesthesia to harvest the product, plus given that they are temporary, there is no risk of long term permanent alteration in a patient’s appearance. Fillers are most commonly used in the periorbital region, the nasolabial folds and the lips. They are highly effective at filling deeper larger wrinkles as well as addressing area of fat atrophy and hollowing which can occur with aging.