Known as a rhytidectomy, a face lift is designed to alleviate some of the changes to the face that occur with aging, gravity and the effects of our environment. This procedure elevates and tightens the facial skin and underlying tissue to eliminate most facial wrinkles and creases and restore facial shape to create a more youthful appearance.

• Most people age in a similar characteristic way. This can be seen by looking at your friends or family members. Also we see these changes through the eyes of various artists in art work throughout the ages.
  
  
• Slowly but insidiously the face begins to change. The forehead begins to show lines, and the eyebrows may move lower. The upper eyelid skin will get loose. Fatty deposits will become more visible in the lower eyelids and the skin and tone of the lower lids will become lax.
  
  
• Fine lines will start to appear and the cheek tissue will start to weaken and sag to create the nasolabial fold which extends from the nostril to the corner of the mouth. Another similar line will form from the corner of the mouth to the side of the chin, the marionette line. The jowl will also form and this will alter the sharp contours of the youthful jawline.
  
  
• Along with these signs of aging, which are mostly due to gravity, there is a loss of facial volume due to a combination of loss of facial fat and descent of facial fat from its location in youth to its location in middle and advanced age.
  
  
• Signs of aging are also present in the neck and often these signs are present before aging signs in the face. The skin becomes loose. Often there is fat accumulation just under the chin. A very thin muscle in the neck gets loose with age and leads to the loss of the youthful angular contour of the neck.
  
  
• Luckily there are a number of procedures to reverse nearly all of these signs of aging. We try to tailor the procedure to the specific problem and to each patient taking into account their appearance now, and their appearance at an age when they liked the way they looked. We consider the part of the face that they are concerned about most and we begin to formulate a plan considering non invasive or minimally invasive procedures first and moving up to more invasive procedures if necessary.
  
  
• In some cases, patients may be candidates for a combination of injectables in order to improve the volume in areas of volume loss. Injectable fillers such as Restylane, Juvederm, Radiesse or Evolence can be utilized to improve contours in discreet areas where lines or folds have developed.
  
  
• Sculptra is used to restore volume over larger areas where volume in the form of facial fat is lost through the normal aging process. In certain patients volume correction will fill out loose skin and delay the need for a surgical procedure.
  
  
• Botox can be utilized to improve lines and wrinkles specifically due to excessive muscle activity. The combination of these injectables can be utilized to create a more well-rested, rejuvenated appearance without surgery.
  
  
• In some cases, Thermage can be utilized together with these injectables as another nonsurgical method of tightening the skin.
  
  
• When surgical rejuvenation of the face is necessary, there are still several choices. Some patients are candidates for a short scar facelift. These patients tend to be younger with less significant signs of aging particularly in the lower face and neck. This operation is accomplished with a scar that is confined to the curves in front of the ear. It does not extend behind the ear. It can be performed either under IV sedation or with local anesthesia alone.
  
  
• If more advanced signs of aging are present a facelift and necklift is performed through incisions placed in natural skin creases in front of each ear and extending up into the hairline above the ear and possibly into the hair behind the ear.
  
  
• This operation has been performed for a number of years. It has been refined over the years and it remains the gold standard for turning back the hands of time and restoring a more youthful appearance to the aging face. It can deliver either a dramatic or a subtle improvement depending on the needs and desires of the patient.
  
  
• The procedure is individualized for each patient. The best patients for this procedure have good underlying bone structure and reasonably good skin elasticity with aging signs such as jowl formation, droopiness of the cheek and laxity of the neck. In most cases, the procedure is combined with other enhancements, such as a brow lift, neck lift or eyelid surgery to more completely rejuvenate the face.
  
  
• Face lifts are usually performed on an outpatient basis under IV sedation with local anesthesia. Patients typically return to their usual routines approximately one to two weeks after surgery, and makeup may be applied after three to five days. Strenuous sports and other activities, however, should not be performed for two weeks.

Sometimes called a forehead lift, a brow lift elevates the eyebrows and reduces or eliminates the wrinkles and "worry lines" from the forehead. At the same time, it restores drooping eyebrows that can create unsightly "hooding" or bulging over the eyes. The result is a firmer, revitalized and refreshed appearance.

• Brow lifts are often performed along with other procedures to enhance the entire face, and are usually performed as outpatient surgery under local anesthesia combined with a sedative. Patients normally return home a few hours after surgery, and most are up and about within a day or two. However, patients should avoid strenuous activities for two weeks.
  
  
• There are several different ways in which a browlift can be performed. An incision can be made at the hairline which does not cause any additional elevation of the anterior hairline and can be utilized in some cases to lower a high anterior hairline. In some cases, a shorter scar approach can be utilized, which not only results in less scarring but also a shorter recovery. In all cases, the procedure is individualized to the patient.
  
  
• In some cases, a nonsurgical approach to the forehead can be utilized with good results. The major muscles of the forehead area cause lines and wrinkles that course horizontally across the forehead and vertically between the eyebrows. Each of these muscle groups can be weakened with the use of Botox. Subsequently, the wrinkles that these muscles cause will improve. In some cases, an injectable filler such as Restylane or Juvederm can be utilized to address these wrinkles and lines directly.

The eyes are often the area on the face that gives away aging first. Eyes are not only expressive they are frequently the part of the face visualized most by others. Men and women are affected equally. Given their prominent location there are a number of ways to improve the appearance of the eyes.

• Excess skin and fatty tissue around the eyes can sag with age creating a tired and listless appearance. A lifetime of exposure to sun or hereditary factors can also contribute to this condition as skin loses its elasticity.
  
  
• Aging affects both the upper eyelid and the lower eyelid. In some cases, the upper eyelid is affected due to the droopiness of the forehead and eyebrows and as such needs to be addressed utilizing a forehead or browlift. Eyelid surgery will not elevate a droopy eyebrow nor will it address crow's feet.
  
  
• When the issue is related to the eyelid itself both the upper and lower eyelids can be improved with surgical procedures. In fact, eyelid surgery, called a blepharoplasty, is the most commonly performed cosmetic surgical procedure in the United States.
  
  
• With the upper eyelids, a combination of excess skin and fat is removed to restore a toned, more refreshed look. With the lower eyelids, primarily fat and a small amount of excess skin are removed to eliminate "bags" under the eyes. In some cases, these surgical procedures are combined with nonsurgical procedures such as professional skin care or perhaps a chemical peel or skin resurfacing in order to refine the improvement further or to improve the textural changes of the skin or dark circles under the eyes.
  
  
• While this procedure can be performed by itself on either the upper or lower eyelids or both it is often combined with other procedures to rejuvenate the face. This procedure may be performed under local anesthesia with or without additional sedation on an outpatient basis, and patients normally return home a few hours after surgery. Most people return to their usual activities approximately one week after surgery, and make up can be applied after three to five days. Strenuous activities should be avoided for two weeks.

The nose holds a prominent position on the face and therefore it is one of the strongest character assigning features on the face. Throughout history, surgery on the nose has been performed to change its appearance and also to restore form following trauma. This procedure (also called a rhinoplasty) can redefine the nose's shape, size and general appearance to achieve an aesthetic balance between the nose and the other facial features.

• During a rhinoplasty, the cartilage and/or bone structure that gives the nose its shape is modified. The skin is then re-draped over the newly shaped framework, providing the nose its new appearance. The changes can be subtle or dramatic depending on the patient's needs. Rhinoplasty is often performed in conjunction with other procedures to achieve the most natural facial appearance.
  
  
• The goal with a rhinoplasty is a nose that appears natural, functions properly and is in balance with the rest of the face. The patient's wishes with regard to the type of nose desired are always considered. However, there are limiting factors. The texture and thickness of the skin, previous injury, individual differences in healing, and differences in facial proportions all play important roles in what can be achieved.
  
  
• A rhinoplasty is usually performed as outpatient surgery, with patients returning home the same day. A rhinoplasty can be combined with other procedures, most often a chin augmentation with an implant. This combined procedure can be utilized to improve proportion between the chin and nose both of which strongly affect the profile. In most cases, surgery is performed under light general anesthesia or IV sedation and most people return to their normal routines within a day or two. However, patients should avoid strenuous activities for two weeks.
  
  
• Typically at your initial consultation we will take digital photographs and place these on a computer which will allow us to make digital changes to the photographs to give patients an idea of what may be possible with surgery. This helps to visualize the post operative appearance.

• Lip augmentation has become a popular procedure among women who desire a more aesthetic, youthful appearance. In some cases, it can restore fullness to lips that have become narrower with age.
  
  
• There are a number of procedures that utilize different materials to achieve the desired results. The non-surgical techniques for lip augmentation tend to be less long lasting, but are also less extensive and offer an easier and faster recovery. Lip enhancement using injectable fillers are temporary. The injectable Restylane and Juvederm are used most often for this and often give results lasting 6 - 9 months with little downtime. Some bruising and swelling may occur. This is an office procedure performed under local anesthesia and most patients will return to normal activities either the same day or the next day.
  
  
• A surgical lip augmentation utilizes fat injections, fat or tissue from other areas of the body or synthetic materials. These techniques may offer a longer lasting enhancement but they do require a longer recovery. There is typically more swelling and bruising associated with these procedures. During "fat grafting," fat is harvested from a discreet site on the patient's body for use as the augmentation material. Because the material is from the patient's own body, there is no chance of rejection. More than one treatment may be necessary in order to achieve the desired permanent fullness.

Superficial changes that occur within the skin - such as wrinkles, surface irregularities and differences in pigmentation - can be treated by a variety of methods. These methods are collectively referred to as skin resurfacing.

Until recently, the most common procedures included chemical peels and dermabrasion, in which the outer layers of the skin are removed to achieve a smoother, fresher appearance. Chemical peels are still used today. A TCA peel is a relatively mild chemical peel that requires about 5 -7 days of recovery. No anesthesia is necessary. It is used to treat pigmentation changes as well as fine lines. A more aggressive chemical peel is a Croton Oil peel which is more aggressive and is used to treat moderate to deep wrinkles. It requires about 2 weeks for healing and the skin may be red for several months after that. Several weeks of home pretreatment are also usually necessary.

Other approaches include laser resurfacing - most notably with CO2 and Erbium lasers. The Sciton laser is a variation of the Erbium laser. These treatments can be either mild or more aggressive as the laser energy can be adjusted upward or downward depending on the situation and the desired results. The newest addition to laser resurfacing is the Fractionated CO2 laser which delivers the laser energy to a "fraction" of the entire skin surface leaving some areas untreated. This is on a microscopic level so the skip and treated areas cannot be seen with the naked eye. The untreated areas, however, allow faster healing. The attractive aspect of this technique is the shorter healing time and shorter downtime.

Laser treatments are usually performed under general anesthesia or under sedation and local anesthesia on an outpatient basis. Microdermabrasion requires no anesthesia. This is typically performed by an aesthetician or skin care specialist.

Facial implants enhance the basic structure of the face by aesthetically recontouring certain areas such as the cheeks or chin to create a more attractive look. It is not uncommon for patients to supplement surgical procedures such as a face lift or a brow lift with a facial implant procedure to restore a more youthful appearance. Quite often a chin implant is placed at the time of a rhinoplasty, an operation to reshape the nose because the relationship of the nose and chin are important to one another in achieving natural facial proportions.

Facial contouring entails inserting an implant within the facial tissue through small incisions made on the inside of the upper and/or lower lips. If external incisions are necessary, they are small and discreetly placed in the natural contours or creases of the face. In almost all cases, the procedures are performed on an outpatient basis. Full recovery typically extends over one or two weeks.