When you look as good as you can look, you will feel good. And when you feel good, the sky's the limit. Rejuvenation of the face and neck is usually a good start to ‘reach for the sky’. But something more is needed when one wants to ‘get closer to the sky’. That ‘something more’ - further positive steps to extend youth -has to come from the well functioning body of the patient.
When people start to look good and feel good, they begin to want to do more for themselves. The primary myth of youth extension is that ‘it cannot be done’. Rejuvenation of face and neck banishes that myth once and for all. It points out readily that youth can be extended.
We all grow older. If we fall under the spell of the ‘you can't do anything against aging’ myth, then we can get depressed. When depressed, one is likely to just sit in a corner and do nothing for depression and aging. One can get caught in a downward spiral of aging and illness.
Rejuvenation of face and neck can act as the first decisive battle won against the forces that cause aging as well as those that take away motivation, the will to live, and the determination to live a joyful and meaningful life.
There are more battles that must be won, more steps that must be taken to slow down aging. For those, visit: http://www.stem-cell-transplantation.com/Anti_Aging_Treatment_Aging_disease.html
Cosmetic surgical procedures on the face are divided into two groups. First there are those that change the shape or contours of the face, such as rhinoplasty, cheek implants, chin implants, jaw implants, lip surgery, etc. Second, there are those that rejuvenate the face only, and should not change the shape or contours that were given to you by Mother Nature.
The most commonly performed cosmetic surgical procedures for rejuvenation have been the face and neck lift, forehead and eyebrow lift, rejuvenation surgery of the eyelids; submental tuck-up (combined with lipectomy or fat suctioning). Today some of these are being replaced by the non-surgical rejuvenation of face & neck by a surface application of stem cell transplants.
Let’s now describe various facial rejuvenation operations:
The face and neck lift (or what the public calls a "face lift") is a lift of the lower half of the face and the upper half of the neck.
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Today a face lift has become a major operation. It requires major removal of redundant skin and tightening of a unique skin muscle found in the lower part of the face and in the neck, called the platysma muscle.
The incision, and thus the final scar, is quite inconspicuous. Half of it is hidden in the hair, in the temple and behind the ear, and one quarter of it is hidden behind the auricle. Only the part of the incision in the ear canal, and around the earlobe is somewhat visible, depending on the quality of healing.
Once the incision is made, the skin is first undermined to the necessary extent in the temple, face, and neck. Then the platysma muscle is dissected free as necessary, repositioned upward and backward, and trimmed if necessary. The platysma muscle is then sutured in this new position. Then the skin is draped upward and backward and redundant portions of it are removed. The margins of the cut skin are then stitched back.
At the end of the operation, a heavy bandage is applied to assure complete rest, so that the skin and the platysma muscle will grow back together with the underlying tissues.
In certain instances, the surgeon will perform only the facial portion of the face lift. In other instances, only the neck portion of the operation is carried out. The decision depends upon evaluating the condition of your face and neck during the consultation.
The submental tuck-up is performed sometimes along with face and neck lift, when there are excessive folds of platysma muscle under the skin, excessive skin as in ‘witches chin’, or in some cases of ‘double chin’.
The final scar is quite obscure.
FOREHEAD LIFT
This is a surgical procedure which has been minimally used ever since Botox appeared on the scene. In this operation the entire forehead is pulled upward. The benefits of this operation are several. It places the eyebrow at the proper level and thus opens up the eyes. It improves the frown lines above the root of the nose and makes he lines across the forehead less conspicuous. The procedure improves crow's feet.
In forehead lift surgery, the surgeon makes an incision on the top of the head. The forehead tissues are dissected from the membrane that covers the bone from the incision down to the level of the high bony arches above the eyes. The two small muscles causing frown lines above the root of the nose are exposed, cut across, and cauterized. Similarly, the forehead muscle that is causing the lines across the forehead, is cut across, or a strip of it is removed.
The purpose of the division of the muscles is to interrupt their function and thus give the patient a chance, temporarily, to avoid the bad habit of frowning or raising his eyebrows, which is what created the wrinkles in the first place. These muscles do heal back in about four to six months. But for the majority of people, this is long enough to break the bad habit. Finally, the forehead tissues are pulled upward. A redundant amount of skin and underlying tissues is removed and then the skin margins are sutured.
The forehead lift can be done by itself or it can be combined with the face and neck lift into a complete lift of face and neck.
The forehead lift is one of the simpler procedures in cosmetic surgery, with the lowest incidence of complications, yet patients are afraid of it because it reminds them of Indian scalping techniques which they may have watched in ‘westerns’.
COSMETIC SURGERY OF THE EYELIDS
Cosmetic surgery of the eyelids is often the first kind of rejuvenation surgery that people think about. In most people, the eyes will show aging first. When you first meet a person, you consciously or subconsciously look into his or her eyes. And when you see eyes that look tired or baggy, you immediately put the person in the 45 and up age group, even when the person may be only 30 years of age.
Rejuvenation surgery of the upper eyelids removes redundant skin and bags of fatty tissue to recreate a youthful looking eyelid. The surgeon draws a pattern of redundant skin. Then, following this pattern, the redundant skin is removed along with the underlying muscle. Finally, the necessary portion of fat that is creating the fatty bags is removed. Then the surgeon closes the skin. The surgical scar is hidden in the crease that we all have in the upper eyelid, and part of it in one of the crow's feet, laterally.
Rejuvenation surgery of the lower eyelids removes the redundant skin and muscle to tighten the eyelid and also removes the bags of fatty tissue, as necessary. The incision follows the line of the eyelashes and then turns sideways following one of the lines of the crow's feet. The skin and underlying muscles are lifted up and the fatty tissues exposed. The necessary amount of ‘bags- causing’ fatty tissue is removed. The redundant skin and underlying muscle is excised and the eyelid tightened in an upward and backward direction. Then the skin is closed. The final scar, after healing, is barely visible.
 Be aware that eyelid surgery cannot eliminate the fine lines in the skin. Those people who smile with laugh lines will still have them after this operation, but the lines will be less noticeable. The only procedure that improves these fine lines in the skin is the non-surgical rejuvenation by a surface application of stem cell transplants.The same applies to ‘crow's feet’. The eyebrow lift is very often recommended in conjunction with rejuvenation surgery of the upper eyelid. In some people, the eyebrows are so depressed that they totally obscure the upper eyelid, and no matter what a surgeon does to the upper eyelid, the result of the work will not be visible. These problems are more functional than aesthetic: they produce a heavy feeling in the upper eyelids and interfere with peripheral vision. To perform an eyebrow lift for women, the surgeon removes a strip of skin just above the eyebrow, without cutting any of the hair. By closing the skin together, the eyebrow is pushed into a higher, more youthful position. The scar will be just on the top of the hairline of the eyebrow and; thus, can be easily camouflaged by using a cosmetic pencil. In a man the operation is performed at a slightly higher level, so the final scar will be placed in one of the creases that run across the forehead. Scars from an eyebrow lift are visible and will require camouflage during the first year after the operation. This visibility of scars will encourage the majority of patients to choose a forehead lift over the eyebrow lift, particularly since the forehead lift will take care of other aging signs, as well. |
HOW LONG WILL THE SURGICAL RESULTS LAST?
Every experienced cosmetic surgeon knows that patients with strong facial bones, and ‘chiseled face’, will have better result than those with weak jaw line, flat cheek bones, and face being more on the ‘chubby’ side.
Aging will not stop on the day of face lift. You will continue to grow older. And thus, the time may come when you will start to think that your surgeon has not done enough, and you will start to think about what else to do. When this time will come is impossible to predict. It may be anywhere starting from five years after the first operation. Serious illness, markedly unstable weight, and generally poor self-care, and other factors that would make you age faster, erase the result of your surgery quicker than you expected.
Your surgeon should forewarn you at the time of the consultation that you may indeed expect a lesser result. This typically comes up in a situation when you have waited too long before you decided to make the first trip to a cosmetic surgeon. The tissues of your face and neck became so loose that it would be unsafe during the operation to tighten them any further in order to give you the result that you probably had expected from cosmetic surgery.
This problem comes up most frequently in women start to think about facial rejuvenation after the onset of menopause. Unless you have taken a hormone replacement therapy, your skin will lose its elasticity and become like a rag, sometimes very quickly so. At menopause, there is a drop in sex hormone output and the quality of female skin starts to deteriorate. Of course, the quality of your skin can be preserved by proper anti-aging program. Good nutrition, exercise, anti-aging treatment, which includes hormone replacement therapy, and stem cell transplantation, are all effective in protecting and rejuvenating the skin.
WHAT ARE THE OTHER CAUSES OF LESS SATISFACTORY RESULTS?
A fairly common reason for a less than satisfactory outcome after a face & neck lift is a weak jaw and chin line. If the bones of your face are weak, particularly the jaw bone, the result of the surgery will not be as dramatic, even under the best circumstances, unless the surgeon advises you and you accept as a part of the neck lift an augmentation of your chin or jaw, depending what is needed.
Look at pictures from the time you were in your 20s. Suppose you find that you never had a sharp neckline but your neck was just slanting down, sometimes reaching the stage of what we call ‘turkey gobbler’. That usually goes hand in hand with underdeveloped bones of the jaw line. Here the surgeon, even when using the most advanced and aggressive methods of platysma surgery, cannot give you a sharp neckline. In situations like this, the augmentation of your chin or jaw will provide a dramatic improvement.
Another reason is deep naso-labial lines (furrows that run from the nostril down towards the lip, separating the cheek from the upper lip), which are sometimes so deep that they cannot be perfectly flattened to the patient's satisfaction by surgery alone regardless what surgeon does. Here the addition of a ‘filler’ is necessary. Quite often these deep creases are hereditary; with some people developing them already in their 20’s.
If you have too many superficial lines in the skin around the lips, eyes, and cheeks, you cannot expect that face lift or eyelid surgery or even forehead surgery will completely eliminate it. These lines are deeply imprinted in your skin and the only way we can get rid of them is by non-surgical rejuvenation by surface application of stem cell transplants…
Lower eyelid surgery is the only one that does not need to be repeated, if performed correctly the first time. The above statement requires an explanation. The eyeball sits in a cushion of fat, which protects it from body vibrations or movements. This fat is kept within the confines of the bony orbit by a membrane in your eyelids. When that membrane is weakened, the fat that is cushioning the eye will push through the membrane into the eyelids, much like an abdominal hernia. In some people this occurs because of genetic reasons. These are people who will have fatty bags in their eyelids in their teens and early 20s. Most commonly, the weakening occurs with age, and that's the reason why, with aging many people get fatty bags under the eyes and sometimes also in the upper eyelids.
CAN MY FACE BE TIGHTENED TOO MUCH BY FACE LIFT?
Many patients voice a concern that rejuvenation surgery of the face will make them look different. They will always mention a celebrity or movie star whose face supposedly changed after a face lift. Unfortunately, many surgeons love to show off by using the more aggressive techniques of face & neck lift, which lead to an ‘over-operated look’ or to such a change of the patient’s appearance, that they become unrecognizable by their friends. The only way to avoid such an occurrence is to select a non-surgical rejuvenation of face & neck by surface application of stem cell transplants rather than face & neck lift whenever possible.
When it comes to a second, third, or fourth face lift, this danger is a real one even in the best hands. In such situations the surgeon has to be very careful not to tighten the skin too much or to tighten it uniformly all over. If not careful, it is possible that the face may turn into a statue or that a patient will have his or her mouth widened or the face will be in a state of permanent smile indeed, as you often see in the movies or on TV.
HOW SOON AFTER SURGERY WILL THE ‘NEW ME’ BE READY FOR THE WORLD?
There are two answers to this question. Physically, you will go through a period during which you will look quite bruised and swollen. But this period of visible physical healing can be predicted fairly accurately. For a face and neck lift, it takes about two weeks before you can go back to work. In three weeks you can go to a party with a minimum of makeup, and no one will be able to tell you've had an operation. After a forehead lift, you will be able to go back to work or even to a party in one week. After eyelid surgery, you can go back to the majority of occupations after the sutures are removed in three to four days. Up until the time that you can wear makeup, which is seven days after the operation, you can wear dark glasses to hide the bruises. Once makeup can be worn, glasses are no longer necessary. Amazingly the forehead lift surgery or eyebrow lift very seldom will cause any bruising.
The second answer to this question is not so easy to give with any accuracy, since it really depends on the patient. In addition to a period of physical healing, there is also a period of emotional healing. You will go through a period in which the ‘new you’ looks quite strange to you. You will have to get used to seeing your new face in the mirror. Some people go through a brief period of slight depression following surgery, too, which is why it's so very important to live in a supportive environment.
WHAT ARE THE POSSIBLE COMPLICATIONS?
You should be aware that there is the possibility of damaging the branches of the facial nerve during the course of face and neck lift surgery, and that there is a possibility of causing a pulling down of the lower eyelid so that the white of the eyes shows under the cornea.
Bleeding under the skin flaps, or hematoma, occurs very rarely after forehead lift surgery, but it will occur in about two percent of patients after face lift surgery. It usually requires loosening of a few stitches, expressing the blood clots out and reapplying of bandages.
Infrequently, the patient may need to be taken back to the operating room, where more of the sutures are removed, blood is drained, and the bleeding vessel is cauterized. Then the skin is stitched back and bandages reapplied.
Minor hematomas after face lift will resolve by themselves. They will sometimes cause a certain lumpiness, particularly in the cheek area, which may take two to three months to subside. Bleeding is generally not dangerous except for those very rare cases of bleeding after lower eyelid surgery, where blindness could be an outcome.
Obvious scars after eyelid surgery are extremely rare and after the face lift are seldom problems. Scars after the forehead lift are covered by the hair. Scars after the eyebrow lift are noticeable, however, and will require camouflage by an eyebrow pencil. Infections are extremely rare after any one of these operations.
WHY ARE PHOTOGRAPHS TAKEN?
In the same way as your family doctor writes down in your medical record about what he detected when he listened to your heart, the cosmetic surgeon makes a note about his findings during your examination. A thousand words cannot describe what a photograph can. For this reason, medical photography has become a routine matter in plastic surgery.
WHAT TYPE OF ANESTHESIA IS USED?
For many reasons, a local anesthesia combined with neuroleptanalgesia is preferred because it is safer for the patient and there is much less bleeding during the operation.
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HOW LONG IS THE OPERATION?
The actual surgical time will vary depending upon the amount of surgery. A face lift usually requires approximately 90 minutes and eyelid surgery, one hour. Eyebrow lift takes one-half hour and forehead lift, 45 minutes. When you arrive you receive pre-medication and your surgery will start in about45 to 50 minutes. After surgery you will spend approximately 2 hours in the recovery area.
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ARE BANDAGES APPLIED?
Bandages are applied to the head and neck after a face lift. These are removed 48 hours after surgery. Bandages are applied to the eyelids for approximately an hour. Following removal of the bandages, ice compresses are applied to the eyes for the first 24 hours. When eyebrow lift only is done, no bandages are used. After forehead lift bandages are on for 24 hours. Compresses will help to minimize bruising and swelling. The bandages are applied to keep the operated area as immobile as possible. For the same reason, it is important to cut down talking to visitors and over the telephone to an absolute minimum. Postoperative pain is infrequent and is usually well controlled by common pain medication.
WHEN ARE STITCHES REMOVED?
After an eyelid operation, the stitches will be removed on the 3rd to 5th day, post-operatively. After a face lift, stitches around the ear canal are removed on the 5th to 6th day, post-operatively. The remaining stitches are removed after another week. After the eyebrow and forehead lift, sutures are removed on the 7th day after the surgery.
WHEN CAN MAKE-UP BE APPLIED?
Eye make-up may be applied approximately 4 to 5 days after the removal of sutures. Facial make-up after a face lift can usually be applied after 14 days. It is important to remove all makeup at the end of the day using an upward motion. Oiled eye pads are recommended for the removal of eye make-up.
WHEN MAY I GET MY HAIR DONE?
On the 4th day following a face lift or forehead lift surgery, you may comb your hair by using a solution of soap in warm water and a wide tooth comb. You can shampoo your hair the first time 10 days following surgery. It is preferable to have this done by an experienced hairdresser or another person. Rollers may be used loosely. Hair dryer may also be used, but should never be hot since you will not have any sensation in certain areas of face and around your ears and thus may get burned. Tinting and coloring can be done approximately 3 weeks after the operation.
IS HAIR SHAVED FOR THE OPERATION?
The hair is not shaved. However, there will be stitches in your hair above your ears and behind your ears after the face lift or on the top of your head after the forehead lift.
WHY TO CHOOSE NON-SURGICAL REJUVENATION OF THE FACE AND NECK BY A SURFACE APPLICATION OF STEM CELL TRANSPLANTS?
If you compare the description of non-surgical rejuvenation of face and neck by a surface application of stem cell transplants with a surgical rejuvenation, in particular face & neck lift, you may come to the conclusion that the non-surgical method is safer, and overall better, because it will be still “you” that you will see in the mirror after this procedure, as compared with face & neck lift.
Cosmetic surgery makes one look younger in the shortest possible time. This is of great value as a motivator. If you look in the mirror and don't like what you see, you may not feel too good about yourself. You slide into depression and take worse and worse care of yourself. You may not want to bother with any anti-aging treatment program.
Most plastic surgeons eventually recognize that their work on the body exterior has severe limitations in accomplishing what their patients ask them to do: improvement of external signs of aging. When the body does not work well anymore, all the marvels of modern plastic surgery are not going to camouflage it. If patient’s mind is not at its best, people recognize it even after the best face lift. On the contrary, when a person is obviously not well, or aged, attempts to cover that fact by extensive cosmetic surgery may only make observers laugh.
People who seem to stay younger longer, do so because they decide to do what it takes to fight the aging process. They grow old, too. They begin to sense their bodies' functioning dropping off a little at a time, with those little nuisance problems of aging adding up as the years go by. The difference is they don't just let it happen. They take steps to slow it down as much as they can. What's to prevent you from taking those same steps? Nothing at all. Steps that must be taken to slow down aging are increasingly known. For a complete anti-aging program see: http://www.stem-cell-transplantation.com/Anti_Aging_Treatment_Aging_disease.html
UPPER EYELID SURGERY FOR ORIENTAL PATIENTS
One half of Orientals lack a fold of the upper eyelid, i.e. they have ‘single eyelids’. In many of the second half of Orientals the fold exists but has not sufficiently developed to be esthetically pleasing. Oriental individuals with such ‘partial double lid’, as well as ‘single lid’, frequently desire to get a ‘complete double lid’ look.
Plastic surgeons in the Orient devised operations to accomplish this already 50 years ago. Besides creating the fold, these operations remove some fullness of the upper eyelid, also typical of Oriental people.
The surgery takes ~ 30 minutes and is done under local anesthesia. For the first 24 hours postoperatively you must apply ice compresses to the eyes. You can go back to non-physical work right then and there. Sutures are removed 3 days after surgery. Eye make-up can be applied 7 days after the operation. Swelling may take 6 – 8 weeks to disappear.
Fullness of the upper eyelid is sometimes caused by a drooping eyebrow, and that has to be dealt with by another procedure.
Some patients desire correction of the ‘epicanthal fold’ of the upper eyelid – the skinfold next to the nose, present to various degree in the majority of Oriental peoples. It can be done but the operation is quite ‘tricky’ and the results may not be satisfactory.
SURGICAL TREATMENT OF BALDNESS
Diminution or lack of hair, whether it is on a man or a woman, makes you look older. The pattern of baldness is distinctive for men and women.
The appearance of ‘male pattern baldness’ is familiar to all of us. ‘Female pattern baldness’ is distinctively different. The frontal hairline does not recede, as on a man. Nevertheless, the thinning of the hair throughout the remaining portion of the scalp creates quite a problem for many women.
Before you seek a surgical solution to male or female pattern baldness, whether you're a man or a woman, you should make reasonably sure that it is ‘pattern baldness’. Hair loss can be caused by several other factors. Prolonged stress, malnutrition, and severe injuries can cause hair loss. Marginal nutritional deficiencies probably do not affect hair growth that much. But prolonged fad dieting that does not provide enough protein, vitamins, and minerals can cause hair to fall out.
Trauma to the hair itself can cause it to fall out. If you overdo grooming, pull too hard, apply too much pressure to the hair and scalp, expose your hair to strong chemicals, abuse cosmetics, or expose yourself to toxic gases or radiation, your hair may fall out. A serious infection of the scalp or of the entire body can cause hair loss. Certain prescription medications cause hair loss as a side effect. And if you're one of those people who pull at their hair when they're nervous, that could be the cause of your hair loss.
Although you should check out these causes, it's true that most cases of hair loss are hereditary. For some hereditary reason yet unknown to medical science, but which is definitely connected to levels of male and female sex hormones, the hair follicles on top of the head in men and all over the scalp in women get a signal to stop growing.
In men especially, thinning hair progresses to larger and larger bald spots. In men, dihydro-testosterone is the culprit responsible for ‘male pattern baldness’. An enzyme 5-alpha reductase controls the conversion of testosterone into di-hydrotestosterone. ‘Propecia’ (finasteride 1 mg) inhibits this enzyme, so that the levels of dihydro-testosterone are decreased, and thereby baldness process slowed down or stopped.
Someday, medical science may be able to make the hair follicles wake up and start growing hair again. Until that time, the only options you have are surgery and artificial hair.
There are three types of surgical procedures designed to help alleviate baldness: hair transplantation, scalp reduction, and pedicle scalp flaps.
HAIR TRANSPLANTATION
Hair transplants consist of tiny (usually four millimeters in diameter) plugs of scalp, each with 10 to 15 hair follicles, which are taken out of an area of the scalp with relatively heavy hair growth and transplanted into a thinning or bald area.
We choose transplants from the back of the head and, if needed, from the side of the head because that hair is genetically different, which means that when it is transplanted into the frontal hairline, it will grow there for the rest of the life of the individual. It is not going to fall out. Many people are worried that after the transplant they will have hair for a while, but will fall out again. The advantage of the hair transplant is that the hair will never fall out even into advanced age.
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Hair transplanting is considered minor surgery. Hair plugs are taken from the donor area and transferred into the frontal hairline.
To be effective, hair plugs must be placed four millimeters apart. Because it is not possible to place them close together during a single operation, the entire hair transplantation is usually performed over the course of three sessions, one month apart, plus one touch-up session after six months. From 10 to 100 plugs can be transplanted per session. In some cases, additional sessions may be required. Tiny micro-grafts will then be placed in the hairline for better camouflage. Remember, transplanted hair always falls out within two to three weeks after the procedure. New hair will start to grow after 3 or 4 months.
SCALP REDUCTION
Scalp reduction is an operation that makes it possible to alleviate baldness even in those patients who, because of the extent of their baldness, were considered poor candidates for hair transplants. Now one can improve man’s appearance even where there is extensive baldness by combining this operation with hair transplantation for the frontal hairline.
The bald scalp with hair on the sides and back of the head will have, at most, 400 to 600 grafts available for transplantation. That's all. So if a person has an excessive area of baldness on the top of the head, we have to utilize those 400 to 600 grafts to cover the entire top of the head. Therefore, the grafts will have to be used sparingly to get complete coverage.
As a result of that, before the era of scalp reduction, many patients were turned down for the procedure because surgeons were aware that coverage would not be adequate. Frankly, if the procedure still was done, the coverage was poor and many of those men continued to use artificial hair even after hair transplants. The turndown rate was 80 percent of patients before scalp reduction came into being.
The purpose of scalp reduction is to remove the bald scalp from the top of the head. Each scalp reduction saves between 100 and 150 grafts. The more scalp reductions the surgeon can do on the top, the fewer grafts will be required for the top of the head, thus leaving more of them to develop a frontal hairline. The more grafts available for the hairline, the better will be the overall aesthetic appearance.
The technique involves doing scalp reductions first, up to four of them, until the bald top is reduced as much as the looseness of the scalp will allow. This is helped by including techniques of scalp extension during the first – and successive - scalp reduction operation. Then the surgeon proceeds to develop a frontal hairline with hair transplants.
With this combination of scalp reduction plus hair transplants, the turndown rate is only about 50 percent of patients. In addition to men that have very extensive baldness, the patients who are turned down consist mainly of men who are under 25. It is considered highly improper to start to do any baldness surgery on very young men, because up until the age of 25, the baldness will continue to progress, and it is hard to estimate how far it will go. One can inquire about baldness pattern in the maternal grandfather, which is supposedly genetically closest to the individual in question. But in reality, only after the age of 25 can one get a idea of what the pattern of baldness will be. Now for this very reason, it is very unwise to use hair transplants on the top of the head, particularly in younger individuals, even if the scalp reduction could not get a complete closure. One never knows whether or not the baldness on the top will continue.
If you have not had any hair transplants on top, you can always have more scalp reductions in the future to take out the bald spots. Hair transplants will scar the scalp so that it will lose its elasticity and, thus, the scalp reduction becomes much less effective in terms of how much scalp can be removed during such operation.
Scalp reduction is considered surgery of intermediate seriousness. An ellipse of bald scalp approximately one to one and a half inches wide is removed, and scalp with hair growth from the sides of the scalp is advanced toward the top. The overall effect of the operation is to reduce the size of the bald area. Depending on the extent of baldness, anywhere from one to four operations may be performed, two to three months apart.
Both hair transplants and scalp reductions are done under local anesthesia. Complications are rare, and pain is minor. Bandages are taken off in a day, sutures removed in a week. Most people can return to work one day after surgery.
PEDICLE SCALP FLAPS
This is a major operation in which a piece of scalp with hair is transplanted from the side of the head to the forehead. A new frontal hairline is thus established. The operation is performed in two or three stages. This operation is not very popular because of the magnitude of the procedure and the relatively higher complication rate.
RHINOPLASTY
Rhinoplasty is the operation designed to correct deformities of the nose. The operation consists of the removal of excess bone and cartilage and rearranging and reshaping the remaining portion of it into a new nose. An important prerequisite is a sense of realism and emotional maturity when approaching such surgery.
The following facts should be accepted before the discussion of nasal surgery.
1. Every patient is not a good candidate for surgery for one reason or another; nor is every patient who requests cosmetic surgery accepted for the operation.
2. The goal of the operation should be improvement of appearance, not perfection. If a patient is seeking absolute perfection, he should not undergo cosmetic surgery.
3. A surgeon is a doctor, and not a magician. The degree of success certainly depends on his skill and his experience. Equally important however, is the age, health, skin texture, bone structure and specific problem of the patient. These are all widely variable factors limiting the surgeon.
4. The motives that impel a person to seek surgical aid should be realistic. Plastic surgery is not a cure-all. Such surgery will not solve all of one's problems, particularly if he blames his lack of success in life on appearance. Patients should not expect universal acceptance from family, friends and acquaintances following surgery. A surgeon may not be able to duplicate what the patient has in mind.
5. Usually there is relatively little pain, incapacity or discomfort following nasal plastic surgery. However, the patient must be mature enough to accept the little there is and realize that it is only temporary.
6. Every surgical procedure entails some degree of risk in terms of complications and results which may not match the expectations of the patient.
7 It would be unethical for any physician to guarantee the results of any treatment he renders or operation he performs.
8. All wounds heal by scar formation, a process over which a surgeon has little control following the operation. This explains some of the changes that occur as healing progresses.
9. Photographs are generally obtained before and after the operation to serve as a permanent record.
10. The patient will receive the type of anesthesia that the surgeon deems most appropriate for the individual. Local anesthesia is much preferred because there is less bleeding which helps the surgeon, and less swelling which makes healing faster for you. An actual rhinoplasty operation takes about 30 to 45 minutes, depending on the complexity of the case.
11. Following the surgery, nasal packing may, or may not be utilized. A splint is applied to the nose. The surgeon will provide a list of important ‘do's and don'ts.’ Most types of employment permit the patient to return to work one or two weeks after surgery. Following the removal of all dressings, the patient will visit the office for periodic checkups for up to one year after surgery.
12. Approximately 1 out of 20 patients will require a touch-up which is usually carried out 9 to 12 months after surgery.
POINTS THAT SHOULD BE UNDERSTOOD
1. When the dressings are first removed, the nose may appear stiff and turned up too much due to the effects of the bandage and swelling of the tissues. Therefore, the patient who expects to see a perfectly shaped nose as soon as the dressings are removed will be disappointed. It generally takes upwards of one year for the last one or two per cent of the swelling to disappear. This does not usually bother the patient or detract from the appearance of the nose.
2. In like manner, the tissues within the nose are somewhat swollen after surgery, therefore, progressively decreasing amounts of nasal blockage should be expected for a time.
3. The thicker the skin, the longer it takes for the nose to return to its final shape. Nasal plastic surgery is basically achieved by altering the shape and size of the supporting structures, such as cartilage and bone. It cannot change skin that is inherently thick and oily. Such skin limits the amount of correction that can be obtained.
4. All the work done is usually on the inside of the nose. There are no scars on the outside. There are exceptions, however.
5. Patients should remember that there is a limit to the degree of correction possible. The surgical goal is improvement and not to match the ideal which might be present in one's mind. Some of the limiting factors in rhinoplasty are the contour and shape of the face, the texture and thickness of the skin, and the inclination of the chin, lip and forehead, the depth of the angle between the forehead and the nose, the height of the individual and the healing powers of his tissues.
6. The human body is not symmetrical and the same applies to the face and nose. The majority of people are not aware of it, particularly if the degree of asymmetry is minor. This kind of asymmetry cannot be corrected by surgery.
7. A crooked nose resulting from an accident can only rarely be straightened completely, some deviation usually remains.
8. Nasal obstruction is always caused by two factors: A. By the crooked nose and the nasal septum. B. By a swollen and/or thickened nasal lining. Surgery can improve the crookedness of the nasal pyramid and nasal septum, but cannot correct the swelling or chronic thickening of nasal mucosa. The abnormalities of nasal mucosa will require medical treatment postoperatively.
CORRECTION OF A STRAIGHT NOSE
CORRECTION OF A CROOKED-INJURED NOSE
A FEW WORDS ABOUT NASAL SURGERY FOR ORIENTAL AND BLACK PATIENTS:
While the majority of Caucasian patients desire a reduction in nasal size, the Black and Oriental patients usually request nasal augmentation and some of them the correction of flaring nostrils. Nasal augmentation is accomplished by the placement of solid prostheses on the top of nasal bones and cartilages. The surgery will not alter the basic racial characteristics of your face: the increase in height and decrease in width of the nose is limited by inherited structure of your face.
Patients with plastic implants on the surface of nasal bones and cartilages should realize that such an implant is a foreign object and can cause trouble in the future. When the nose is injured the implant can get displaced. Whenever this happens, the patient should see the surgeon as soon as possible.
CHIN AND JAW AUGMENTATION
The appearance of the entire face and neck depends a great deal on the size of your chin and jaw. When your chin or jaw is small, your nose appears larger. When the chin or jaw is enlarged, the nose appears to shrink. About 25 percent of the people who request rhinoplasty actually need chin or jaw enlargement, as well, procedures that will give the entire face markedly improved proportions.
Ten to 20 percent of the patients that come in for rejuvenation surgery of the face and neck are advised to have their chin or jaw built up too. As discussed in the chapter on rejuvenation surgery of the face and neck, this substantially improves the result of the neck lift.
Because we see ourselves only from the front much of the time, we don't get a clear picture of the lines of our face from any other angle. This is in contradistinction to all other people who usually see us from all other angles but frontal. Thus, it is not surprising that to 90 percent of candidates for cosmetic surgery, recommendation of chin or jaw augmentation during consultation comes as a complete surprise. However, patients with small chins or jawbones appreciate the results of such surgery.
Chin augmentation, because of the small size of the implant, can be performed through a small incision in the mouth, just in front of the gums. It is accomplished by placing a Silastic implant over the prominence of the chin through an incision made in the mouth.
You will wear a tape over the chin for 3-5 days. The first 2 days you will be able to eat liquids only, the next five days soft food and after the check-up which is one week postoperatively, you will be allowed to eat regular food.
It will take several months to "forget" the presence of the implant in your chin.
Jaw augmentation, depending on the size of the implant, can also be done through the mouth.
The surgeon makes a half inch long incision and creates a pocket in front of the jawbone, which matches the size of the implant perfectly. The surgeon inserts the implant and then closes the incision in several layers. The implant is placed in front of the bone, and in about two weeks, it becomes glued to the surface of the jawbone by the natural healing powers of the body. The implant will move with the jawbone as part of it; and after that period of time, it can no longer be dislodged unless excess force is applied. The implant will not be felt as a foreign object, and in about three months, the patient forgets the presence of it.
In some, the problem is of greater magnitude. The middle third of the face or lower jaw or both may be under or over-developed which is usually accompanied by the disturbance of an occlusion ("bite"). In these instances major oral surgical procedures are recommended followed by prolonged orthodontic treatment.
CHIN & JAW AUGMENTATION
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CHEEK IMPLANTS
Our society considers high cheekbones a trademark of beauty. Most people are surprised when they learn that high cheekbones can be created by cosmetic surgery. It's a very simple, safe operation. Unfortunately, many people who did not know of this operation had liquid silicone injected into their faces to raise their cheek bones with sometimes disastrous consequences. The operation consists of placing a plastic implant on top of the prominence of the cheekbone, just under the bony cavity holding the eye and slightly to the side of it. The implant will increase the height of the prominence of the cheeks to the aesthetically necessary level. The incision made in the lower eyelid is actually a shortened version of the usual incision for eyelid surgery. The dissection is carried down to the membrane that covers the cheek bone. The membrane is then elevated and a pocket is created. This has to match exactly the size of the implant, so the implant will not be dislodged or displaced during the healing process. After perfect fit is obtained, the incisions are closed. The implant will become glued to the surface of the bone by the healing powers of the body. The swelling gradually subsides, and after about three months the patient is no longer aware of the presence of the foreign material.
COSMETIC SURGERY OF THE LIPS
Very few people are aware that there is such a thing as beauty surgery for the lips. Lips can indeed be made larger, thinner, or fuller, and the upper lip can also be lifted. The most commonly requested operation is thinning of the lips, or lip reduction. You should be aware that sometimes lips only seem larger than normal, but the problem is elsewhere. In the case of the upper lip, it is often due to an orthodontic problem of protruding upper front teeth. In this instance, of course, surgery is not advised at all, or is definitely postponed until the orthodontist has corrected the teeth. Then we must decide if the need for the operation is still there. And in the case of the lower lip, the oversize is frequently caused by the small size of the chin. The patient needs a chin or jaw enlargement first, and then lip reduction, if still necessary. Lip reduction involves reducing the size of the red portion of the lips. It cannot do anything about that portion of the lip that is covered by a normal skin. Lip thinning is accomplished by removing a horizontal strip of the red portion of the lip. The size of the strip depends on the aesthetic requirements and the patient's wishes. The removal is carried out behind the closure line of the lips, which makes the final scar invisible when the mouth is closed. By closing the skin, the junction of the red and white skin is pulled down in the case of the upper lip and up in the case of the lower lip. In this way, the reduction is accomplished. Lip augmentation will increase the size of the red portion of the lips without all dangers of Silicone injections. Lip enlargement is accomplished by removing a strip of white skin just at the junction with the red skin. The red portion is advanced upward, in the case of the upper lip, and downward in the case of the lower lip. By closing the skin, the lips will appear larger, because the red portion of the lips is larger. The final scar is located where the red portion of the lip meets the surrounding lighter skin. These incisions are somewhat noticeable and that's why this procedure is advisable only for women, who usually wear lipstick. It is noticeable not so much because the scar would not heal well in this location, but because the transition of colors between red and white or dark and light, is sudden rather than gradual, as it occurs in normal, un-operated lips. You will appreciate this if you take a close look in the mirror. The body of the lip can be thickened to a certain degree. The surgeon makes several incisions on the undersurface of the red portion, again behind the closure line. Then the material of the lip is pulled from the side over to the middle, increasing the bulk of the middle portion of the lip. Upper lip lift (or shortening) is recommended in those patients whose upper lip is too long in comparison with the rest of the face or it is too big so that it covers the upper teeth completely even while a person is smiling, which some people consider rather unattractive. Here, skin is excised in the shape of a thin butterfly at the base of the nose to the necessary extent; and by closing the skin the upper lip is shortened and/or lifted up. All the procedures on the lip are minor in nature. The recovery doesn't differ very much from the recovery from an injury when somebody is smacked on the lip.
OTOPLASTY
In western civilization, prominent ears are a stigma leading to ridicule and a psychological handicap for their bearer. Although modern hairstyles are helpful in hiding this deformity, males are still requesting this operation more frequently than females. Because of emotional consequences, it is generally recommended that prominent ears be corrected before the child enters the school - at age 5 or so. In children under 12 - 14 years of age, the operation is performed under general anesthesia, in older age groups under local anesthesia. The incision is made on the back of the ear so that it will remain well hidden. The ears are "pinned back" by the rearrangement of ear cartilage. Postoperatively, you will wear a bandage for 7 days. Subsequently for the next 5 weeks when ever you want to lie down and could fall asleep you must put a stockinette (or ladies stocking) on your head to prevent ears from curling under. This, or any other injury could break the stitches holding the cartilages in their new position and the ear could "spring back" into its preoperative position.
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The next day after the operation the bandage must be changed to check for possible hematoma or early infection.
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CAN COSMETIC SURGERY BE OF ANY BENEFIT TO ME ? E-MAIL TO:
cosmetic@cell-tissuetransplantation.com
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