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Many patients come to me with concerns about facial aging, but when I bring up surgery, they become hesitant towards discussing it. Common worries they express are:
- Do I really need a face-lift?
- Will my face look pulled?
- Is a facelift a big, scary procedure?
- What if it looks unnatural or something goes wrong?
The reality is if you want a more youthful looking face and to get rid of a saggy neck, jowls, fat loss, excess lid skin, droopy brows and wrinkles, surgery is your best option. There is no needle or laser that will fix those issues. But…there is hope for natural, beautiful results that you will love.
What really happens to your face as you age?
Skin: The sun, aging and genetics contribute to sun damage, brown spots, wrinkles, and other skin damage on the surface of the skin.
Forehead/Eyelids: Some patients (and many surgeons) erroneously believe that the bulging fat in the lower eyelid is extra fat that should be removed. It’s not. This fat was just uncovered by fat loss in the cheek (like when low tide reveals things hiding in shallow water). Youthful brows start low medially and end high laterally (look at young models in magazines). Over time, the lateral portion of the brow rotates downward. As our brow descends, our eyelids send signals to our forehead and stimulate our forehead to raise our brow, which in turns leads to more wrinkles. This interaction is automatic and many times a low brow cannot be appreciated until the eyes are closed, which allows the forehead to relax.
Mid-face: Young faces aren’t tight. They have fullness and curves (curves and tension are enemies). As we age, we lose facial fat, especially below the eyes in the mid-face area. The lid-cheek junction, which is about 5-6 mm below the lashes when young, moves downward so that it appears 15-20 mm below the lashes and forms a “bag”. The cheek deflates and falls, creating a jowl and disrupting the smooth contour of a youthful jawline.
Neck: The neck skin loses elasticity and the thin neck muscles (platysma) develop banding.
How is a facial surgery at BPS different from other traditional facial surgeries?
Traditional facelifts have unacceptably long scars and remove too much skin, which makes people look unnatural and too tight. Brow-lifts can unnaturally elevate the entire brow, which makes people look surprised. Fat is too often removed from the lower-lids, which makes them look even more sunken. Skin is pulled tight in an attempt to counter deflation rather than filling the lost volume. Lasers are used improperly and change the basic color of the skin and create scarring, leaving a look that is too white and waxy.
Here is how I approach each area of the face:
Face & Neck: On face and neck lifts, I use a short scar that starts in the sideburn area and ends up a short distance behind the ear lobe. I do not create a “hairline” scar, as that scar is a visible sign of surgery, which we are trying to avoid. (we need a photo of incision. The yellow incision represents a “short scar, the red represents the additional component of a “long scar”.) I often replace lost volume in the face with fat grafting and I rotate the cheek upwards rather than pull it backwards, for a more natural look. This restores the cheekbone and improves the lower lid areas while narrowing the jowl area (young face = apple, old face = pear). The neck has fat removed both on top of and below the muscles. The muscles are repaired in the midline and advanced on the sides (as the cheek is elevated) to create a tighter neck (tension is OK on the neck, a cylinder). The end result is a youthful, beautiful and natural appearance with minimal visible scaring.
Lower Lids: When it comes to lower lids, one procedure doesn’t fit all. The aging in the lower lid can be due to fat loss, skin laxity, wrinkles, texture, spots, etc. I tailor the lower-lid procedure to the identified problems. Sometimes fat grafting and laser is enough. I may remove some excess skin or rearrange fat so it doesn’t look like it’s bulging. Often times I use a combination of procedures (lift cheek, fat graft, remove skin excess and laser) to achieve our desired results.
Upper Lids & Brows: Upper lids and brows are evaluated together. For the brow, I use a small incision about 1-2 cm behind the hairline (hidden) to elevate the lateral part of the brow, giving it a natural and youthful appearance. The upper lid skin excess is removed with an incision in the eyelid crease (I will also remove that bulging fat medially if present). To create the most natural looking results, I leave the inner part of the brow alone and just lift the outer part enough to get over the bony edge. In most people, the brow does most of the work to improve the upper lids.
A good way to look at examples of youthful looking brows is to browse images in fashion magazines. You will notice that the inner brow starts low (compared to the bone edge) and tracks well above the edge as it moves outward. This is normal and natural. A brow that is high all the way across is unnatural, which is the results people receive from a traditional facelift.
Fat Grafting: Fat grafting is a wonderful way to restore volume to the face. I typically graft about 30-45 cc of fat into the face when doing this procedure (as compared to 1-3 cc of injectables in the office). When done properly, fat grating does not create the puffy, over-done look, which I despise. Fat can be grafted into the chin, marionettes, lips, nasolabial folds, mid-face, lower lids, cheekbones, submalar areas, temples, upper lid, etc. Little bits here and there add up to a nice overall improvement. About half of the fat survives and is permanent. We don’t know exactly how, but fat is able to meld with the skin and enhance the skin’s appearance. The loss of fat probably contributes to the aging process of skin.
Laser: The laser procedure we do with facial surgery is called the Pearl Fusion. According the Pearl Fusion laser manufacturer, we perform the most Pearl Fusion procedures in the country. The Pearl Fusion is a combination of the Pearl and the Pearl Fractional lasers, done together serially. The Pearl treats 100% of the surface area of the skin very superficially. It causes the skin to peel improving sun damage, browns, and texture. The Pearl Fractional drills small holes into the skin, similar to aerating a lawn, causing significant improvement of wrinkles and texture. The combination of the two lasers brings a nice overall improvement to the skin without harming the skin’s natural pigmentation or leaving a waxy appearance.
Is surgery worth it?
Having surgery is a trade-off. You have to weigh the positive: a youthful and natural looking face, confidence in your daily interactions, appearing years younger, etc., to the negative: procedure recovery time, scarring and cost, etc. If I don’t think that the trade off is worth it for you, I won’t recommend the treatment. In other words, if I don’t think you will get enough improvement to warrant a particular procedure, then I’ll tell you that and possibly suggest an alternative or tell you to save your money. But if I do make the recommendation, it is because I believe that I can make enough improvement for you that it is worth the risk, recovery, scars, etc. My beliefs come from having done this many, many times and observing patients reactions, level of satisfaction and feedback from all the different procedures I have done over the years.
What is the ideal age for this procedure?
Because my facial surgery results are so natural looking, I have found that I can apply the surgery to younger and older faces, without the fear of making them look surgical.
Because the trade-off starts at a much younger age, I can help more people. Age is much less relevant since my patients will look natural. It becomes a question of whether we can achieve enough improvement to make surgery worthwhile. I am less concerned about the actual age of a patient and more about the health of the patient.
Where do the procedures take place?
All of our surgical procedures are performed at our state-of-the-art, on-site surgery center. Blackhawk Surgery Center is an accredited OR (AAAASF and Medicare) with an anesthesiologist present. Patients are not awake during the procedure, feel no pain and do not remember anything about the surgery. A complete face takes about 3.5 hours and then the patient goes home afterwards. My anesthesiologist, William Kemerer MD, has been with me since I started my practice. I am fortunate to have the best of everything and this undoubtedly includes Dr. Kemerer. Private nursing is available but not required.
When I discuss recovery time, I typically give the time it takes for most patients to feel comfortable returning to work in an office type situation. Whether you do the entire face or half of the procedures, the recovery is about two weeks. A good number of patients return even sooner.
The recovery in my practice has reduced over the last decade due to two major advancements:
1.The change from the traditional or mainstream long-scar facelift to my version of the short scar facelift.
2.The use of activated PRP/Thrombin. During surgery we draw your blood, process it and combine it with Thrombin, which we then spray into the surgery sites. The spray turns into a gel of your own body’s glue. This seals off the capillaries and lymphatics, which dramatically reduces bruising and swelling. With these advancements, the recovery time is less than half of what it used to be.
Why chose Blackhawk Plastic Surgery for your facial surgery?
Faces are complex and not for the neophyte or the non-expert surgeon. You only have one face so you want to make sure you do it right. Certainly don’t trust your face to a non-plastic surgeon or a discount doctor. My practice performs an extremely high amount revisional plastic surgery, repairing the mistakes of previous surgeons.
Your Facial Rejuvenation will be performed in Dr. Ronan’s surgery center located in Danville.