Archive for the 'facial aging' Category
While more women than men undergo facelift procedures, men still make up about 15% to 20% of the facelift population. Men are almost exclusively bothered by a ‘neck waddle’ and usually consider a facelift at an older age than women when this waddle is more significant. One of the keys to facelifting in men is not too overdo it. I have see many men who have had a facelift and they look a little unnatural at best and some even look more effeminate. I am certain this is not what they were seeking from the procedure. A subtle improvement for men is much better than an overdone dramatic one. Men, understandably, are particularly skiddish about being known as having had a facelift.
From a planning and technical standpoint, the male facelift patient differs from the female in one significant way….hair. Both the amount and style of scalp hair and the presence of beard skin changes several aspects of the operation. The placement of the incisions and their eventual obscurity is of critical importance. Like all facelifts, the first and most important goal is to have scars that are difficult to find. No matter how great the neck and jowl result is, or how long the result may last, poor and visible scarring will make that all irrelevant. I have yet to find a patient who wants to advertise that they have had a facelift. (although some results that you have seen scream that they have!)
Men have beards which provide both an advantage and a disadvantage. The upward-disappearing sideburn that can occur in women with a facelift (the tuft of hair in front of the ear gets higher) is not an issue for most men. When their existing sideburn gets higher after surgery, they simply start shaving lower regaining the lost sideburn. Most men should even start before facelift surgery in growing longer sideburns so they will be at a normal level after surgery. The diadvantages are that the incision in front of the ear must stay…in front of the ear. It can not be placed partially inside the ear as in women (known as retrotragal) because beard skin will drawn up into the ear which is both a nuisance and not natural looking. In addition, because of the direction of pull behind the ear in a facelift, some beard skin will end up behind the ear necessitating shaving this area. As long as men are advised of this possibility and after surgery requirement, I have not seen it to be a problem.
One final thought on male facelift results…..men do not usually get a particularly dramatic result. Their skin often stretches more than a woman’s making it difficult (and unnecessary) to create a super sharp neck angle. They are also prone to more settling or some ‘relapse’ after surgery due to their thicker heavier skin. As already mentioned, however, men are usually not interested in spectacular changes but prefer less obvious ones. This may be the most important key to the male facelift patient.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
As we age, most people will develop lower eyelid prominences otherwise known as lower eyelid bags. Ini addition to the excess skin thaty develops, a big part of these bags is caused by fat coming out from underneath the eye. In plastic surgery, we call this ‘herniated orbital fat’ which has alway been believed to be caused by the weakening of the tissue that runs between the eyelid and the underlying rim of orbital bone. (known as the orbital septum) Much like a hernia, this support tissue becomes weak and allows some of the fat which wraps around the eyeball to come protruding out. As a result, lower eyelid surgery (lower blepharoplasty) has traditionally involved removing this overhanging fat as well as the extra skin to make this area look better and smoother.
A recent study published in the September 2008 issue of the journal, Plastic and Reconstructive Surgery, looked at the progressive development of these lower eyelid fat prominences to try and explain why we see with age. Their objective was to evalute more closely the long-held belief of a fat hernia under the eye. Through MRI studies of forty patients of different ages, measurements were taken of the eye, fat amd surrounding bone. What they found was that the eyeball stayed in the same position throughout life but the amount of fat around the bottom part of the eye actually increased as we age. These measurements suggest that as we age there is actual fat expansion below the eye that accounts for the development of the lower eye bags.
Recent thoughts on aging lower eyelid (blepharoplasy) procedures have leaned toward doing more of a hernia repair rather than relying on traditional excision for management of the lower eyelid bags. These study findings, however, indicate that the removal of lower eyelid fat is still a good thing to do and is an important component of lower eyelid procedures for many aging patients. There is always the concern that removing this fat may make the eye look ‘too hollow’ over time. But this is not something that I have observed nor do I see it reported in the plastic surgery liiterature.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
A smaller lower face has been shown to be more attractive and youthful looking. Recent research (at the University of Texas - Southwestern and published in Plastic and Reconstructive Surgery 2008 by Dr. Joel Pessa) has shown that, as we age, the lower jaw continues to grow more so than the rest of the face. Therefore, there is a change in the shape of the face as we get older that in some patients makes it less attractive. These bony changes combined with the loss of facial fat as one ages accentuates the appearance of age. A youthful face is full which is lost as we age, particularly around the eyes and cheeks. These bone and fat changes make the cheeks more sallow and give the impression, with the development of jowling, that the chin is bigger.
Understanding these aging changes provides direction as to how to approach facial rejuvenation surgery in the aging patient. While you can’t make the jaw smaller, you can make it appear smaller by augmentation of the cheek and midface areas. This can be done with either fat grafts or cheek implants. Which one is best must be individualized for each patient. Cheek implants or submalar (under the cheek) implants can help lift a sagging midface as well as provide better cheek projection. If malar crescents (sagging skin from the lower eyelid hanging on the cheek) are significant, then a midface lift may also be done with a lower blepharoplasty to work out the excess skin as well.
The lower face and jowling still relies on the ‘traditional’ facelift approach with the objective of eliminating the jowling and tightening up loose neck skin. This effect, combined with cheek volume restoration, helps make the face look younger by changing the disproportions caused by aging.
In the younger patient with early signs of facial aging, injectable facial fillers can be an effective non-surgical approach in the cheek area. When these fillers become more long lasting or even permanent, we will see more of these patients seeking these treatments earlier before the negative facial effects of aging become too noticeable.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Men pose uniquely different challenges than women when it comes to the consideration of facelift surgery. Men age just like women but usually are only concerned with their neck when becomes more of a waddle. As a result, they often are seen in plastic surgery consultation with more advanced facial aging concerns than what one sees in women. Because of their more advanced neck issues and the heaviness of the male skin, minor or more minimally invasive procedures are not going to be effective at making a significant difference in their neck. Only a real facelift procedure will do the trick.
But the typical facelift operation is more difficult in men because of two hair issues….their beard skin and the hairline and quality of hair density (or lack thereof) around their ear area. As the conventional facelift procedure uses incisions in and around the ears, with a subsequent redraping of skin back and over the ear, men will often end up with beard skin behind their ear and potentially even inside their ear after the skin excess is trimmed. For this reason, the male facelift must often use an incision in front of the ear at the junction of the beard and non-hearing skin just in front of the ear to keep hair out of the ear after the operation. Keeping beard skin from ending up behind the ear is difficult and most men should expect that they will have to shave behind their ears after a facelift procedure. ( at least for an inch or behind the ear lobe)
For some men, their sparse hair over the temple areas and around the ear may make a conventional facelift very difficult to do to end up with good camouflaged scars. This is rarely a problem in women. Usually the scar ends up above the ear in the hairline, but with todays’ very short hairstyles particularly in men with thin or little hair, it may not be very camouflaged and this is a very real consideration and concern. No male wants any area of the facelift scar to be visible so where to end the scar, and how that may affect the outcome of the procedure, must be thoroughly discussed prior to facelift surgery.
Me also will not get as dramatic a change in the neck as women will with a facelift. The heaviness and thickness of male facial skin does not allow it to tightened as much. And the way the facelift must be done in consideration of their hairline will also play a role in the outcome. Men are also prone to more ‘rebound relaxation’ in the jowl and neck area after surgery due to the quality of their skin, another factor that plays into the long-term outcome. Fortunately, men do not usually want a dramatic change anyway from any facial procedure so all of these issues usually add up to a good result that will please most men.
In rare cases of the much older male (usually greater than 65) who has a large neck waddle and does not want or can not undergo a significant operation, the direct neck lift can be an option. Rather than using any incisions around the ears, the loose skin is cut out directly in the neck. This produces a pretty significant change that offers a much more limited recovery. And can be a consideration if the man can accept a scar running vertically down from the chin to the adam’s apple. Surprisingly that scar can heal very nicely due to it being in beard skin which scars less than non-beard skin most of the time.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The concept of a facelift for many patients, initially, seems extreme. Prospective patients often have a vision of being swollen and bruised for weeks over their entire face. Such thoughts have driven some patients to other less or minimally-invasive procedures which are often inappropriate for their facial aging problem. They may have been less invasive and may have cost less, but the end result may have also been disappointing.
Some potential patients suffer two fundamental misconceptions about facelifts…what they are and what the recovery may be. Over half of the facelifts that I do are done in isolation without any other facial procedures. Some patients are only concerned about the appearance of their neck and are not concerned about their eyes, for example. If that is only what concerns the patient, then that is the only issue that needs to be addressed.
An isolated facelift, or a neck-jowl lift, causes none of the issues that many patients fear. There would be no swelling or bruising around the eyes. The neck and jowl line will have some mild swelling and bruising…but it will be painless as the neck and jowl skin are numb for several months after surgery anyway. The only discomfort will be around the ears where the incisions are placed. The ears will be tender for a week or two as these incisions heal. While I use a head dressing that wraps around the neck for the first night….with surgical drains… all of this gets removed the following morning. In limited facelifts, there is no further dressing needed. In full facelifts, a small neck strap is used for a few more days. Showering and washing one’s hair can be done the next morning. There is no concern about getting the incision lines wet. Once can style and blow-dry their hair as they wish. Even with some mild swelling and bruising the neck and jowl
Patuent fears about facelift surgery are often unfounded. When done as the only facial procedure, a facelift is much easier to go through than most envision. An improved understanding of a facelift and its recovery is helpful for patients to make better decisions and ensure a good return on their investment.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Limited Facelift in Indianapolis
As we age, our face starts to show jowling and loose neck skin. This happens due to the pull of gravity on our facial tissues whose attachments to the underlying bones and tissues gradually loosens. While there are other signs of facial aging, these are often the most bothersome to many people. Most do not notice these facial aging signs that much until they see themselves in pictures from a side or profile view, to which they may be quite surprised that their neck or jowls looked ‘that bad’.
All facelifts are not done alike. Simplistically, they fall into two main categories….full and limited. The limited facelift has become quite popular and represents nearly 50% of all facelifts that I do today. The limited facelift goes by a lot of different names such as the LifeStyle Lift, Quick Lift, Swift Lift, S-Lift. to name a few of the most prominent and marketed. There are other names as well and there will be more marketed and practice-branding names in the future. But essentially they are all the same (despite what each may claim) with a few minor variations that quite frankly don’t mean anything to you as a patient nor to the long-term outcome of the procedure. The difference between a full and limited facelift is…..that the limited facelift is to no surprise more limited. Very little work is done in the neck area and the procedure and scar is isolated to in front of the ear. Mechanically, the upward pull of the limited facelift is fairly vertical as opposed to a full facelift which is closer to 45 degrees so that the excess neck tissue can be worked out behind the ear.
The result of a limited facelift is obviously less than that of a full facelift but the results in the jowl and upper neck area can still be quite impressive nonetheless. The key to a very satisfied outcome after a limited facelift is in proper selection of the patient. My approach in patient selection is that it is good for two types of patients. The ideal candidate is the ‘younger’ patient who has early onset or only a moderate degree of jowling and loose neck skin. These are the perfect patients for the procedure as they will get an ideal result. Furthermore, their ‘problem’ doesn’t merit a full facelift anyway. The other patients who can benefit are those whose jowl and neck issues are more severe, and they would get a better result from a full facelift, but they desire less of an operation for a a variety of personal reasons. As long as they can accept and have been fully apprised that the result will not be similar to a full facelift, they can get good results also. For these type patients, its all about understanding that the results are effort-driven. The less of a procedure you do, the less of a result you will get.
Unlike some advertised plastic surgery procedures, the limited facelift lives up to its hype. It is a 60 to 90 minute outpatient procedure that requires no drains or dressings. A good social recovery (how do I look?) does take only about a week. Other than some mild ear tenderness, there really is no pain. When combined with other facial procedures (which may require a more normal recovery), even more dramatic changes can be achieved.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
I would have to say that one of the biggest misconceptions on the part of patients in plastic surgery is in understanding what a facelift is. On a near daily basis, I explain to potential patients, much to their surprise, that what they envision a facelift to be it is not. Most patients have the perception that a facelift involves the entire face, from the scalp down to the neck. And they envision weeks of horrid facial swelling and bruises. These images are further fostered by what they have seen on the internet and on TV.
In reality, however, this is not what a facelift is. A facelift is a rather poorly named surgical procedure. More accurately, it should be called a neck or neck-jowl lift for this is what it actually does. A facelift affects only the lower third of the face and does nothing for the upper and middle thirds of the face. It helps re-create a sharper neck angle and gets rid of those saggy jowls. When a facelift is done in isolation, there is no bruising or swelling around the eyes or the rest of the face! Many times, however, patients wants a more complete facial improvement and then simultaneous procedures involving the eyes, nose, or mouth may be done with a facelift, the effect of which is to more closely mimic the images that patients originally imagined a facelift to be.
When I do a facelift only, patients do have a head dressing and surgical drains for the first night after surgery. However, these are removed the next day and replaced with a small chin strap that they wear for the rest of the week. Patients may shower and wash their hair the next day. Short of bending over or strenuous exercise there are no specific activity restrictions. Recovery is really of a social nature, rather than that of a physical one. There is virtually no pain and only some mild tenderness around the ears. You really will look pretty from a facelift only procedure in seven to ten days.
Undergoing a facelift should not be viewed, therefore, as a scary or arduous undertaking. Most patients will tell you that it was a lot easier than they had imagined. Many times patients will want a more complete amount of facial improvement and surgery on the eyes (blepharoplasty) would be the most plastic surgery procedure done with a facelift. This is because most patients feel that the eyes and neck are their top two facial aging concerns they want improved.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Facelifts do an excellent job at achieving a rejuvenated facial appearance by tightening the neck and eliminating those sagging jowls. In the world of plastic surgery, there has been much debate over decades as to the best way to get and maintain a good facelift result that will hold up over years. These include such concepts as platysmal release and plication and many different methods of SMAS development and repositioning, all methods that manipulate the tissues from the deeper muscles up to the overlying skin. While there is clearly benefit to doing so, there is no concensus on which methods are most optimal. Moreover from a patients perspective, they are completely unaware of these types of non-skin efforts and, while they are very interested in getting a good long-term result, there are certains aspects of a facelift from which they have more important concerns.
First and foremost, patients certainly do not want to sustain any complications from surgery particularly om their face. The most dreaded complication of a facelift would be an injury to the facial nerve. While such a rare injury, if it occurs may only be temporary, but any form of transient facial nerve paralysis is unsavory. Deeper plane facelifts definitely have a greater risk of this problem. The balance of its benefits vs its risks must be thoroughly discussed with your plastic surgeon during your consult.
Secondly, patient do not want to have any telltale signs of having had a facelift. This would be the result of poor scar placement around the ears or an altered temporal hairline that is moved up too high. In my opinion, proper incision placement is more important than whether one does a deep plane technique or not. Also, patients definitely do not want an unnatural look from being pulled ‘too tight’. I have yet to see a patient who has asked that their face be pulled as tight as possible. What patients have to realize is that their cheek-lip grooves (nasolabial folds) or the down turning of the corners of the mouth will not be improved no matter how tight a facelift is pulled. They require other simultaneously done procedures at the time of the facelift to get improvement in those aged areas.
Lastly, most patients really don’t want a long social recovery after a facelift, meaning that they look ‘bad’ for two or three weeks due to swelling and bruising. No matter how good the long-term result will be, they will never forget that type of recovery. Patients want a good result, but they also want a recover that is not unduly prolonged.
Facelifting surgery is a balance of how aggressive to be with the lifting and tightening process at the risk of a longer recovery and an increased rate of complications. A good thorough consult before your facelift with your plastic surgeon should cover these issues in detail so you can make an informed decision.
Dr. Barry Eppley
http://www.eplpeyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
While there are many changes that occur in the face as we age, one of the most bothersome to many patients is the changes that occur in the neck. Progessive fullness of the neck, loose sagging skin, the development of vertical banding, the numerous horizontal wrinkles that appear low in the neck and the loss of a good sharp neck angle all capture the eye of the patient and others as well. These neck changes rank right up there with aging around the eyes as the most concerning facial aging concerns to most patients.
Like the rest of medicine, it is important to determine what the anatomic problems are in the neck to match up the best operation to improve it. Younger patients often just have some beginning neck fullness and a little bit of jowling. Simple liposuction and a little jowl tuck-up may be all that is needed in these younger patients. In some of these cases, I have used LipoDissolve injections alone and have gotten a good result if the patient can tolerate the temporary swelling that comes after eacj injection session and the 3 to 4 months to get the final result. Older patients usually have more sagging and loose skin and something like a more extended facelift (neck-jowl lift) is more appropriate. This is where sitting down with your plastic surgeon and going over your concerns with the aid of a mirror is so important. The selection of which operation is best for you will depend on a good understanding on your part of what do you want to see changed and what are you willing to go through to get it.
The aging neck in the male poses some different issues. They often have more skin excess and the facelift incisions that are used in females have to be altered to account for the male beard pattern. In addition, males have a much greater tendency towards some relapse after facelift surgery due to their thicker and heavier skin. Men also have a much greater aversion to major facelift surgery and may opt for an alternative procedure known as a direct neck lift. This procedure dramatically reshapes the neck and can produce a very sharp neck angle…but at the cost of a midline neck scar from below the chin down to the adam’s apple. For some older men this may be a good trade-off and this scar usually turns out fairly well due to how better hair-bearing skin heals scars.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The Role of the Limited Facelift in the Younger Patient - Dr Barry Eppley in Indianapolis
The last five years has seen the introduction and popularity of numerous non-surgical or minimally invasive techniques for facial rejuvenation. The list includes Botox, injectable fillers, skin tightening devices, and threadlifts. Each one of these techniques has carved out a niche amongst facial improvement methods, some far more effective than others.
From a simplistic standpoint, I like to think of early facial anti-aging procedures as central or lateral, in terms of the areas of the face where they are used. Botox and injectable fillers are widely used, effective and are essentally central facial treatment techniques. Both are used primarily around the eyes and mouth, central treatment areas. Skin tightening devices such as Thermage and threadlifts are used mainly in the neck, jowl, and brow areas, lateral treatment areas. Using this concept, clinical experience has shown that non-surgical methods work well centrally, but are less effective in lateral facial areas.
While I like the concepts of skin tightening and threadlifting, for many patients and their aging issues they don’t produce enough of an effect or last long enough to justify the effort. I have found that more limited types of facelifts, while it is surgery, produce much better results with really minimal recovery. Through limited incisions in the temporal hairline carried in front of and into the ear, the skin can be lifted and the underlying SMAS layer tightened. This produces a nice uplift of the jowl area and jawline and some tightening of the neck. In the younger patient with early signs of jowling and a looser neck, a limited facelift is a much better value than any other lateral non-surgical procedure. It lasts longer and has a more visible and immediate effect. The costs may be higher, but dollar for dollar, it is usually a better investment of your cosmetic resources. The intermittent use of limited facelifts ove the years may eliminate, or at least put off, the need for a more complete and extensive full facelift.
In the central face, however, the use of Botox and injectable fillers is unmatched by any type of more invasive procedure.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indian
Indianapolis