Facial rejuvenation procedures are performed to reverse or minimize the
effects of facial aging. This is accomplished by addressing one or more of the
three major features of facial aging: skin aging, volume depletion, and tissue
laxity and sagging.
Skin aging is due primarily to sun exposure, but also due to other environmental
agents and to some extent, the natural aging process. Aging skin is characterized by
a roughened skin texture, thinning, enlargement of the pores and
discoloration, both red and brown, as well as sallow complexion and wrinkling.
Volume depletion is due to a loss of facial structural tissues including the collagen
layer of the skin, structural fat, muscle, and facial skeletal bone. Laxity and sagging are the result of gravity acting on tissues affected by skin aging and volume depletion. The result is downward displacement of the facial tissues, flattening of the middle part of the face, deep folds around the mouth, jowls, and loose tissues in the neck.
Skin rejuvenation is accomplished by a variety of procedures including skin resurfacing, both invasive and non-invasive, Botox® Cosmetic to diminish the number of fine lines by quieting the muscles of facial expression, and skin fillers to fill in fine lines and skin irregularities.
Facial volume loss usually becomes apparent in the fourth decade of life, as
heaviness of the folds between the cheeks and the lips, as well as flattening
in the middle part of the face. As it continues, it creates hollows around the eyes and
around the mouth, as well as other areas of the face. The best
correction for volume loss is volume replacement, which is accomplished by either autologous fat transplantation, (injecting one’s own fat), other injectable fillers, and in some cases, placement of facial implants: cheek, sub-malar, and chin.
Facial laxity and sagging is corrected to some extent by volume replacement
but more significantly by lifting procedures, including facelift,
mid-facelift, and forehead lift or brow lift.
A major component of facial aging is gravitational aging, which is seen as drooping, bagginess, and sagginess of the facial tisues. This is due to the downward displacement of the facial soft tissues: skin, muscle and fat due primarily to gravity and volume loss. While all the causes of facial aging act in concert, they’re treated separately.
The facelift, or cervico-facial rhytidoplasty, corrects the gravitational changes in the lower one third if the face and the upper neck by smoothing the jaw-line, softening the jowls, taking up the lax skin in the neck and under the chin, and repositioning the lower cheeks in a more superior position, resulting in a smoother, more youthful appearance. While a facelift (or any other surgical procedure for that matter) can’t stop the aging process, it can “turn back the clock”.
“In many younger individuals 40-55 years of age a more abbreviated form of the facelift operation, a minimal incision facelift, can be performed”. This operation uses a shorter incision and less surgery to rejuvenate the face. It has an excellent effect on the jowl and lower cheek, but less effect on the neck than the standard facelift operation. It results in a much quicker healing time. Whether or not you are a candidate for this operation is determined at the time of consultation, depending on your concerns, expectations for improvement, and Dr. Russo’s examination of your face.
Facelifts can be performed alone or with other cosmetic procedures such as forehead lift, mid-face lift, or blepharoplasty. Most are performed under general anesthesia in an outpatient surgical facility. Depending on the area to be treated, facelifts usually involve incisions made along the hairline, which extend around the ears to the lower scalp. The skin is lifted away from the fat and muscle underneath, and excess fat is sculpted and the remaining tissue is tightened, the skin is replaced, tightened and secured with sutures or clips
Swelling and minor discomfort lasts for a few days; sutures and clips are usually out within the first eight days.
Following surgery, strenuous activity, which increases your blood pressure, should be avoided for about three weeks. Along with prolonged exposure to heat or the sun.
The mid-face is the area between the lower eyes and the mouth. The mid-face begins to show signs of aging by age forty in most individuals. The cheek pads begin to look saggy and flattened, lower eyelids become lengthened, puffy and hollow; the lines and folds between the nose and corner of the mouth begin to deepen, and the corners of the mouth may begin to turn downward.
The mid-face lift restores the natural curves and fullness of the cheeks, shortens the lower eyelids, and reduces the nasolabial folds by elevating the mid face tissues from the bone, repositioning it upwards toward he eyes, and fixing it in place until it re-adheres in its new elevated position naturally to the bone.
This procedure subtly restores cheek volume and more youthful mid face contours. In the younger patient this is often performed as an isolated procedure or with lower eyelid skin excision. It can also be combined with other procedures for more complete facial rejuvenation.
Dr. Russo uses the Endotine™ mid-face device to hold the tissues in their new, elevated position until healing occurs. The device is not visible and usually not easily palpable. The device dissolves in the same manner as a dissolvable suture. This procedure can be performed under general or sedation anesthesia as an outpatient.
Deep furrows, frown lines over the brow, drooping eyebrows and hood-like skin over the eyes are all conditions that can make you look tired, angry, and older than you are or feel. A Forehead (Brow) lift can give you a more youthful, rested, and alert appearance. Forehead lifts are usually performed under general or twilight anesthesia. Dr. Russo makes an incision at or just above the hairline. Some patients are best treated by the endoscopic or minimal incision approach. Excess skin, fat and portions of the muscle are then removed through the incision, which is then closed with clips or sutures or clips. Forehead and brow lifts may be performed alone, or along with other procedures such as a facelift, mid-face lift, or eyelid surgery. Most patients are up and about the next day, and back to work in 7-10 days.
A newer mini-brow lift is performed though the upper blepharoplasty incision. The brow is elevated and suspended from an absorbable device attached to the forehead bone. Surgery and recovery is much quicker. Not every patient is a candidate for this procedure.
This describes the surgical approach, not a "surgical procedure". Endoscopy is applicable to a number of different facial procedures that are performed in a minimally invasive way by making small incisions and introducing an endoscope or surgical telescope with an attached TV camera under the skin. Areas remote from the incision could then be operated on while being magnified and visualized very well on a TV monitor. This has the most application in our practice in treatment of the forehead and sometimes the mid-face. When performing an endoscopic forehead lift, we utilize the Endotine™ dissolvable suspension device so that no permanent hardware is left under the skin.
Eyelid lift (or blepharoplasty) is the preferred treatment for removing bags under the eyes or heavy upper eyelids, conditions that can give you a tired or haggard look, make you look older than your years, and even impair your vision.
Eyelid surgery is frequently performed under local anesthesia with intravenous sedation (twilight sleep) as an outpatient. Dr. Russo will make small incisions along the natural lines of your eyelids, through which excess fat, and loose skin and muscle are removed. The incisions are closed with fine sutures, which will leave scars that are practically invisible. Lower eyelid surgery is frequently performed using an internal incision which results in no visible scars.
Lower eyelid aging, in some individuals, is due more to sagging of the cheek pad than the changes in the eyelid itself. These individuals require a mid-face or cheek fat pad lift for optimal rejuvenation of this area, in addition to lower eyelid blepharoplasty.
Most patients are back to their normal routines within days after eyelid surgery, although complete recovery may take a few weeks. Swelling, and bruising and some discomfort are part of the recovery process, and usually can be alleviated with cold compresses and appropriate medication.
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