Forehead Lift

Browlifts can revitalize drooping or lined foreheads, helping you to look less angry, sad or tired. Using either traditional or minimally invasive (endoscopic) methods,browlifts involve the removal or alteration of the muscles above the eyes to smooth lines and raise the eyebrows for a more youthful appearance. The procedure is often combined with other operations such as blepharoplasty (eyelid surgery) and facelifts to improve the look of the eyes and other areas of the face.

While browlifts are typically performed on patients aged 40-60 to counteract the effects of aging, anyone with lined or inelastic skin on the forehead – whether it’s caused by muscle activity or inherited conditions – are eligible. The procedure is usually performed in an office-based facility or surgery center under local anesthesia and sedation.

Traditional browlift: First, the patient’s hair is tied with rubber bands near the incision site. Then the surgeon makes a coronal (headphone-shaped) incision behind the hairline, stretching between the ears and across the top of the forehead. The incision may be placed further back or made along the skull bone joints to minimize visibility in patients with thinning hair or who are bald. Then the forehead skin is lifted, tissue is removed, muscles are adjusted and the eyebrows may be lifted. Excess skin is trimmed and the incision is closed with stitches or clips. The site is washed and the rubber bands are removed. Some surgeons will protect the stitches with gauze or bandages.

Endoscopic browlift: After the hair is tied as with the traditional procedure, the surgeon makes three to five short incisions (less than an inch long) behind the hairline. The endoscope is placed in one so the surgeon can see beneath the skin without having to make a large incision, while he or she lifts the skin and adjusts muscles through the other incisions. If the eyebrows are lifted they will be stitched or screwed (temporarily) into place. The site is washed and the rubber bands are removed. Some surgeons will protect the stitches with gauze or bandages.

With both procedures, you will be on your feet and able to wash your hair in a day or two, and many patients return to work or school in 7-10 days or less. Swelling and bruising should fade by the third week.

Complications are rare and usually minor but may include temporary numbness, nerve injury, hair loss along scar edges, formation of a broad scar requiring surgical correction, and infection and bleeding.


 

Facial Resurfacing

Laser skin resurfacing, commonly called a laser peel, removes the outer, often damaged layer of skin for a smoother, younger look. Laser resurfacing can reduce the appearance of sun damage, wrinkles, fine lines, uneven pigmentation and superficial scarring, usually on the face. A carbon dioxide laser beam of intense, precisely-focused light vaporizes the surface skin and reveals the undamaged layer beneath. The procedure can take anywhere from a few minutes to two hours depending on the size and severity of the area being treated, and may be combined with other procedures such as a browlift or eyelid surgery for even more dramatic results.

Chemical peels remove damaged outer layers of skin on the face to smooth texture, reduce scarring, and remove blemishes and pre-cancerous growths to produce healthy, glowing skin. There are three types of chemical peels, ranging from mild to strong – alphahydroxy acids (AHAs), tricholoroacetic acid (TCA) and phenol – and formula strengths are tailored to each patient. Peels can be combined with other procedures such as facelifts for a younger look. They may be covered by insurance if they are performed for medical rather than cosmetic reasons.

AHAs are the gentlest of the three types of chemical peel. They consist of a group of glycolic, lactic and fruit acids that smooth and brighten skin by treating fine wrinkles, dryness, uneven pigmentation and acne. AHAs are typically applied once a week, or may be mixed in a milder concentration with a cream or cleanser to be used daily; treatment takes 10 minutes or less. Patients may choose AHAs if they do not want the lengthy recovery time of a phenol or TCA peel. Occasionally AHAs, Retin-A (a prescription medication containing Vitamin A) or hydroquinone (a bleach solution) are used to thin the skin and even its tone as a pre-treatment for TCA peels.

TCAs are commonly used for medium-depth peeling (though depth is adjustable) to treat fine surface wrinkles, superficial blemishes and pigment problems, sometimes in combination with AHAs. TCAs are the preferred chemical solution for darker-skinned patients and may be used on the neck and other areas of the body. Results are often less impressive and do not last as long as with phenol peels, and multiple treatments may be required, but treatments only last 10-15 minutes and recovery time is shorter.

Phenol, the strongest chemical peel, treats deeper skin problems such as coarse facial wrinkles, pre-cancerous growths, and areas of blotchy or damaged skin caused by sun exposure, aging or birth-control pills. Because phenol can lighten skin where it is applied, the patient’s natural pigmentation is a factor in determining eligibility. Phenol is used only on the face, as it may cause scarring elsewhere. Full-facial treatment can last an hour or two and recovery can take a few months, with possible permanent skin lightening and removal of freckles.


 

Eyelid Surgery

By removing excess fat, skin and muscle from the upper and lower eyelids, blepharoplasty can rejuvenate puffy, sagging or tired-looking eyes. It is typically a cosmetic procedure but can also improve vision by lifting droopy eyelids out of the patient’s field of vision. Blepharoplasty cannot be used to raise the eyebrows or reduce the appearance of wrinkles, crow’s feet or dark circles under the eyes, but the procedure can be combined with others such as a facelift and Botox® treatments to achieve these results.

The procedure is usually performed in an office with local anesthesia and lasts 45 minutes to a few hours depending on how much work is done. Incisions are made along the eyelids in inconspicuous places (in the creases of the upper lids, and just below the lashes on the lower lids). The surgeon removes excess tissue through these incisions and then stitches them closed with fine sutures. In the case that no skin needs to be removed, the surgeon will likely perform a transconjunctival blepharoplasty, where the incision is made inside the lower eyelid and there are no visible scars.

Stitches are removed after three or four days and most people return to work in ten. Contact lenses may not be worn for two weeks. The effects of blepharoplasty can last for a long time and are sometimes even permanent.


 

Rhinoplasty

One of the most common plastic surgery procedures, rhinoplasty is performed to reshape, reduce or augment a person’s nose, remove a hump, narrow nostril width, change the angle between the nose and the mouth, or to correct injury, birth defects, or other problems that affect breathing. Results depend on the patient’s nasal bone and cartilage structure, facial shape, skin thickness and age (teenagers should have had their growth spurt). Insurance may cover rhinoplasty if it is done for reconstructive or medical reasons, but likely not for cosmetic purposes .

Rhinoplasty is usually an outpatient procedure performed under either local or general anesthesia and lasts one to two hours unless more extensive work needs to be done.

Surgeons use one of two techniques: the incision is either made within the nostrils, thus hiding scars after surgery, or across the columella (the vertical strip of tissue separating the nostrils) in an “open” procedure, where scars are small and hidden on the underside of the base. In both procedures the skin is lifted, the bone and cartilage sculpted, and the skin replaced and stitched closed.

For a short time after surgery you may experience puffiness, nose ache or a dull headache, some swelling and bruising, bleeding or stuffiness. Most patients feel like themselves within two days and return to work in about a week. Contact lenses can be worn immediately but glasses will have to be taped to your forehead or propped on your cheeks for up to seven weeks.

Complications are rare and, when they occur, minor. These may include infection, nosebleed, or a reaction to the anesthesia.


 

Otoplasty

Ear surgery typically serves two functions: setting prominent ears back closer to the head, and reducing the size of large ears. Surgery may also be helpful for “lop ear,” “cupped ear” and “shell ear,” large or stretched earlobes, and lobes with large creases and wrinkles. Surgeons are also able to construct new ears for patients who are missing them from injury or other causes.

Although surgery for adults is available, the operation is most often performed on children aged four to 14 — ears are almost fully grown by age four, and early surgery can prevent a child from being teased in school.

Otoplasty lasts from two to three hours and may be performed in a hospital, office-based facility or an outpatient surgery center. General anesthesia is recommended for very young patients, while local anesthesia and a sedative are used for older children and adults.

During surgery, a small incision is made behind the ear, revealing the cartilage which is then sculpted, bent into its new position and stitched into place. In some types of otoplasty skin is removed but the cartilage is left in one piece and merely bent back on itself for a smaller-looking ear. A bandage is wrapped around the head to ensure the new positioning. To achieve better balance, both ears may be operated on even if only one has a problem.

Patients of all ages usually feel back to normal after a few hours, although the ears may ache or throb for a few days. Bandages are replaced with a surgical dressing after a few days, and stitches are removed within the week. Adults often return to work in five days and children may return to school in seven. Otoplasty leaves a faint scar on each ear that fades with time.

You should not expect your new ears to match exactly; even normal, natural ears are not identical.

Complications are rare and usually minor, but may include blood clots and cartilage infection (usually treatable with antibiotics but occasionally requiring surgery).


 

Scar Revision

The extent of scarring after injury or surgery depends on a number of factors, including the nature of the injury or the surgeon’s skills, your body’s healing mechanism, the size and depth of the wound, how much blood supplies the area and the thickness and color of your skin. Scars are by definition permanent, but surgery can narrow, fade and otherwise reduce the appearance of severe or unattractive scarring, which is especially helpful in areas of cosmetic importancesuch as the face and hands.

Because large, tight, dark and otherwise problematic scars can improve after many months, it is recommended to wait at least a year before considering surgery. In the meantime, itching and other symptoms can be relieved with steroid injection. There are many surgical methods of scar revision, only some of which may be appropriate for a particular type of scar or its location. These include surgical excision, skin grafts, flap surgery and Z-plasty (repositioning a scar so that it aligns with the face and is less noticeable). Keep in mind that there are non surgical alternatives, such as dermabrasion, which can soften scars, and phototherapy and laser treatments, which can lighten them.


 

Hair Replacement

Only professional treatment by a physician can counteract hair loss. Customized treatment plans for individual patients using the latest techniques and technology make it possible to successfully compensate for thinning hair or baldness. Treatments vary depending on the extent and pattern of hair loss and the patient’s preferences, lifestyle and expectations, but typically include hair transplants, scalp reduction, skin lifts/grafts, medication or a combination of these.

In a hair transplant, thin strips of skin containing hair are removed from the scalp and replaced in tiny holes (often created with the use of lasers) in the bald or thinned area. The grafted hair falls out after the procedure but then grows back and should last as long as the hair from the area in which it was taken.

Scalp reduction involves surgical removal of all or part of the bald scalp, followed by the lifting and pulling-together of the remaining hair-bearing skin. Occasionally scalp extenders or tissue expanders are used.

During a skin lift or graft, a “flap” of hair-bearing skin is surgically created and rotated onto the bald or thinned area.

Additionally, drugs such as Minoxidil and Finasteride may be applied to the scalp alone or in conjunction with the above procedures to preserve existing hair and stimulate the growth of new hair.