Facelift
As such, the facelift represents the cornerstone of facial rejuvenation. Though laser skin resurfacing, peels, endoscopic procedures, fatgraft injections, and åmini-facelifts¼ have their role, they do not represent a substitute for a proper facelift. Therefore in situations where the facelift is indicated, relying on these ancillary procedures will ultimately create disappointment.
Forehead and Eyebrow Lift
Eyelid Surgery
Surgery of the Nose
Facelift
As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and the mouth. The jaw line becomes slack and jowls become prominent. Folds and fat deposits appear around the neck. A facelift, technically known as a Rhytidectomy, can't stop this aging process. It can, however, set back the clock, improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping this skin of the face and neck. The facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or laser skin resurfacing.
The maximum beneficial effects of the facelift are in the region of the neck, the jaw line, the area of the jowls, and the lower two-thirds of the face. As good as the facelift is, it does little for the vertical lines around the mouth, frown lines, the forehead, and the upper and lower lids. When these areas represent issues, they can be addressed at the time the facelift is performed. There is, therefore, one visit to the operating room, one anesthesia, and one recovery period.
The purpose of the facelift is to rejuvenate while retaining a soft, natural appearance. Poor examples of facelifts are readily obvious. The face assumes a mask-like appearance. This skin is tightly drawn as it drapes across bony prominences. The face may even appear expressionless, with all lines of expression eliminated. The proper facelift, on the other hand, leaves an appearance which is distinctly natural but rejuvenated.
The procedure is done in an outpatient operating room facility under a superficial plane of general anesthesia. Though the facelift can be done as an outpatient procedure, an overnight stay is recommended. All dressings are removed the morning after surgery, and the patient may shower and shampoo before discharge from the facility.
The incisional scars are designed to be essentially imperceptible. All sutures are removed within one week. Pain and discomfort are modest, and most bruising and swelling should be resolved within 7-10 days. Return to work is generally within two weeks.
The forehead lift, also known as a Browlift, can minimize some of the most visible signs of aging: dropping eyebrows, hooding over the eyes, forehead furrows and frown lines that come with age.
Postoperative pain associated with a forehead lift is minimal. Bruising and swelling are uncommon and postoperative dressings are removed the morning following surgery. On the first postoperative day, the hair can be shampooed and conditioned. No subsequent dressings are applied, and sutures are removed on the seventh postoperative day.
The Blepharoplasty may be performed on the upper eyelids, the lower eyelids, or both. It may be performed as an isolated procedure, or in combination with a facelift or brow lift. Blepharoplasty is performed as an outpatient procedure under either local anesthesia or under a superficial plane of general anesthesia. The eyelids are not blind folded following surgery, and soothing iced compresses are applied for 48 hours. Bruising and swelling are modest, and are usually resolved in seven to ten days. Discomfort is minimal.
Forehead and Eyebrow Lift
In a forehead lift, the muscles and skin responsible for the signs of aging are removed or altered to smooth the forehead, raise the upper eyelids, and minimize frown lines. The result can be a more alert, more animated, more youthful appearance. The forehead lift can be done alone, or in conjunction with other procedures such as a facelift, eyelid surgery, or laser resurfacing 
The appeal of the forehead lift is that it accomplishes a number of goals at the expense of an essentially imperceptible scar. The incision is buried in hair approximately two inches behind the hairline. Hair is neither shaved nor cut in preparation for the surgery. Through this incision the forehead is elevated in such a way that the brows are brought into a pleasing position, the transverse lines of the forehead are softened, and the vertical frown lines above the nose are eliminated. In addition, excess skin of the upper eyelids is often eliminated without the necessity for upper eyelid surgery.
Eyelid Surgery
Eyelid surgery, or Blepharoplasty, is a procedure designed to remove the fat and excess skin, which give the eyelids an aged or tired appearance. The excess skin is a reflection of loss of elasticity due either to the aging process or to familial tendency. The excess fat is not referable to body fat, but rather represents a herniation or moving forward of fat from deep within the bony orbit. As we age, the structures around the orbit, which keep the fat positioned deep in the orbit, begin to relax.
This causes a movement forward, or herniation of fat, which creates the fullness characteristic of a tired or aged appearance. The purpose of the Blepharoplasty is therefore to remove excess skin and herniated fat. In a proper Blepharoplasty, the shape of the opening of the eye does not change. An oval-shaped eye remains oval, and is not made round. Though crow's feet and fine wrinkles are not improved by Blepharoplasty, they may be addressed with laser resurfacing. Surgery of the Nose
Rhinoplasty, or surgery to reshape the nose, is a procedure designed to make the nose more aesthetically pleasing. Rhinoplasty can reduce or increase the size of the nose, refine the tip, straighten the bridge, narrow the nostrils, or change the angle between the nose and the upper lip. It may also correct a birth defect or injury. At the time the Rhinoplasty is performed, related procedures such as chin augmentation or surgery to straighten a deviated septum in order to relieve airway obstruction may be performed 
The skin of the nose makes little, if any contribution to the shape of the nose. It is the bone and cartilaginous framework beneath the skin that gives the nose its shape and proportion. In Rhinoplasty, the shape and size of the nose is changed by altering the bone and cartilage framework. The skin simply shrinks to conform to the new underlying architecture.
Rhinoplasty is generally performed as an outpatient procedure under a superficial plane of
general anesthesia. Because the procedure is performed from within, there are no visible
scars on the skin of the nose. Following surgery, a splint conforming to the shape of
the nose is applied for a period of seven days. The nose is generally not packed following
Rhinoplasty. Pain and discomfort are modest, and bruising and swelling is generally resolved
by the time the splint is removed. Return to work is generally within one week.
Copyright © 2006 Dr. Laurence E. Wolf, M.D. All Rights Reserved.
