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The eyebrows form an integral complex with the upper eyelids. Sagging eyebrows and upper eyelids give one a tired or sad appearance. Deep horizontal forehead creases and deep vertical furrows (glabellar lines) in between the eyebrows are other common problems. Patients seeking improvement in these areas usually complain that people mistaken them for being angry or sad when in fact they are not sad or depressed at all. A common scenario occurs when patient desire upper eyelid surgery when really what they need are the eyebrows lifted.
Perhaps the best way to explain the eyebrows is by using the analogy of a curtain and rod. Imagine the rod is the eyebrow and the curtains are the skin of the upper eyelids. Now envision that the curtains are dangling onto the floor. This can be fixed by either raising the curtain rod or by trimming the curtains shorter. Now let's look at the face. The same situation can be fixed by removing excess skin of the upper eyelid or by raising the eyebrows. Sometimes, both an upper blepharoplasty and brow lift can be performed simultaneously, but only if the patient has a large amount of excess upper eyelid skin. Again, it is important not to remove too much skin to allow for complete eye closure.
Surgical approaches include two major categories – open versus endoscopic. Open approaches include making a long incision either in the middle of the forehead through a naturally occurring skin crease, at the hairline, or behind the hairline. Disadvantages of these techniques are having a longer incision and numbness over the scalp behind the incision.
The endoscopic technique represents the latest in surgical advances but has been around for a few years. This procedure entails making several small incisions behind the hairline and using special cameras and instruments through these incisions to raise the forehead. The muscles in the lower mid forehead are also addressed to prevent the deep vertical creases in between the eyebrows. These are the same muscles that are often injected with botox, so a browlift may also prevent the need for botox in this area.
The procedure is performed under intravenous sedation or general anesthesia. A pressure dressing is placed for the first night. Minor bruising of the forehead lasts 1-2 weeks. Patients may experience forehead headaches temporarily.
For additional information on this procedure from the American Academy of Facial Plastic & Reconstructive Surgery, go to: http://www.aafprs.org/patient/procedures/forehead_lifts.html
Facelift is a bit of a misnomer, because it really only address the lower two-thirds of the face, primarily the neck and jowls (lower cheeks) and not the entire face. This is the surgeon's answer to reversing the effects of gravity and aging of the face. A facelift on average may make you look approximately ten years younger. Many ask if this is a permanent improvement. Once a facelift is performed, you will always look younger than your actual age, but unfortunately it will not stop the aging process. Often it may be combined with eyelid or eyebrow surgery to achieve the best result.
One of the most important aspects of a facelift is the placement of incisions. After all, a major part of a terrific result are hidden incisions. Dr. Liu has written an article detailing the technique he uses. During your consultation, he will show you exactly where he places the incisions and the reasoning behind it. A part of every facelift that he performs are two other procedures referred to as PLATYSMAPLASTY and SUBMENTAL LIPOSUCTION. These two procedures address the area under the chin. Sometimes the area under the neck appears as two bands rather than one smooth tight surface. This is secondary to the muscle (platysma muscle) in the area becoming lax. Dr. Liu will remove any excess fat in the area and then tighten the muscle under the chin.
The procedure is typically performed under general anesthesia. While not absolutely necessary, an overnight stay in the hospital can make the first night more comfortable. A pressure dressing is placed for the first night and is removed the next day. Bruising lasts 1-2 weeks and can be concealed with make-up.
For additional information on this procedure from the American Academy of Facial Plastic & Reconstructive Surgery, go to: http://www.aafprs.org/patient/procedures/rhytidectomy.html
Implants can be placed in many various parts of the face – the chin, cheeks (malar implants), under the cheeks (submalar implants) to correct a hollowed out appearance, the nasolabial folds, and others. Again, there are a multitude of implant materials available today, some temporary and some permanent.
Cheek implants are placed through an incision inside the mouth. Chin implants made be placed either through an incision under the lower lip inside the mouth to avoid an external scar or through a small incision through the chin skin. Chin implants are one of the most popular types of facial implants that patients seek. Placement requires light anesthesia. After the procedure, a dressing is worn over the implant for several days to keep it in the proper place. Temporary numbness of the chin may occur.
There are a variety of different materials available for injection to fill deep lines or creases or augment certain facial features such as the lips. As of today, the ideal material probably does not exist yet. The perfect material would have the following characteristics: easy and painless insertion/placement in the office, natural look, natural soft feel, permanent, no minimal swelling, no complications such as infection, and relatively low cost. There are some wonderful products on the market that are able to achieve many of these qualities. Together with Dr. Liu, you choose the method that best suits your individual requirements
For some areas of the face, options range from injections that can easily be performed in the office to implants that require more of a "surgical" procedure. Some are temporary while others are permanent. The most common areas that patients seek improvement of are the lips and the "nasolabial folds" which are the creases between the cheeks and upper lip. Other than collagen, most materials do not require
any skin testing (this is necessary with collagen before the actual injection to ensure that one does not have an allergic reaction).
For additional information on this procedure from the American Academy of Facial Plastic & Reconstructive Surgery, go to: http://www.aafprs.org/patient/procedures/wrinkles.html
As there is a trend to have results with the least invasive method, Botox has become one of the most popular procedures. Botox A® is a derivative of Botulinum toxin and works by temporarily paralyzing the muscle which in turn helps decrease facial wrinkles. It has been used for years for injection into the vocal cords for vocal cord spasms and other indications such as blepharospasm (intermittent uncontrollable spasms of the muscles surrounding the eye) since the early 1990's. It was only recently that it became FDA approved for cosmetic use specifically in the area between the eyebrows although it has been used for cosmetic purposes for several years. Dr. Liu has been injecting Botox® for both cosmetic and non-cosmetic purposes since the late 1990's.
Injections typically do not require any anesthesia. Sometimes ice may be placed for several minutes or if needed a topical numbing ointment. The area may be red for several hours but there is essentially no "downtime." The entire procedure is relatively quick and can be performed in a 15 minute office visit. The maximal effect occurs after about 2 days. After the procedure, one should not rub the area for the next day to prevent possibly diluting the material into the surrounding tissues. Botox® typically lasts 4 months but can be highly patient dependent. There are no specific age limits but optimal results typically occur between the ages of 18 to 65. The procedure is equally effective in women and men.
The most common area to inject is the mid lower forehead referred to as the glabellar lines. These are the vertical "frown" lines that occur when you try to bring your eyebrows towards the middle. Other areas of common injections include the horizontal forehead wrinkles, the lines on the sides of the eyes known as crows feet, and muscle bands under the chin in the upper middle neck. Botox® will help but usually will NOT remove all wrinkles that are present with the face at rest although it may somewhat smooth them out since repetitive muscle movements are halted.
For additional information on this procedure from the American Academy of Facial Plastic & Reconstructive Surgery, go to: http://www.aafprs.org/media/media_resources/fact_botox.html
In the face, the area under the chin in the upper neck referred to as the "submental" area is the most common area to perform this procedure. This is a routine part of the facelift that Dr. Liu performs, or it may performed as an isolated procedure. There is typically minor bruising that lasts for about one week. A pressure dressing is worn for the first day and then only at night for 1-2 weeks.