Facelift Procedures

What is a face lift?

A face lift is called a rhytidectomy in the world of medicine. It involves tightening the muscles of the face and smoothing the skin so that the face appears younger and rejuvenated.

However, it must be remembered that a face-lift is not a total anti-aging solution. General health and fitness, body and skin, are critical factors.






Types of Facelift Procedures

The type of facelift procedure performed depends on areas of concern, the time set aside for recovery, and the individual patient’s wants and expectations. The various types of facelift procedures include:

  • Traditional Full Facelift: The traditional full facelift provides a comprehensive plan to improve many of the signs of aging. It can effectively improve sagging around the cheeks, lines around the mouth, extra fat and rolls under the chin, and jowls. This lift requires extensive incisions along the temple, around the ear, into the hairline behind the ear, and skin flap elevation down into the neck. It is typically chosen by those between 50 to 70 years of age.
  • Mid-Facelift: A mid-facelift involves lifting and tightening of tissues below the eyes and around the cheeks. This requires deep surgery to enhance the contours of the face and to sculpt prominent cheekbones. As this procedure is limited to the mid-face, candidates are usually men and women between 30 and 60 years who just want subtle changes. Post-operatively the goal is to look refreshed rather than “overhauled”.
  • Mini Facelift: A mini facelift can do just that with smaller incisions and a shorter recovery period. Mini facelifts are ultra-focused and target small, precise areas such as jawline and lower cheeks. Incisions are made in front of and behind the ears and excess skin is excised. This procedure can be done under monitored anesthesia care and does not usually require post-operative drains.
  • Lower Facelift: A lower facelift focuses on the lower third of the face and is a terrific procedure for improving jowls, defining the jawline, reducing deep nasolabial folds and helping sagging lines starting at the corners of the mouth. A Lower facelift is used for patients of most age groups to reduce the signs of aging and to promote facial rejuvenation.
  • Submental Facelift: This is also known as “necklift” and involves removal of fat directly or with liposuction, with or without muscle plication. It would be used to improve a double chin. Incisions are made in front of and behind the ear, as well as under the chin. A drain is usually placed for 24 hours after surgery. This procedure is usually appropriate for middle-aged men and women, but may be indicated for younger patients.

When is a face-lift offered to patient?

A Face-lift is offered in a number of different scenarios. The presence of deep creases in the middle of the face or at the mouth and jawline are some indications. As we get older, the collagen in our face is gradually lost and this makes the skin on the face appear rather unsightly. In addition, the loss of skin tone can create loose and saggy skin on the face. In such situations, a face lift is wonderful, as it can significantly improve the appearance of saggy skin and wrinkles.


How is it performed?

First, the patient will have a detailed consultation with their surgeon regarding the benefits and risks of a face lift. For the decided upon procedure, the patient is placed under sedation or general anesthesia. Incisions are made and the skin and underlying tissue is moved around and redistributed across the face in order to give the face a fuller and less droopy appearance. Additional incisions may be made under the chin if needed.

At the conclusion of the face-lift procedure, the incisions are closed cosmetically with a combination of sutures, staples and possibly tissue glue. The goal is to have a scar that is barely visible.


Benefits of face lift

A face-lift can provide a smoother, tighter, less droopy face without drastic changes

A face-lift can rejuvenate one’s external appearance and by doing so can improve overall confidence of the recipient.


Are there any risks of face lift?

There are risks associated with a face-lift, which is the case for any surgical procedure.
There are certain risks associated with the anesthesia itself.
A slight amount of bleeding and bruising is to be expected and this improves and fades over several weeks.
In some individuals, the incisions may not heal optimally and additional treatment may be required.
Damage to underlying tissues and structures, such as the facial nerve, can occur but is rare.
The risk of disappointment and/ or dissatisfaction after the procedure can hopefully be reduced by having in-depth pre-operative discussions with the surgeon concerning reasonable expectations for the procedure planned.
An infection can occur any time an incision is made and would necessitate treatment with antibiotics.


Facelift – A Comprehensive Overview

Facelifts have proved to be uplifting experiences for thousands of individuals across all walks of life. People undergo this cosmetic procedure with the hope of regaining a bit of their youthfulness.

Long gone are the days when only high profile actors, politicians, or influential businessmen had access to this seemingly complex surgical procedure to improve upon their given facial features. Today, facelift procedures remain one of the most commonly performed cosmetic procedures and can boast excellent results.





Understanding Facial Anatomy


Your face is made up of layers of tissues varying in texture and consistency. These tissue layers overlie the bony skull, which provides the support for and structure of your face. From a cosmetic surgeon’s standpoint, your face is made up of the following components: skin, fat, superficial musculoaponeurotic system (SMAS), platysma muscle, Erb’s point (containing important nerves), deep cervical fascia and the retaining ligaments of the face. Mastering the art of tweaking these components in the correct proportion and in an aesthetically pleasing manor is the surgeon’s delight and goal, the reward being the facial improvement that you desire.

The thickness of skin overlying your face is variable - your eyelids have the thinnest skin while your cheeks and forehead are covered by a thicker skin. Facial skin is repeatedly exposed to the sun and elements. This skin is also affected by aging, resulting in loss of elasticity and the development of rhytids or wrinkles. The skin consists of two main layers - the inner layer called dermis and the outer layer called epidermis. Our epidermis is what everyone sees!

Fat is one of the most important components of your face and lies just beneath your skin, i.e. subcutaneous fat. It consists of lobules partitioned by fibrous septa which connect the inner layer of the skin, the dermis, to the superficial fascia just beneath the fat. The distribution of fat in the face is variable, with a major portion deposited right beneath your cheek as the malar fat pad. It is also found below the eyes, lateral to your nose, and in front of your ears. Fat accentuates your cheek bones nicely. The malar fat pad is propped up by connections to the orbitomalar ligament, the superficial musculoaponeurotic system (SMAS), underlying soft tissue, and bone. With age, the malar fat pad shrinks, causing the cheeks to droop towards the crease between your nose and lips. This drop of cheek tissue results in a deeper fold and shadow-- a definite sign of aging.

The SMAS or superficial musculoaponeurotic system covers and connects the muscles of facial expression to the deeper layers of your face. It lies beneath the fat layer of your skin and provides definition to your facial expressions. The SMAS is a thin layer of connective tissue that lies attached closely with the platysma muscle, frontalis muscle, galea and superficial temporal fascia. It is also closely attached to the superficial muscles of facial expression (including the orbicularis muscle), pre-orbicularis fat and the malar fat pad. The SMAS is attached to bone at the infraorbital rim, zygoma, and the mandible.

The Platysma is a thin, flat muscle that begins in the chest just in front of your collar bone, the clavicle, moving up towards the face and covering the front and sides of the neck. It eventually attaches to your jaw bone and skin, then merges with several muscles and continues as the SMAS over the parotid (salivary) gland and cheek. Both sides of the Platysma merge at the midline just below your jaw line. As one ages, the platysma muscle becomes loosely attached to the underlying structures resulting in vertical banding and bowing under the chin.

The Deep Cervical Fascia is a connective tissue in the neck that covers and protects the muscles, nerves, blood vessels and glands of the face. Surgery deep to the deep cervical fascia can result in injury to the facial nerve, which is the primary nerve supply to the face. Damage to any of its five branches could cause weakness of the muscles supplied by that particular branch. Utmost care must be taken to avoid injury to the facial nerve or its branches.

Erb’s point lies vertically below the ear canal just behind the sternocleidomastoid muscle and represents the point of emergence of several nerves that provide sensation to the neck and lower face. It lies just over the sternocleidomastoid muscle. Its largest branch, the greater auricular nerve emerges 6.5 cm below the ear canal and provides sensations to the lower portion of the ear and area just behind the ear. Hence, it is important to meticulously dissect this area to avoid damaging any of these nerves.

Retaining ligaments or tendons provide support to the soft tissues of the face and also provide points for movement of muscles of facial expression. The retaining ligaments important during rhytidectomy surgery are:

  • Allergy or unpredicted response to anesthesia
  • Infection is a possibility with any surgery but is rare.
  • Bleeding and hematomas are more common. Hematomas are seen in 15 percent of cases.
  • Nerve damage is rare but can occur with deeper dissections.
  • Visible scars are the bane of any cosmetic surgeon. Surgeons try to keep the scars hidden from view as much as possible.
  • Mild pain, sensitivity, bruising and swelling are common after a facelift.
  • Temporary numbness can occur due to sensory nerve interruption.
  • Some incisions take longer to heal compared to others. Diabetes, autoimmune diseases, lung and heart disease can all contribute to longer healing times. Diabetics should be in good control prior to and after surgery.
  • Skin necrosis with sloughing is a rare complication and seen most commonly in smokers.
  • Hair loss along the hair line is common and is usually temporary. Occasionally, it is permanent and might require hair transplantation.
  • Contour irregularities can occur, sometimes due to too aggressive sculpting of the fat.
  • Distortion of the hairline, the ear lobe and the tragus can occur.
  • Facial nerve injury is reported in 0.5 to 2.6% of facelift surgery.



Dos and Don’ts after Facelift Surgery

  • Take care not to remove any dressing or drains your surgeon has placed.
  • Rest at home and do only moderate work. Do not exert yourself physically, bend, carry heavy objects or exercise for 3 weeks. Walking is not restricted.
  • It is natural to feel tired or weak for 7-14 days after the surgery.
  • “Three pillows for three weeks” is the dictum to be followed. Try not lie down on your side.
  • Swelling maximizes during the first two days but then gradually subsides.
  • Apply antibiotic ointment to the suture or staple line 3 times a day. Sutures and staples are removed in 7-14 days.
  • You should avoid Vitamin E, Aspirin or related products. It is best to ask your doctor before you take any over the counter medications.
  • You should avoid smoking, alcohol and flying for at least 2 weeks.
  • Avoid hair dyes or perms for at least 6 weeks and wait to shower until 24 hours after surgery. The shower spray should be directed at your shoulders.
  • Avoid brushing your hair forcefully for at least 7 to 10 days. Use your fingers gently to style your hair.
  • You may wear hypoallergenic cover-up after 1 week. No makeup on incision areas for at least 3-4 weeks
  • Avoid the sun for six weeks as it makes you prone to skin pigmentation and irregularities.
  • Avoid wearing your earrings for three weeks and wear clothes that button down the front to avoid entanglements.
  • You should avoid tweezing, waxing or bleaching your facial hair for at least a month.
  • Wait for dental procedures for at least 6 weeks, unless it is an emergency and completely unavoidable.
  • Don’t expect your final results for at least 3 months after the surgery.
  • Be careful not to use extremely hot water for warm compresses.
Procedures
Anophthalmos
- Anophthalmia is a medical term used to describe the absence of the globe and ocular tissue from the orbit. - This was first reported more than 400 years ago, yet it is only recently that significant reconstructive options became available. - There are many reasons why one might lose an eye. - Surgeries which result in anophthalmos
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Blepharoplasty
What is Blepharoplasty?
- Your eyes including your eyelids, are perhaps one of the first things people notice in you. This makes your eyes and eyelids one of the most important components for an appealing facial expression and aesthetic appearance. Any visible change in the shape or size of the orbital or periorbital region can spoil the look of your face.
- As you age and grow older, your eyelids may become ‘droopy’ or ‘baggy’ due to the stretching of your eyelid skin and gradually decreasing tone of your eyelid muscles. Your droopy eyelids and brow together cut a sorry figure for your face making you look tired, sleepy and haggard, further leading to eyelid or brow straining or both. In extreme cases, your saggy, baggy eyelids can even obstruct your vision, particularly peripheral vision causing difficulty in reading or driving.
- Blepharoplasty ensures cosmetic or functional corrections to the area around your eyes to enhance your look or to correct any abnormalities in function.
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Blepharospasm
- Blepharospasm is defined as an abnormal, involuntary, sustained and forceful closure or twitching of the eyelids. It is derived from the Greek word ‘blepharon’ which means eyelid, and ‘spasm’ which is an uncontrolled muscle contraction. Blepharospasm is usually associated with headache, eyebrow strain and occasionally loss of vision.
- Isolated blepharospasm is rare and represents a minority of patients presenting with blepharospasm. Blepharospasm is commonly associated with lower facial spasms as part of a syndrome or disease complex. Some examples are:
   - Meige Syndrome: Characterized by spasm of the eyelids and midface.
    - Brueghel’s Syndrome: Presents with blepharospasm and marked spasms in the lower face and neck.
    - Segmental Cranial Dystonia: In addition to the usual spasms of the eyelids and facial muscles it is associated with spasms along distribution of various cranial nerves, most frequently involving the Facial Nerve.
    - Generalized Dystonia: Presents with spasms across various body parts in addition to blepharospasm and facial spasms.
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Brow Lift
A forehead lift, also known as a browlift or browplasty, is a cosmetic surgery procedure used to elevate a drooping eyebrow that may obstruct vision and/or to remove the deep worry lines that run across the forehead and may portray to others anger, sternness, hostility, fatigue or other unintended emotions
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Congenital
Congenital anomolies include :
- Eyelid Disorders
- Orbital Disorders
- Congenital Ptosis
- Congenital Nasolacrimal Duct Obstruction

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Dry Eye
What is Dry Eye?
- Dry eye is a reduction in your eye’s ability to produce sufficient natural tears.
- Insufficient tear production can lead to irritation and pain, and even scarring of the cornea (the transparent part of the eye that covers the pupil and iris).
- Many people will experience dry eye symptoms at some point in their lives.
- Often due to environmental factors such as indoor heating or air conditioning, it can also be caused by occupational factors such as prolonged computer use.
- Dry eye symptoms can affect anyone.
- Some of the symptoms of dry eye include a burning sensation or gritty feeling in the eyes. You may also experience decreased tolerance to contact lens wear or sensitivity to light.
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Eyelid Laxity
- Eyelids protect your eyes from any foreign bodies while keeping them lubricated throughout. Any alteration in the shape, position or function of your eyelids can predispose your eyes to a plethora of ailments or interfere with our vision.
Our eyelid is a complex structure consisting of three theoretical layers:
   - Anterior Layer contains the skin and orbicularis muscle
   - Middle Layer contains the orbital septum and eyelid retractors
   - Posterior Layer contains tarsus and conjunctiva.

- Eyelid malpositions include any unnatural or incorrect positioning and orientation of eyelids due to various factors that influence any of the three layers of the eyelids. They may be caused due to ageing, trauma, scarring, birth defects or medical disease involving any or all of the three layers.
- The most common forms of eyelid malposition are eyelid retraction, ptosis, entropion and ectropion.
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Face
The world of cosmetic surgery has advanced tremendously over the last two decades. New procedures have emerged that can make an individual look and feel younger in a matter of a few minutes. Amongst the vast number of cosmetic procedures currently available, the face lift is a commonly performed one that is sought after by both men and women. Here we shall take a look at this procedure in a little more detail.

- What is a face lift?    - A face lift is called a rhytidectomy in the world of medicine. It involves tightening the muscles of the face and smoothening of the skin so that the face appears younger.    - However, it must be remembered that a face-lift is not an anti ageing solution.
Read More..
Lacrimal System
- The lacrimal gland produces tears which enter into the "duct" that drain the tears from the eye into the nose. The most common symptoms are If one has a plugged up "tear duct," not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can become infected.    (1) excess tearing (tears may run down the face) and    (2) mucous discharge - This may lead to recurrent red eyes and infections. - The excessive tearing can also produce secondary skin changes on the lower eyelids.
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Lagophthalmos
Patients with lagophthalmos have an inability to close eyelids. This may occur, for instance, in patients with Thyroid eye disease.
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Latisse
LATISSE® makes lash growth possible because of its active ingredient: bimatoprost. Although the precise mechanism of action is not known, research suggests that the growth of eyelashes occurs by increasing the percent of hairs in, and the duration of, the anagen (or growth) phase. Lashes can grow longer, thicker and darker because bimatoprost can also prolong this growth phase.
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Orbital Tumors
- Orbital Tumor is any tumor that occurs within the orbit of the eye. The orbit is a bony housing in the skull about 2 inches deep that provides protection to the entire eyeball except the front surface. It is lined by the orbital bones and contains the eyeball, its muscles, blood supply, nerve supply, and fat.
- Tumors may develop in any of the tissues surrounding the eyeball and may also invade the orbit from the sinuses, brain, or nasal cavity, or it may metastasize (spread) from other areas of the body. Orbital tumors can affect adults and children. Fortunately, most are benign.
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Ptosis
- Ptosis is an abnormally low position (drooping) of the upper eyelid
- Ptosis occurs when the muscles that raise the eyelid (levator and Müller's muscles) are not strong enough to do so properly.
- It can affect one eye or both eyes and is more common in the elderly, as muscles in the eyelids may begin to deteriorate.
- Compare with dermatochalsis (extra skin and fat)
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Skin Rejuvination
A radiant, smooth, youthful skin is the essence of beauty and trendy looks. Skin care routine highly contributes in the slowing down of rate of aging of the skin. Choosing the right skin care products for your skin type enhances your beauty keeping the skin cleansed, moisturized and well toned. Use of superficial skin resurfacing treatments to counter fine lines and wrinkles, acne scars and blemishes before they deepen ensures skin rejuvenation.
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Skin Tumors
Cancer of the eyelid, like any other cancer, can be a worrying thing. Treatments are variable and depend on the type of cancer. In this article, we shall take a brief look at the different kinds of eyelid tumors.
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Symblepharon
A symblepharon is a fibrous tract that connects bulbar conjunctiva to conjunctiva on the eyelid.
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Thyroid
Graves' disease is an autoimmune disease.
It most commonly affects the thyroid, causing it to grow to twice its size or more (goiter), be overactive, with related hyperthyroid symptoms such as increased heartbeat, muscle weakness, disturbed sleep, and irritability. It can also affect the eyes, causing bulging eyes (exophthalmos).
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Trauma
Eye injuries are extremely common with over 2 million cases reported every year that require medical treatment. Blindness in one eye is most commonly due to cataract and this is followed closely by eye injuries. In addition, in children, injury to the eye is a recognized as the most common cause of blindness in one eye that is not due to a birth defect.
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