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Facial cosmetic surgery has come a long way since its humble beginnings.  The advancement in technology alone has provided the industry with a much broader range of facial surgical options.  We offer a variety of facial surgery and rejuvenation procedures that will enhance the natural beauty of your face.  Talk to the doctor during your initial consultation about your goals for facial rejuvenation.

 

Sculptra Aesthetic

 

    

Welcome to the new age of anti-age! Our office is happy to introduce Sculptra® Aesthetic as a treatment option for patients who desire a more youthful facial appearance.

Sculptra ® Aesthetic is the first facial injectable that gives you subtle results over time by replacing lost collagen. It helps correct shallow to deep facial wrinkles and folds that appear with aging.

 

           

About Sculptra ® Aesthetic 
 
Age doesn't have to look the way it used to. It's more subtle. More gradual. Shouldn't your anti-age be just as subtle? 
 
Introducing Sculptra ® Aesthetic (injectable poly-L-lactic acid). Not an overnight miracle. Long lasting. Not a quick fix. The first facial injectable that gives you subtle results over time. Replacing lost collagen. Giving you a more natural-looking appearance, without giving you away. A full treatment of Sculptra ® Aesthetic, an average of 3 injection sessions over a few months, can last up to 2 years. Individual results and treatment sessions may vary. So you have more time to see how sensational subtle can be. Welcome to the new age of anti-age. 
 
Sculptra ® Aesthetic is a new type of facial injectable made from poly-L-lactic acid (a synthetic material that has been used safely for decades in resorbable stitches and as an injectable since 1999 in over 30 countries. It is biocompatible and biodegradable. Poly-L-lactic acid is the main ingredient in Sculptra ® Aesthetic), which helps to replace lost collagen. It helps correct shallow to deep facial wrinkles and folds that appear with aging by replacing lost collagen. Safety and effectiveness of Sculptra ® Aesthetic have not been evaluated in areas other than nasolabial wrinkles and folds in clinical trials. 
 

          

 

 

Sculptra ® Aesthetic gradually replaces lost collagen 
 
Collagen is a key structural component that keeps skin youthful looking and smooth. As you age, your body's collagen production decreases, and you may begin to see wrinkles. Sculptra ® Aesthetic works to correct shallow to deep facial wrinkles and folds,* as it replaces lost collagen, which can help provide a refined, more youthful looking appearance. 
 
Sculptra ® Aesthetic works to replace lost collagen in a series of treatments administered by a Sculptra trained physician like Dr. Charles Day. On average, three injection sessions are needed over a period of a few months. The number of injection sessions and the number of injections per session vary from person to person. 
 

Sculptra ® Aesthetic works within the deep dermis

Within the deep dermis, your skin's structure is reinforced as Sculptra ® Aesthetic helps to replace lost collagen. This reinforced collagen structure provides a foundation that gradually restores the look of fullness of your shallow to deep facial wrinkles and folds* that has been depleted over time. The result? Sculptra ® Aesthetic is different because it gradually and subtly corrects these facial wrinkles. This can provide a refined, more youthful looking appearance that can last up to two years.**

*Safety and effectiveness of Sculptra Aesthetic have not been evaluated in areas other than nasolabial wrinkles and folds in clinical trials.

**Individual results and treatment sessions may vary.

 

Facelift

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A Facelift (Rhytidectomy) is a surgical procedure designed to smooth and firm the skin, providing a fresh, youthful appearance.  Throughout one’s life, the sun’s radiation, stress, gravity, and other factors cause the skin to sag and fit more loosely.  Areas of the face and neck, in particular around the jaw line, are especially prone to the aging process.  Though these changes are gradual, wrinkles and other signs of aging can make individuals “feel older” than they really are.

Surgery for a facelift involves the contraction and realignment of facial and neck skin, and in some instances the removal of excess fat deposits.  A facelift is often performed in combination with other facial cosmetic procedures and can be performed any time signs of aging begin to appear.  However, patients are generally in their forties or older when they elect to undergo this procedure.

Reasons for Considering a Facelift:

  • Sagging skin, muscles, and fat in the face and neck.

  • Excess skin and fat on the neck.

  • Sagging jaw line.

  • Crease lines along the nose, mouth, and chin.

The most important point to understand about facelifts and facial aging is that we all age differently and in different ways. The causes vary and include sagging of excess skin, deflation of the face due to fat loss, changes to the bony structures around the mouth and eyes, and bulging of fat around the lower eyelids. Other causes are still in the process of being fully understood. There is wide variation in the type and magnitude of these changes between individuals.This means that no single operation or procedure should be applied to all people. Instead, your plastic surgeon should be comfortable with a variety of facelift techniques and “customize” their use for each individual patient.

Q & A

What is a facelift?
In its simplest terms a facelift removes excess or sagging skin belonging to the face and neck. The classic (subcutaneous) facelift involves incisions placed in front of and behind the ears. The skin and fat of the face and neck is then lifted off of the underlying structures such as facial muscles, nerves, and other soft tissue structures. Excess skin is pulled up and back and trimmed off. The edges of the incisions are brought together and closed with sutures. The resulting scars are well hidden in natural skin borders and creases around the ears and adjacent to the hairline

Are there different types of facelifts?
Facelifts originated near the turn of the century still serve as the basis for treating excess or drooping skin of the face and neck. Better understanding of the anatomy of the face and causes of facial aging has resulted in several innovations and additions to the classic facelift. Besides removing excess skin most facelifts include repositioning of the deeper tissues by tightening of a support layer to the face known as the “SMAS”. SMAS stands for the Superficial Musculo Aponeurotic System. The acronym SMAS is often used to describe facelifts that tighten this layer in addition to removing excess skin to help achieve rejuvenation of the face.

What is a midface lift?
The area of the cheeks and lower eyelids is known as the midface. Recently much attention has been focused on this area since the classic facelift frequently does not satisfactorily correct this area. Also the midface will typically sag and droop sooner than the lower face and neck. In response, facelifts have been developed termed “midface lifts” to help pull up sagging cheeks and older or tired-looking lower eyelid. There are actually about as many ways to lift the midface as there are plastic surgeons. However, almost all operations involve separating the cheek tissues from the underlying cheek bones and placing them in a higher position. Removal of excess lower eyelid skin is done after the cheek tissue is secured in its new position. Midface elevation can be done by incisions placed in the hairline of the temple, lower eyelid, inside of the mouth, or a combination of these approaches. In addition, some surgeons use a small scope or TV camera to aid in lifting the midface through smaller access incisions. Sometimes fat in the lower eyelid is removed, repositioned, or even added to achieve a more youthful look.

At what age should one have a facelift?
In general the traditional facelift (for the neck and jowls) is usually performed for individuals in their 40’s to 60’s. Since the midface seems to show signs of aging sooner, the midface lift is recommended for individuals as early as 30-40 years of age. These procedures can be, and often are, combined in one operation. Timing also depends on when each individual feels they are in need. This can differ widely depending on a patient’s geographic or cultural background. The correct answer to the question of timing is whenever the changes of aging become disturbing.

Will a facelift help with the line that runs from the corner of the nose to corner of my mouth?
The nasolabial fold is a crease or fold that runs from the ala of the nose, or “corner” of the nose, down to the corner of the mouth and sometimes the jaw line. Many different procedures ranging from the traditional facelift, SMAS facelift, midface lift, or even to cutting out the crease have been attempted. None have been able to correct this aging feature with any long-term success. Injecting substances such as fat or collagen to “fill out” the fold seems to help, but only temporarily as these materials will absorb with time.

What recovery time is involved with a facelift?
Recovery time for a facelift is generally from 1-2 weeks for most swelling and bruising as well as suture removal. If any drains have been placed they are usually removed in the first 2-3 days. However, it takes at least one month for the more obvious changes accompanying a facelift to disappear. This is a good time-frame to keep in mind if you plan on attending an important social occasion, travel or just “show off” your new look.

How long does a facelift last?
The general rule of thumb is that a facelift will last about 5-10 years. Facelifts can be repeated after several years if necessary. The longevity of the result can be adversely affected by bad behavior such as smoking or chronic sun exposure. The same forces that prematurely age skin are not reversed by having a facelift. Aging is an individual characteristic that is independent of having had surgery.

What other operations can be done at the same time?
Usually other facial procedures will accompany a facelift. These procedures include chin liposuction, brow lifting, eyelid surgery, chin implants, cheek implants, or rhinoplasty (nose surgery). Occasionally, operations such as a tummy tuck, liposuction or breast augmentation can be performed at the same time as a facelift. Combined procedures are commonly done, and the decision to do so depends chiefly on the anesthetic risks involved. 

Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

 

Forehead Lift (Brow Lift)

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Upper Eyelid and Brow Surgery

Eyelid surgery is one of the most commonly performed cosmetic operations. It is done by a wide variety of surgeons to improve the excess skin that hangs over the upper eyelids. At Aesthetic Surgery Associates, we emphasize that the upper eyelids should never be evaluated for problems by itself. The appearance of the upper eyelid is heavily dependent on the position of the eyebrow. If you learn nothing else about the upper lids, please “take home” the fact that the upper eyelids and the brow are an integral unit. One should never be evaluated without simultaneously evaluating the other.

Q & A

Why has “excess” skin started to pile up on my upper eyelid? This is a bit more complicated than you think. Intuitively, most people think that it is due to “extra” skin that appears over the upper eyelid with age. Although this seems obvious, it is not entirely accurate. Skin does not magically appear anywhere in the body. It has to be created by forces that stretch it (such as the effect of pregnancy on the tummy), or by loss of underlying soft tissue volume (deflation as with massive weight loss that makes tummies and breasts sag). In the case of upper eyelid skin, there are several forces at work. The skin is stretched by upward movement of the eyebrows in combination with the opposing downward action of closing the upper eyelid. These opposing forces over time act to stretch the lid skin, which is some of the thinnest skin on the body. At the same time, soft tissue volume decreases with time resulting in “hollowing” of the eye socket. The combined effects of stretched skin and volume loss results in “loose” skin hanging over the upper eyelid

Is “excess” skin the only problem? Skin hanging over the upper lid is only part of the problem. A significant portion of the skin is not true excess. It is actually skin that “piles up” due to descent of the lateral eyebrow with time – a problem referred to as “brow ptosis”. You an easily demonstrate this by lifting the lateral eyebrow with your finger and watching a significant portion of the excess skin disappear. The reason that skin “hooding” is most pronounced in this area is that there is no muscle to elevate the lateral one-third of the brow. There is however, a strong muscle to elevate the middle two-thirds of the brow, and this is why wrinkles are usually very conspicuous across the middle of the forehead. In the lateral third of the brow, there is a strong muscle which pulls the brow down. It is the same muscle that causes “crow’s feet” at the outer corner of the eye. Over time, this strong muscle pulls the lateral eyebrow to a lower position where it remains and contributes to the skin overhanging the eyelid. In this situation, removing the eyelid skin alone will not adequately correct the problem.

Why not simply cut out the excess upper eyelid skin? This is commonly done and is referred to as a “blepharoplasty”. The scar is hidden in the natural fold of the upper eyelid, and the recovery period is fairly short. Ask yourself though, “if the skin disappears when I push up my eyebrows, is this really extra skin?” If eyebrow descent, or ptosis, is creating the appearance of “extra” skin, removing it will result in further descent of the eyebrow as the forehead muscles relax. Chronic contraction of the forehead muscles is present when there are transverse wrinkles across the forehead with the face at rest. This is a sign that the muscles have to pull up the brow to keep skin from weighing down the eyelids. When the skin is removed, the forehead muscles relax, resulting in a lower position for the eyebrow. This is fine for circus clowns who wish to project a sad affect, but most of us would prefer a more alert and rested appearance. In addition, when the brow descends, more skin piles up on the lid and can defeat the whole purpose of having had a blepharoplasty.

What else is done in addition to removing the excess skin? Typically, surgeons also remove fat and some muscle. Overly aggressive removal of fat can aggravate the natural hollowing of the eye socket that occurs with aging. Excess fat removal can also change the position of the eye in the socket by removing the supportive “padding” that cushions the eye and helps to maintain its position. Conservative fat removal can improve some “bulges” or “fullness” of the upper lids. Removal of muscle with the skin is typically done to further shape the final result. Muscle resection rarely, if ever, causes problems.

What are the surgical options? The most commonly performed operation is removal of the “extra” lid skin, or blepharoplasty. It is a popular procedure due to its simplicity and rapid recovery. For the reasons noted above, it also may not be the most appropriate or definitive operation. Many surgeons do not have the training or background to perform surgery to raise the brow, and so apply only the limited choices of operations is their personal armamentarium. The result can yield temporary relief of the problem, but recurrence of excess skin is common over the subsequent six months. In addition to blepahroplasty, there are several choices for raising the brow position:

1. Supra-brow lift: This operation cuts out a patch of skin above the eyebrow and leaves a scar just above it. It has a high rate of relapse, and the scar is very visible in nearly all patients who undergo the operation, even if attempts are made to hide the scar in a wrinkle. We do not recommend this operation.
2. Coronal brow lift: This operation makes an incision in the scalp from ear to ear and cuts out some of the hair-bearing scalp to pull the forehead and brow up. It typically also raises the forehead tissues up and weakens the muscles that tend to pull the brow position down. The scar is hidden in the scalp, but can spread with time and create a “part” in the hair at this location. Coronal brow lifts also create a permanent numb spot on the scalp in most patients.
3. Temporal Brow lift: Scars from this procedure are hidden in the scalp or along the hairline in the temples. It is a useful operation for raising the lateral brow, and the scars are well hidden in most patients.
4. Endoscopic Brow lift: Three to Five small incisions (2 cm) are place behind the hairline in the scalp and a special operating telescope and camera system are used to dissect down to the eyebrow to release the tissues holding it down, and weaken the muscles that pull it down. It is an excellent option for most patients, even those with thinning hair.
5. Hairline brow lift: Some patients have an extremely high forehead and lifting the brow can push the hairline back even further. To prevent backward migration of the hairline, excess forehead skin is removed by placing an incision just in front of the hairline. The scar is usually very cosmetic, but is in a visible area for some patients with thinning hair. Unfortunately, it is the only good option for those patients with high foreheads with deep wrinkles.

What are the risks of surgery? Although serious complications are very rare, the most feared complication is blindness. It is caused by bleeding within the eye socket post-operatively, and is a complication that few surgeons have seen. Another serious problem is inability to close the eyelid due to overly aggressive skin removal. The medical term for this condition is lagophthalmos. If surgery is done on both the brow and the eyelid, a mild lagophthalmos is common for the first three days following surgery. It almost always resolves quickly, and rarely creates problems. Scarring that creates complaints is very rare. If it occurs, it is due to the incision being carried too far laterally into the crow’s feet. With time, even these scars usually become inconspicuous. The most commonly voiced concern in our experience is asymmetry of the eyelids post-operatively. “Mis-matched” eyelids usually result from underlying facial asymmetries that are unmasked by the surgery. Careful study of you pre-operative photographs will enable you surgeon to point this out to you before surgery. After healing is complete, these asymmetries are usually subtle and seldom require correction.

How long does it take to recover from surgery? If only blepharoplasty is done, the majority of the recovery is complete at 7 to 10 days. Some patients have more extensive bruising which can take two weeks to completely clear, similar to a black eye. Stitches in the eyelid are usually removed in five days. When browlifts are done with the blepharoplasty, 10 days to two weeks are needed for swelling and bruising to resolve.

Is this surgery covered by insurance? Some eyelid surgery is covered by insurance if there is proof that the overhanging eyelid is interfering with vision. Evidence required by insurance companies is typically a formal visual field examination using specialized equipment in most optometrist’s or ophthalmologist’s offices. Like many insurance claims, patients may have to “jump through hoops” in order to persuade their insurer to reimburse the cost of the procedure.

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

 

Upper Eyelid Surgery

 

Eyelid surgery (known as blepharoplasty) is a corrective procedure that can reduce dark circles or “bags” under the eyes, remove excess wrinkles, and provide a more youthful appearance to the eyes.  One of the first things noticed about a person is their eyes.  During the aging process, wrinkles, lines, and puffiness contribute to a tired or aged appearance.  The blepharoplasty surgery is often performed in conjunction with other facial procedures such as a face lift or brow lift.      

Reasons for Considering Eyelid Surgery:

  • Dark circles or bags under the eyes.

  • Excessive skin or wrinkles surrounding the eyelids.

  • A tired appearance or puffiness due to inherited factors.

Eyelid surgery is a very common cosmetic operation. It is done by a wide variety of surgeons across a range of specialties. Patients typically seek to improve the excess skin that hangs over the upper eyelids. At Aesthetic Surgery Associates, we emphasize that the upper eyelids should never be evaluated for problems independent of simultaneous consideration of the position of the brow and forehead. If you learn nothing else about the upper lids, please “take home” the fact that the upper eyelids and the brow are an integral unit. One should never be evaluated without evaluating the other.

Q & A

Why has “excess” skin started to pile up on my upper eyelid? This is a bit more complicated than you think. Intuitively, most people think that it is due to “extra” skin that appears over the upper eyelid with age. Although this seems obvious, it is not entirely accurate. Skin does not magically appear anywhere in the body. It has to be created by forces that stretch it (such as the effect of pregnancy on the tummy), or by loss of underlying soft tissue volume (deflation as with massive weight loss that makes tummies and breasts sag). In the case of upper eyelid skin, there are several forces at work. The skin is stretched by upward movement of the eyebrows in combination with the opposing downward action of closing the upper eyelid. These opposing forces over time act to stretch the lid skin, which is some of the thinnest skin on the body. At the same time, soft tissue volume decreases with time resulting in “hollowing” of the eye socket. The combined effects of stretched skin and volume loss results in “loose” skin hanging over the upper eyelid.

Is “excess” skin the only problem? Skin hanging over the upper lid is only part of the problem. A significant portion of the skin is not true excess. It is actually skin that “piles up” due to descent of the lateral eyebrow with time – a problem referred to as “brow ptosis”. You an easily demonstrate this contribution by lifting the lateral eyebrow with your finger and watching a significant portion of the excess skin disappear. The reason that skin “hooding” is most pronounced in this area is that there is no muscle to elevate the lateral one-third of the brow. There is a strong muscle to elevate the middle two-thirds of the brow, and this is why wrinkles are most pronounced over the middle of the forehead. In the lateral third of the brow, there is a strong muscle which pulls the brow down. It is the same muscle that causes “crow’s feet” at the outer corner of the eye. Over time, the strong muscle that pulls the lateral eyebrow to a lower position where it remains and contributes to the skin overhanging the eyelid. In this situation, removing the eyelid skin alone will not adequately correct the problem.

Why not simply cut out the excess upper eyelid skin? This is commonly done and is referred to as a “blepharoplasty”. The scar is hidden in the natural fold of the upper eyelid, and the recovery period is fairly short. Ask yourself though, “if the skin disappears when I push up my eyebrows, is this really extra skin?” If eyebrow descent, or ptosis, is creating the appearance of “extra” skin, removing it will result in further descent of the eyebrow as the forehead muscles relax. Chronic contraction of the forehead muscles is present when there are transverse wrinkles across the forehead at rest. This is a sign that the muscles have to pull up the brow to keep skin from weighing down the eyelids. When the skin is removed, the forehead muscles relax, resulting in a lower position for the eyebrow. This is fine for circus clowns who wish to project a sad appearance, but most of us would prefer a more alert and rested appearance. In addition, when the brow descends, more skin piles up on the lid and can defeat the whole purpose of having had a blepharoplasty.

What else is done in addition to removing the excess skin? Typically, surgeons also remove fat and some muscle. Overly aggressive removal of fat can aggravate the natural hollowing of the eye socket that occurs with aging. Excess fat removal can also change the position of the eye in the socket by removing the supportive “padding” that cushions the eye and helps to maintain its position. Conservative fat removal can improve some “bulges” or “fullness” of the upper lids. Removal of muscle with the skin is typically done to further shape the final result. Muscle resection rarely, if ever, causes problems.

What are the surgical options? The most commonly performed operation is removal of the “extra” lid skin, or blepharoplasty. It is a popular procedure due to its simplicity and rapid recovery. For the reasons noted above, it also may not be the most appropriate or definitive operation. Many surgeons do not have the training or background to perform surgery to raise the brow, and so apply only the limited choices of operations is their personal armamentarium. The result can yield temporary relief of the problem, but recurrence of excess skin is common over the subsequent six months. In addition to blepahroplasty, there are several choices for raising the brow position

1. Supra-brow lift: This operation cuts out a patch of skin above the eyebrow and leaves a scar just above it. It has a high rate of relapse, and the scar is very visible in nearly all patients who undergo the operation, even if attempts are made to hide the scar in a wrinkle. We do not recommend this operation.
2. Coronal brow lift: This operation makes an incision in the scalp from ear to ear and cuts out some of the hair-bearing scalp to pull the forehead and brow up. It typically also raises the forehead tissues up and weakens the muscles that tend to pull the brow position down. The scar is hidden in the scalp, but can spread with time and create a “part” in the hair at this location. Coronal brow lifting also creates a permanent numb spot on the scalp in most patients.
3. Temporal Brow lift: Scars from this procedure are hidden in the scalp or along the hairline in the temples. It is a useful operation for raising the lateral brow, and the scars are well hidden in most patients.
4. Endoscopic Brow lift: Three to Five small incisions (2 cm) are place behind the hairline in the scalp and a special operating telescope and camera system are used to dissect down to the eyebrow to release the tissues holding it down, and weaken the muscles that pull it down. It is an excellent option for most patients, even those with thinning hair.
5. Hairline brow lift: Some patients have an extremely high forehead and lifting the brow can push the hairline back even further. To prevent backward migration of the hairline, excess forehead skin is removed by placing an incision just in front of the hairline. The scar is usually very cosmetic, but is in a visible area for some patients with thinning hair. Unfortunately, it is the only good option for those patients with high foreheads with deep wrinkles.

What are the risks of surgery? Although serious complications are very rare, the most feared complication is blindness. It is caused by bleeding within the eye socket post-operatively, and is a complication that few surgeons have seen. Another serious problem is inability to close the eyelid due to overly aggressive skin removal. The medical term for this condition is lagophthalmos. If surgery is done on both the brow and the eyelid, a mild lagophthalmos is common for the first three days following surgery. It almost always resolves quickly, and rarely creates problems. Scarring that creates complaints is very rare. If it occurs, it is due to the incision being carried too far laterally into the crow’s feet. With time, even these scars usually become inconspicuous. The most commonly voiced concern in our experience is asymmetry of the eyelids post-operatively. “Mis-matched” eyelids usually result from underlying facial asymmetries that are unmasked by the surgery. Careful study of you pre-operative photographs will enable you surgeon to point this out to you before surgery. After healing is complete, these asymmetries are usually subtle and seldom require correction.

How long does it take to recover from surgery? If only blepharoplasty is done, the majority of the recovery is complete at 7 to 10 days. Some patients have more extensive bruising which can take two weeks to completely clear, similar to a black eye. Stitches in the eyelid are usually removed in five days. When browlifts are done with the blepharoplasty, 10 days to two weeks are needed for swelling and bruising to resolve.

Is this surgery covered by insurance? Some eyelid surgery is covered by insurance if there is proof that the overhanging eyelid is interfering with vision. Evidence required by insurance companies is typically formal visual field examination using specialized equipment in most optometrist’s or ophthalmologist’s offices. As with many insurance claims, patients may have to “jump through hoops” to persuade their insurer to reimburse the cost of the procedure.

 

Lower Eyelid Surgery

 

Lower Eyelid surgery is most commonly performed due to patient dissatisfaction with lower eyelid “bags”. Lower lid surgery is done by a wide variety of surgeons across a range of specialties. At Aesthetic Surgery Associates, we emphasize that the lower eyelids should never be evaluated for problems by themselves. The appearance of the lower eyelid is heavily dependant on the position of the midface, or cheekbone area. If you learn nothing else about the lower eyelids, please “take home” the fact that the lower eyelids and the midface are an integral unit. One should never be evaluated without simultaneously evaluating the other. Problems with lower lid position after cosmetic surgery are common, and difficult to correct when serious.

Q & A

Why do my lower eyelids have bags that keep getting worse? Lower eyelid “bags” can result from a variety of causes. Most people intuitively realize that swelling from allergies or sinus infections can make them worse, just as they are worse in the morning after a good night’s sleep. Lower lid bags that appear with aging are a bit more complicated to explain. These are caused by weakening of the soft tissue barriers that hold fat in the eye socket, in combination with descent of the tissues that make up the midface. The midface is the fat pad over the cheekbones in the upper part of the face. With aging, the soft-tissues of the midface lose volume and descend to a lower position on the face. The result is that a crease appears below the eyelid (in some patients it is also a darker color), and the eyelid bulges more significantly due to loss of support. You can easily demonstrate this on yourself by looking in the mirror and pushing your cheeks up against the lower eyelid. The eyelid immediately assumes a more natural and youthful appearance, and the bags become less conspicuous. The point here is that the lower lid and cheek are and integral unit with the appearance of one being dependant on the other. Bulging of the lower lid is caused by the combination of changes in the midface and lower lid structures that function as a barrier to retain fat in the eye socket. Over time, the bulging can stretch the thin skin of the lower lid creating significant wrinkles in addition to the bulging. Some of the wrinkles can appear to be very deep due to thickened bands of muscle on either side of the wrinkle.

What other problems can the lower lid have? In addition to “bags” under the lower lid, the lid can become loose, or “lax” with time. This is especially true in older patients where the lower lid can actually hang away from the eye, a condition termed “ectropion”. Patients with laxity of the lower eyelid also typically have descent of the lower lid. Descent is evident when looking at the eye by noticing that too much of the white of the eye shows lateral to the iris. This is termed “scleral show”, and is an all-too frequent problem after lower eyelid cosmetic surgery. Ecropion too can be caused by overly-aggressive surgery designed to improve the appearance of the lower eyelid. Lid descent can cause symptoms of “dry eyes” due to increase tear film evaporation resulting from greater exposure of the surface of the eye.

Can the excess lower lid skin simply be cut out? This is a commonly performed operation which is referred to as a lower lid blepharoplasty. The scar is just below the eyelashes of the lid, and is very cosmetic. The problem with this approach is that it tends to pull the lid down, resulting in excessive scleral show,, or an abnormally round appearance to the shape of the eye. This is especially true in patients who have laxity of the lower lid, or who have protruding eyes (eyes that “bug out). It is vital that the surgeon evaluate each patient for factors predisposing to lower lid descent, and counsel them appropriately before surgery. Frequently, the “simplest” operation can lead to long-term problems.

What else is done in addition to removing the excess skin? Most surgeons recommend removal of excess fat from the lower lid to help decrease the bulging. The fat can be removed through the lower lid blepharoplasty incision, or through an incision on the inner surface of the lower lid – a procedure known as “trans-conjunctival blepharoplasty”. Trans-conjunctival approaches are most appropriate for younger patients who have few wrinkles on the lower lid. The scar is invisible, and combining the operation with peeling of the lower lid skin can yield a very satisfactory result in these patients. Whatever the technique, overly aggressive fat removal should be avoided to help prevent “hollowing” of the eyes later in life with aging.

What if the midface has dropped down? In this situation the midface needs to be elevated. Lifting the midface position adds support to the lower lid and improves the cosmetic result. This is accomplished by a mid-face lift, or “cheek lift”. There are a variety of techniques used to elevate the midface. Most separate the cheek tissue from its attachments to the bone and re-attach it at a higher position. Some also “tighten” the structures that retain fat in the lower lid. Although midface lift is not essential in all patients, it illustrates the need to address the lower lid and midface as a unit when discussing the most appropriate surgical option

What are the risks of surgery? Although serious complications are very rare, the most feared complication is blindness. It is caused by bleeding within the eye socket post-operatively, and is a complication that few surgeons have seen. Another serious problem is ectropion due to overly aggressive skin removal. Occasionally, scarring inside the lower lid can result in ectropion that evolves over time rather that immediately following the operation. If tightening of the lower lid is performed, patients can have an “asian” appearance to the eye for two weeks post-operatively. This appearance resolves to leave a pleasing, and more youthful shape to the lower lid. “Mis-matched” eyelids usually result from underlying facial asymmetries that are unmasked by the surgery. Careful study of you pre-operative photographs will enable you surgeon to point this out to you before surgery. After healing is complete, these asymmetries are usually subtle and seldom require correction.

How long does it take to recover from surgery? If only blepharoplasty is done, the majority of the recovery is complete at 7 to 10 days. Some patients have more extensive bruising which can take two weeks to completely clear, similar to a black eye. Stitches in the eyelid are usually removed in five days. When midface lifts are done in conjunction with blepharoplasty, 10 days to two weeks are needed for swelling and bruising to resolve. Subtle swelling can persist for up to a month.

Is this surgery covered by insurance? Lower eyelid surgery is covered by insurance only for severe lower lid laxity, ectropion, or problems with tear drainage. If the surgery is designed only to improve appearance, it is considered cosmetic and not covered.

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

Chin and Cheek Implants

 

High cheekbones and a strong jaw line have long had a history of allure.  Along with the eyes, the cheekbones and jaw line form the most photogenic aspects of the face.  Chin and cheek implants are a great way to enhance a facial profile by improving the overall proportion and balance of the face.  With chin implants (mentoplasty), the symmetry of the face can be shaped and contoured.  Cheek implants (malarplasty), also known as malar (high cheek) or submalar (low cheek) augmentation, can add fullness and definition to the face.  Utilizing permanent chin and cheek implants can provide a rejuvenated, youthful facial profile.

Reasons for Considering a Chin and/or Cheek Implant:

  • Extend or enlarge the chin if the chin is recessed or small.

  • Create a more defined facial profile if the jaw, chin, or cheeks lack distinction.

  • Bring the various aspects of the face into proportion.

  • Round out the cheeks if they are hollow due to heredity or aging.

  • Accent the upper cheeks making them appear higher and fuller.

General Procedure

With chin surgery, an implant is inserted in front of the jawbone in order to augment the chin or jaw.  A small incision is made inside the mouth to allow the implant to be positioned in a pocket just under the skin.  An alternate location for this incision is below the chin (on the outside).  Chin surgery is commonly performed along with rhinoplasty (nose surgery).  With cheek augmentation, incisions are made either inside the mouth, through the lower cheek, or directly below the bottom eyelid on the high cheek.  Cheek surgery is often performed in conjunction with a facelift procedure.  Both chin and cheek implant procedures normally last from 30 minutes to one hour.

Recovery Process

Immediately after surgery, the face will be fitted with bandages, taped, or otherwise secured in order to speed the recovery process and to reduce swelling.  Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and recovery time.  Keeping the head elevated during the initial recovery phase is also important. Patients sometimes report minor pain associated with surgery.  Any pain can be treated effectively with oral medication.  Patients may experience some swelling and bruising of the face which can be eased by using cold compresses.  A liquid diet may be required for a few days, as chewing may be difficult.  While complications are rare, patients can minimize potential problems by carefully following the post-operative directions given after surgery.  The substance used for chin and cheek implants is made of durable, solid material that will last for years.

Ear Surgery

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Surgery of the ear, also known as otoplasty, is a procedure that helps reduce protrusion of the ear away from the head.  Most often, ear surgery is performed on children between the ages of four to fourteen.  Ears that “stick out” are often the source of teasing and ridicule in young children.  This teasing can have a devastating effect on the child’s psyche.

Otoplasty is not limited to children and may also be performed on older patients.  Cosmetic procedures are available for those individuals with large ears and for those with congenital (birth) irregularities that detract from their appearance.  Additionally, an individual’s ears may exhibit abnormal traits due to their genetic make-up or an accidental injury, such as losing an ear or part of an ear.  Otoplasty is used successfully for each of these situations.  Regardless of the procedure, patients have been pleased with the long-lasting improvements to their appearance offered by ear surgery.

Reasons for Considering Ear Surgery:

  • Bring proportion to the face if the ears “stick out” too much.

  • Correct folded ear tips (lop ear).

  • Reshape long or offset earlobes.

  • Enhance very small ears or other congenital defects.

  • Remedy an accidental injury, including the loss of an ear.

General Procedure

Ear surgery is commonly performed under general anesthesia for children and local anesthesia for adults.  The standard otoplasty procedure brings the ears closer to the head.  Otoplasty begins with an incision hidden in the crease behind the ear.  This incision allows the cartilage located behind the ears to be reshaped in order to position them closer to the head.  The procedure takes approximately one to two hours, depending upon the extent of surgery.

There are various surgical techniques involved in correcting irregularities other than protruding ears.  These techniques can be discussed with your physician during the initial consultation.

Recovery Process

After the surgery is completed, large bandages will be wrapped around the head. This method secures the ear in place and assists with the healing process.  The bandages are usually removed within a week and replaced with smaller dressings.  Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and reduce the recovery time.  Patients sometimes report minor pain associated with surgery.  Any pain can be treated effectively with oral medication. While complications are rare, patients can minimize potential problems by carefully following the post-operative directions.

Nose Surgery

 

Nose surgery (Rhinoplasty) is a procedure to reshape the nose in order to create a more pleasing look and, in some instances, to correct severe breathing problems.  With approximately 400,000 operations performed each year, rhinoplasty is considered the most popular cosmetic procedure in the United States.  Rhinoplasty usually involves reducing the size of the nose by removing and sculpting the nasal tissues in order to enhance the facial appearance.  The results are unique to each individual, and depend upon such factors as skin condition and thickness, nasal and facial structure, genetic contributions, and age.  Traditionally, a “nose job” was performed only to correct major problems.  However, recent surgical innovations allow for individuals to benefit from more moderate improvements from the procedure as well.  In general, having nose surgery provides the patient with a better facial balance and overall appearance.

Reasons for Considering Nose Surgery:

  • Bring a better proportion to the nose and facial features.

  • Reduce the size of the nose that is too large or too wide.

  • Correct an overly arched or “Roman” nose.

  • Re-form a crooked or elongated nose tip.

  • Restore the nose if damaged from an accident or sports injury.

  • Help with breathing problems by rebuilding the nasal passage.

  • Treat nasal deformities caused at birth.

Note:  If rhinoplasty is being utilized to correct a breathing problem or nose deformity, the procedure may be covered under the patient’s insurance policy.

General Procedure

The rhinoplasty procedure lasts from one to three hours.  The surgeon may elect to utilize either local or general anesthesia, depending upon the complexity of the operation.

To begin the surgery, tiny incisions are made which allow the surgeon to access the underlying nasal structure.  Once the skin is opened, the cartilage and bone are reshaped to form the basis for the new look.  Two basic methods are utilized for performing nose surgery.  These methods are referred to as the ‘open’ and the ‘closed’ techniques.  The open technique allows for maximum visibility and control over the procedure.  The incision used in the open technique is placed in-between the nostrils on the columella (the medial nostril strip).  In the closed technique, the incisions are internal and heal faster; however, there is less surgical control over the outcome.  The physician can discuss which technique is best when the patient arrives for the initial consultation visit.

Recovery Process

Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and to reduce the recovery time.  Some swelling may be noticed; however, any swelling will disappear within a few weeks.  A splint, bandages, and/or gauze are applied immediately following surgery to aid in the healing process and to minimize movement of the nose.  Patients must refrain from smoking for several weeks before and after the surgery.  In addition, any corrective glasses that are worn must be taped up and off the nose.  The nose will need to be well-protected from the sun for the first year after the procedure while the body is adjusting to the new look.  Patients sometimes report minor pain associated with the surgery.  Pain can be effectively treated with oral medication and/or cold compresses.  While complications are rare, patients can minimize the risk of potential problems by carefully following the post-surgical directions given by the surgeon.

Lip Augmentation

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Lip augmentation is a procedure designed to make the lip or lips fuller, more youthful, and more sensuous in appearance. This procedure can also help to decrease the lines around the mouth known as “smoker’s lines” that wick lipstick.

Q & A

How is lip augmentation done?
A material known as “filler” is either injected or surgically positioned into the upper and/or lower lips to augment them. There are actually many different materials used to perform lip augmentation. The main “filler” substances used today include collagen, fat and (most recently) a substance known as hyaluronic acid. In the past, other substances such as silicone injections and Gortex strips have been used with unacceptable and sometimes disastrous results.

Are there different forms of collagen?
There are several different forms of collagen used to augment lips. They can be divided into two main forms: liquid collagen and collagen strips. The liquid, or injectable, collagen is derived from either a bovine (or cow) source or a human source. Collagen strips are currently exclusively derived from a human source. All fillers are treated to prevent rejection or other reactions with our immune system. The bovine collagen, unlike the human form, does require a skin test to make sure that patients are not allergic to it.

How is fat grafting done?
In a technique known as “liposculpture”, fat from one part of the body is removed and injected into another - in this case the lips. Fat harvesting is done by numbing an area, usually the lower tummy or outside of the thighs, and gently suctioning fat cells into a syringe. The unusable oils and debris are then filtered out. Remaining fat cells are concentrated and injected into the lips.

What is the best substance to use for lip augmentation?
Each substance used for lip augmentation has advantages and disadvantages. The injectable collagens, whether from a human or bovine source, do not last very long (despite manufacturer claims to the contrary). This period can range from an optimistic 2-3 months to as short as 1-2 weeks in others. However it is a procedure that can be done in the office and allow a return to work on the same day. Collagen strips (Alloderm) have the best track record to date with recent studies showing up to 80% of the amount placed lasting after one year. Alloderm does cost more than injectable forms, and is usually done in an operating room or office setting with intra-venous sedation.. Fat injection, or liposcupture, falls roughly in between the two with about 30% remaining after the original injection. Like Alloderm, fat injection is usually done in an operating room setting and is therefore more costly.

Will my lips be swollen after and for how long?
All substances used for lip augmentation will lose volume to differing degrees (see the above question). This means that it is necessary to over-augment at the time of the procedure to allow for the inevitable shrinkage that will occur. Swelling after Alloderm implantation is typically much less that fat grafting, and resolves much more quickly.

Is this procedure permanent?
At the present time there is no permanent substance for lip augmentation. Some fillers such as Alloderm last much longer than Bovine collagen or injection of one’s own fat.

Why do some Hollywood celebrities have such a “lumpy” look to their lips? This typically arises from repeated collagen injections that form “pockets” of collagen in the lips, leaving an irregular border where the upper and lower lips meet instead of a straight line. One advantage to augmenting lips with sheets of material is that this is not a problem. Repeated injections can also lead to greater inflammation due to allergic reactions as the body becomes sensitized to the collagen.

Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

 

Chemical Peels

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A chemical peel is an aesthetic procedure performed to achieve better skin tone and to remove fine lines, especially on the face.  The chemical solution removes outer layers of skin which are damaged by age, sun, acne, wrinkles, or pigmentation problems.  Removing the outer skin prompts the body to generate a new layer of skin cells which are tainted by the previous skin condition.  Chemical peels may not be appropriate for darker skin complexions.

Reasons for Considering a Chemical Peel:

  • Reduce facial wrinkles and lines.

  • Improve sun-damaged skin.

  • Correct age spots and pigmentation problems.

  • Lighten scars (especially from acne).

  • Treat precancerous skin lesions.

General Procedure

At the time of your procedure, any active skin disease, infection, or acne needs to be under control in order to maximize results.  There are several different types of chemical solutions which can be used, ranging from a mild solution to a very strong one.  The surgeon will select what is best for the patient based on their skin condition, color, and desired result.

During the procedure, the skin is first cleansed of oils.  A solution is then carefully applied and is allowed to remain on the skin for a short time in order to remove the layers of damaged skin.  At this point, the skin will turn white, a frost-like effect.  The skin is then neutralized and cleansed.  Finally, an ointment is applied to the skin to aid in healing.

Recovery Process

Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and recovery time.  An ointment and dressings are applied immediately following surgery to aid in the healing process and to minimize swelling.  The skin will have a pinkish color, and a thin crust may form over the area that was treated.  Patients sometimes report minor pain associated with the procedure, which can be treated effectively with oral medication.  While complications are rare, patients can minimize potential problems by carefully following the post-operative directions given by the surgeon.  Recovery time varies depending upon the extent of the chemical peel and can sometimes take several months.

Botox Treatments

 

Botox® is a relatively new procedure using Botulinum Toxin which was developed to treat the visual signs of aging by reducing or removing wrinkles.  The procedure is considered a safe, effective way of treating aging skin.  Common areas for Botox® injections include horizontal forehead furrows, vertical lines between the eyebrows and "crow's feet" around the eyes.  Botox® has proven to be the best non-surgical form of facial rejuvenation and is capable of producing phenomenal improvements in your appearance.

Reasons for Considering a Botox Treatment:

  • Excessive facial wrinkles.

  • Large wrinkles or furrows in your forehead.

  • Small wrinkles or “crow’s feet” around your eyes.

  • A vertical “frown line” between your eyebrows.

Q & A

What is BOTOX?
BOTOX is a temporary muscle blocker that is produced by bacteria. Modern science has been able to purify and carefully standardize the amount available for injection. It is packaged “freeze-dried” into glass vials that must be kept refrigerated up to the time of its use. Sterile saline solution (actually harmless salt water) is added to the bottle prior to injection. Once mixed, it can be safely stored in the freezer for up to 10-14 days and re-used. Using a small needle the mixture is injected just below the skin surface into a particular facial muscle.

How does it work?
Botox works by temporarily blocking nerve impulses that normally tell our facial muscles to contract or squeeze. The result is that wrinkles caused by the muscle movement can smooth out or disappear altogether as the result of this blocking effect. Not only will wrinkles improve after BOTOX injection, but those that are already present will not grow deeper over time. BOTOX is thus not only a good treatment, it is also good prevention.

Does Botox work on all wrinkles?
Wrinkles on the face result from the normal aging process of the skin. The formation of these wrinkles is accelerated by sun exposure or cigarette smoking. If the wrinkles are present with the face at rest, they are known as static wrinkles. BOTOX alone does not effectively treat these types of wrinkles, but can improve them somewhat. BOTOX is effective on other wrinkles known as dynamic wrinkles. These result from the contraction, or squeezing, of our facial muscles. The wrinkles they typically respond well to BOTOX are the between the eyebrows (frown lines), the sides of the eyes (Crow’s feet), and across the forehead. Long standing wrinkles or deep furrows will only improve slightly with treatment. However treatment can prevent them from becoming worse. BOTOX can be effective in treating string-like muscular bands on the neck also.

How is BOTOX measured?
It is important to understand that BOTOX is measured and administered in units with each vial containing 100 units. Since each office injects a different amount of sterile water to the vial it can be either concentrated or dilute. This means that the volume, or amount of fluid injected, is not the same as the number of units given. By using units as the “measuring stick”, both the patient and practitioner know how much has been given for a particular treatment. In addition, these units should be the basis for a fee quote given to you by your practitioner. Otherwise, you will not know how much BOTOX you are actually paying for. If you doctor charges for each “area” treated, ask how many units he typically uses for each “area”.

How much BOTOX is necessary for treatment? 
A typical treatment amount for the area between the eyebrows is about 20-30 units, for the forehead about 30- 40 units and for the Crow’s feet about 10-20 units on each side. In general, women require fewer units than men who have much thicker and stronger muscles. Over time less BOTOX is required to treat a given area since the muscles can atrophy or shrink as a consequence of initial treatment. .

How long does BOTOX last?
The wrinkle smoothing effect usually does not become apparent until 4-5 days following the injection. Since BOTOX acts by blocking the movement of muscles, the most significant improvement will appear in those wrinkles that are most apparent with facial animation. BOTOX is not permanent and its effect will wear off with time. It can last up to 6 months before requiring re-treatment with the average effect lasting 3-4 months. If “follow-up” treatments are administered at the first sign of returning wrinkles, they tend to last significantly longer with each subsequent BOTOX session. In addition, less BOTOX is usually needed with subsequent treatments due to atrophy (shrinking) of the muscle.

Can Patients have an allergic reaction to BOTOX? This is theoretically possible, but has not been reported in the medical literature. Patients who have had repeated injections of BOTOX have circulating antibodies against the foreign protein of the toxin. Again, this does not create problems, but can create a situation in which more BOTOX is needed to obtain the desired effect.

How many times will I have to be stuck by the needle? This depends on the area injected, and who does the injections. At Aesthetic Surgery Associates, we able to limit the number of needle sticks in the frown lines to three at most. The crow’s feet usually require three of four per side, and the forehead frequently needs eight or more. Topical local anesthetic creams can be used to reduce the discomfort, but sometimes do not work well in these areas. Simply cooling the area with ice reduces pain significantly

What are the complications of treatment? The most common complication is bruising due to the needle stick in an area rich with veins and arteries. Bruising typically resolves in days, and can be easily covered with make-up if it occurs. Problems can occur if BOTOX gets into muscles other than those intended. For example, if it diffuses into the muscle that raises the eyelid, the lid can droop and cover the pupil – a condition called lid ptosis. If BOTOX gets into the muscles that control movement of the eyeball, it can cause double-vision. These symptoms can be troublesome, but usually resolve without treatment in two to three weeks. Rarely, the same muscles on opposite sides of the face can respond differently and asymmetry can result with facial movement. Similarly, if the muscles that pull the eyebrows down are paralyzed to improve frown line and crow’s feet, wrinkles across the forehead can appear worse due to unopposed brow elevation resulting from “knocking out” the muscle that depress the eyebrow.

Are there any other desirable effects of BOTOX treatment? With time, our eyebrows tend to descend due to the action of the muscles that cause frown lines and crow’s feet. After BOTOX treatment, many patients note that they have a “softer” and more well-rested look due to elevation of the brow position. This has been termed a “chemical brow lift” in the medical literature. As mentioned above, BOTOX also prevents the progression of wrinkles with time.

Additional information can be found on the following web sites:
plasticsurgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

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254.526.5106
800 West Central TX Expressway 
Suite 100, Harker Heights, TX 76548

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