Facial Surgery, The Center for Plastic Surgery : Washington DC

Facelift (Rhytidectomy)

Browlift

Eyelids (Blepharoplasty)

Nose Reshaping (Rhinoplasty)

Chin Implants

Malar Implants (Cheek)

Ear Protrusion (Otoplasty)

Skin Smoothing & Peeling

Orthognathic Surgery for Reconstruction

FACELIFT (Rhytidectomy)

As the face ages, gravity's effects become more obvious. The earliest apparent change is loss of the cervical mental angle, the angle formed by the neck and lower jaw. As the neck skin becomes lax, it sags and gradually obliterates the youthful sharp angle. This condition generally has three components: a laxity of skin, a laxity of the underlying muscles (particularly the platysma muscles) and an accumulation of fat. Lax platysma muscles cause the bands in the front portion of the neck that often are seen in older persons. In the upper portion of the face along the jawline, excess skin creates jowls. These jowls may be characterized by fat deposits. The folds that run from the nose to the jaw (nasolabial folds) also become more accentuated with age.

Surgery to improve the appearance of the aging face and neck is called a facelift. This procedure removes accumulated fat, repairs muscles that have stretched and removes excess skin.

While a facelift removes coarse wrinkling and sagging skin, it cannot remove the fine wrinkling associated with sun exposure.

The usual facelift incision is from the temporal hairline in front of the ear, around the earlobe, behind the ear and into the hairline around the back of the neck

There may also be a small incision under the chin. This placement of the incisions restricts any scarring to less obvious areas. There have been recent improvements in the procedure to support the underlying facial structures, resulting in a more successful and longer lasting outcome.

There is no special age for a facelift. A facelift may be desired whenever changes due to aging become bothersome to the individual. For some people, this occurs as soon as the cervical mental angle begins to fall. Others are not bothered until changes are more advanced and jowl formation or platysmal banding begins.

Patients often ask how long a facelift lasts. The answer is as individual as the patient. While surgery can turn back the clock, it does not stop aging. Facial aging will continue at the normal rate for that person. The average time before people begin to consider a second facelift is usually six to ten years. Many patients never have a second procedure.

In scheduling your surgery, we recommend that you allow six weeks for healing prior to any important function you plan to attend, in case your healing is slow or there is an unexpected complication. We recommend that you have any hair trimming or coloring done during the week before surgery. You should wait four to six weeks after surgery before coloring your hair again.

After surgery you will be wrapped in a turban-type dressing that extends under the neck and chin. One to two days after, you will return for a checkup, and we will remove this dressing and replace it with a lighter one. You will see noticeable bruising and swelling. Your surgeon will let you know when you will be able to shower. Three to five days after surgery, we will remove sutures around the ears; the rest will be removed about seven days later. When all sutures have been removed and the wounds have healed, you may want to consult with the makeup specialist in our office about techniques to camouflage any remaining bruises. There is no charge for this service. Most bruising will subside by fourteen to twenty-one days after surgery. Swelling may take longer to disappear. Most patients are able to resume a normal level of activity within two to three weeks after surgery.

Possible risks associated with a facelift include skin damage in front of or behind the ear and damage to the nerves that move the face. Complications are rare and usually temporary. Skin damage, however, is more common in cigarette smokers.

BROWLIFT

Browlift can be performed alone or is frequently performed in conjunction with other procedures such as facelift or eyelid surgery. The browlift corrects the deep horizontal lines in the forehead and raises the brows back to a more youthful position when they fall below the orbital rim (eye socket). This procedure can be performed through an incision running over the top of the head or with an endoscope through much smaller incisions in the scalp.

After surgery you will be wrapped in a light headdressing for 48 hours. Drains may be used and will be removed in the office 24 to 48 hours after surgery. Mild bruising and swelling during the first week to ten days is not unusual. Most patients are able to resume a normal level of activity within two weeks after surgery. Possible risks associated with a browlift include numbness and weakness in the muscles of the forehead. Complications are rare and usually temporary.

EYELIDS (Blepharoplasty)

As people age, some of the earliest changes are in the eyelids. The skin of the upper and lower eyelids stretches out.

Blepharoplasty can make a person appear more rested and youthful. We also offer the most advanced technique for blapharoplasty, laser eyelid surgery.

Fatty tissue that surrounds and supports the eye also may begin to bulge, creating a puffy, tired or angry appearance. Surgical repair of this condition is called blepharoplasty. This surgery can improve the puffy appearance. While it also can make improvements in the fine wrinkles on the lower lids and "crow's feet" on the side of the eye, it cannot eradicate them completely. Sometimes, sagging skin can become so excessive that it hangs down onto the lashes and obstructs vision. Repairing this condition is considered a medical necessity and may he covered by insurance, unlike the repair of a lesser deformity.

During blepharoplasty, the excess skin and muscle and any protruding fat are removed. The resulting scar on the upper eyelid usually is hidden in the crease formed when the eyelid opens. The extension of the scar to the side usually is hidden in any "crow's feet."

Two approaches can be used on the lower lid. One approach involves making the incision just under the lower lashes and the scar usually is inconspicuous. Another common approach is called a transconjunctival blepharosplasty. The incisions are made from the inside of the lower lid avoiding an external incision, minimizing problems with lid position and eye shape.

Postoperatively, there will be bruising and swelling of the eyelids. If both upper and lower lids are operated on at the same time, it may be difficult to see for two or three days until some of the swelling dissipates. Permanent alterations in visual acuity are extremely rare. Some patients may have difficulty closing their eyes completely or may notice changes in their lower lid position, but these problems are most often temporary. Sutures will be removed within three to five days after surgery, and you may shower then. You may resume light exercise one week after surgery and more strenuous exercise two weeks after the operation. Most bruising will disappear within ten to fourteen days postoperatively.

NOSE RESHAPING (Rhinoplasty)

Rhinoplasty is the operative procedure used to change or improve the shape of the nose. Nasal deformities may be congenital, may develop as the person grows or may be the result of injury.

Underlying bone and cartilage give the nose shape. Rhinoplasty can straighten the nose or improve the shape of a nose that does not otherwise fit the face.

Nasal deformity also may cause breathing difficulty. Rhinoplasty to improve appearance can be performed in conjunction with a procedure to correct the breathing problem. In instances of functional problems, insurance may cover some of the costs.

Rhinoplasty can be done at any time once nasal growth is complete. In women, this usually occurs by age thirteen, in men by age sixteen.

Rhinoplasty incisions are inside the nose and are closed with dissolving sutures. If the nostrils must be narrowed, there may be small incisions and removable sutures at the nostril rim. These sutures are taken out five days after surgery.

When rhinoplasty is completed, packing is sometimes inserted inside the nose and a splint placed on the outside. The packs remain for one to five days and will be removed in our office by a physician or nurse. The splint will be removed about one week after surgery and showering will be permitted at that time. Most bruising and swelling will disappear within ten to fourteen days. Prolonged swelling of the tip of the nose is an uncommon problem which may require special attention. You may participate in non-contact exercise two weeks after surgery, but you should avoid contact athletics for six weeks.

CHIN IMPLANTS

As the facial skeleton grows, some people develop a receded or "weak" chin. If bite correction is not required but the chin is recessive, its prominence can be increased with an implant. These implants are made of plastic or similar material and are inserted through an incision in the mouth or through a small incision under the chin. The implant rests on the front surface of the lower jaw and gives a permanent result. Another procedure to reposition the lower jaw, called sliding genioplasty, may sometimes be indicated. These procedures are often combined with rhinoplasty. Chin implants often are combined with cosmetic rhinoplasty to improve facial balance.

After surgery, the chin will be swollen, and the lower jaw may look bruised. You will be on a liquid or soft diet for the first few days. There are no restrictions on showering or bathing. Most swelling will subside by ten to fourteen days after surgery. You may resume exercise at that point. Some patients have postoperative numbness which usually lasts only three to four weeks. The chin may not feel completely normal, however, for four to six weeks.

MALAR IMPLANTS (Cheek)

Cheek implants are used to enhance facial definition and create a more prominent cheek bone. These implants are made of plastic or similar material and are placed on top of the cheek bone through incisions in the mouth. You will be on a liquid or soft diet the first few days. Most swelling will subside by ten to fourteen days after surgery at which time you may resume exercise. Possible risks associated with malar implants are infection or numbness of the upper lip. Complications are rare and usually temporary.

CORRECTION OF EAR PROTUSION (Otoplasty)

Otoplasty is surgery to correct protruding ears. Most people's ears project about two centimeters from the head. As some children grow, however, their ears protrude noticeably further. Approximately ninety percent of ear growth is completed by age three, and corrective surgery may be performed anytime after this point. Most commonly, it is performed at age five or six, but can be performed even into adulthood.

Otoplasty changes the shape of underlying ear cartilage by removing portions of it or by forming normal folds of the ear where they are absent. Protruding ears can be corrected by reshaping the underlying cartilage.

After surgery, you will have a turban-type head dressing that will remain in place for three to five days. When that dressing is removed, you will wear a light dressing over the ears. Children may prefer to wear a ski-type headband. You will be able to shower as soon as this turban dressing is removed. Your ears will be wrapped at night for three weeks after surgery, when healing should be almost complete. There are rare Instances of mild recurrence of the protruding ear which can be easily corrected under local anesthesia. Most bruising and swelling will resolve in ten to fourteen days. You may resume your normal exercise about two weeks after surgery, but you should avoid contact athletics for six weeks.

SKIN PEELING

While fine skin wrinkles cannot be corrected by a facelift or by blepharoplasty, there is a procedure called skin peeling that can improve, or in some cases, eliminate these wrinkles. Skin peeling does not correct the excess skin or fat accumulation which can be treated by a facelift or blepharoplasty. Sun damage and the loss of skin elasticity due to aging cause most wrinkles. As we age, the elastic fibers in the deeper layers of the dermis (the second layer of the skin) lose their strength, allowing the skin to sag and wrinkle. Frequent or excessive sun exposure greatly accelerates the problem.

Chemical skin peeling frequently can restore some of the elasticity by penetrating to the dermis and microscopically tightening the elastic fibers to give the skin a smoother, more youthful appearance. Skin peeling can eliminate many wrinkles caused by aging and sun damage.

There is a wide range of peels available. Micropeels are very light and are repeated several times to obtain the final result. These light peels allow you to wear makeup immediately and to maintain your normal routine. The deep peels do not require repeated applications and more deeply penetrate the skin. This will cause crusting and peeling, which will take three to fourteen days to heal, depending on the type of peel solution used. Some patients find their skin will he slightly lighter or darker after a deep peel. Makeup covers this easily.

Fine lines and other skin defects can also be improved with a new procedure called laser skin resurfacing.

ORTHOGNATHIC SURGERY

Orthognathic surgery is extensive facial surgery involving incisions in the bone or osteostomies of both the upper and lower jaws (maxilla and mandible). This is an essential part of reconstruction for both facial form and aesthetics as well as function. Reconstructive surgery seeks to optimize facial skeletal and dental alignments. This may involve other members of a surgical team in order to ensure proper alignment and expeditious healing. Orthodontists may also be involved in order to ensure that the dental relationships are the best that can be achieved with the movement of the bony structures. Often, this type of surgery can have profound changes on a person's appearance.

The surgery is often carried out in the hospital as an overnight stay with possible wiring of the jaws in a closed position. Other times, there may be elastic bands holding the teeth into its proper relationships. Swelling is often obvious for the first few days, but readily dissipates as the healing process continues.

The postoperative period is significant for swelling of the face and numbness which readily dissipates over the first week. The risks are usually temporary numbness of the lips and cheek which improves very steadily as the healing process continues. At times, because of the swelling, the hospital stay may have to be extended for a day or two until this resolves to a satisfactory state. As the healing process continues, the orthodontist and surgeons will remove the elastic bands and wires as well as the banding of the teeth.