Aging of the face is inevitable. As the years go by, the skin begins to loosen on the face and neck. Crow's feet appear at the corners of the eyes. Fine forehead lines become creases and then, gradually, deeper folds. The jawline softens into jowls, and beneath the chin, another chin or vertical folds appear at the front of the neck. Heredity, personal habits, the pull of gravity, and sun exposure contribute to the aging of the face. As the aging population grows, it is obvious why rhytidectomy has become the third most desired facial plastic surgical procedure.

 If you ever wondered how a rhytidectomy, or facelift, as it is commonly called, could improve your looks or self-confidence, you need to know how a facelift is performed and what you can expect from this procedure. This website can address many of your concerns and provide you the information you need to begin considering facelift surgery.

  Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery is performed. Your surgeon can answer specific questions about your specific needs.

  As with all facial plastic surgery, good health and realistic expectations are prerequisites. Understanding the limitations of rhytidectomy is crucial and psychological stability is vital. There is no ideal in a facelift. Rather, the goal is to improve the overall facial appearance. Skin type, ethnic background, degree of skin elasticity, individual healing, basic bone structure, as well as a realistic attitude are factors that should be discussed prior to surgery. This procedure is sometimes performed on patients in their thirties, and successful surgery has been performed on patients in their eighties. A facelift cannot stop aging, nor can it turn back the clock. What it can do is help your face look its best and give you a look of health and a more youthful appearance. A side benefit is that many patients experience increased self-confidence.

  Before deciding on a facelift, you should discuss with your facial plastic surgeon whether the overall effect will be more successful if additional changes are made in the chin and neck areas through other facial surgery. Many patients decide to have facial liposuction to remove excess fatty deposits in conjunction with a facelift. If several flaws need correction, more than one procedure may be necessary for the best overall result.

  Making the decision for a facelift

  Your choice of a qualified facial plastic surgeon is of paramount importance. During the preliminary consultation, the surgeon will examine the structure of your face, skin texture, color, and elasticity. Photographs will be taken so the surgeon can study your face. Individual risks will also be examined, especially those related to medical situations such as high blood pressure, a tendency to scar, smoking, and any deficiency in blood clotting. The surgeon will take a thorough medical history, as well as assess the patient's mental and emotional attitudes toward the surgery. Because a realistic attitude is crucial to the success of the surgery, the surgical procedure and realistic expectations will be discussed.

  After the decision to proceed with a rhytidectomy is made jointly by you and your surgeon, the surgeon will describe the technique indicated, the type of anesthesia, the surgical facility, any additional surgery, the pros and cons to include possible complications, and costs of the procedure.

  Understanding the surgery

  The surgeon begins the incision in the area of the temple hair, just above and in front of the ear, and then continues around the lobe, circling the ear before returning to the point of origin in the scalp. The skin is raised outward before the surgeon repositions and tightens the underlying muscle and connective tissue. Some fat may be removed, as well as excess skin. For men, the incision is aligned to accommodate the natural beard lines. In all cases, the incision is placed where it will fall in a natural crease of the skin for camouflage.

  After trimming the excess skin, the surgeon closes the incisions with fine sutures and/or metal clips, which permit surgery without shaving hair from the incision site. Depending on the extent of the surgery, the process can take from two to four hours. When the procedure is performed with a combination of mild sedatives, local anesthesia, and a mild intravenous anesthesia, the patient will experience little discomfort. Some surgeons prefer to use general anesthesia for facelifts. Following the surgery, the surgeon will apply a dressing to protect the entire area where the incisions have been made.

  What to expect after the surgery

  Even though most patients experience very little pain after surgery, the surgeon will still prescribe medication. Some degree of swelling and bruising is unavoidable, and your surgeon may instruct you to use cold compresses to keep swelling to a minimum. If a dressing has been applied, it will be removed within one to two days. The surgeon will also instruct you to keep your head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort. Though there are few risks in facelift surgery and thousands are performed every year, some risk exists in any surgery.

  In some cases, a drainage tube may have been inserted during surgery. This will be removed on the first or second day after surgery. All sutures and staples are usually removed within five to 10 days following surgery. Surgeons generally recommend that patients avoid vigorous activity. Patients should prearrange for post-surgery support from family and friends.

  Recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are usually not noticeable after enough time has passed for them to mature. In any case, they are easily disguised in natural skin creases, by the hair, or, in persistent cases, by makeup until total healing has occurred. Bear in mind that theaging process continues after surgery and that some relaxation of tissues will occur over the first few weeks.

  Facial plastic surgery makes it possible to correct many facial flaws and signs of premature aging that can undermine self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself.

  Eyelid surgery or belpharoplasty is a technique used to correct drooping upper lids and puffy bags below your eyes. It uses a procedure that removes fat along with excess skin and muscle from the upper and lower eyelids to correct the features that make you look older and tired. It is done alone or can be performed in conjunction with other cosmetic procedures such as a facelift or a browlift.

  This procedure works best for men and women over the age of 30 who are physically health and realistic in their expectations. If droopy eyes or baggy eyelids run in your family you may want to have this procedure a little earlier. Certain health conditions can make this procedure a little more risky.

  By selecting a qualified plastic surgeon, and closely following their instructions before and after the surgery, you can insure that your chances of complications are very low, and any that do occur are relatively minor.

  You may experience some double vision or blurred vision and some swelling at the corner of the eyes. However, these are temporary symptoms that should be gone within a couple of days.

  Other more rare complications include difficulty closing your eyes after the surgery, and pulling down of the lower eyelid. If any of these are present a subsequent surgery may be required.

  Planning and preparing for your eyelid surgery

  After selecting a qualified plastic surgeon, you will proceed to your initial consultation. Here, the doctor will perform a complete medical exam. It is important that you make the doctor aware of any health conditions you may have, if you use any types of drugs or medications, or if you smoke. The doctor will pay close attention to your eyes, testing your vision, tear production and examining any glasses or contact lenses you may use.

  This initial consultation gives you the opportunity to discuss your goals and expectations for this surgery. Your surgeon will explain the techniques and anesthesia that he will use and whether all four eyelids or just the upper or lower ones will be done. Lastly, any questions or concerns you have will be addressed, in addition to an explanation of where the surgery will take place, the risks involved and the cost of the procedure.

  Your surgeon will give you precise instructions on what types of medications to take and not to take leading up to the day of your procedure. He or she will also give some additional lifestyle and diet recommendations that you should follow closely in order to minimize the potential for any adverse side effects to the surgery. The surgeon will also let you know if he feels that you should arrange for someone to drive you home after the procedure and help you out for a few days.

Eyelid surgery

  The procedure normally takes place in a surgeon's office facility but can also be done in a hospital. It is usually performed under a local anesthetic coupled with medication that will make you drowsy and relaxed - but awake - through the procedure. In some instances, a doctor may choose to perform the surgery with the patient under a general anesthetic, in which case you will be asleep of the entire procedure.

  The surgery itself can take from one to three hours depending on how many eyelids will be done. The doctor will make incisions along the natural lines of your eyelids: in the creases of your upper eyelids, and just below the lashes in the lower lids. This will minimize any visible scarring after the surgery. Working through these incisions, the surgeon then separates the skin from the underlying fatty tissue and muscle, removes excess fat, and trims any sagging skin and muscle that is present. He or she will then seal of the incisions with very small sutures.

After the surgery has been completed your surgeon will probably lubricate your eyes with ointment and apply a bandage of some sort. You may experience some tightness and soreness in your eyes at first which is normal and easily treatable with some prescription medication from your doctor.

  Returning to normal activities

  After the procedure you should try to keep your head elevated for several days, and to use a cold compress on your eyes and head in order to reduce and prevent any swelling or bruising that may occur. Any bruising that is present should completely disappear anywhere from two weeks to a month.

  You may find that your eyes are somewhat "gummy" and dry for the first few days, and your doctor might prescribe some eye drops and give you some instructions on how to clean your eyes at home. It is also normal to experience some blurring, double vision, itching, tearing and sensitivity to light in the days following your eyelid surgery. These will all subside within a few days. The stitches will be removed within a week and this will increase the speed of recovery from these symptoms even more.

  You will find that you will be able to do things like reading or watching television comfortably within a couple of days of your surgery. You should avoid more strenuous activities like bending, lifting, and sports for about three weeks. If you use contact lenses, you will be instructed to not where them for at least two weeks after this surgery since they may impede your recovery process.

  By one to two weeks you will be ready to go back to work and, depending on your surgeon's recommendations; you may be able to wear some makeup to hide any bruising that is still present.

  During the recovery process you may find that your eyes are more sensitive to sunlight and wind so be sure to wear sunglasses and eyelid sunblock whenever you go out.

  The new you

  Along with the thousands of others who have had this simple procedure before you, you will find that the eyelid surgery will make you look more alert and youthful. This new rejuvenated you will last for many years and in some cases, the results are permanent.

 Ear surgery or otoplasty is normally performed in order to set back prominent ears closer to the head or to reduce the size of large ears. The procedure is normally done on children between the ages of four to14; however, ears surgery on adults is also possible.

  Since ears are almost fully grown by age four, by doing this procedure earlier, the less teasing and ridicule your child will face while growing up. It is important that as a parent you stay alert to your child's feelings about protruding ears. Do not force you children into something they may not be ready for since children who want the surgery are generally more cooperative during the process and happier with the outcome.

  In addition to protruding ears, ear surgery can help with other ear problems including:

• lop ear, when the tip seems to fold down and forward cupped ear, when the ear is very small shell ear, when the curve in the outer rim and the natural folds of the ear are missing lobes with large creases and wrinkles ear reconstruction for those who were born without ears or who lost them through injury

  Ear surgeries are a common procedure, and when performed by a qualified surgeon, carry little risk. However, as with all surgeries a small chance exists that some complications will arise. Most of the complications that arise are normally quite minor and can be dealt with medically quite easily. A small percentage of patients may develop a blood clot in the ear that can drain on its own naturally or drained by a needle. Another possible complication is the presence of an infection that will have to be treated by antibiotics or by drainage.

  Planning and preparing for ear surgery

  During your initial consultation with the surgeon, your doctor will recommend the most effective technique for you or your child after a thorough medical evaluation. He or she will also give you specific instructions on how to prepare for the procedure.

 Ear Surgery

  The procedure normally takes place in a hospital or a doctor's office and depending on the patient's age a general anesthetic (your child will sleep through the operation) or a local anesthetic combined with a sedative, so you or your child will be awake but relaxed. Typically, general anesthetics are used for younger children whereas as older children and adults are treated with local anesthetics.

  The surgery itself will take about two to three hours depending on how complicated the problem is and the age of the patient. The surgeon will make a small incision in the back of the ear in order to expose the cartilage beneath the surface of the skin. Then, the doctor will sculpt the cartilage and bend it back toward the head or remove a piece of cartilage, with non-removable stitches used to help maintain the new shape. In most cases, a faint scar in the back of the ear will be all that is left as evidence of this procedure.

Returning to normal activities

  Unless you or your child was under a local anesthetic during the procedure, you should be up and about just a few hours after your procedure. The patient's head will be wrapped in bandage in order to best maintain the new sculpted shape of the ears and to promote quick healing. Some people may experience some pain or throbbing in the ears but that is easily treated with routine medications.

  After a few days any bulky bandages will be removed completely or replaced with a lighter dressing similar to a headband. Any stitches will be removed or dissolve on their own within a week following the procedure.

  Since children can be very active, it is very important that you as a parent prevent them from doing any activities that might cause the ear to bend. Children can go back to school after a week or so but you want to ask your child's teacher to make sure that your child is careful about playground activity etc. Adults can go back to work about five days after the procedure.

 The new look

  Although some imperfection may remain after procedure, most patients are thrilled with the more natural looking ears of ear surgery. Your child can lead a more normal school life and childhood void of any ridiculing and adults can be more satisfied with a more natural look

 An endoscope is a fiber optic device that is utilized by a surgeon to carefully inspect structures deep beneath the skin and subcutaneous tissues. Endoscopes are an integral tool in modern surgery.

The above disciplines incorporate the endoscope to assist in surgical treatments and procedures. During the 1990’s, the endoscope became an extremely important part of nearly every surgical specialty, including facial plastic surgery.

A small endoscope is a fiber optic tubular probe that assists in visualizing structures with precision. Magnification helps to delineate subcutaneous structures. During endoscopic surgery the doctor will view the surgical field either directly through the endoscope or by viewing a television screen connected to the endoscope.

Endoscopic Advantages

Endoscopic surgery is a “minimally invasive” technique of facial plastic surgery resulting in less trauma then procedures used in the past. For example, small incisions are required for the endoscopic brow lift. Traditionally, a “coronal” incision was created for a brow lift. This incision ran from one ear to the other, over the top of the head. The coronal lift is now considered an outdated procedure and essentially is no longer used. The advantage of an endoscope is that minimal incisions are required. As few as two to five small incisions are made behind the hairline, which nicely camouflages the subsequent healing wound.

Aging of the upper eyes and upper forehead

Probably the first areas to show the signs of aging are the regions in and around the eyes and forehead. This is particularly noticeable in one’s forties. Heredity, stress, poor diet, poor health, sun exposure, and time all contribute to the severity of this aging process. These time-related physiologic changes are also dependent upon each particular individual’s response.

In one’s twenties, redundancy overlapping folds of skin and laxity (droop) of the upper eyelids slowly develops. It becomes more noticeable in one’s thirties and particularly becomes noticeable in one’s forties. With time, the eyebrows and forehead tend to become lax and to droop into a position that is much less aesthetically pleasing. The resultant may leads to an angry, fatigued, depressed, and/or tired appearance. Horizontal forehead lines develop due to an individual’s consistent attempt to elevate the eyebrows and open the eyes widely. In some cases, this action may be necessary to see. The appearance of the eyes and their relationship to the brows significantly affect one’s overall aesthetic and youthful appearance. Both sun exposure and time are significant factors that play a role in changing the appearance of youthfulness and health to the forehead and eyebrows.

Overall, the typical signs of aging of the upper eye and forehead region are prominent horizontal forehead creases, prominent glabellar furrow, droopy eyebrows, and droopy upper eyelids. Commonly, all four conditions will develop at the same time; however, sometimes only one, two or three will develop in any one individual. The eyebrows and forehead significantly affect the upper eyelids. Over time, as the forehead and brows descend, the redundancy and fullness of the upper eyelids increases. With correction of the position of the eyebrows, the excess skin of the upper eyelids is oftentimes significantly diminished. Forehead wrinkles develop due to a persistent tendency to raise the eyebrows due to the sagging (ptosis) of the eyebrows. The endoscopic brow lift resolves the prominence of forehead wrinkles. Deep glabellar lines (worry lines between the eyes and above the nose) are also removed. Overall, a combination of four significant areas of concern are rejuvenated and repositioned with the endoscopic brow lift. Specifically, the areas restored with the endoscopic brow lift are as follows: 1) elevation of the descended eyebrow positions, 2) reduction of the fullness of the upper eyelids, 3) reduction of the horizontal lines of the forehead, and 4) diminished worry lines in-between the eyes.

Advantages of the Endoscopic Brow Lift

In many decades past, youthful restoration of the upper forehead area was performed with the “coronal” brow lift technique. Essentially, scalp and skin tissue were elevated, pulled backward, and removed. The long (coronal) incision that extended from one ear to the other was required to remove tissue. The disadvantages of the procedure were that tissue, scalp and hair were removed and a scar from ear to ear was permanent and could sometimes be seen, especially in the event of male pattern baldness.

The traditional forehead rejuvenation surgery incorporating the long coronal incision is more and more a thing of the past. Clearly, the most advantageous aspect of the endoscopic brow lift is that of the minimal incisions and resultant minimal wounds located behind the hairline. Generally speaking, three to five incisions are created and all are behind the hairline. They hide reasonably and satisfactorily well in the confines of the hair. Even individuals who have male pattern baldness can have incisions that are created in such a manner so as to minimize and camouflage the scar. In the past, individuals with male pattern baldness could not undergo the coronal incision forehead lift due to the unacceptable resultant scar. With endoscopic minimally invasive techniques, forehead rejuvenation becomes a possibility for many. Additionally, scalp tissue is essentially not removed in the procedure and there is basically no hair loss.

The Procedure

Endoscopic brow lift is performed under I.V. sedation with local infiltration with tumescent technique. The procedure takes approximately one to two hours. Generally, between three to five incisions are created behind the hairline. Commonly, three incisions are created behind the upper portion of the forehead behind the hairline. Each incision is approximately one to two centimeters in length. A temporal incision (located above the ear in the temple area behind the hairline) on each right and left side is created and extends approximately two to three centimeters. The minimally invasive technique of endoscopic visualization is performed utilizing the fiber optic endoscope. Visualization in an exact plane beneath the skin, scalp, and subcutaneous tissues is performed employing the endoscope to visualize the tissues. Tissue is released and repositioned in an upward fashion. The hairline is slightly raised. The eyebrows and redundant eyelid skin are repositioned upwards concurrently. Pre-operative measuring is done to assure that the desired repositioning is achieved. Also, during the endoscopic procedure the forehead glabellar muscles are trimmed. Specifically, the muscles of the central forehead, which cause facial expressions of worry, concern and fatigue, are addressed. From an aesthetic standpoint, it is beneficial to reduce or even eliminate the ability of these muscles to function. A “muscle sectioning procedure” is performed in the central portion of the forehead during endoscopic visualization. Following the healing process, the muscles will not work as well and the appearance and sense of worriedness, fatigue and tiredness will be resolved at the same time.

Inherent Risks

Bleeding is generally minimal during the procedure and is not generally a concern postoperatively. Bruising and swelling are typical. Incisions heal invisibly although sometimes the incisions can widen and hair loss can occur in and around the incisions. This is typically resolved after a three to six month period of time. It is rare for incisions and scars to require repair or revision. Numbness to the forehead and scalp is generally temporary; however, in rare instances permanent numbness can occur. Of course, there are anesthetic risks although I.V. sedation is a relatively safe procedure. A “surprised” look is an unusual problem after a forehead surgery, as is persistent brow ptosis. Scarring or pigmentation changes are also unusual. If either condition occurs, then revision treatment is performed. Nonetheless, the overall success rate is quite high when performed by an experienced surgeon.

Postoperative Care

The wounds are closed with absorbable sutures and skin clips are placed in the scalp area. Pins are inserted into the bony cranium to secure the positioning of the soft tissue, fascia, skin and scalp. Individuals return home the evening of the procedure under the supervision of a relative or friend. A head turban bandage is applied which is removed the following day in the office. Generally, drains are not required. It is recommended that the head be elevated in an upright position to reduce swelling. Ice compresses are placed in and around the forehead and eye area and are continued for approximately 36 to 48 hours. Pain medications of the codeine type are utilized. Patients will experience some mild to moderate discomfort in and around the forehead for 24 to 36 hours but the discomfort is reasonably controlled with the oral pain medication. Ice compresses help to reduce the postoperative discomfort. Anti-nausea medications are provided also, as they are occasionally needed until the anesthesia metabolized out of the system. The day after the procedure, the patient returns to the office for removal of the bandage. Typically, individuals are able to resume normal housework activities after two to three days and generally speaking, individuals are able to return to work after five to seven days. This is course, varies from person to person. Activities that require exertion are not recommended until two weeks after the procedure. Clips to the skin are removed approximately seven to fourteen days after the procedure and pins to the cranium are removed approximately two to three weeks subsequent.