|
Example images >>>
Candidates:
We have been performing "refreshing" techniques over the past ten years, offering our patients an alternative to the classical facelift for facial rejuvenation. We start treating our patients at an earlier age say 35, and can also improve the face that has been "over-stretched" by the traditional facelift techniques With these techniques we can improve the facial appearance of patients of all ages. Our technique of Superficial Syringe Liposculpture use the finest cannulas to recontour the jaw line, and inject fat in the naso-labial, malar and glabellar regions, and this combination will postpone the first facelift, or complement our older patients' facelift. "Refreshing" does not give the same results as rhytidoplasty, it is a more gentle, facial recontouring procedure and complements other facial techniques. We appreciate the needs of the patients looking to improve their appearance with a simpler, faster procedure, other than the "cut and stretch" techniques. We offer smaller procedures under local anesthesia, with no need for hospitalization. Introduction Rejuvenation can be described as a state of mind, but there is always the factor that improving the appearance helps to improve the state of mind. "It is much better to look young and have no wrinkles, than to carry the burden of an old face all your life" said a patient. The interesting point is that the changes need not be drastic to provoke a more youthful appearance and elevate the spirit and the "tired" face. The human appearance is the sum of a number of components. It has been studied for centuries by artists and more recently by psychologists and plastic surgeons. History I had to alter my concept of facial rejuvenation, I was never happy performing facelifts on young patients, 35 to 45 years old. Firstly I hesitate putting an extensive and permanent scar on "borderline age" cases and felt there was another approach other than stretching the skin to accomplish the "younger look". The stigma of a stretched face, the "what's happening?" look, although can be avoided by a good surgeon, alters the facial proportions and the outward personality of the patient. A good result will still leave marks that cannot be disguised. Of course I perform the procedure, when indicated, but I find it is less often, and only in very select cases. Several patients in this age group, 25-35, ask for rejuvenation, to "have something done" to improve their appearance, without having to undergoing. Before liposuction, little could be done. The 'so-called' mini-lift, of the temporal or cervical regions, still has the stigmas of rhytidoplasty. Blepharoplasty, solves the problems of excess skin, muscle and fat within the orbital region. Blepharoplasty is a wonderful procedure, made quicker and safer with the use of the CO2 laser, giving a fast recovery time for the busy patient (3 - 4 days.) It solves the eyelid problems thoroughly and leaves inconspicuous scars. Using the trans-conjunctival incision we avoid the lower eyelids skin incision. After the removal of fat, skin retracts in 90% of the patients. The fine wrinkles that do not disappear with the procedure, can be treated with the light AHA peels, especially with 70% glycolic acid, or even with a CO2 laser peel. We rarely revise excess skin after the second post-operative month. In the early 1980's we started using liposuction to improve facial contours. Cannulas were thick in those days, 4mm to 6mm and results, as in all cases of liposuction then, were limited by the patient's skin quality and the deepness of suction. A patient was considered a "good candidate" for liposuction only if young with good skin tone. By the mid 1980's we had started fat grafting of the face and body, and by 1986 we were using only 10cc disposable syringes for the facial sculpturing. In 1988 we changed to syringe liposculpture for all our body work and totally abandoned the aspirator. This facial procedure has became extremely delicate with the use of much finer cannulas, 1.5 mm to 3 mm. Anesthesia has greatly improved with the tumescent technique, and we offer facial and body contouring as an office procedure under local anesthesia. Office surgery has become 90% of our work, the ease and safety of the procedure allied with a global financial recession that has drastically cut the number of hospital surgeries. Fat grafting is now an accepted alternative. We have perfected the technique and for the past years have had a very high rate of patient satisfaction. CO2 laser peels are a new technique, allied to Retin A and the introduction of the Alpha-Hydroxi-Acids peels. We can now treat Caucasians, Negroids and Orientals all year round, providing they follow our strict recommendations of skin care and the use of sun-blocking agents. Technique In the younger patient, we generally inject fat only in the naso-labial folds. The next step will also include fat injection of the malar region. The original malar fat has already started to be reabsorbed or displaced by gravity. This injection also will enhance the naso-labial area, giving it the continent support the skin has lost. The glabellar region is next, with a fold or two forming between the eyebrows. By the late thirties we start suction of the jowls and sub-mandibular area, redefining the "lost" jaw line. Suction is usually performed once and fat injection three times. Injection is performed in 3mm threads, and repeated after 35 days. This means, in reality, that a facial liposculpture patient, is ready to return to normal activities the following day, if they had only fat injection, in two to three days, if they had suction, depending on the amount of fat removed and on patients' predisposition to bruise. Corrective make-up is useful, when clients have a busy schedule and cannot stay away from work (or fun) for too long. In the last two years have we added a light chemical peel to our facial rejuvenation armamentarium. It allows us to treat older patients that need more than facial liposculpture. The peels improve fine wrinkles and those old age spots, giving the skin a more youthful and healthy appearance. We prescribe Retin A treatments in low doses, controlled by weekly visits to the office, for a period of, at least six months. Alpha-Hydroxi-Acids peels are done fortnightly in the office and also prescribed as daily creams. Perhaps the greatest change we have noticed in our results in the last years, is related to the role of skin retraction. We started performing superficial liposculpture in March 1989, using it to improve the body contour of flaccid skin patients, and to treat superficial irregularities and cellulite. The liposuction "law" that states we should stay deep, at least 1 to 2 cm deeper than the skin level, has already been disputed by us. In facial suction never could have followed this rule. Rarely can we stay as deep as 2 cm, or even 1cm. In 1987 we were using 3 mm gauge, cannulas to treat the face and the neck area. Our results were good at the time, but felt we could improve them if we went even more superficially, even closer to the skin, using the same principle we were using to provoke skin retraction in the abdominal and femoral regions with superficial syringe liposculpture. We have developed a 1.5 mm two holed flat tipped 15 cm long cannula, adapted to 10 cc syringe, the same syringe we use for facial suction and injection. Our modification works well especially in patients with flaccid skin of the jowls and sub-mental area. After fat suction, the cannula is turned, the holes facing the dermis, to scrape the skin, provoking an even, controlled retraction of the area. Results We have seen sequaelae of superficial suction of the face, with unacceptable retracted skin areas around the neck, difficult to correct. The difference here lies in the words even, uniform, and controlled retraction. Retraction occurs only when and where it is indicated. Even using this technique, some patients still have excess skin, and then we start with skin resection. We had a surprise reoperating some of these patients. In many cases we managed to recontour the neck without having to resect skin or muscle. The safety limits established for facial liposuction, in our hands have changed. Suction is only part of our "refreshing" procedure. Subtle changes can radically alter our perception of a human face. Combining suction, fat injection and the use of these light peels, the results could be comparable to the results obtained through a more extensive, difficult surgery, that frequently involves hospitalization and a higher risk and cost. To finalize, the traditional procedures have not been abandoned, but their indications should be revised according to the developments of modern plastic surgery.
|
