We notice many facial changes during the normal aging process: the cheeks get smaller, jowls develop, creases and lines show up and the lips change. Lip changes can be quite upsetting to woman making rejuvenation of this important aesthetic area a common goal during facial enhancement. Common treatment options include resurfacing to improve these vertical wrinkles and volume enhancement to restore lost lip definition. In addition, some patients develop an elongated upper lip: the distance between nose and red lips increases covering more of the front teeth. This is where a lip lift can help: access is gained from just underneath the nose and 2 or 3 millimeters of lip skin is removed. A better balance can be achieved in the incisions usually heal very well.
See a patient example here.
By deep tissue firming and stimulating collagen contraction, SkinTyte is an effective non-invasive means to improve flaccid skin of the belly. Sciton’s SkinTyte delivers uniformly deep heating energy to problem areas - without causing downtime. Therefore, our patients resume their regular activities right away after their SkinTyte session. We like that the effective treatments are available for all skin types. And because there is minimal discomfort during the SkinTyte treatment, no anesthesia or needles are necessary. In addition, it is cost-effective.
Especially popular is the combination of SkinTyte with CoolSculpting - the non-surgical “Freeze-that-Fat-Away” treatment.
We are proud to introduce non-invasive fat removal for our patients.
Please watch video of ABC’s Nightline coverage of CoolSculpting. This effective treatment has been recently approved by the FDA.
Studies demonstrate a 22% to 25% reduction of fat bulges in just one non-invasive treatment.
Alar base reduction is a procedure to narrow the nostrils. When performed, it ususally is done in conjunction with rhinoplasty. Sometimes, patients may wonder, if over-corrected narrowing can be repaired.
When planning alar base reductions, both patient and plastic surgeon should consider it irreversible!
Although creative creative reconstructive procedures can be considered by a rhinoplasty surgeon if the nostril narrowing was undesirable. Unfortunately, these revision surgeries routinely do not look very good, even in the best hands.
Therefore, Dr. Fechner carefully decides if alar base reductions are necessary. If they are performed, conservatism and exact execution of the procedure are of utmost importance.
A 20-year old patient asked us: Am I too young for blepharoplasty?
With any cosmetic procedure, the patient goals, motivation and anatomy have to be considered first. The age is really secondary. In rejuvenation procedures such as facelifts, age is an important consideration. For the eyelids, enhancing the definition and appearance of the eyes can be a valid goal for a 20 year old. Age related changes are obviously not the concern.
A consultation with an experienced facial cosmetic surgeon will help in discussing concerns, goals and possible treatment options. Risks associated with an eyelid lift need to be discussed, too.
Upper blepharoplasty is commonly performed in many people of Asian heritage in order to achieve a more defined upper lid crease (a.k.a. double eyelid). Most Asian patients are between 18 and 30 years of age.
Patients sometimes ask about the benefits of an laser eye lift which they may have heard about.
Because the term ”laser eyelid surgery” is not well defined for plastic surgeons, the discussion has to start by asking what it actually is. There are a couple of possibilities:
1. Laser resurfacing around the eyes. The out layers of the skin are removed through heat generated by the laser machine. The depth of resurfacing will determine how much change can be anticipated. Usually, fine lines and wrinkles are the main target. This procedure has been fallen out of favor for many experienced facial plastic surgeons. For Dr. Fechner, re-sculpting the lower lid region by reducing puffiness and filling in the dark-circle depressions below the lids take a priority. For the upper lids, resculpting and removal of skin excess result in very nice improvements.
2. The laser is used to make an incision for blepharoplasty. Although it is possible to make incisions with many different instruments, none have been proven to heal better than the one made with a high quality scalpell.
Some patients report the observation that closed rhinoplasty result may be better than what they saw after an open operation. Does the rhinoplasty surgeon’s experience play a role?
It sure does! Dr. Fechner stresses that the cosmetic outcome after nasal plastic surgery is not determined by the approach - open vs. closed. Much more important is the careful examination of the nose, followed by the appropriate planning and exact execution of the rhinoplasty.
Either technique (endonasal or open) can lead to an excellent cosmetic results for almost every nose. Complex revision surgeries represent an exception: sometimes extensive reconstruction with cartilage grafting (often using cartilage from the rib) may become necessary.
Certainly, many plastic surgeons prefer one technique over the other. This is usually a reflection of the surgeon’s training, experience and comfort.
The choice for the rhinoplasty surgeon is best not be guided by the doctor’s favorite approach (closed or open) but by the patient’s comfort with the surgeon, his experience and prior results.
Prominent Veins may develop around the eyes - how can they be treated.
These veins are located superficially, just underneath the skin. Fat grafting is very effective for under the eye hollowness (a.k.a. tear troughs). We reserve Sculptra for other facial regions such as cheeks and jawline.
But for veins, both fat grafting or filler injections would likely fail to provide satisfactory results. One of the secrets to successful volume treatments is placement deep underneath the skin, especially in the lower eyelid region.
Vascular lasers (such as a YAG) can be tried. If this does not work, one may be left with 3 further options: attempt of micro-coagulation, make-up or surgical repair through a small incision.
Aging of the face is not only due to sagging of facial tissues but also deflation: we lose youthful facial roundness over the years. Combine this volume loss with drooping of facial tissues and you see the early and advanced signs of aging: facial hollowness, loss of soft contours, jowls and neck looseness. Facial fat grafting is the transfer of fat from the patient’s own body to the face and injections of fat into the aging face represent an extremely valuable addition to a face and neck lift. But, it cannot replace it!
For best results in patients with significant facial aging, we perform facelift in conjunction with fat grafting.
Current research suggests that within the transferred fat plenty of stem cells can be found. These stem cells have the ability to develop into “new” cells of virtually any type including skin, fat and other soft tissues. Although the final scientific explanation is pending we certainly observe that fat transfer provides benefits beyond facial volume enhancement. For instance, Dr. Fechner commonly observes improved texture and elasticity of the overlying skin. Although this may be the result of providing the skin with its lost deeper support, research suggests that the stem cells are in part responsible for a true rejuvenation of the skin itself.
When we examine our patients after successful fat transfer, we are commonly amazed how gentle contour enhancements of the temple, under eye region, cheeks and jaw line can advance the facelift’s improvements for a remarkable, natural-looking and youthful appearance.
We feel that blepharoplasty is well suited to be performed under local anesthesia with pre-operative relaxing medications. Although everybody is very protective of one’s eyes, our patients are usually surprised how relatively easy the procedure is for them. The sedatives are administered by mouth and take usually about 30 minutes to be effective. Once the patient finds themselves in a relaxed state, markings are performed for accurate planning of the procedure. Next, using a tiny needle, local anesthetic solution is deposited underneath the lid skin. After the first injection, additional “pokes” are performed through the already numb skin. Therefore, the patient feels only a slight stinging as the solution ”freezes” the lids. Once complete, the blepharoplasty procedure itself can be performed without discomfort. The lids will stay anesthetized for approximately 1 hour.
We conducted a study evaluating the discomfort associated with local anesthesia injection in 56 patients. When using a scale from 1 to 10 (1 representing no pain; 10 excruciating pain), the average discomfort level was 4 (mild to moderate pain).