ecent advancements in facial rejuvenation surgery have been dramatic. The older techniques of simply pulling tightly on the facial skin created an unnatural "tight as a drum" appearance. These techniques have given way to recent advancements which have enabled us to achieve superior, more natural results.

As opposed to the body where the various features can be well hidden by clothes, facial features, whether desirable or not are there for the world to see. Facial aging is due to several factors, including hereditary, environmental (sun exposure, etc), and self-induced (diet, alcohol consumption and smoking).

Tremendous surgical and technological advances in the past decade now permit us to operate on the various structures of the face with smaller scars and gentler tissue manipulation, therefore leading to a much smoother post-operative course with less discomfort, swelling and bruising. As well, these new advances now allow us to restore the natural beauty to the face rather than create one. The operated look is out and the natural, refreshed and well rested look is in.

In addition, when doing facial rejuvenation surgery, frequently, the eyelids must also be addressed. The addition of lasers to our surgical armamantarium has recently enabled us to achieve far more esthetic results, with smaller and sometimes no scars, less post-operative discomfort and bruising and therefore, a faster return to one's daily routine.

Facelift

Firstly, our understanding of facial anatomy and of the aging process has taught us that it is not merely the skin which sags with time but rather many of the underlying structures as well. Therefore, a properly performed facelift today is not merely a lift of the skin alone but of the underlying muscles and fatty tissues as well. Therefore, the final result is one of a refreshed, younger appearance and one which, due to the nature of this type of lift, should last much longer than the previous techniques.

The usual incisions for a facelift follow the contours of the ear and then are tucked behind the earlobe and into the hairline, thus, being fairly well concealed. In most cases, with a bit of cover-up makeup, these scars are negligible. In addition to the possible risks mentioned in the section on complications, one other risk which would be specific to this operation is the possibility of damage to one of the facial nerves which control the muscle movements of the face. This is a rare complication and in most cases, should it occur is usually one of a temporary nature

 

Eyelid surgery (blepharoplasty)

Before

After

Before

After

Gravity, time and aging can cause a loosening of the upper and lower lid skin. Typically, the upper lid skin begins to droop and quite often, the skin actually comes to rest on the eyelashes. On the lower lids, the fat, which normally cushions the eyeball in youth, begins to bulge forward, forming bags and pouches under the eyes. All of these features give the patient a sad and tired appearance. Blepharoplasty can certainly improve the appearance of the eyelids.

This is an operation which is normally done under local anesthesia, whereby the excess skin and fat are removed from the upper lid, following which the upper lid is then re-contoured to restore the previous youthfulness.

Recent advances now allow us to operate on the lower lid without making the external incision which used to be made below the lower lid lashes. We now make a small incision on the inside of the eyelid and thus, leave no external scar. From this incision, the bags under the eyes are corrected by partially removing and/or re-contouring the fat. Finally, the skin on the outside is then resurfaced and tightened and the small wrinkles are removed with the use of a CO2 laser. This operation may be performed in conjunction with any other facial procedure.

Bruising and swelling usually lasts for 1-2 weeks. Post-operative discomfort is minimal. Most patients are able to resume fairly normal activities within that time frame. Due to the thinness of the skin, the healing in this area of the body is most often excellent with barely noticeable scars on the upper lids and no scarring at all on the lower lids.

 

Forehead/Brow lift

Quite often, when assessing the need for eyelid surgery, we also assess the need for a lift of the eyebrows. Naturally, with gravity, brows will descend. The standard procedure for many years was the trans-coronal incision which basically spanned the area between the ears in the scalp (temple to temple). Via this incision, the forehead and eyebrows were lifted but, due to the length of the incision and its placement, numerous problems could be encountered including numbness of the entire scalp, skin necrosis, etc. Technological advances in the past decade now allow us to perform an endoscopic brow lift which requires 1cm (1/3 inch) incisions placed strategically in the scalp, well hidden within the hair. Using a miniature telescope, we then access the muscles of the brows and lift them to their appropriate level. Discomfort with this procedure should be minimal and normal bruising and swelling is to be expected. Recovery time is usually between 10-14 days.