Cosmetic Surgery For The Face

What Is Cosmetic Surgery For The Face?

The word plastic comes from the Greek word plastikos, meaning to mold or give form. Plastic surgery makes it possible to mold or reform parts of the human body in order to heal or correct deformities caused by injury, disease, or birth defects. Cosmetic or aesthetic surgery is a branch of plastic surgery concerned with improving physical appearance.

Nice To Know:

The first cosmetic surgery is recorded as early as 600 BC in India. A technique was developed there to use a portion of the forehead to reconstruct the noses of women who had been penalized for marital infidelity.

Modern cosmetic surgery offers sophisticated techniques for restructuring noses and chins, brows and cheeks. Although cosmetic procedures were once the privilege of the rich, modern techniques have made them safer and less costly, so that they are available to people of most socioeconomic backgrounds. Many people now consider cosmetic surgery as normal as crowned teeth or tinted hair.

An increasing number of cosmetic procedures are available to counteract the results of premature aging. Most are concerned with smoothing out wrinkles, removing excess skin and fat, and restoring more youthful contours to the face.

Why Does The Face Age?

The skin begins to age when the body stops growing in late adolescence, but the effects of aging don’t show until mid-life.

As we age, skin cells replace themselves more slowly, and the thick underlayer of the skin, the dermis, begins to thin. The network of elastin and collagen fibers that allows our skin to stretch and retract begins to unravel, and the fat layer under the dermis sags. (Elastin and collagen are proteins found in the body’s connective tissue.) Sweat and oil glands slow production, and the skin can no longer retain moisture.

On the face, the thinner and less elastic skin tends to sag and fold. Permanent crease lines and crow’s feet form on the brow and around the eyes. The eyebrows drop, and loose skin folds around the upper and lower eyelids. Tiny wrinkles form around the lips. The tissues of the jaw and neck droop into jowls and double chins. The skin of the neck droops into folds and wattles.

Genetic factors and lifestyle affect skin aging.

  • Fair-skinned people are more susceptible to the photoaging caused by sun exposure than darker-skinned people are.
  • Prolonged exposure to the sun causes skin to become stretched and leathery.
  • Smoking cigarettes causes the body to produce oxygen-free radicals that damage cell membranes and age the skin.
  • Air pollutants can also increase production of oxygen-free radicals.
  • Rapid weight loss can cause wrinkling by reducing the cushion of fat under the skin.
  • Constant stress also speeds aging of the face.

Some people consider lines and wrinkles in the face to be signs of wisdom and character. Other people, especially those who wrinkle at an early age, find these droops and sags to be a social liability that lowers their self-esteem.

For those who would like to reverse the signs of premature aging, cosmetic surgery procedures are available to restore a more youthful appearance to the face.

Nice To Know:

Unfortunately, the aging process can’t be stopped or reversed, but good daily skin care can slow the process.

  • wash the face daily with mild soaps containing moisturizers
  • avoid prolonged exposure to the sun
  • use sun blocks
  • eat plenty of grain, fruits, and vegetables
  • exercise daily, and do facial exercises to retain muscle tone
  • do not smoke


Who Is A Good Candidate For Cosmetic Surgery?

Wrinkles can make us feel and act older than our years. Cosmetic procedures can restore a healthier, more youthful look to the face, and in so doing can boost confidence and self-esteem. But cosmetic procedures cannot restore youth or stop the aging process.

A good candidate for cosmetic surgery is in good general health and is psychologically stable with realistic expectations.

Skin type, color, and elasticity, bone structure, and individual healing patterns should all be considered before deciding to undergo a cosmetic procedure. Because deep chemical peels using phenol cause permanent loss of skin pigmentation, they usually are not recommended for people with dark skin. Phenol is also not recommended for people with heart, liver, or kidney conditions.

What Treatment Options Are Available for Cosmetic Surgery of The Face?

Cosmetic procedures currently available for the aging face include:

  • The face lift, or rhytidectomy, is a surgical procedure to remove wrinkles (rhytids) from the face, jaw, and neck. It removes and tightens loose skin, removing the sag of the cheeks around the jaw line, lifting the corners of the mouth, and reducing the creases between the cheeks and lips.
  • The brow lift, or forehead lift, is a surgical procedure to lift drooping eyebrows and smooth out forehead wrinkles. It can be done in conjunction with a face lift or as a separate procedure.
  • Liposuction is a surgical procedure that uses suction to remove fat deposits. It can be used to remove focal deposits of fat in the face, often in the area between the chin and neck. It can be done in conjunction with other facial surgery or as a separate procedure.
  • Facial resurfacing or exfoliation removes the thin top layer of the skin in order to improve skin quality and remove tiny wrinkles. Resurfacing can be done by means of chemical peels, mechanical abrasion (dermabrasion), or lasers.
  • Facial implants are injections of body fat, silicone, or collagen to expand skin tissue and fill in tiny depressions left by wrinkles or scars.
  • Newer techniques also are available.

What Are The Risks And Possible Complications of Cosmetic Surgery of the Face?

All surgery involves some risk. Generally speaking, cosmetic procedures are safe and the risk is low if they are performed by a well-trained surgeon. Complications are infrequent and usually minor. They include:

  • Hematoma, or a collection of blood under the skin. In some cases, a hematoma must be removed by the surgeon. Some small hematomas can be allowed to resorb naturally or may be drained with a needle and syringe.
  • Infection and bleeding. Any surgical procedure carries a slight risk of infection and bleeding.
  • Complications of anesthesia. Any procedure using anesthesia carries a slight risk of complications.
  • Injury to nerves that control facial muscles. Nerves and muscles are severed during surgical procedures such as a brow lift. In rare cases, nerve injury can cause loss of the ability to raise the eyebrows or wrinkle the forehead. Additional surgery may be necessary to correct the problem.
  • Numbness. Injury to nerves may also cause numbness along the line of incision after a face or brow lift. This numbness usually disappears as nerves heal.
  • Scarring. Wide scarring may occur along incision lines. Additional surgery may be required to correct the condition. Wide scarring may also occur after deep chemical peels. People who have taken Accutane for acne seem to be particularly prone to scarring.
  • Skin discoloration. In some instances, facial resurfacing techniques, especially deep chemical peels, can cause patches of darker or lighter pigmentation in the skin.
  • Tiny whiteheads and enlarged pores. These complications of skin resurfacing usually disappear with healing.

How To Prepare For Cosmetic Procedures

The surgeon will provide specific instructions on how to prepare for any cosmetic procedure or combination of procedures.

  • As with all surgeries, it will be necessary to stop certain medications, such as blood thinners, a week or so before the procedure.
  • It is especially important to stop smoking at least a week or two before and after the procedure. Smoking inhibits blood flow to the skin and can interfere with healing.
  • People with short hair may prefer to let it grow for a while before having a face lift or brow lift. Longer hair can help conceal scars while they heal.
  • Special medications are sometimes prescribed for pretreatment of the skin before a chemical peel. It may be necessary to treat the skin for as long as a month before the peel.
  • It may be necessary to refrain from eating for several hours before the procedure.
  • Most cosmetic procedures are done as outpatient surgeries under local anesthesia, but a driver will be needed for the trip home and some help may be needed for the first day or two of recovery. Occasionally the procedures are done in the hospital.

Need To Know:

Let your doctor know if you have:

  • High blood pressure
  • Blood clotting problems
  • Allergies
  • A tendency to produce excessive scar tissue
  • A history of cold sores or blisters on the mouth
  • A history of acne

Also let your doctor know if you take medications (especially aspirin or other blood thinners) or if you smoke or use drugs.


Face Lift (Rhytidectomy)

A face lift is a procedure that is done to tighten the skin of the face and remove large creases and wrinkles that have formed around the nose and mouth. The face and neck are usually treated at the same time, and the procedure is sometimes called a face-and-neck lift.

The Procedure

A face lift is performed through an incision made in such a way that most of the scarring will occur on the scalp and along natural lines of the face. For men, the incision follows the natural beard line and can be camouflaged by sideburns. Only a thin line of hair will be trimmed along the incision line.

  • The incision begins in the hairline, continues down in front of the ear, around the earlobe, and ends in the hairline behind the ear.
  • After the incision has been made, the skin is gently freed and raised from the underlying fat and muscle.
  • Excess fat is trimmed or suctioned from the neck and chin.
  • If jowls and drooping neck skin are a problem, the fibrous tissue and muscle immediately under the skin (called the platysma) may be separated and made tighter.
  • Sometimes a small incision is also made in the shadow line under the chin to allow for trimming or suctioning of focal areas of fat along the jawline or under the chin.
  • The skin is then pulled tight and the excess is trimmed away.
  • The incisions are closed with fine sutures and staples.
  • In some cases, a small drainage tube is placed under the skin behind the ear to drain off any excess blood and fluids that may collect there. This tube will be removed within a day or two after the procedure.
  • Gauze dressings are placed along the incision lines and the head is wrapped in an elastic bandage. These bandages will be removed on the first or second day.

Face-lift surgery can last from two to five hours. It can be performed in an outpatient facility with local anesthetics, and sedatives may be given to relieve tension. Some surgeons, however, prefer a general anesthetic and a brief hospital stay.

Nice To Know:

Submental lipectomy, or liposuction, is a procedure for cutting away (lipectomy) or suctioning (liposuction) the fatty tissue that some people develop between the chin and the neck. The underlying muscles can also be tightened to produce a more defined chin and jaw. Although a submental lipectomy is sometimes done as a separate procedure, it is most often performed in conjunction with a face lift.

After The Surgery

The head should be kept elevated to reduce swelling. Sutures will be removed within five to ten days after the surgical procedure. Incisions and bandages must be kept dry. The surgeon will give specific instructions about bathing and washing the hair.

Medication will be prescribed for pain, although most patients experience little discomfort after a face lift.

Most people should allow two to three weeks for recovery from a face lift. This period allows time for bruising and swelling to heal.

  • During this time, vigorous activity should be avoided.
  • Use of cosmetics is allowed after sutures are removed.
  • Numbness and muscle stiffness should resolve during the recovery period, though complete return of sensation may take several months.
  • Use of hair tints and hair dryers may be restricted for some time.
  • Earrings should not be worn until sensation has returned to the earlobes.

Need To Know:

Scars can take nearly a year to fade and soften. However, most of the scars should be hidden by the hair. Other scarring can be camouflaged by makeup and jewelry.

How Effective Is A Face Lift?

  • Face lifts address only the face and may have to be done in combination with other lift procedures before the desired effect is achieved.
  • Face lifts correct deep wrinkling and sagging of the tissues. Fine wrinkling, such as that around the lips, must be corrected by a skin resurfacing technique such as a chemical peel or dermabrasion.
  • Face lifts do not stop the aging process, and signs of aging may reappear as time passes.

Need To Know:

The longevity of a face lift is influenced by lifestyle choices such as alcohol and tobacco use, by environmental factors such as sun exposure, and by heredity.

With a healthy lifestyle, the effects of a face lift may last for 10 years. In some cases, the improvements are permanent.

Nice To Know:

Disguising the scars soon after surgery

Bruising can last as long as three weeks after cosmetic surgery and scars can take several months to fade. Skillful use of cosmetics can disguise the bruises and scars and facilitate an early return to normal activities.

Cosmetics can often be applied to hide scar lines as soon as sutures are removed. The cosmetics must be hypoallergenic and fragrance free.

They should be bought fresh with fresh clean applicators. They should also be creamy enough that they won’t pull against fragile skin. The recommended cosmetics are thicker and more opaque than regular foundation makeup.

Three kinds of cosmetics are recommended for disguising temporary effects of surgery:

  • Concealers are used to hide healed incision lines, scars, and bruises. They go on under the foundation.
  • Color correctors are used to disguise the yellow discoloration of bruises or the redness that follows facial resurfacing. These tints are also applied under the foundation.
  • Contouring colors are ordinary foundations or pressed powders bought in light and dark shades and applied to create the illusion of depth when tissue is swollen. Contouring can make cheekbones look higher and can minimize a swollen nose or chin.


Brow Lift

A brow or forehead lift is most often done to raise drooping eyebrows and smooth out wrinkles and creases on the forehead and between the eyes.

The tissue of the forehead and brow can sometimes sag down over the upper eyelid to such an extent that the eyelashes and eyebrows meet. Wrinkles or “corrugations” in the forehead and the frown lines between the eyes become fixed. These wrinkles and creases can cause a person to look tired, sad, or angry all the time.

A brow lift alters or removes the tissues that cause furrowing and drooping of the forehead, raises the eyebrows, and reduces frown lines.

Nice To Know:

Combination brow and eyelid surgery:

People most often have a brow lift after age 40 to reduce the visible effects of aging. However, people of any age may consider the surgery if they have inherited a tendency for baggy eyes, especially if the drooping skin interferes with vision. In this case, the brow lift is often done in combination with eyelid surgery. If the puffiness is limited to the upper lid, the brow lift alone may be sufficient to correct the problem.

The Procedure

The brow lift is performed through an incision made from ear to ear across the crown of the head. The pattern of the incision follows much the same line as a set of headphones. Before surgery, the hair is bound up in rubber bands on either side of the incision. A thin line of hair may be shaved along the incision.

The skin of the brow is lifted carefully and some of the underlying muscle tissue is altered or removed. It is the downward pull of the muscles that causes the brow to droop. The skin is pulled back and the excess skin is trimmed away so that it exactly fits the incision line. The incision is closed with sutures or metal clips.

The brow lift raises the hairline in a way that may look unnatural on someone whose hairline is high or receding. In this case, the incision may be made just at the hairline to avoid adding more height to the brow.

For a person who is bald or losing hair, the incision may be better placed so as to follow the natural lines of the scalp.

Brow-lift surgery usually lasts between one and two hours. It is usually performed in an outpatient facility with local anesthetics and sedatives to relieve tension.

Nice To Know:

Endoscopic brow lift

In some cases, an endoscopic technique can be used to perform a brow lift.

An endoscope is a thin flexible tube that contains a light source and a camera that can project images onto a television screen. An endoscopic lift can be done through a series of one-inch incisions in the scalp.

The surgeon inserts the endoscope through one of the incisions and uses it to guide other instruments (inserted through the other incisions) in lifting the skin and trimming the underlying tissue. The eyebrows may also be raised and secured in a higher position either by stitches under the skin or by specialized temporary fixation devices under the hair.

An endoscopic brow lift causes less scarring and numbness and it doesn’t raise the hairline as severely as the traditional procedure.

After The Surgery

Bandaging is not always necessary after a brow lift. In some cases, however, gauze dressings are placed along the incision line, and the head is wrapped in an elastic bandage. These bandages will be removed within the first three days after the procedure. Sutures will be removed within 7 to 14 days after surgery. Hair can usually be washed as soon as the bandages are removed, but it is best to check with the surgeon for specific instructions.

  • Most people experience little discomfort after a brow lift, but some medication for pain may be prescribed.
  • A certain amount of swelling and bruising is normal in the first two weeks after a brow lift. The swelling may extend into the cheeks and eyes. Keeping the head elevated can minimize swelling. Cold compresses may also help reduce swelling.
  • Most people return to their normal routine within two weeks of brow-lift surgery. However, vigorous activity, such as jogging or heavy housework, should be limited for several weeks. Prolonged exposure to heat and sun should be avoided for several months.
  • There will be some numbness around the incision. This numbness may be replaced by itching as healing progresses. Both sensations should disappear within six months.
  • There may be thinning or loss of hair along the edges of the scar line. Normal hair growth should return within a few weeks. Permanent loss of hair is rare.
  • Visible signs of surgery should disappear within three weeks.

How Effective Is A Brow Lift?

  • A brow lift addresses only one area of the face and therefore may have to be done in combination with a face lift or eyelid surgery before the desired effect is achieved.
  • A brow lift corrects deep wrinkling and sagging of the tissues of the forehead. Fine wrinkling, such as crow’s feet around the eyes, must be corrected by another technique such as laser resurfacing or collagen injections.
  • A brow lift does not stop the aging process, and as time passes signs of aging may reappear.

Need To Know:

The longevity of a brow lift is influenced by lifestyle choices such as alcohol and tobacco use, by environmental factors such as sun exposure, and by heredity. With a healthy lifestyle, the effects of a brow lift may last for 15 years. In some cases, the improvements are permanent.


Liposuction Of The Face

Liposuction is a technique that uses suction to improve body contour by removing excess fat from specific areas of the body.

Liposuction of excess fatty tissue of the face can be done at the same time as other procedures on the face, using the same incisions, or independently.

Liposuction is most often used on the face to remove a double chin and fatty deposits from the cheeks or neck. Fat is removed from the face under suction, through a narrow tube called a cannula, allowing the skin to lie flatter.

Chemical Peel

What Is A Chemical peel?

A chemical peel is the application of an acid to the skin to achieve a controlled burn to the top layers of skin. Chemical peels are used to remove

  • fine lines, especially around the mouth
  • small scars
  • discolorations such as freckles or liver spots
  • areas of sun damaged skin and spots of precancerous keratoses

Peels can be applied to the whole face or to an isolated area, such as the upper lip. A full-face peel is usually done as a separate procedure before or after a face lift or eyelid surgery. However, if only a small area is being treated, the peel may be done at the same time as the surgical procedure. Chemical peels cannot be done around the eyes.

The type and concentration of acid controls the depth of the burn used to achieve superficial, medium, and deep peels.

  • Superficial peels are produced using alphahydroxy acids (AHA) (glycolic, lactic, and fruit acids). AHA peels are used to treat rough, dry skin and improve texture. These acids can be mixed with a bleaching agent to correct uneven pigmentation.
  • Medium peels are most often done using trichloroacetic acid (TCA). TCA peels are used to treat fine wrinkles and superficial blemishes.
  • Deep peels are produced using carbolic acid (phenol). It is used to treat coarse wrinkles, blotches caused by sun, birth-control pills, or aging, and precancerous growths. Phenol is almost always used only on the face. It may cause scarring on the neck or other areas of the body.

Nice To Know:

Regulation of chemical peels varies from state to state.

  • Some states do not require personnel applying any type of chemical peel to have a medical degree.
  • Other states regulate the types of peels that can be applied by non-physicians.

Caution is advised in choosing a practitioner to apply deep chemical peels using phenol or TCA.

The Procedure

Before the chemical is applied, the skin of the face is thoroughly cleaned with an agent to remove excess oils. The eyes and hair are protected from contact with the acid. The physician then applies the chemical to the face.

AHA peels. The process of applying an AHA solution should take no more than 10 minutes. Periodic treatments may be needed to achieve the desired result. Some people may be able to achieve the desired result by twice-daily applications of a face wash or cream containing an AHA.

TCA peels. A full-face TCA peel should take no more than 15 minutes. The solution may sting when it is first applied, but the feeling will pass quickly. Two or more TCA peels may be needed to obtain the desired result. The treatments may be spaced out over several months.

Phenol peels. After a phenol peel, the physician may coat the treated area with petroleum jelly or waterproof adhesive tape. A full-face phenol peel takes one or two hours. If the peel is concentrated to a region such as the upper lip, it may take only 10 or 15 minutes. A single treatment usually achieves the desired result.

Chemical peels are usually done as an outpatient procedure. In most cases, an anesthetic is not required because the chemical itself acts as an anesthetic. A relaxing sedative may be used. Pain medication may be needed before or during a deep peel.

After The Treatment

It is customary to return home with supervision after a chemical peel, but in some cases a day or two in an outpatient care facility may be required. The skin is not bandaged in most cases.

After a TCA or phenol peel, the doctor may prescribe a pain medication to relieve tingling and throbbing. If tape was used to cover the face, it will be removed within two days.

It is important to avoid the sun during the heeling process after a chemical peel. A commitment must be made to the continued aggressive use of sun block. Overexposure to the sun hastens the aging process and can reverse the effects of the peel.

AHA peel. An AHA peel affects the skin like sunburn. The skin will probably become red and dry, then begin to flake and peel. The flaking should end within five days. Most people can return immediately to their normal activities.

TCA peel. A crust or scab may form on the treated area and there may be significant swelling. The swelling will subside within the first week. After about 10 days, the new skin should be apparent and healing should have progressed enough to allow a return to normal activities.

Phenol peel. After a phenol peel, the face will become quite swollen. The eyes may even swell shut temporarily. Talking should be avoided if possible, and a liquid diet may be required. New skin will begin to form within ten days. The skin will be very red and several weeks may be required for the red color to subside. During this time, exposure to the sun without skin block can cause blotches and irregular pigmentation. After about two weeks, the skin should be healed sufficiently to allow a return to work and to some normal activities. Cosmetics can be worn at this time.

How Effective Are Chemical Peels?

Fine lines and wrinkles are caused by the deterioration of the connective fibers (collagen and elastin) in the skin. Chemical peels force the growth of new tissue in which fibers are more plentiful and better organized. Although it may take several months for skin to recover from a deep chemical peel, the end result is skin of better tone and more youthful appearance.


What Is Dermabrasion?

Dermabrasion uses a power-driven sanding wheel that looks somewhat like a dentist’s drill to remove the topmost layers of skin.

Dermabrasion was first developed to smooth the pitting caused by acne scars, but the technique can also be used to remove wrinkles, liver spots caused by sun and aging, and precancerous growths. For such treatment, dermabrasion is usually done on isolated areas of the face. Dermabrasion cannot be done around the eyes.

Dermabrasion has much the same effect as a chemical peel. In general, chemical peels are more often used to treat fine wrinkles than is dermabrasion. However, dermabrasion is less likely to cause extreme changes in skin color and may be the preferred technique for people with darker skin.

The Procedure

The dermabrasion procedure is begun by cleaning the treatment area with an antiseptic agent. The surgeon abrades away the outermost layer of skin with a wire brush or a burr containing diamond particles. Soothing ointments are then applied.

Nice To Know:

Dermaplaning. The surgeon may also use an instrument called a dermatome. The dermatome looks a bit like an electric razor and works more like a wood plane than a sander. The dermatome has an oscillating blade that planes off surface areas of the skin surrounding pits and other defects. Dermaplaning is most often used to treat scars.

Dermabrasion takes only a few minutes if it is being performed on a small area. For larger areas, the procedure may take about 90 minutes.

Repeat procedures are sometimes required.

It is usually done as an outpatient procedure with local anesthetics and a sedative to relieve tension. Sometimes a numbing spray is used instead of a local anesthetic, or the two may be used in combination. If extensive work is being done, a brief hospital stay may be required.

After The Treatment

For a few days after dermabrasion, the skin feels as though it were severely sunburned. It will be red and swollen, and eating and talking may be difficult. There will be some tingling, burning, and aching that can be controlled by medication. Most people do not experience severe pain.

A crust may form over the treated area. It will disappear with healing. The skin underneath will be tight and pink. The face may itch as the new skin grows. Frequent showers and use of emollients can speed recovery. Men will be asked not to shave for several days and then to use an electric razor until the skin is completely healed. Healing takes about 10 days.

The skin will be slightly swollen, sensitive, and bright pink for several weeks after dermabrasion. Non-allergenic cosmetics can be worn as soon as the skin is healed.

Normal activities should be resumed gradually.

  • Avoid any activity that might cause a bump on the face for at least two weeks.
  • Avoid chlorinated swimming pools for at least four weeks.
  • Avoid active sports such as ball games for as long as six weeks.
  • Avoid exposure to sunlight for at least six months. Aggressive continued use of sun block is required after dermabrasion.

How Effective Is Dermabrasion?

Fine lines and wrinkles are caused by the deterioration of the connective fibers (collagen and elastin) in the skin. Dermabrasion forces the growth of new tissue in which fibers are more plentiful and better organized. Although it may take as long as 12 weeks for skin to recover from dermabrasion, the end result is skin that is smoother and more youthful looking.

Nice To Know:

Microdermabrasion polishes the skin with tiny crystals that are then removed with a vacuum. This technique doesn’t traumatize the skin the way dermabrasion does and it produces only a mild redness. It may have to be repeated several times, however, to achieve the desired result.


Laser Resurfacing

What Is Laser Resurfacing?

Lasers can be used to create a controlled burn of the most superficial layers of skin and achieve the same results as chemical peels and dermabrasion.

Laser resurfacing offers greater control of the depth of the burn and more precision for use around delicate areas such as the lips and eyes.

Lasers can also be used to treat the entire face, or in combination with face-lift procedures to produce a comprehensive rejuvenation.

Laser resurfacing can be used to treat:

  • fine lines and wrinkles, including crow’s feet around the eyes
  • brown spots and splotchy discolorations
  • scars

Duration of laser resurfacing depends on the extent of the treatment; it can take up to two hours. Repeat procedures are sometimes required. It is usually done as an outpatient procedure with local anesthetics and an intravenous sedative to relieve tension. A topical anesthetic cream may also be used.

After The Treatment

Ointments and topical bandages will be applied to the treated area. Bandages will be removed within the first week.

As with other resurfacing techniques, a crust may form over the treated area and the skin will be red or pink. It may be slightly swollen. Within two weeks, the swelling should disappear and the redness should soften to a color that can easily be covered by cosmetics. The redness may take several months to disappear completely.

As with other cosmetic procedures, sun should be avoided during the recovery period. A commitment to the use of sun blocks is required if the resurfacing is to succeed.

How Effective Is Laser Resurfacing?

Fine lines and wrinkles are caused by the deterioration of the connective fibers (collagen and elastin) in the skin. Like dermabrasion, laser resurfacing forces the growth of new tissue in which fibers are more plentiful and better organized. Although it may take several months for skin to recover from laser resurfacing, the end result is skin that is smooth, soft, and silky.

Facial Implants

Implants of several materials can be injected into the face to fill in wrinkles.

  • Collagen. Collagen is the protein that makes up the white fibers of skin, tendon, bone, cartilage, and other connective tissue. Injections of bovine collagen (that is, collagen from cows) are used to fill in wrinkles around the eyes and mouth. Collagen is gradually absorbed and removed by the body, however, so injections must be repeated after six to twelve months. There is also a small chance that the body will reject collagen implants. Tests for allergic reaction should be done before the implant procedure is performed.
  • Fat Transplantation (microlipo-injection). Deep creases in the forehead and around the nose and mouth respond well to transplantation of the body’s own fat. Liposuction techniques are used to remove fat from sites of excess such as the thighs or abdomen. Local anesthetic is used for the liposuction; the incisions are small. The fat is then injected into depressions through a syringe and needle. Since this is the body’s own fat, there is no danger of an allergic reaction. The body absorbs much of the fat over time, however, and repeat injections are required.
  • Silicone. Silicone also works well on furrows in the forehead and large wrinkles around the nose and mouth. Special care must be taken when making the injections to prevent beading. Several repeat injections are required. The long-term safety of silicone injections is still under study.
  • Expanded polytetrafluoroethylene (Gore-Tex). Gore-Tex is an inert, porous, synthetic material often used as an insulator in jackets and sleeping bags. Tiny patches of Gore-Tex have been injected under the skin to fill out wrinkles. Because the material is very porous, cells and blood vessels can penetrate it. Allergic reactions are rare.

What Are The Newer Techniques for Facial Cosmetic Surgery

In recent years, several new surgical technologies have been adapted for use with cosmetic surgery. These technological advances promise cosmetic procedures for the future that will be safer, less painful, and more effective.

Lasers. Lasers (intense beams of light) are currently being used very effectively for facial resurfacing and eyelid surgery. Laser incisions are sterile, and they cauterize blood vessels so that there is very little bleeding. Swelling is reduced and recovery is quicker. A face-lift procedure called laser neck and jowl liposculpture, and platysma resurfacing, can be done through a one-inch incision under the chin using only a local anesthetic.

Endoscopy. Endoscopic techniques are currently being used to do face lifts and brow lifts. Surgery guided by an endoscope allows for smaller incisions, less trauma to tissues, and a quicker recovery time. Facial structures are raised without cutting away flaps of skin. Currently, endoscopy is an option only for people whose skin is still somewhat tight and elastic.

Ultrasound-assisted lipoplasty. Older liposuction techniques tear fat from the body in great chunks. Ultrasound is now being used in conjunction with saline injections to break up and liquefy fatty deposits so that they can be extracted with a lower level of suction. This procedure causes less bleeding and bruising. It also allows the surgeon more control in sculpting the area. At this time, traditional liposuction is preferred for the face.

Botulinum toxoid injections. Botulinum is a bacterial toxin found in uncooked foods that can cause paralysis and a condition called botulism. It is a powerful muscle relaxant. It has long been used in a purified form (Botox) to relax muscle spasms caused by certain neurological diseases and conditions.

Botox is now being injected into the muscles of the face to relax creases in the forehead and crow’s feet around the eyes. Botox injections must be repeated after three to six months. Research is now being done to confirm the long-term safety of this procedure.

The most obvious risk with Botox injections is that the face will become mask-like. One may lose the ability to squint or frown, and the corners of the mouth may droop.

Frequently Asked Questions: Cosmetic Surgery For The Face

Here are some frequently asked questions related to cosmetic surgery for the face.

Q: What does cosmetic surgery cost?

A: The cost of a procedure will depend upon local rates for the surgeon and the surgical facility. Facility costs include an anesthesiologist, nurses, medicines, and many other factors. A physician should discuss cost and payment with you before you commit to a procedure. Since most cosmetic procedures are not covered by insurance, advance payment is usually required.

Q: Does health insurance cover cosmetic surgery for the face?

A: In most cases, procedures done for purely cosmetic reasons are not covered by health insurance. Costs may be covered if a procedure is done to for a medical reason, such as to treat precancerous lesions. Always check with the insurance carrier for exact terms of coverage.

Q: How long do the effects of lift surgery last?

A: The longevity of a lift procedure depends on many factors, such as heredity and life style. Smoking, alcohol consumption, and long exposure to the sun can all shorten the effectiveness of a lift. Some people have a repeat procedure in 5, 10, or 15 years. Other people never have a second procedure.

Q: How much scarring will be caused by surgery?

A: Classical cosmetic procedures (face, brow, and eyelid lifts) will leave scars, though these scars usually fade until they can barely be seen. Endoscopic surgery leaves smaller scars. However, not everyone is a good candidate for an endoscopic procedure.

Q: How long will I have to miss work?

A: Recovery time will vary according to the procedure. Superficial chemical peels and collagen or fat injections probably won’t cause any loss of work. Deep chemical peels, dermabrasion, and classical face lifts may require two or three weeks of time at home.

Q: How can I hide scars, swelling, and redness until I return to normal?

A: Both men and women can make use of makeup techniques to disguise the temporary effects of cosmetic surgery.

Q: How do I find a cosmetic surgeon?

A: Professional organizations can provide a list of cosmetic surgeons practicing in an area, but word-of-mouth is sometimes best. Ask people who have had cosmetic surgery how they found their surgeon and whether they were happy with the results. Primary care physicians can also make recommendations. Check a surgeon’s experience and credentials. Most public libraries carry the Directory of Medical Specialists, a reference that can be used to check the credentials of any referred physician.

Q: Can I tell beforehand how I will look after surgery?

A: Some practitioners have computer imaging programs that can show a person what the procedure might accomplish.

Putting It All Together: Cosmetic Surgery For The Face

Here is a summary of the important facts and information related to cosmetic surgery for the face.

  • Realistic expectations are the key to satisfaction with cosmetic surgery. Cosmetic procedures for the face can alleviate some of the most visible signs of aging. They cannot restore youth or guarantee happiness.
  • An open and honest relationship between patient and surgeon is also important to satisfaction with cosmetic surgery. It is important for the patient to know exactly what to expect and to feel that his or her concerns are being addressed. It is also important that the patient be candid with the surgeon about medical history and background.
  • The effects of a cosmetic procedure will last much longer if a person is committed to a lifetime of proper skin care. Smoking, alcohol consumption, and long hours in the sun will soon reverse the effects of cosmetic surgery.
  • Use of sun block is extremely important after a cosmetic procedure, especially a resurfacing procedure that removes a layer of skin. Exposure to the sun can cause permanent discoloration of the treated area.

Glossary: Cosmetic Surgery For The Face

Here are definitions of medical terms related to cosmetic surgery for the face.

Blepharoplasty: A blepharoplasty is a surgical procedure to reshape (plasty) the upper and lower lids of the eyes. A blepharoplasty is performed to correct a sagging upper lid that can sometimes interfere with vision and a puffy, baggy lower lid.

Botulinum toxin: Botulinum toxin is the paralytic poison associated with botulism. In a distilled form, it is injected into muscle tissue to induce a controlled paralysis. Such treatment is used to release the spastic muscle contraction associated with some neurologic conditions. Botulinum toxin is also being used to reverse wrinkling in the brow and around the eyes.

Collagen: Collagen is the fibrous protein found in the white tissue of skin, bone, cartilage, tendon, and other connective tissue. Collagen is made of rodlike molecules that have great tensile strength. Collagen works in partnership with elastin to give our bodies both structure and elasticity.

Dermis: The dermis is the layer of skin immediately under the epidermis. The dermis contains blood vessels, nerves and nerve endings, glands, and hair follicles.

Elastin: Elastin is protein found in yellow elastic connective tissue. Chains of elastin molecules form rubberlike fibers like a bunch of rubber bands. The molecules stretch when the skin is pulled and recoil when the pull is relaxed. Elastin works in partnership with collagen to give our tissues both structure and elasticity. Normally the body stops making elastin once the body matures.

Epidermis: The epidermis is the most superficial layer of the skin. The epidermis does not contain blood vessels.

Laser: The word “laser” is an acronym for Light Amplification by the Stimulated Emission of Radiation. Lasers produce an intense beam of light in one specific color (wavelength) that can be controlled for intensity and pulse duration. Light is amplified in a laser by bouncing back and forth between optical mirrors and lenses. The light gains strength with each cycle and when it has reached the right power, it is released in a quick burst of energy. The two most common types of lasers are the carbon dioxide (CO2) and the erbium:YAG. The CO2 laser delivers short bursts of high-energy light. The erbium:YAG laser produces a wavelength that is gentler and cooler. Both can be used for skin resurfacing techniques.

Platysma muscle: The platysma is a platelike muscle that runs from the neck to the jaw and the skin around the mouth. It acts to open the jaw.

Rhytidectomy: A rhytidectomy is a surgical procedure to reduce the most visible signs of aging. It eliminates excess fat, tightens muscles in the face and neck, and removes sagging skin.

Rhytid: A skin wrinkle. From the Greek rhytis, meaning wrinkle.

Submental lipectomy: A submental lipectomy is a surgical procedure to cut away excess fat under the chin. Submental liposuction vacuums away the fat under the chin.

Additional Sources Of Information: Cosmetic Surgery For The Face

Here are some reliable sources that can provide more information on cosmetic surgery for the face.

American Academy of Cosmetic Surgery 
Phone: 312.527.6713

American Society for Dermatologic Surgery 
Phone: 847-330-9830

American Society of Ophthalmic Plastic & Reconstructive Surgery 
Phone: (407) 647-8839

American Society of Plastic Surgeons 
Phone: 847-228-9900

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