|
"God has given you
one face," said Shakespeare's Hamlet, "and
you make yourselves another."
OK,
so maybe the Bard wasn't talking about facial rejuvenation,
but today, there are probably as many options for people
seeking to turn back the clock as Will had sonnets.
From facelifts to Botox(r) injections, there are many
procedures that can help the face look more youthful
or in proportion-and not all of them involve surgery.
People
are taking advantage of these opportunities to look
younger or improve a perceived facial flaw. Three of
the five most frequently performed cosmetic surgeries
in 2000 involved the face, according to the American
Society of Plastic Surgeons: Nose reshaping was the
most popular, with 389,155 procedures; followed by eyelid
surgeries, with 327,514, in third place; and facelifts,
with 133,856, ranking fifth.
While other medical specialists
perform certain facial procedures (an ophthalmologist
might do eyelid surgery, for example), plastic surgeons
have the specialized, comprehensive training to work
on all areas of the face. That's important, since patients
often choose to have more than one procedure done on
different parts of the face on the same day. A person
might opt to have surgery to make her lower eyelids
look less baggy and a facelift to improve the appearance
of the lower two-thirds of her face, for instance. Dr.
Mark Granick, professor of surgery at the New Jersey
Medical School and chief of plastic surgery at University
Hospital, who is board certified in both plastic surgery
and otolaryngology (ears, nose, and throat, or ENT),
says his dual specialty enables him to offer patients
"the best of both worlds."
When
choosing a surgeon, one item to look for is certification.
A surgeon certified by the American Board of Plastic
Surgeons has completed at least five years of residency
training (typically three years of general surgery and
two of plastic surgery); practiced plastic surgery for
at least two years; and passed written and oral exams.
It's
also in a person's best interest to ask a lot of questions
about the surgeon and the procedure before committing
to anything. Talk to friends and acquaintances who've
had facial rejuvenation procedures about their experiences,
or ask a primary care physician whom he or she would
recommend. The surgeon should be experienced in the
desired area and someone the patient feels comfortable
talking to, never pressuring him or her to undergo a
surgery.
Which
isn't to say the surgeon won't offer recommendations.
"If a person wants her nose reshaped, she might
not realize that without also augmenting a weak chin
with an implant, her face will not look balanced,"
says Dr. Granick. "My goals are to look at the
face as a whole, use the simplest procedure to accomplish
what the patient wants done, and to do all of this with
safety as a top priority."
Most
facial rejuvenation surgeries are same-day procedures
that use a "twilight" intravenous sedation,
or, in some cases, a local anesthetic. While some of
these surgeries have been around for many years, the
techniques are constantly being refined. The benefits
can include smaller incisions, a faster healing period,
or a more natural look.
Take
the facelift. While Phyllis Diller's mask-like facelift
provided fodder for late-night talk show hosts in the
1970s, this procedure has undergone a transformation.
"Plastic surgeons have learned a lot about the
structure below the skin since then and have adapted
some techniques used by craniofacial surgeons,"
explains Dr. Granick. "Typically, we lift the tissue
off of the skeleton, remove fat and tighten the muscle,
and then reposition the skin. This results in a facelift
that is more natural looking."
While
the facelift addresses problems on the lower two-thirds
of the face, such as sagging skin around the neck and
jaw line, a browlift focuses on the upper one third.
A browlift can help diminish the appearance of furrows
in the brow and create a more youthful, pleasant look.
For this minimally invasive procedure, button-hole-size
incisions are made in the scalp. Using an endoscope-
a thin, telescope-like surgical instrument attached
to a tiny camera-the surgeon can tighten the underlying
skin and muscle.
Eyelid
surgery, or blepharoplasty, can help correct heavy,
droopy-looking upper eyelids or lower lids that have
"bags" beneath them. The surgeon can work
on one or both sets of lids. "As with the facelift,
there have been many advancements made in eyelid surgery,"
notes Dr. Granick. "What was one surgery for both
lids now has evolved into several procedures. We can
hide incisions within the lower lid so there is no visible
scarring and tighten the lids without that 'pulled-down'
appearance."
While
most facial rejuvenation procedures and treatments are
not covered by insurance companies, when the heaviness
of upper lids is so severe that it interferes with vision,
eyelid surgery is sometimes the exception.
The most popular facial
rejuvenation surgery, rhinoplasty, is also one of the
most complex, says Dr. Granick. "The nose is three
dimensional and requires precision and artistry to produce
the desired result. We're working on bone and cartilage,
which respond differently to injury, and sometimes internal
structures, such as the septum, as well." Chin
or cheekbone augmentation-implants that can be inserted
in these areas-can be done alone or in conjunction with
a "nose job" to provide balance to the face.
| Pre
Procedure |
 |
Post
Procedure |
 |
|
 |
There's another facial
surgery that, while it doesn't help people look younger,
can correct an often-embarrassing problem: significantly
protruding ears. Otoplasty is a relatively simple operation
that can reshape the cartilage of the outer ears. Ideally,
this operation is done when the patient is young-about
first grade. "There are also adults who, having
undergone years of teasing as children, now can afford
to have their ears reshaped," says Dr. Granick.
Right
Ear
Before Procedure |
|
Right
Ear
After Procedure |
|
 |
|
 |
|
Left
Ear
Before Procedure |
|
Left
Ear
After Procedure |
|
 |
|
 |
All of these facial rejuvenation
procedures usually have few complications. However,
there can be swelling, bruising, and. as with any surgery,
a chance of anesthesia-related problems or post-operative
infection. Most people who undergo facial rejuvenation
surgery are able to return to work within one to two
weeks.
Non-Surgical
Approaches to Facial Rejuvenation
Sometimes
people want a more youthful appearance, but don't want
to have surgery. There are limits to what surgery can
accomplish, also. While a lower eyelid lift can remove
"bags," for example, it does not erase "crow's
feet."
Botox is one of the most
popular treatments to reduce the appearance of facial
wrinkles. This diluted form of botulinum toxin blocks
the nerve stimulation of muscles, forcing them to relax.
As a result, the wrinkles "smooth" away. "Botox
is very effective in areas where wrinkles result from
skin being pulled by muscles, such as the forehead and
around the eyes," says Dr. Granick. "While
Botox is given by injection, it is not painful. The
recovery time is immediate, and the results are long-lasting-about
four to six months."
There
are other options that can be done by themselves or
in addition to facial rejuvenation surgery. Collagen,
a natural protein, can be injected to "plump up"
wrinkled areas or add fullness to the lips. Chemical
peels are solutions that can be applied to the face
to help reduce fine lines and acne scarring and correct
uneven pigmentation. Peels come in various strengths,
and the healing time can be lengthy. Another non-invasive
procedure, microdermabrasion, buffs, or exfoliates the
skin, using a special crystal technique.
Dr.
Granick offers a couple of caveats about facial rejuvenation
procedures. First, most are considered elective and
therefore not covered by insurance. Some people reach
for the "plastic" to pay for hospitalization
costs, surgeon's fees, and the anesthesiologist's bill.
There are also financial organizations that specialize
in making loans to plastic surgery patients.
One
more thing. "Facial rejuvenation doesn't give back
youth," he says, "but it does a great job
of letting people borrow it."
For
more information about the Cosmetic Surgery Center,
visit our Web site at: www.TheUniversityHospital.com/plastics
or call (973) 972-8071.
|
|
