Facial Plastic Surgeries
Aging of the face and neck is an inevitable, usually predictable stage that we all enter. A number of factors play into this including genetics, sun and tobacco exposure, and body weight. For many of us, the most noticeable early signs are skin changes or facial volume loss. This is most often treated with good topical skin care, medical laser or micro-needling, Botox, dermal fillers, and fat transfer, or most often, a combination of some of these therapies.
With time, we will all develop some laxity of face and neck skin and muscle. At this point, a surgical approach is typically needed. Being able to identify the problem and treat it appropriately is the key to a balanced and natural result. For those trying to cheat the system such as adding more volume to treat the laxity, or treating the laxity without appropriate volume, can lead to a very ‘operated on’ and unnatural appearance (and we do not care for that look at all!)
Once skin laxity in the neck and along the jawline have developed, unfortunately there are no more shortcuts and we are headed down the path of a face and necklift. I feel it is quite important to address the underlying muscle even more than the skin to avoid a tight or drawn appearance. Occasionally we will address the neck alone with liposuction but that is most often in younger patients with extra fat only and tight skin overlying it. I will often combine face and necklifts with both fat transfer to the face as well as a skin laser in order to restore a more balanced and youthful appearance to the final result.
Upper Blepharoplasty (Upper Eyelid Lift)
This is one of my favorite procedures! With time, most of us will develop skin laxity involving the upper eyelid. Some patients also notice extra fat, others complain of a tired appearance. There is a very close relationship with the upper lid excess and the height of the brow, so we will spend time discussing this balance and how best to treat it. The reason I enjoy this procedure so much is that is can most often be performed in the office under local anesthesia. There is always a risk of some bruising which can last a couple of weeks, but otherwise the recovery is quite quick. In most cases, patients tell us that people couldn’t figure out what they’ve done but that they just look better and more rested! You will maintain the natural look and shape of your eye, just your more youthful version. In some cases there is underlying ptosis which is sagging of the upper lid obscuring a portion of the pupil. Those patients will be referred to an oculoplastic surgeon for a ptosis repair.
Lower Blepharoplasty (Lower Eyelid Lift)
Many patients will complain of a very tired appearance because of bagginess associated with their lower eyelids. A lower eyelid lift will remove or shift some of the fat of the lower eyelids and, in certain cases, remove a small portion of the skin or tighten it with a laser therapy. In patients with particularly lax eyelids, some tightening of the lower lid may be necessary as well. The overall goal is to improve the contours of the lower lid as it transitions to the cheeks. These procedures can create some additional dryness in the eyes particularly in patients with this predisposition. In patients with dry eye symptoms, we will recommend that you see an ophthalmologist prior to surgery.
Most patients who notice heavy or drooping upper eyelids also have at least some component of eyebrow ptosis (or droop) that contributes to this “tired” appearance. Many patients unknowingly compensate for this by activating their forehead muscles to help elevate their brow position and make it easier to see. Addressing this surgically can vary greatly depending on both where and how severe the ptosis is as well as hairlines. This procedure is almost always performed in combination with an upper blepharoplasty in the operating room, and the result is very natural and youthful.
There are a number of different settings on our Sciton Erbium Laser depending on a patient’s individual needs:
- The BBL component is an intense phototherapy light which can help with some of the dark splotches which many people develop with time and sun exposure over time.
- The Profractional component is similar to ‘aerating your lawn.’ Deeper holes are created with the laser to damage the underlying collagen which stimulates new collagen formation and tightening of the skin.
- The Microlaser Peel is a precise way of shaving the superficial layer of the skin. This makes the wrinkles in the skin shallower and less obvious.
Most patients will require a combination of multiple settings and multiple procedures for the best results. With this advancing laser technology, we can personalize your laser plan based on your goals, budget, and downtime.
Cleft Lip and Palate
A cleft lip (with or without an associated cleft palate) occurs in 1 per 940 babies each year in the United States. An isolated cleft palate occurs in 1 per 1500 births. Together, this makes cleft lip and palate the most common birth defect in the US. The underlying cause is not entirely known but is felt to be a combination of genetics and environment early in pregnancy – often before a mother even knows she is pregnant.
Prenatal ultrasounds pick up the majority of these diagnoses, but an isolated cleft palate can be easily missed. We are happy to provide prenatal counseling for those parents wishing to learn more about the care and surgeries required to repair a cleft lip or palate. This would be followed by another appointment after your baby is born to finalize both a diagnosis and discuss timing for any procedures. For most children, the lip is repaired in either 1 or 2 stages beginning at approximately 3 months old, with the cleft palate and second-stage lip repair completed at approximately 1 year old. Many children will require additional surgeries over the course of their lifetime which we continue to evaluate as they grow up with visits in the Rose Hospital Cleft Clinic.
The most important early advice is to spend time bonding with your new baby. Your baby may require some additional attention, especially when it comes to feeding. Most babies with cleft palates can’t use a traditional bottle. There are a number of specialty bottles such as Haberman or Pigeon bottles which can help, if they aren’t able generate enough suction to feed. Teresa Snelling, our speech-language pathologist associated with the cleft clinic, is an invaluable resource for this and other related problems.
As a father of two girls, watching a new baby come into the world is exciting yet stressful. The many challenges that a parent and child face in the setting of a cleft can seem that much more daunting. Our office and team at the Cleft Clinic is dedicated to help your family through these challenges.