Giving yourself a gift

Through the holiday season you have donated your time and money to worthy causes and generously given to friends and loved ones. Now it is time to give yourself a gift—how about improving your quality of life.

If you are considering facial plastic surgery for the first time, a minimally invasive procedure might be the right choice for you. It requires less time in the doctor’s office with little to no recovery time (depending on procedure). Popular injectable treatments include Botox, Dysport, and hyaluronic acid. For more dramatic results, the most common surgical cosmetic procedures include rhinoplasty (nose surgery), blepharoplasty (eye lid surgery), and facelift.

Botulinum toxin A, Botox, is injected just under the skin to weaken the muscles in the forehead and around the eyes that pull the skin and cause wrinkles. Treatment sites include between the eyebrows, corners of the eyes (crow’s feet), and forehead furrow. The overlying skin remains smooth and unwrinkled from three to six months.

Dysport is also derived from botulinum toxin A and used to paralyze muscles that contract and cause wrinkles. Dysport is suspended in lactose; whereas Botox is suspended in sodium chloride. Talk to your facial plastic surgeon regarding which might be better for you; Dysport lasts between three to six months.

Hyaluronic acid is used to improve moderate to severe facial wrinkles and folds, e.g., nasolabial folds. The injectable fills in the space between collagen and elastin fibers, replenishing the natural volume lost during aging. The body naturally absorbs the filler over time; results may last six to 12 months.

Rhinoplasty is nose surgery to improve the function or shape of the nose—reduce or increase parts of the nose, remove a hump, change the Giving yourself a gift shape of the tip or bridge, improve breathing ability, or narrow the nostril span.

Blepharoplasty removes excess skin in the upper and lower lids and reduces the amount of fatty tissue under the eye. This surgery can correct drooping skin and reduce bags or puffiness under the eyes.

A facelift removes excess skin and tightens the muscle and connective tissue in the lower two-thirds of the face. The result is smoother skin, reduced jowls, and a refined jaw line.

Attend to your own needs as you recoup from the busy holiday season. You deserve a refreshed appearance and a boost in your confidence. Start researching your options. Set up an initial appointment with your facial plastic surgeon to talk about procedures and treatments that will rejuvenate you. This is a great way to start the new year.

Help! My eyes are giving away my age. What are my options?

As we age, the eyelids stretch, the muscles supporting them weaken, and fat deposits collect under the eyes. Sun damage, genetics, fatigue, and repeated facial expressions can further expedite wrinkling of this delicate skin around the eyes. Blepharoplasty (surgery of the eyelids) can reshape and adjust the lids for both cosmetic and functional purposes.

Do you desire more youthful, bright eyes? Each year, over 100,000 men and women choose to have blepharoplasty. Whether you are looking to reduce puffiness and sagging skin, or to correct dropping eyelids—explore the options and see if you might be a good candidate for this procedure.

Upper eyelids

Cosmetically, you may want to reduce the excess skin in your upper eyelids to create a younger, more wide-eyed appearance. In upper eyelid surgery, your physician will follow the natural lines and creases of the eyelid in order to keep the scars as invisible as possible. The incision is made and excess fat, muscle, and loose skin are removed. For patients that seek to add a crease to their upper eyelid, a variation of this surgery is used. Fine sutures are used to close the incision and minimize the visibility of any scar.

Lower eyelids

Most people seek lower blepharoplasty to eliminate the bags under their eyes. The surgeon can make an incision under the lower lashes or from inside of the lower eyelid to remove the skin and fatty tissues. The scar is hidden and self-dissolving sutures may or may not be used. Under normal conditions, blepharoplasty can take from one to two hours.

Are you a good candidate?

This procedure is for patients that want to reduce puffiness, sagging skin, and drooping eyelids. Blepharoplasty cannot remove dark circles (caused by excess pigmentation), fine lines and wrinkles around the eyes (crow’s feet), nor improve sagging eyebrows. It is important that you have realistic expectations and discuss this with your surgeon.

Several factors will be considered to determine if blepharoplasty is right for you, including age, skin type, ethnic background, degree of vision obstruction, and overall health. During the pre-surgical consultation, you will be examined and asked to answer queries concerning vision, tear production, use of lenses, and your desires for surgery.

The better you take care of yourself— nutritious diet and exercise—the better your body will heal. If you smoke, now is a good time to quit. Besides causing premature wrinkles, it affects the progress of your body’s ability to heal.

Your facial plastic surgeon will discuss with you the best plan of action, whether it includes eyelid surgery, a combination of procedures, or another alternative. See sidebar for minimally invasive options.

Insurance

If your vision is restricted due to excessive skin of the upper eyelids, your insurance company may agree to pay for all or part of the surgery. Lower eyelid surgery is not covered by insurance unless there is a deformity or previous defect.

Recovery

Your facial plastic surgeon will give you specific postoperative instructions to ensure a quick and comfortable recovery. Plan to take it easy for the week following surgery. The eye area may feel tight. Keep your head elevated, use cold compresses to reduce swelling, and apply prescribed eye drops to ease dryness or itching. If you have stitches, they will be removed two to seven days after the surgery. Some patients return to work in a few days, but you may be more at ease waiting seven to 10 days. Patients may use makeup to conceal discolorations the first few weeks.

The area around your eyes is prone to showing signs of aging long before the rest of your facial features. If your reflection is tired and aged, you may want to consider blepharoplasty. The dramatic results will leave the skin around your eyes smoother and younger looking.

Body dismorphic disorder … what is this “imagined ugliness”

Most facial plastic surgeons have encountered a patient with “imagined ugliness,” or body dismorphic disorder (BDD). Withthis condition, a person is intensely obsessed over a flaw in one’s appearance—that may actually be minimal or even non-existent. This preoccupation causes distress and impairment in social and occupational areas. The person usually has a low self-esteem and is embarrassed regarding this perceived defect.

In a cosmetic surgery settings, between six and 15 percent of patients will screen positive for BDD. The vetting process is crucial; the physician has to take into account that it is difficult for the patient to reveal symptoms due to shame and humiliation. The following questions may be presented at the consultation appointment:

  • What concerns do you have about your appearance?
  • Does this concern preoccupy you? If so, does this preoccupation interfere significantly with your academics, social life, job, etc.?
  • Have your appearance concerns caused you a lot of anguish?
  • Have your concerns affected your family or friends?

Answers to these questions will help in diagnosing if there is a problem. For example, if a patient states that she thinks about her “ugly” appearance between three and eight hours a day, this is not normal. Additionally, if a patient expresses issues with depression, anxiety, panic attacks, self-consciousness, or confining oneself to the house, these are clues that cannot be ignored. Typical BDD behaviors may also include comparing one’s appearance to others, excessively checking an imperfection, excessive grooming, seeking reassurance about a flaw or attempt to convince others of ugliness, camouflaging or trying to hide the face, buying excessive beauty products, and continually seeking medical treatment.

A person with BDD may request extensive work-ups, consultations with multiple physicians, or try to pressure a surgeon to prescribe unsuitable or ineffective treatments. Please note: Facial plastic surgery will not cure a person of body dismorphic disorder. In fact, it has been reported that patients with BDD that have had treatments are often unsatisfied with the results and seek additional procedures or treatments to “fix” the “flaw.”

Body dysmorphic disorder is not a new phenomenon. The term, “dysmorphophobia,” was coined over 100 years ago. Although it is underrecognized and not prevalent in research studies, it has been gaining more investigation recently.

If the facial plastic surgeon suspects a patient may have BDD, the patient will be encouraged to avoid surgery and other nonpsychiatric medical treatment. In recent studies, successful treatment frequently incorporates medication or cognitive-behavior therapy. Educating the patient and their family members regarding treatment options may provide support and help facilitate recovery.

Low-tech options

While minimally invasive treatments are convenient, keep in mind that the results are not long-lasting.

  • Creams that contain retinoid (vitamin A) and antioxidants can help reduce the appearance of wrinkles under your eyes. Retinoid stimulates skin-cell turnover and therefore stimulates collagen production. The antioxidants help prevent the breakdown of collagen.
  • Injectable fillers will plump up the area and soften the wrinkles, e.g., crow’s feet. Fillers are temporary and will require repeated treatments.
  • Botox or Dysport can be injected under the skin to paralyze the muscles in the face that pull the skin and cause wrinkles. The resulting smooth skin lasts from three to six months.
  • Microdermabrasion uses micronized crystals to remove dead cells and smooth crow’s feet and forehead lines.
  • Chemical peels can be used to remove the superficial layer of skin, boost collagen production, and soften wrinkles.
  • Fractional laser resurfacing treats a fraction of the skin by causing microscopic “wounds” or tiny holes in the skin. These targeted areas are treated intensively, while leaving the surrounding tissue unaffected. This triggers the skin’s own healing process and stimulates new collagen production. The result is a new, smoother and healthier skin. Fractional lasers are effective for treating wrinkles around the eyes, as well as acne scars, age spots, and melasma.

ASK THE SURGEON

I’m considering laser skin resurfacing to take care of some acne scarring on my face. Is the process painful? Do you use anesthesia or a numbing agent when performing this procedure?

Your treatment will be determined by the type and extent of the scarring and your skin type. There are many different wavelengths (strengths) of lasers that can be used to remove the top layer of skin over the acne scar. This promotes wound healing and smoother skin. If the scars are deep, usually general anesthesia or intravenous sedation is preferred. You may have mild discomfort—like a bad sun burn feeling—for a few hours following treatment. After your facial plastic surgeon evaluates your skin, you can discuss and agree upon an optimal plan to meet your needs. Sometimes treatment may include a combination of different lasers, microdermabrasion, or a chemical peel. Your physician will explain all of the options.

HEALTH TIP

How can you lower your risk of infection after having a procedure? An infection is an over growth of bacteria. Your surgical site provides an entry for bacteria to get in and multiply, which will prevent your incision from healing normally. Be proactive in lowering your risk of infection. First and most importantly, follow any and all specific instructions from your surgeon. Generally, you will want to make sure to keep the incision site clean and dry for the first 72 hours. Keep the dressing clean and dry while it’s on, and always wash your hands thoroughly with soap and water before and after touching or changing the dressing. Do not touch your surgical site unnecessarily. Avoid baths, swimming pools, and hot tubs until your incision is healed. Take all prescribed medication as directed.

Regardless of your vigilant efforts, if you start to run a fever of 101.5 or higher or have increased redness or warmth at the skin, you may have an infection. Call your facial plastic surgeon, you may need to be seen.

WHAT’S NEW?

A laser-powered “needle” promises pain-free injections, according to a paper recently published by the Optical Society. Professor Jack Yoh, of Seoul National University in South Korea, and his graduate students, have developed a new laser-based system. It uses an Er: YAG laser to propel a minuscule, precise stream of medicine with just the right amount of force. The jet of medicine smoothly and quickly penetrates into the targeted epidermal layer. Due to the narrowness of the stream, the medicine enters into the epidermal layer, which has no nerve endings. This makes the injection a pain-free experience. Professor Yoh is working with a company to produce low-cost replaceable injectors for use. Besides eliminating unpleasant needle pricks, this technology will reduce the amount of waste generated by single-use hypodermics.