Planning your treatment, near or far, factors to consider

You may have heard the media buzz about more Americans traveling abroad to have medical procedures. This proposed “medical tourism” may sound trendy, but is it right for you? Regardless of location, the surgeon, procedure, facility, and postoperative care should be considered before making your decision.

Go to the facial plastic surgeon you feel best meets your needs. This will help ensure that you receive the results you desire. Research the doctor’s credentials, board certifications, experience, and training. Does he or she practice in a specialty you normally would associate with facial enhancement or improvement? Ask for referrals; review before and after photographs. If possible, schedule a consultation appointment (in person or virtually) to get to know the doctor and to ask questions. This will allow you to get a sense of the doctor’s compassion and personality. You want to try and develop a level of comfort, trust, and openness with the doctor before committing to the surgery.

The best options, including the pros and cons, should be explained in detail and in plain language to you. Once you and your facial plastic surgeon agree on the optimal treatment plan, make sure you understand all of the steps in the process. What is required before the surgery? Find out if the facial plastic surgeon will be overseeing all of the stages of treatment or if some of this will be relegated to another person. If you are not at home, how long should you plan to be away? Will you have to make several trips for follow-up visits?

Check out where the procedure will be performed. The facility should be accredited by a governing organization, e.g., the Joint Commission International or the Accreditation Association for Ambulatory Health Care. Enquire about the sterilization processes of the facility.

Postoperative care is crucial in order to minimize the risk of infection or other complications. Your facial plastic surgeon should provide you with a detailed list of postoperative instructions. Where will you be staying to recover? When will sutures be removed? How long is the recovery? Who will be overseeing your recuperation? Be sure to ask when you will be able to resume normal activities.

Doctors here and abroad are competing for patients and this in turn raises the quality of care. Some surgical centers may try to lure you with concierge services, sightseeing packages, additional spa and facial treatments, or even restaurant reservations. While these are enticing and the pampering appreciated, they should not guide your decision. The best patient is a well-educated patient.

Exploring different approaches to facelifts and possibly less invasive allternatives

Facial plastic surgeons have pioneered new techniques and variations of the standard facelift over the last 10 years. Technology has improved and noninvasive treatments have become more readily available. Should you get a traditional facelift or try a minimally invasive treatment? Review the facelift options, in addition to some minimally invasive treatments that might suit you.

Traditional facelift

Overall aging to the face—loss of that youthful look—may be a combination of loose skin, laxity of underlying muscles, an accumulation of fat along with some degree of facial deflation. One of the earliest signs is the obliteration of the angle formed by the neck and the lower jaw. A facelift can improve the appearance of the lower onethird of your face by lifting and repositioning the sagging skin and tissues underneath the skin.

Incisions are made above the hairline; the skin is separated from the fat and muscle below. The muscle is resupported with stitches. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The skin is redraped and tightened to a natural point; the excess skin is removed. Stitches or sutures may be used to secure the skin and to close the incisions. Additional incisions may be made under the chin to address loose deposits of hanging tissue. The procedure requires up to six weeks for the skin to completely heal. This option is major surgery that yields major, permanent improvement to your appearance.

Mid-facelift

This procedure is performed through tiny incisions placed within the hairline and/or on the inside of the mouth. Underlying muscle and fat are repositioned; excess skin is removed. This redraping improves the nasal furrows and restores a more youthful appearance. This option is advantageous to the patient who does not have an excessive amount of drooping skin around the jaw and neckline and is seeking improvement in the cheek and lower eyelid area, which the traditional facelift usually does not address. Results are permanent, although the face will continue to age naturally.

Limited incision facelifts

The following procedures—S-lift, J-lift, and short scar facelift—minimize the incision length. The advantage may be a shorter recovery. The disadvantage of a limited incision facelift is that changes are not as extensive as a traditional facelift procedure.

The S-lift derives its name from the “s” shape of the excision used near the ear. Soft tissue is fixated to the cheekbones to provide stability and fullness to the area.

The J-lift lifts and firms the lower one-third of the face and neck. Its name comes from the area that is corrected by the procedure, the jaw line or jowls. By repositioning of the muscle groups underneath the surface, the jowl is lifted to its natural best site for beauty. The incisions are hidden.

The short scar facelift has an incision length half the size of a traditional facelift incision. This lift repositions the skin and soft tissues of the face that have been affected by the aging process, with the principle difference being minimized scarring. Unfortunately, not all patients are good candidates for this technique; patients with excessive skin around the neck would benefit more from a traditional facelift.

Minimally invasive options

If you are looking for more subtle changes, a minimally invasive procedure or treatment might be right for you.
A liquid facelift uses fillers to treat lines and replenish volume in the face. The benefit is temporary; specific length of time depends on the type of filler used. This might be a good option if you are seeking immediate results and don’t have the recovery time or funds for a full facelift. Plan ahead; there may be initial bruising and mild swelling.

There are multiple skin tightening devices on the market in the U.S., all of which seek to achieve temporary tightening of the skin through heating of collagen. Thermage is one of these devices that uses radio-frequency to tighten the skin. The resulting improvement from these devices is variable and in general not as remarkable as that from more aggressive procedures. It is most appropriate for younger candidates with slight wrinkles. The patient’s skin is numbed with a cream, and then the heat of the radio frequency energy activates the skin’s natural collagen, making the skin contract and tighten. The outpatient treatment does not require downtime; minor redness may result for a day or two. Results can last from six months to two years.

Stem cell facelifts are a variation on fat injections and attempt to restore volume to the aging face. Some physicians feel that this technique may also improve overall skin quality and regenerate collagen. The technique attempts to concentrate the stem cells in fat, which are then injected into the face. The U.S. Food and Drug Administration has not approved stem cell facelifts or the use of stem cells in cosmetic procedures. While fat injections have been around for many years, the added stem cells may increase the success of the fat. More clinical studies and scientific evidence are needed.

Make sure you consult with your facial plastic surgeon to discuss the options that might best meet your needs. While younger patients may benefit greatly from less extensive procedures or older patients may request less downtime, recent advances and modern variations to the traditional facelift offer a wide range of procedures. Trust your face to a facial plastic surgeon to personalize your procedure, decrease operative time, reduce postoperative complications, and provide optimal results.

What to expect with cleft lip and cleft palate repair

A cleft is a hole, or space, where there should normally be tissue. Cleft lip and cleft palate deformities affect approximately one out of every 500 to 700 babies born in the United States each year. The majority of clefts are caused by a combination of genetic inheritance and environmental factors. There are several challenges that the child may face, including eating, breathing, speech, hearing, dental, and social issues. An interdisciplinary team of specialists is necessary to ensure care and attention is given to enhance a child’s quality of life as soon as possible and up through adulthood. Lip and palate repair begin usually before the child is three months old.

Lip repair

The normal lip has three layers, a mucous membrane inside the mouth, a middle muscle layer, and an outer skin layer. The curve in the middle of the upper lip line that separates the vermilion part of the lip from the rest of the lip skin is referred to as Cupid’s bow. In cleft lip repair, the three layers of the lip must be reconstructed and Cupid’s bow defined. The goal is to minimize the visibility of the scarring so that the repaired lip can look as natural as possible.

Palate repair

The normal palate extends from the gum line all the way back to the uvula. It separates the oral cavity from the nasal cavity and is made up of three layers. There is an oral mucosal layer, a middle bone layer in the hard palate, or a muscle layer in the soft palate, and then there is a nasal mucosal layer. The hard palate does not move, but the soft palate moves and serves a very important function. Elevating against the back of the throat, the soft palate closes off the nose and prevents food or speech sounds from coming through the nose.

The goals of the surgery are to close the cleft, generally in two
layers for the hard palate and two or three layers for the soft palate separating the nasal cavity from the oral cavity. Some surgeons will attempt techniques to lengthen the soft palate or realign the muscles. There is a new device that doctors are experimenting with that is inserted into the roof of the mouth. By applying mild tension to the palate, the bones and soft tissues of the hard palate begin to slowly spread across the roof of the mouth. After 30 days, the device is removed and the doctor is able to close the tissue flaps. The procedure, osteogenesis, has been used to address problems with other facial bones, but is new to patients with cleft palate.

There is some controversy over which repair technique provides the best results. The desire to repair or close the cleft early has to be balanced with the potential disturbance in the growth of the palate, gums, and middle portion of the face. Upon reaching the teen years or young adulthood, the patient may need refinement or corrective procedures due to issues from facial growth.

Treatment for cleft lip and cleft palate usually includes many years of surgery. Doctors are working determinedly to improve outcomes, reduce the trauma, and lessen psychosocial issues.


ASK THE SURGEON

I have heard that surgery can cure sleep apnea. Is this true? How do I know if I am a good candidate?

When sleep apnea is moderate to severe, the standard treatment is continuous positive airway pressure, commonly known as CPAP. A machine helps a person breathe more easily during sleep by increasing air pressure in the throat so that the airway does not collapse while breathing in. Typically, a mask covers the nose and/or mouth or prongs fit into the nostrils. Patients may find the CPAP to be cumbersome and awkward for sleep.

Surgical options depend on the extent and cause of your condition. If you have a deviated septum that is contributing to your sleep apnea, reconstructive rhinoplasty (nose surgery) may be the right option for you. There is also a procedure, uvulopalatopharyngoplasty (UPPP), which removes soft tissue from the back of the throat and palate, increasing the width of the airway at the opening of the throat. Maxillomandibular advancement (MMA) surgery permanently enlarges the airway by moving the mouth, tongue, and chin forward. This is a more aggressive approach that isn’t for everyone with apnea, especially if you are having success with CPAP or another conservative treatment. Consult with a craniomaxillofacial surgeon to discuss your options and if you would be a good candidate.

HEALTH TIP

Bone mineral density in the face changes with age. Researchers at the University of Rochester Medical Center compared the facial bones and lumbar spine from 60 patients ranging from 20 to over 60 years old. The lumbar spine bone mineral density decreased significantly for both men and women between the middle and old age groups. Similar results were noted for the facial bones, which can contribute to the appearance of the aging face. What can you do about it? Easy ways to increase bone density and strength include combining calcium and vitamin D supplements with weight-bearing exercise (such as walking); weight training (lifting weights or using weight machines); and using medicines such as calcitonin (Miacalcin), alendronate (Fosamax), risedronate (Actonel), or ibandronate (Boniva).

 

WHAT’S NEW?

Scientists in Japan state that they have engineered hair follicles—the tissue essential to hair growth—from human induced pluripotent stem (iPS) cells. Could this be a cure for baldness? The goal is to find methods to generate hair and hair follicles more efficiently. Hair follicles are made of skin cells called keratinocytes, which become hair when stimulated by proteins secreted by hair papilla cells. The researchers cultured human iPS cells until they grew into precursors of keratinocytes. Hair formed after two to three weeks. This could lead the way for productive hair loss remedies.