Facial Surgeries

Facial Surgeries

Blepharoplasty

Some people have eyelid surgery to correct problems that are a result of aging, while others have inherited traits such as bags under their eyes that cause them to seek treatment at a younger age.

If the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead (brow) lift may be recommended. Smoothing of crow’s feet may require Botox, chemical peeling or laser resurfacing procedures. Circles beneath the eyes caused by dark pigmentation may be treated with a bleaching solution or chemical peel. Alternately, sinking around the bony orbit below the eye can be addressed with fat grafting or a mid face lift.

High blood pressure, thyroid problems or diabetes are some of the conditions that can increase the risks during eyelid surgery. Your plastic surgeon will ask if you have allergies or if you have been told that you have “dry eye” or any other eye problems
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There are two different approaches to lower lid surgery. One uses an external incision and the other is performed from inside the lower lid. Your age and the extent of the fatty deposits you have will determine which approach is preferred.

The incision is hidden within the natural fold of the upper eyelid for upper eyelid surgery and it is through this incision that excess skin and fat are removed. Because the incision follows the natural contour of the upper eyelid, it will be well camouflaged when it has healed.

For lower lid surgery the incision is usually hidden below the lower lashes. Through this incision, excess skin, muscle and fat are removed. Fat may also be redistributed to improve puffiness or bulges. Other adjustments such as canthopexy (eyelid tightening) may be done to correct special problems such as muscle laxity.

You and your plastic surgeon may decide that the best approach for removing excess fat is a technique that needs no external incision. This procedure is called trans-conjunctival lower blepharoplasty. While it is a good approach for younger patients, it cannot be used to remove excess skin so a laser may be used in conjunction with this method to tighten the skin under the eyes.

After your surgery, you may have a feeling of dryness or irritation in the eye. This may require treatment. There is also a chance of a temporary reduction in eyelid sensation or impaired eyelid function. Impaired lid function may be treated with additional surgery.

Mild swelling persists for several weeks in some cases while others see swelling resolve in just seven days. Bruising is gone in most people in seven to ten days and you may use makeup within the first week to hide discoloration. You may find your eyes are temporarily sensitive to light. You may also experience some excess tearing or dryness. Your plastic surgeon may recommend eye drops to relieve burning or itching. You may want to wear dark sunglasses for a couple of weeks to protect your eyes from the wind and sun. The incision lines will fade over several months until they become barely visible.

For further information about blepharoplasty, please click HERE

Rhinoplasty – Aesthetic

It is also referred to as reshaping the nose or nose job. It is done to improve the looks of the nose and enhancing self confidence. Surgery on the nose is also done to correct impaired breathing caused by structural abnormalities in the nose. The shape of your nose is usually a result of heredity; the appearance may have been altered in an injury or during prior surgery.

Rhinoplasty surgery can change:

• The size of the nose; symmetrical with the face
• The nose width at the bridge
• The nose profile; visible humps or depressions on the bridge
• The nasal tip; large or bulbous, drooping or too upturned
• Nostrils are too large, wide or upturned
• Nasal asymmetry and deviation

Rhinoplasty is a personal choice that you should do for yourself, not for anyone else.

Rhinoplasty is a good option for you if:

• Your face has stopped growing and you are 13 years of age or older.
• You are physically healthy.
• You don’t smoke
• You have specific but realistic goals in mind for the improvement of your looks.

Rhinoplasty Risks:

• While the majority of women do not experience complications, it’s important to understand and discuss the risks with Dr. Tumi during your consultation.

It is very important to speak to your plastic surgeon about any important questions about your procedure. It is normal to feel anxiety, don’t be shy to express these feelings with your surgeon.

After the procedure is completed, a splint, internal tubes or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during the healing process. You will be given instructions to follow during your recovery from the rhinoplasty. These instructions will include how to care the surgical site, medications and when to follow up.

Rhinoplasty – Post Traumatic

While there is no upper age limit for having rhinoplasty patients may be advised to wait until they are 16 (when the nose is fully developed) before considering undergoing rhinoplasty. Sometimes breathing problems related to the internal nasal structures can be corrected at the same time as nose reshaping. It is important to have a clear idea of how you would like your nose to look as well as to know there are some limitations to aesthetic nasal surgery.

Your plastic surgeon may ask whether you have difficulty breathing through your nose, suffer from allergies or use nasal spray excessively.

In evaluating you for rhinoplasty, your plastic surgeon will examine your nose both internally and externally. Skin quality as well as the size and shape of your nose must be carefully studied. Sometimes, chin augmentation may be suggested so that a more harmonious facial balance can be achieved. With rhinoplasty, work is done on the cartilage and bone that form the structure of your nose. Certain bones may need to be altered in order to make your nose look narrower and straighter.

If your nose needs to be augmented, this can be accomplished using cartilage from your nose or cartilage from another part of the body. The skin and soft tissues will re-position themselves over the new form of your nose. In most cases, incisions will be placed inside your nose so they will not be visible. If the base of the nose is narrowed or the nostrils reduced, small pieces of skin below the nostrils will be removed.

When external incisions are recommended they are placed in well hidden areas like the crease where the nose and cheek join or where the nose and the lip join. Skin numbness after rhinoplasty may occur but is usually temporary. Occasionally, extra surgery may be necessary to refine the result. Bruising is mostly gone after a week and you can use concealing makeup if you wish. Swelling, however, can last a number of weeks or months though residual swelling usually affects just the nasal tip.

For further information about skin cancer treatment, please visit ASPS and www.plasticsurgery.org

Skin Cancer

More than one in four fair skinned Canadians who are currently alive will get a skin cancer in their lifetime. Plastic surgeons are involved in removing a large share of these as most of them occur on the “sun belt” of the face which includes the nose, cheeks, temples and ears. Almost all skin cancers are caused by sunburns. Aging Canadians should also not burn as the damage caused by ultraviolet light is not as well reversed by DNA repair enzymes as you age. In other words, the older you are when you get sunburn, the more likely you are to get a skin cancer from the sunburn. This is why no one should sunburn anymore.

The longer you wait to have a skin cancer removed, the bigger it gets, and the more complicated the reconstruction becomes to make the patient look as close to normal as possible. This is why it is best treated early while it is still small.

Basal cell skin cancer is the most common kind of skin cancer. It is usually a smooth pink or red flat or lumpy area. Basal skin cancer does not go away but gradually gets larger and larger. These cancers generally do not know how to spread elsewhere (metastasize). They therefore do not generally get into the blood and do not spread to the lungs, liver or brain as do many cancers such as breast or bowel cancer. Basal cell skin cancer generally never kills people unless you refuse to do something about it and you let it grow out of control, as it will not stop growing. The cure rate with removing these surgically is over 95%. Those who are not cured simply have not had all of the cancer cells removed and will require additional surgery to remove the leftover cancer for cure.

Squamous cell skin cancer is very much the same as basal cell skin cancer in appearance except the red areas tend to have hard rough spots on them and bleed more easily. Squamous cell skin cancers also have a slightly higher risk of metastasizing than basal cell skin cancers. However, the risk of metastasis and death is usually less than 5% if the squamous cell skin cancer is in a sun induced area (i.e. not on the genitals, inside the mouth or in the anal areas). Squamous cell skin cancers on the hand, the lip and the ear do have a higher risk of metastasis than sun induced squamous cell skin cancers on the rest of the face and body.

Malignant melanoma occurs in 1% of fair skinned Canadians. This kind of cancer does know how to metastasize and result in death. However, if you catch it early and have it removed, the cure rate is high. There are three things that make melanoma obvious, as this is not a subtle skin cancer in most instances:

• Melanoma is usually black or has black in it and arises from moles
• Melanoma tends to grow quickly and will often double in size over weeks
• Melanoma tends to have an unusual or irregular shape as opposed to benign moles which are usually round or oval

If you have a thin melanoma (less than 1mm thick) your plastic surgeon will usually recommend a 1cm excision of normal looking skin around the tumour followed by no further treatment. If you have an intermediate thickness melanoma (1-4mm thick) you will usually have 2cm of normal looking skin removed from either side of the tumour followed by a sentinel (first relay) lymph node dissection.

Dr. Tumi will discuss the details of this with you. For further information about skin cancer treatment, please visit ASPS and www.plasticsurgery.org

Rhytidectomy

A facelift, or rhytidectomy, is a surgical procedure that improves visible signs of aging in the face and neck, such as:

  • Relaxation of the skin of the face causing sagging
  • Deepening of the fold lines between the nose and corner of the mouth
  • Fat that has fallen or has disappeared
  • Jowls
  • Loose skin and excess fat of the neck that can appear as a double chin or “turkey neck”

The loss of youthful contours in the face can be due to variety of factors, including thinning of the skin, loss of facial fat, gravity, sun damage, smoking, as well as heredity and stress.

Other procedures that might be performed in conjunction with a facelift are brow lift and eyelid surgery to rejuvenate aging eyes. Fat transfer or fillers may be suggested to replace the lost fatty volume. Skin treatments such as IPL, dermabrasion, peels or laser may be offered to improve the quality and texture of the skin.

What facelift surgery can’t do

As a restorative surgery, a facelift does not change your fundamental appearance and cannot stop the aging process.

A facelift can only be performed surgically; nonsurgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery.

Some nonsurgical treatments, such as stem cell facelifts, are of unproven benefit.

Neck Lift

Is meant to correct the saggy neck skin as a result of aging or weight loss etc. It usually is a part of the lower face lift, which means tightening the skin of the neck and jowls

Causes: Aging, weight loss, excessive fat deposition and genetics.

Management: Problem – excessive fat deposition

• Liposuction or sub mental fat dissection
• Skin excision – tightening using short scar technique; behind the ear
• Platysma band – sub mental incision and band resection or tightness
• Combined problems need combined approaches

Technique:

• Lateral approach through the periauricular incision.
• Central approach for platysmal band correction and direct fat excision. Most of the time, both approach in moderate to severe neck laxity
• Liposuction of the sub mental fat pad.
• Surgery could only be one of the above techniques or all of them. It depends on the severity.

Post Operative Management:

• Cold compresses
• Avoid Pressure
• Drains
• Incision management with antibiotic cream
• Facial cleansing

Complications:

• While the majority of women do not experience complications, it’s important to understand and discuss the risks with Dr. Tumi during your consultation.

How to improve the result:

• Realistic expectations
• Report any infection or healing issues
• Follow the instructions
• Your surgeon should know what you want and if he could do that for you. You need to know if he could do that for you.
• Pre-op consultation – a few visits to office

Brow Lift

Overhanging skin in the upper eyelids can be addressed in two ways: an upper eye lid lift or a brow (forehead) lift. While in the past surgeons often chose to automatically perform an upper eyelid lift to correct sagging of the upper lid, a brow lift is often used today to create the same result.

A brow lift can be performed alone or it may be performed at the same time as a facelift to remove excess skin and tighten muscles in the middle and lower face.

Younger adults who have a naturally low brow, or who already have deep frown lines due to stress or muscle over activity, may also benefit from a brow lift. Sometimes, patients may focus their attention on excess skin in the upper eyelids and not realize that it is their sagging eyebrows that are the cause of the problem.

Your plastic surgeon will explain the benefits of both eyelid surgery and brow lift as each procedure applies to you.
The surgical technique that your plastic surgeon recommends will depend on things such as the position of your eyebrows, the amount of excess upper eyelid skin you have and the height of your hairline (the height of your hairline can be altered a little after surgery). Often, an incision is made across the top of the scalp, beginning above the ears and hidden in the hair. Sometimes, the incision may be placed in front of the hairline. The incision is designed to be inconspicuous once healed. Through these incisions, your plastic surgeon can modify or remove parts of the muscles that cause frown lines, remove excess skin, and lift your eyebrows to a more youthful level.

Another forehead lift technique uses an endoscope. This is a long, thin tube with a light on the end, attached to a video camera. The endoscope is inserted through a few tiny incisions in the scalp. It allows your plastic surgeon to see and work on the inside structure of the forehead. The endoscopic technique has the advantage of requiring minimal incisions, but it may not be appropriate for all patients.

If your main concern is frown lines between your eyebrows, a limited endoscopic procedure can be performed to correct these problems. If you are having upper eyelid surgery performed, it may also be possible to treat frown lines by way of the incisions that are made in the upper eyelid.

While the majority of women do not experience complications, it’s important to understand and discuss the risks with Dr. Tumi during your consultation.

Swelling and bruising are usually gone within two weeks. You may use camouflage makeup almost immediately. You will have an accurate idea of how you will look within a few weeks.

For further information about Blepharoplasty, please click here

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