How do I know if I need a Facelift? What is a facelift?

Patients often ask me "Do I need a facelift ?" This then goes into the second phenomenon that I describe in the aging process, namely the loss of ligamentous support.  As we age, along with losing volume as I have described before, the tissues that "hold up" our face begin to lose strength as well.  Take a look at the image below to understand how the face ages.

This is where you begin to notice deeper lines and wrinkles around the naso-labial folds and jowls.  This is also very evident in the neck region as the tissue gets loose and just cannot « stay up » any longer.  The platysma muscle in the neck, which is contiguous with the SMAS (muscle soft tissue of the face), begins to droop and patients will notice banding of the muscle ( the so-called turkey gobbler neck).  It is at this point that the patient will likely need some surgical intervention to reverse these changes.

Once these changes begin to occur, a patient needs to consider facelift as a solution.  Facelifts have many different connotations for patients.  I think this is because there are so many different techniques and approaches that you all have heard about.  Mini-Facelift, Short scar facelift, LifestyleLifts (strong TV marketing), SMAS facelifts, Twilight lifts, Smartlifts, Deep Plane Facelifts just to name a few and I probably missed a couple in there !  The main goal of any of these procedures should be to restore the laxity that  and ligamentous support.  When I evaluate a patient, I take all these factors into consideration before deciding which technique fits that patient.  It is a mistake to try and fit one technique to all patients that walk in.  I try to be versed in all these techniques to assure natural results and long term results.

Lipoatrophy- What does it mean?

So lets break down our earlier blog and discuss more specifically the changes I talked about.  Lipoatrophy represents, in my opinion, one of the changes that aging brings.  It is a term that we use to describe loss of fat or volume in the face.  When a patient says to me that they "looked so much younger" in old photographs, what they are looking at is volume.  Their face simply has more volume as compared to present.
The simple answer to this problem is to restore lost volume.  We can do this in many ways and with various techniques available to us.  The first "filler" was fat and it still is today.  Sometimes we do fat grafting independently or we can combine it at the time of a facelift.  Other fillers that are available on the market like Restylane, Perlane, Juvederm, and Sculptra also play a significant role in facial volume restoration.  In the last 10 to 12 years, the advent of these fillers has made these procedures very popular.  My goal when I meet a patient for facial aging is to find the right treatment option.  The art, of what I offer, lies in the proper assessment and treatment. The ultimate goal is to achieve the most natural appearance for the patient.

Facial Aging - How does it happen?

Facial aging is one of the most common reasons that patients come to see me.  What I offer to patients is anti-Aging  solutions.  It is entirely possible that this can be gracefully and naturally achieved.  Aging process occurs at various rates and to various extents depending on many factors that I have outlined in previous blogs. 

Patients will often point out to me that someone they know who is the same age looks a lot younger.  This is often a factor of genetics more than anything else.  Why not do something about this now ? What are you waiting for ? 

As a plastic surgeon, it is NOT true that we ONLY recommend surgery for everyone that walks in to the office.  There are so many non-surgical options to consider today that surgery is NOT always the answer.  During the consultation, I first try to explain the aging process, before I recommend any treatment.  In my opinion, if patients understand facial aging, it is easier to understand the treatments that we offer.

So lets review facial aging.  I have tried to condense years of reseach into essentially three basic processes : lipoatrophy, loss of ligamentous support, and skin surface damage .  It is a bit simplistic approach and explanation of what really is a very complex process involving many factors, but keeping things simple is often the best approach in life.  These processes are NOT mutually exclusive, isolated, step-wise events.  They can occur at varying rates, intensity, and duration throughout the lifespan of the patient.  This conept is extremely important as I design a treatment solution.     

Tuberous Breast Deformity - Breast Augmentation is the Solution

Once in a while I will encounter a patient as pictured above, who is seeking breast augmentation.  Often this patient does not realize that the reason she does not like her breasts has to do with not only the small size but also the shape of the breasts.  She has tuberous breasts.  Tuberous breasts have a number of characteristics that make them unique.  It is important to state that there is nothing wrong with these breasts.  This is strictly a cosmetic issue for most women.

Tuberous breasts have a narrow base width and a high constricted infra-mammary fold.  The breasts are  conical in shape and have the appearance of underdeveloped breasts.  In fact they are actually fully developed but lack the proper aesthetics.  In severe cases of tuberous breasts, the nipple areolar complex is often large and misshapen due to breast tissue that herniates behind the areolae.  

Breast augmentation is the best solution to improve the appearance of these breasts.  These cases are challenging.  They require a level of understanding of the proper aesthetic relationship of the breasts.  This again is where the art and science comes together to sculpt beautiful breasts.  These procedures are very satisfying for patients and I love doing them.  

Below is the patient shown about 3 months post surgery using implants.  She is very happy.

South Jersey Magazine Top Physician Award for 2013

Please pick up a copy of August issue of the most popular magazine in South Jersey.  It seems that we have done it again!  Being selected as a Top Physician for South Jersey is a deep honor that I take pride in.  We have received this award consistently since 2007 and I remain proud of this accomplishment.  Thank you to all patients who take the time to vote for us.  We will continue to deliver excellence in plastic and cosmetic surgery to our patients.  For those who are considering plastic surgery, please check us out and let us be part of that transformation for you.   

How young is too young for Cosmetic Rhinoplasty?

Often I am evaluating a young patient for rhinoplasty and this topic needs to be re-visited in my opinion.  Improving the appearance of a nose combines the art with the science of rhinoplasty.  This is where science plays a major role in deciding when to do rhinoplasty.  An aesthetically poor appearance of the nose can have a devastating effect on a young patient from a social standpoint.

We know through our scientific analysis that the nasal anatomy matures during the teen years.  It is generally understood that the female nose matures between the ages of 16 to 18 and the male nose takes a bit longer.  In general the male nose matures closer to 18 to 20 years of age.

Theoretically, we can perform rhinoplasty at the age of 16 in girls, BUT this has to be based on the surgeons assessment of the facial anatomy of that patient.  What I tell patients is that it not just enough to evaluate the nose, my assessment has to include other structures on the face.  How does the nose fit in relationship to other parts of the face for instance, the jaw bone and the orbital bones.  Sometimes, these other structures are lagging behind in terms of growth and waiting is the best option for that patient.  My job is to help patients determine this issue.  In most cases, 16 is the earliest that I would initially consider a female patient for cosmetic rhinoplasty.

Physician Excellence Award

Last week, Virtua Hospital system held their annual Super Star Award ceremony.  At this ceremony, I was recognized by the Board of Directors to receive the Physician Excellence award.  I was extremely touched and grateful for this recognition.  This award has a significance in that it is a recognition of excellence of service by peers.  There is no recognition greater in my humble opinion than that by peers in your profession.  It shows our commitment to excellence at South Shore Plastic Surgery. I would like to thank any and all who were kind enough to nominate me and then to actually award me over so many excellent and amazing doctors in South Jersey.