Category Archives: FACIAL SURGERY

Cosmetic Eyelid surgery news

The Eyes have it

Cosmetic Eyelid surgery, or Blepharoplasty, is a surgical procedure to remove the excess skin and fat from the upper eyelids and lower eyelids. Today I am going to talk about cosmetic eyelid surgery news that I have recently come across.

Here are some blogs about how the procedure is performed

 https://www.tavmd.com/2010/10/23/eyelid-surgery-blepharoplasty/

https://www.tavmd.com/2012/11/23/upper-eyelid-surgery-blepharoplasty-video/

https://www.tavmd.com/2012/11/28/cosmetic-lower-eyelid-surgery-blepharoplasty/

 

New Information about eyelid surgery

Cosmetic plastic surgeons have known for a while the importance of the eyes in perceptions of looking younger and more rested.

I always tell my facial plastic surgery patients that the first area for cosmetic rejuvenation surgery is the eyelid area.

Eye movements women in red men in blue

When looking at each other, we spend 80% of the time looking at a rectangle that goes form side to side of a face , up to the eyebrows and down top the bottom of the eye socket. The glabella, or area between the eyebrows falls in this area – another reason Botox in this area is so important in making us look better.

New research now shows that there are distinct differences between men and women in how we look at faces.

For any given period of time, men will look at the nose , and two eyes in a slower manner. Men spend more time looking at the nose, then one eye and then the other.

For the same period of time, women will look at the three areas in a more rapid sequence. Women will look at each area for a briefer amount of time but then repeatedly come back to it again.

The implication here is that by looking more often at the same area, there is a more pronounced and deeper imprint of the image on the brain. Maybe that is why women are better than men at remembering faces.

One brain cell per face

Another amazing new discovery is related to how our brains function to remember faces. Research now shows that  we allocate one brain cell or neuron to each face we see. It seems that we do not care how many different photos of the face in various guises there are. Our brain cell is dedicated to that one face and will recognize it despite changes in photo angle, hats, or even age. One neuron per face. Our family, friends, acquaintances, Hollywood actors, TV personalities and politicians  obviously take up a large number of neurons. What a waste of some neurons that I could have spent on better things.

One neuron per person

 

 

Cosmetic Neck surgery

Throughout history a pleasing and long neck has been one of the most important attributes of “beauty”. In fact, all over the world, native tribes strive to exhibit this area by elongating their necks with jewelry or rings, sometimes to an exaggerated point. Though rings around our necks are not as profuse in this culture, we still appreciate the beauty of a long smooth neck like the girl below.

long neck                                  beautiful neck

 

A beautiful human neck that is young and healthy is universally known to be

  •  slim (not fat)
  • long (not short)
  • smooth (not wrinkled)

Like all other areas of the body, it can suffer the ravages of time and the environment and come to look less than ideal. Fortunately we now live in a world where repair and improvement of the damage to our necks is possible.

platysma

Signs of an old neck

  • Skin of the neck is particularly thin and is one of the first areas to lose its youthful tone. Sun damage will often cause irregular coloring and loosening of the skin in patients as young as 40.
  • Muscle laxity of the underlying “platysma” muscle follows soon after, causing the typical vertical banding that can be seen on either side of the neck midline. Uncorrected, this condition leads to further separation of the muscle and the final result is the “Turkey Neck” with lax muscles and excess skin, and the look of a short wrinkled neck.
  • Fat accumulates in the neck as we grow older

Cosmetic Surgery of the neck

For patients with cosmetic neck problems, a neck surgery can significantly improve their appearance. Surgery is performed each of the problems of skin laxity, muscle separation and fat accumulation, and sometimes all three together.

Neck lift surgery 

Neck lift Surgery consists of incisions behind the ear which allows the skin of the neck to be pulled back and the excess neck skin removed.  A drain is sometimes necessary and is removed in 48 hours.  and return to work is within 5-7 days.

 

Neck Muscle Surgery

This consists of tightening the platysma muscle  at the same time skin is being removed through hidden incisions behind the ears and extending into the hair of the scalp. There is often an incision made under the chin to allow the platysma muscle to also be tightened in the midline and remove the “turkey neck” separation that occurs.

 

Neck Fat Removal

Some patients have good skin tone and tight muscles but excess fat in the neck. The neck fat accumulates both above and below the platysma muscle.  This gives the appearance of a short neck as well as a receding chin. The jaw line is non-existent and they have a “thick” neck because of the lack of definition of the face/neckline.

The neck fat can be removed by either liposuction alone, or in cases where there is also skin laxity and muscle separation, during a neck lift surgery.

 

All these cosmetic neck surgery outpatient procedures can be performed under local 1-2 hours in my office. Use of a turtleneck for a few days to hide the bruising may be required, and at the end of a week most signs have disappeared. Most patients return to normal activities in 2-3 days, and sports in 2 weeks.

Brow Lift or Eyelid Lift? Maybe Both

Brow lift with or without eyelid lift

 

As in any job, cosmetic plastic surgeons often see the same plastic surgery condition again and again.

I have written about brow lifts or forehead lifts in the past.

https://tavmd.com/2011/12/30/brow-lift-surgery/

 

Brow lift  and eyelid photo

Today I want to tell you about the decision-making process a cosmetic surgeon uses to determine whether a cosmetic surgery patient with excess skin on the upper eyelids needs an eyelid lift, blepharoplasty, a  forehead lift or both.

 

Eyelid surgery

As we age, our eyelids, like other parts of the face, change due to a number of factors, including:

  1. environmental damage—sun exposure
  2. genetics—thinness of the skin
  3. individual factors —what your anatomy is like

 

The skin of the eyelids is the thinnest skin of the body, so the effects of aging are often seen there first, manifesting as drooping of the eyelids and herniation of fat from around eyes.

Cosmetic plastic surgery to correct eyelid droop is called a blepharoplasty. Cosmetic plastic surgeons will remove excess skin and fat from the upper and lower eyelids to give you a more youthful look.

 

Brow/forehead lift

With aging, foreheads will also droop, as brow muscles and skin become lax and allow a downward migration of structures. When the eyebrow is below the bony part of the brow, you have a droopy brow and may be a candidate for a brow lift! Drooping of the brow causes:

  1. lines between eyebrows
  2. horizontal lines across forehead due to over-activity of muscles trying to pull the brows up
  3. appearance of more skin and fullness of upper lids

Brow lifts include:

  • removal of excess skin of the forehead in the center of the brow and in the lateral areas of the brow
  • Elevation and fixation of the forehead muscles in a higher position

 

Evaluation of a patient for upper eyelid surgery or brow lift

When seeing a patient for facial rejuvenation of the upper facial area, I always start with the eyelids.

  1. I look at excess skin in the upper lids and feel the quality of the skin and see how much skin there is for excision. At the time of blepharoplasty, the excess skin is actually measured to the millimeter to be sure that not too much skin is removed and that the cosmetic patient will be able to close his or her eye!
  2.  I look at any extra fat that may be present around the eyelid. The upper lid has fat in two compartments. The first is along the width of the eyelid and the second in the corner close to the nose. Excess fat is removed during surgery.
  3. I lift up the brow and see how much of a difference that makes to the excess skin of the lids.
  • minimal difference to eyelid skin with brow elevation: there is no need for any brow surgery.
  • great deal less eyelid skin with this maneuver: patient may be a candidate for just a brow lift, as long as the brows are droopy.
  • eyelid skin is improved but not totally gone: cosmetic patient may be a candidate for both a brow lift and an upper eyelid lift.

A complete evaluation of the forehead and eyelid area is imperative for patients considering facial rejuvenation of these areas. It is important for patients to know that in some patients there is a significant contribution to droopiness of upper eyelid skin from a droopy brow, and cosmetic patients will not get the results they want if both areas are not addressed.

 

Morad Tavallali, M.D., FACS

Looking Young with Face Lift?

Face lift surgery was first performed by a certain Madame Noel in Paris, France, in the early 1900s. Since then, face lift surgery has become a common cosmetic plastic surgery that has given thousands of men and women a younger and more attractive look. But is it true that people are looking young with face lift surgery?

There are a number of posts here in which I have written about how facelift surgery and facial rejuvenation is performed.

https://tavmd.com/2013/05/10/when-to-have-a-face-lift-surgery/

https://tavmd.com/2013/04/15/face-lift-with-local-anesthesia/

https://tavmd.com/2013/06/30/face-lift-surgery-by-non-plastic-sugeons/

 

A recent study shows that what some cosmetic plastic surgeons have been telling their facelift patients for years may not really be true. For full disclosure, I have always been particularly careful to tell facelift patients that I cannot make them look younger, as I am not privy to fountain of youth secrets. As a plastic surgeon I have told my facelift patients that I am looking for a natural and rested look after the surgery. If a cosmetic patient wants to call that youth, so be it.

 Face lift photo

Face Lift study

A recent study took a number of subjects and showed them before and after photos of cosmetic patients who had undergone facial rejuvenation surgery and facelifts.

They were asked to rate patients on attractiveness and whether they looked younger after the facial surgery and facelifts.

The results of the study showed two interesting facts.

1. Face lift surgery does not make you more attractive

Attractiveness has more to do with basic facial anatomy and proportions than with aging or looseness of the skin. In fact, my plastic surgery professor taught me that some cosmetic patients were “BU”—basically ugly—and frankly beyond hope. One could pull skin tight, fill and remove fat and do all sorts of surgery, but the patient will ultimately remain BU.

 

2. Face lift patients were found on average to look three years younger

Three years is certainly not that much time, yet cosmetic patients who have facelifts do look better if they have been operated on by a skilled, board-certified cosmetic plastic surgeon. So what is going on?

 

After a face lift, patients do not look more attractive and barely look any younger. Yet face lifts continue to be performed at increasing rates, and patients seem to be happy with their surgical results. One answer may be that it is just removal of the signs of facial aging that give a rested look to the patients, who then sees themselves as looking “better” and feeling better and more confident; the idea is that it’s the inner youth and beauty that shines through.

How about that?

 

Morad Tavallali, M.D., FACS

Looking Good After a Facelift

Healing after cosmetic face lift surgery

 

Face lift surgery is a common cosmetic plastic surgery used to improve facial features and changes due to aging.

I have written about the technical aspects of face lift surgery in the past, including differences between a full face lift and a mini face lift, and face lift surgery under general anesthesia or local anesthesia. Here are some posts:

https://tavmd.com/2013/05/10/when-to-have-a-face-lift-surgery/

https://tavmd.com/2013/04/15/face-lift-with-local-anesthesia/

http://tvamd.com/2013/06/30/face-lift-surgery-by-non-plastic-sugeons/

Face lift surgery photo

How long before I look good after a face lift?

This is a common question I get asked by cosmetic patients wanting to have a face lift. Obviously, the healing time after a face lift is an important factor in deciding when to have surgery.

The face is difficult to hide when compared to other body areas that can be covered by clothing.

Bruising and swelling of the face after a face lift can be covered by:

  • makeup
  • sunglasses
  • scarves
  • hairstyles

But the options are limited, and there is nothing better than time to help the plastic surgery patient recover.

 

Factors that affect healing after face lifts

There are a number of factors that directly affect healing after face lift surgery.

  • Genetic factors; thinness of facial skin and friability of facial blood vessels
  • Hematomas;  bleeding under the skin of the face after surgery due to medicines or opening of blood vessels after exertion such as a sneeze or cough
  • Swelling; common after all surgery but worse in some patients than others
  • Medicines; can cause reactions that adversely affect healing
  • Medical conditions; infection, heart or liver problems can affect healing

 

First week after face lift surgery:  you can be seen by family

The first few days after any surgery but specially face lift surgery, you will want to stay at home placing ice on your face and keeping your head elevated. You probably just want to be around close friends or your family. You may have significant bruising and swelling- sometimes enough to close your eyes!

 

Two weeks after  face lift surgery: you can see your friends

By two weeks after your face lift surgery you will look good enough to see your friends. You will still be swollen and maybe even a little bruised, but you are putting on makeup and are out and about.

 

Three weeks after facial plastic surgery: you can visit with acquaintances

At this time, a great deal of the swelling is gone, and most bruising should also have disappeared. You will still feel some of the normal postoperative feelings of swelling and a “woody feeling” on your face. The incisions should be healing well by now, and sutures may have been removed.

 

Five weeks after face lift surgery: you can see your enemies!

That’s right—those people who are not your friends, the ones who will eat their hearts out at seeing how good you look! At this time you can appear on TV or at public occasions (marriages, parties, etc.) without being considered “operated on.” Don’t let them come too close; the scars may need another few weeks before looking really good—and a year for the final result.

 

After a cosmetic face lift surgery, be prepared to take the right amount of time to recover. Also remember the rules above: 2-3 and 5 weeks for seeing different types of people!

 

Morad Tavallali, M.D., FACS

 

 

Facial Nerve Injury without Face lift Surgery

My facial nerve injury

In the previous blog I wrote about the anatomy of the facial nerve. Here is the link in case you missed it.

https://www.tavmd.com/2013/07/06/face-lift-and-facial-nerve-injury/

 

facial nerve photo

Botox or botulinum toxin injections can also lead to facial nerve paralysis in specific areas. See below.

https://tavmd.com/2012/04/26/why-do-i-have-a-droopy-eyelid-after-botox-injection/

https://tavmd.com/2012/05/01/treatment-of-droopy-brows-and-eyelids-after-botox/

 

Effects of facial nerve injury

Facial nerve injury has many causes, including:

  1. Trauma – getting the facial skin cut
  2. Surgery – facelift surgery or skin cancer surgery
  3. Tumors – brain or Parotid gland tumors or cysts putting pressure on a nerve
  4. TMJ – tempro-mandibular joint inflammation
  5. Bell’s palsy – unknown cause for loss of facial nerve function

 

Why a sudden interest in facelift nerve injuries?

Well, I just woke up with an acute partial facial nerve paralysis. It happens relatively commonly, and in most cases has an unknown cause called Bell’s palsy. In my case, I think it may be due to a TMJ problem that causes swelling around the facial nerve and decreases its function.

Damage to facial nerve functions and results respectively lead to:
  • Chorda tympani – inability to taste with one side of the tongue

  – Decrease in amount of saliva production leads to dry mouth

  • Temporal – inability to wrinkle brow; brow will droop
  • Zygomatic – inability to tightly close eye; eye will tear up

     – Unable to blink reflexively

  • Buccal – inability to puff out cheeks and purse lips
  • Marginal mandibular – inability to show lower teeth

 

Symptoms of facial nerve injury?

 

  • Inability to close my right eye and tearing

I have patched my eye to prevent damage to my cornea

 

  • Unable to chew or drink properly

Just like when you have come back from the dentist after anesthesia, I cannot purse my lips and drinking from a cup; it is… messy.

 

  • Unable to smile

I look grumpy and when I do try to smile I look like a pirate

 

  • Mouth feels dry

Only some of my salivary glands are working

 

  • Lack of taste

Perhaps the most interesting of the symptoms is an almost total lack of taste on one side of the tongue. Technically, it’s the front two thirds that have no sensation, but it feels like the whole side. Of course, the ability to sense a bitter taste is intact in the whole tongue.

Surprisingly I can feel all foods. All food feels alike, from a piece of bread to salami to an olive. They all feel slimy like an oyster! None have any taste at all! This is the worst sensation of all, in my opinion, since I have long suffered from the vice of gluttony, which I am now denied.

 

Since I am someone who usually has a very animated face and uses many facial expressions when talking, the lack of muscle function on one side is even more noticeable.

 

Treatment of facial nerve trauma (nerve palsy)

If the facial nerve is damaged during facelift surgery, it should be repaired immediately by the cosmetic plastic surgeon.

Facelift surgery that has damaged a facial nerve but is discovered later may need complicated cross-face nerve grafts in the future.

If palsy is due to known causes like tumors or cancers, these causes must obviously be addressed and treated first.

Facial nerve injury due to other causes requires treatment with steroids to decrease the swelling around the nerve, exercises to keep the muscles of the face working and taught and… a lot of prayer.

Facial nerve palsy usually improves within three weeks to six months, but some may be left with a remnant decrease in function.

Morad Tavallali, M.D., FACS

Face lift and Facial Nerve Surgery

Face lift and facial nerve; Botox of the entire face

 

Face lift surgery has few serious complications, but one of them is injury to the underlying facial nerve. The facial nerve is the primary nerve for facial expressions and innervates face muscles. Plastic surgeons must know about face lift and facial nerve surgery .

Here are some articles about facelift surgery.

https://tavmd.com/2013/04/15/face-lift-with-local-anesthesia/

https://tavmd.com/2012/05/06/the-face-lift-windswept-look/

The facial nerve has a long and convoluted course.  It may seem boring to read this anatomy lesson, but you will need to have an idea of the subject so my next blog makes sense—that one is going to be unnerving (could not resist). Your cosmetic plastic surgeon is intimately aware of this anatomy.

 

First, as our facial nerve comes out of our brains, it gives off a few branches (chroda tympani) and stapedial (ear) and travels by the tragus cartilage in front of the ear to a higher level. Our facial nerve then splits into five main branches just in front of the ear but still under the facial muscles and gives a combination of sensation and movement to our faces. The nerve comes out to a superficial level past the pupil area. If a branch is damaged during facelift or facial surgery, it may take days or months before function returns.

 

Branches of the facial nerve

facial nerve

 

facial nerve photo

Deep Facial nerve branches

  • Chorda tympani – taste to front (anterior) 2/3rd of the tongue
  • Submandibular/sublingual gland
  • Stapedial branch – to middle ear stapes muscle

 

Superficial Facial nerve branches

  • Temporal – helps to elevate the eyebrow  
  • Zygomatic – helps the cheek to elevate

          – helps eye closure

         – reflex blinking of lids

  • Buccal – helps the corner of the mouth/cheeks to elevate
  • Marginal mandibular – depresses lower lip muscles
  • Cervical – tightens neck muscles

 

Facelift surgery

During facelift surgery, the skin of the face is elevated above the fat and muscles of the face. The fat and muscles are elevated and held in place with sutures. The skin is then pulled tight. All facelift surgery occurs in a level above the face muscles. The facial nerve runs below the muscles. Injury to the facial nerve during facelift surgery is hence rare if the surgeon stays above the facial muscles. The facial nerve does become more superficial, piercing the facial muscles as it gets closer to the nose. Injury can occur in the central part of the face.

More commonly there is a temporary lack of function of the facial nerve due to the local anesthesia that is placed in the skin of the face for facelift surgery. The anesthesia gives the same results as paralysis of the superficial branches of the facial nerve.

 

Botox and botulinum toxin and facial nerve

Botox treatments give very similar results in some cases to facial nerve injury or decreased function. The botulinum toxin will actually stop some of these facial nerve branches from working. If the botulinum toxin is put in the wrong areas, Botox can lead to serious side effects that will require therapy. This is why Botox is only recommended for specific areas of the face, such as the area between the eyebrows, the crow’s feet and the forehead.

So much for the anatomy lesson—stray tuned for the next blog, which shows someone with facial nerve paralysis!

 

Morad Tavallali, M.D., FACS