Most women will attempt to modify the appearance of their brows either with plucking or make-up. The brows frame the eyes. Aesthetically the highest point of the brow in a female should be at the lateral limbus of the iris (the side of the colored part of the eye that faces the temple). As we age our brows tend to drop and deflate in volume. Sometimes excess tissue on the upper eyelid is actually due to sagging of the brows. The brows can be lifted with surgery either alone or concurrently with a lower facelift. Eyelid surgery can also be performed if needed. Botox can be used to produce a slight and temporary correction of brow ptosis. On occasion fat grafting to the brow can be utilized to address volumetric deflation that occurs with aging.
The eyes are the most important aesthetic unit of the face. Beautiful eyes are almond shaped, tilted up and with crisp creases. A large number of procedures exist for rejuvenating the upper and lower eyelids. These procedures are often combined with brow lifts and midface lifts. For lower lids a primary goal is to create a smooth transition between the lid cheek junction.
A full or “cheeky” appearance to the midface is present in youth. Deflation and ptosis (sagging) of the midface with aging can lead to accentuation of the nasolabial folds and an overall appearance of facial deflation. Additionally aging of the midface can produce a hollowed appearance to the lower lid causing a “tear trough deformity”. The midface can be lifted concurrently with a facelift or a lower eyelid surgery. On occasion volumetric deflation should also be addressed with fat grafting, eyelid fat transposition or the injection of facial fillers all with goal of smoothing the lid-cheek transition.
They say that one cannot have a pretty face without a pretty neck. There are many techniques for facelifts with the primary goals of effacing the jowls, lifting the cheeks and midface and smoothing wrinkles while maintaining the patient’s natural appearance. Facelift surgery is one of the most artistic and individualized surgeries in aesthetics and requires a great deal of planning and skill on the part of the surgeon. I have had the opportunity to learn techniques from masters in this field on both coasts and have been studying facelift surgery for over a decade. I am currently involved in active research on the topic and truly enjoy performing this surgery. Facelifting may also involve concurrent modification of the upper face (browlift, eyelid surgery) and in some instances fat transfer. Skin resurfacing can be useful for fine wrinkles in the perioral region. The results can be very satisfying for patients. A natural and long lasting result is the goal. I am proficient in a variety of techniques for surgical and non-surgical facial rejuvenation depending on the patient’s desire, anatomy and tolerance for recovery time.
FACIAL FAT TRANSFER
Facial fat transfer can be useful in select circumstances. At times it may be an adjunct to facelift. Fat transfer can also be used to volumize certain regions on the face. There has been much discussion in the media regarding the stem cells which are present in fat. Although it is true that these stem cells exist, it is not yet proven that certain skin changes which have been empirically observed after fat transfer are simply a result of making loose skin more taught or due to cellular effects of stem cells. In either case, fat transfer can be utilized to correct facial volumetric deflation with aging. At times fat transfer may be combined with a surgical procedure such as facelift.