Showing posts with label facelift. Show all posts
Showing posts with label facelift. Show all posts

Saturday, February 10, 2018

#FatGrafting vs. #ChinImplant

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According to American Society of Plastic Surgeons procedural statistics
between 2000 and 2016 there was a 6% decrease in all cosmetic surgery performed but a 38% decrease in the number of chin operations performed. Between 2013 and 2016 there was a 14% increase in all cosmetic surgery but a 13% decrease in the number of chin augmentation operations. 78% of that decrease were women. Clearly chin surgery is becoming less popular especially for women.

Chin enlargement can be achieved by bone surgery (genioplasty), chin implant placement or injection of temporary or permanent fillers. Chin implant placement is currently the most popular method of chin enlargement. The implants can be made of silicone, goretex or medpor. Each method and type of implant is associated with its own pros and cons. The decrease in number of augmentation surgeries being performed is therefore likely due to dissatisfaction with chin implants. I covered the pros and cons of different implant materials in a previously blog Facial Implants - cheeks, chin, jaw.  The assessment of results for any of these methods focuses on the front to back chin projection, resolution of dimpled chin skin (mentalis muscle strain) and symmetry visible on a frontal view. For middle aged and older patients the presence and severity of marionette lines and lower lip-chin grooves also impact the results and are less likely to be improved by implants alone. This blog will focus on the methods themselves and their pros and cons.


Method Pros Cons
bone surgery (genioplasty) can lengthen vertically and front to back more swelling longer recovery time, blood supply to bone can be compromised, step off at outer corners of the bone cut, teeth can be damaged
chin implant permanent, squared male chin achievable visibility, possible implant displacement, possible infection
injectable filler local anesthesia only, quick recovery most only give temporary result, can only increase front to back projection
injected fat graft can be performed under local anesthesia, ideal for lower lip-chin groove filling, permanent unpredictable fat survival that can cause uneven contour or asymmetry, cannot form a square male chin, can only increase front to back projection, may need more than 1 session to achieve the desired result, can change with weight gain or loss

Although fat grafts and injectable fillers can soften marionette lines the ideal way to remove those lines is a facelift.
Squared Male           Round Female Chin

Square Male Medpor Chin Implant

Round Female Silicone Chin Implant

A published prospective study of 42 consecutive patients (32 female and 10 male aged 19 to 50 years mean age 28 years) who underwent chin augmentation by means of fat grafting between October of 2014 and January of 2016 showed that injection of 4 to 10cc (average 7.5cc) of fat reliably augmented the chin. All patients had not previously had chin surgery and wanted/needed only front to back chin augmentation without vertical lengthening. At 6 month follow up after surgery these patients retained 82% of the injected fat with resulting increased front to back chin projections of 3 to 11mm (average 7mm). The degree of fat survival was not related to the amount of fat injection in these small amounts. Only 3 of these patients requested another procedure for additional chin projection despite all 3 having gained more than 6mm in projection from the first procedure.

Weakness of the chin has been associated with up to 30 percent of rhinoplasty patients. Nevertheless, many rhinoplasty patients are not ready to commit to an implant to improve the chin area. These patients are much more likely to accept fat grafting to improve the chin contour. The recent increasing use of injected fat graft chin augmentation may make chin augmentation more popular with female patients.
Chin Implant Patient

Before (top) and 5 months after (bottom) surgery photos of secondary facelift and injection fat grafting to the chin. The marionette and laugh lines were reduced by a combination of facelift and fat grafting. 5cc of fat was placed in the lower lip chin groove and 8cc was placed directly into the chin. To rejuvenate the area and reduce chin dimpling (mentalis muscle strain).

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Monday, December 19, 2016

Non-Surgical Treatments Cannot Replace Facelift Surgery

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157 patients under the age of 50 who underwent their first face lift at the New York Center for Facial Plastic and Laser Surgery between January 1, 2003, and December 31, 2013 showed that prior to that facelift each patient spent on average a total of $7,000 on nonsurgical treatments. These included fillers, laser, radiofrequency and botox treatments. The patients reported that they appeared 4 years younger after their nonsurgical treatments, but appeared 8 years younger after their facelift. The take home lesson is that nonsurgical treatments are not a replacement for facelift surgery and that is even more true of patients in their 60s and 70s.


Despite that and correcting for the 2008-2009 recession between 2007 and 2015 the population increased by 6.3% while the number of facelifts per year increased by only 6.1%. The percentage of the population undergoing facelift surgery appears to be a relative constant.

How Long Does A Facelift Last?
Face and Neck Lift 1
Face and Neck Lift 2
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Tuesday, December 4, 2012

How Long Does A Facelift Last?

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This a question most patients have going into facelift surgery and my usual answer was 5 to 10 years depending on genetics, age at surgery (it lasts longer in younger patients), exposure to extreme climates and active or passive smoking. Now a long study out of the UK shows that more than five years after facelift surgery, three-fourths of patients still look younger than they did before surgery. The researchers looked at photographs of 50 patients who had undergone facelift surgery an average of 5½ years previously. Surgical changes in the lines around the nose and mouth had the greatest longevity while the angle of chin to neck (the neck outline) changes deteriorated the most during this time frame. This is probably why neck revisions after facelift surgery are more common than revisions above the jaw line. The study does not tell us how long all of the changes last only that they last to some degree for more than 5 years.
One of my male facelift patients in his 60s did not require anything but a laser resurfacing a few years after facelift surgery and sculptra dermal filler injections 8 years after facelift surgery to maintain his results.

Facelift
Male Facelift
Face and Neck Lift1
Face and Neck Lift2
Mini Facelift-Lifestyle Lift-Quick Lift

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Sunday, June 24, 2012

Vampire Facelift is Really a Face Fill

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A google search on Vampire Facelift yielded 1,020,000 results. The term was first used by the press in a July 2010 ABC News report on the use of Selphyl for facelifting. Selphyl first became available in 2009 and involves taking a small sample of blood from the patient mixing it in a test tube to separate blood components, which takes about 20 minutes and then injecting some of the components (platelets) into the area to be filled. Your body then makes collagen to fill the depression or fold. The process takes about 3 weeks from the date of injection to become visible. Because the result was rejuvenating and the material came from one's own blood the term Vampire Facelift was employed. Although hyaluronate injectable fillers like Restylane had been around for 7 years at this point the injection of hyaluronate together with this platelet material began around this time.



Tuesday, March 9, 2010

Even a dog can benefit from a facelift

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As you can see even a dog can benefit from a facelift. This Shar pei required a facelift because the extra folds of skin were damaging the dog's eyes.

This Los Angeles billboard was actually an ad for a Comedy Central television show not a Veterinarian or a Plastic Surgeon


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Thursday, April 30, 2009

Facelift, Midfacelift and Neck Lift 2

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To make things easier I first give the prospective facelift patient a mirror for them to point out areas of concern. That way I can be assured to address these in my overall assessment. I then use a top down approach to evaluate the frontal hairline (high, low or average), brow drooping, presence or absence of forehead wrinkles and crows' feet at the outer corners of the eyes, temple wasting or concavity, aging changes of the eyelids (bags, drooping-ligament laxity, excess skin, nasojugal groove depth), nasolabial fold (laugh line) depth, amount of excess cheek skin, cheek surface contour and bone visibility, presence of vertical skin folds just in front of the ear, marionette line depth, severity of jowls, upper lip height and upper incisor show, neck fat, excess skin and muscle banding and finally the patient's overall health condition. Since a large portion of these patient's are elderly with multiple medical problems on multiple medications an Internist is frequently involved to ensure a safe operation with a smooth recovery.
facial aging



Monday, April 27, 2009

Facelift, Midfacelift and Neck Lift 1

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Facelift surgery to treat the aging face started in the early 1900s. At first this only involved removing some skin in front of the ear and under the chin. Striving for greater improvement the surgeons started to cut just under the skin via these incisions to release it from underlying attachments and allow the removal of greater amounts of skin. This flattened the laugh lines (skin fold between the outer edges of the nose & outer corners of the mouth) and marionette lines and that was good enough. That was how it was done for the first half of the 20th century. Progress in the surgical technique was hampered by societal taboos. No doctor would admit he or she did the surgery and no patient would state they had had the surgery.



Monday, February 2, 2009

Facial Proportions - Facial Analysis in Cosmetic Surgery

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Faces that are considered youthful and attractive in general have certain proportions and relationships in common. These fall into 3 categories.
  • The first is equivalent size where 2 different anatomical structures have the same size.
  • The second is proportional size where one structure is a specific fraction size of another.
  • The third is positional angle relationships between 2 structures.

The optimal values for the first 2 categories are the same for both sexes. The third category can be altered to achieve a more masculine or feminine look. In assessing a patient for facial surgery Plastic Surgeons must keep these proportions in mind in the process of deciding what specific operative procedures would benefit the patient. This also allows the surgeon to custom tailor the procedure for each patient. No 2 patients should have the exact same procedure unless maybe they are identical twins. This is especially important when the margin of error is small such as a rhinoplasty where the margin of error is a millimeter or less.




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