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Archive for July, 2011

Ribbon Facelift

It was just a few years ago that patients unhappy with facial droop had limited choices —full facelift. Advances in minimally invasive facial rejuvenation have opened the field of choices for facial lifting. Midface suspension ribbon lift, also referred to as a cheek or midface lift, corrects sagging midface tissues by surgically repositioning them up and to the side. This accomplishes several goals: volume enhancement of the midface region, elimination of hollows in the area, and a gentle smoothing of the tissues just below the eyes. A successful midface suspension can be a key step in achieving the youthful appearance sought after in minimally invasive facial rejuvenation procedures. As we age our mid face degrades, deflates and descends giving that dragged out tired look of ‘old age.’ The area between the lower eyelids and the mouth is considered the midface. As we age, the effects of gravity, repeated muscle contraction, and lifestyle cause the skin, fat, and muscle in this region to move downwards. When this occurs, the cheeks begin to look saggy or flat, lower eyelids can become puffy or hollow, circles begin to appear under the eyes, andthe lines between the nose and the corner of the mouth increase in size.

Ribbon FaceLift: Who is an ideal candidate?

Good candidates for mid face suspension ribbon lift are those patients who are starting to see some droopiness of the brow, cheeks, jowls and/or neck and would like to see a lift effect, but do not want the risk, scars, or recovery of a real browlift, facelift, or necklift operation. The ribbon lift procedure can achieve 60-70 percent of what a real invasive surgical procedure can deliver without the need for hospital care or general anesthesia.

The Procedure

During a midface suspension procedure, the surgeon makes small incisions in the area above the ear, and in some cases through the mouth. A surgical ribbon implant is then passed through the cheek tissue and secured to the soft tissues above the ear. Similar techniques were tried with suture suspension. The ribbon allows greater fixation than small sutures. In all cases, the surgeon relies upon the implant ribbon to temporarily fixate the suspended cheek in its new position. The ribbon material is slowly absorbed and the tissues created by the body hold the lifted facial tissues fixed in position. This restores cheek volume and establishes more youthful midface contours. The result will be a natural, revitalized appearance that doesn’t appear overdone, plastic or “pulled.”

When performed skillfully, a midface ribbon lift can deliver a natural but noticeable improvement. It is frequently performed with other procedures. However, for many younger patients, under 45 years of age,midface suspension is often a standalone procedure. Good candidates must have realistic expectations and be prepared to follow the postoperative recovery protocol and must be accepting of the risks. Poor candidates include those patients with unrealistic expectations, have uncontrolled medical illnesses that affect wound healing, are grossly overweight (with heavy faces) or are excessively thin, have loose skin. The mid face ribbon suspension may be combined with other, more minor surgical procedures, such as fat transfer, Botox, injectable fillers, fractionated skin resurfacing, deep chemical peel or photofacial intense pulse light treatments. All procedures can be completed using local anesthesia by a cosmetic surgeon as in-office minimally invasive facial rejuvenation.

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Aesthetic surgery of the lips has evolved as the field of cosmetic surgery has evolved. Luscious, full lips speak of youth and vitality.

The lips thin as people age, and the wet line moves lower in reference to the dentition. In addition, the oral commissures begin to downturn. These thin, flat, and poorly defined lips impart a sense of age. Specific procedures address each of these labial-aging signs. Some of these procedures include augmentation to help restore full, well-defined, and proportional lips that impart a sense of beauty and youth.

The lips are the most malleable and animate of all facial features. Many consider them to be the most pleasing feature of the lower third of the face. Many of the techniques used on other areas of the face may not work on the lips because of their 3-dimensional animate nature. With this in mind, many methods are used to augment the lips and to change their animate shape, repose shape, or both. The surgeon must always be aware of how static changes to the lip change the animate aesthetics and function of the lip. Patients occasionally refer to this as “kissability.”

Initial attempts at beautifying the lips probably started with Cleopatra, who colored her lips red. Later, silicone was used to augment the soft tissue of the body and face, including the lips. Other materials were then developed that could be used for lip augmentation. Some of these materials include collagen, facial fillers, fat, and acellular human matrix, just to name a few. Many new injectable materials used to augment the lips have become available, and many more are to be approved by the US Food and Drug Administration (FDA). Temporary injectable materials are the most common method of lip augmentation and reshaping. The problem with temporary injectable fillers is the fact that they are temporary.

Lip Augmentation Procedures

The newest advanced lip augmentation procedures involve the placement of a solid silicon implant —similar to silicon implants used in breast augmentation procedures. The solid silicon implant can be placed into the upper and lower lips through 3mm incisions in the corner of the mouth. These incision sites heal rapidly and are barely visible to inspection after placement. The silicon implants come in several different sizes for permanent lip enhancement. The old silicon injections, like the ones completed on Ms. Priscilla Presley, caused lip deformity with invasive growth into the lip tissues. Injectable silicon is difficult to remove without major surgical excision. Silicon implants, however, can be easily removed if the lip augmentation look is no longer desired. The silicon implants have a soft natural feel.

All lip procedures may be performed in an office surgical suite with local anesthetic (field block, nerve block) and this is, in fact, an ideal way to work on the lips. With general anesthesia, the lips become flaccid and adynamic. The ability for the patient to move the lips during surgery is a great advantage during the sculpture phase.

Again, well defined, full lips speak of youth and vitality. Take care to review before and after photographs of patients treated by your cosmetic surgeon. Make sure that your ideal of aesthetic sense is the same as your surgeon. Beware of lip overfill; big pink slugs and platypus lips do not fit into the category of “kissability.”

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