ORANGE COUNTY FACE LIFT SPECIALIST

Aah, the joy of aging!

Of course, some of us age gracefully like a fine Bordeaux wine.  However, most of us do not.  Fortunately, plastic surgery can improve many signs of facial aging.

As always, I recommend avoiding the sun and discontinuation of smoking.  This is the cheapest plastic surgery one can receive and it’s almost free!

Starting from the forehead region, some of us will develop a drop (or ptosis) of the forehead, resulting in sagging of the eye lid skin.  The tell-tale sign of brow ptosis is hooding of the lateral eye lid skin.  If, from side view, the lateral eye lid skin has a fold, like a hood, then a brow lift is recommended.  It is critical to elevate and correct the brow ptosis before removing any excess eye lid skin.  The forehead muscle has gotten used to the excess “weight” from brow ptosis.   If the excess skin is removed, the brow, in time, will drop more.  It is then very difficult to elevate the brow, since too much skin has already been removed, resulting in inability to close the upper eye lid.

If brow ptosis is not present and only excess upper eye lid skin is present, then an upper blepharoplasty is performed. Although the upper eye lid fat was routinely removed, in the past decade we have realized this will result in a hollow upper eye lid, exaggerating the aging of the eye lid region.  For this reason, I generally do not remove any fat with the skin. This is a relatively easy procedure, and can be done in the office with local anesthesia.

The lower eye lid usually develops a groove between the eyelid fat and the cheek region, resulting in a “hollow” look.  The lower eye lid fat may also become prominent.  In the old days, plastic surgeons removed the fat to smooth out the prominence.  Unfortunately, with time and aging, this resulted in a much worse deformity and a “concentration camp” look.  I usually perform a trans-conjunctival (the incision is made inside the lower eye lid) and reposition the fat under the skin.  This re-draping not only improves the bulging, but will “fill in” the groove deformity discussed previously.

The lower eye lid region can be further improved with a mid-face (cheek lift).  Essentially, after the facial skin has been elevated, the cheek soft tissue is repositioned in a more aesthetically pleasing location.  This not only enhances the cheek area, but also will help correct the hollowness of the lower eye lid region.

The jowls of the lower face are address by repositioning the soft tissue under the skin.  For a simple visualization, aging results in the mid and lower facial tissue going “south and medially”.  Our goal is to reposition the tissues under the skin “north and laterally.”

The neck usually has two areas which need to be addressed.  One is the loosening and separation of the muscle underneath the neck skin (platysma muscle).  The other issue may be actual loosening of the neck skin.  The platysma muscle can be brought together using an incision under the chin area.  If excess, loose neck skin is still present, then a neck lift will be required.

It is important to place the incisions in areas which are not readily visible.  The facial tissue should have harmony and “flow together”, like a symphony.  The result should be as natural as possible.

I have enclosed a before and after photo to demonstrate the effectiveness of this procedure.

Michael A. Jazayeri, M.D.  is a board certified plastic surgeon with over 10 years of experience.  His office is located in central Orange County.  To schedule a complimentary consultation, please call 714-834-0101.

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FACE LIFT-IT’S TIME TO LOOK REFRESHED!!!

The face is the most visible part of our body, and it’s always exposed to the public (unless you are a celebrity and hide your face with a scarf and sunglasses!)

Unfortunately, we are all victims of genetics and the laws of gravity.  Eventually, the signs of aging will make noticeable changes in our face.  From top to bottom these changes are:  ptosis (drooping) of the eyebrows or excess fat and skin in the upper and lower eyelids, descent of the mid-face causing flattening of the cheeks and exaggerating the bulging of the lower eyelids, descent of the lower face creating the jowls (hound dog look), and loosening of the muscles/skin of the neck resulting in a “turkey neck”.

All of the above can be improved with plastic surgery. 

My goal, as a plastic surgeon, is to improve the face while maintaining a natural look.  The incisions for the face lift start in front of the ear, extend behind the ear, and travel back to the junction of the hair line with the back of the neck.  If done properly, the scars heal very nicely.  However, your hair stylist will be able to see the scars from up close.  The face and neck skin is undermined and the facial “muscles” are tightened.  The cheek is repositioned to its youthful position.  The neck muscles are also brought back to their normal position.  The excess face and neck skin are then removed.  It is important to take the right amount of skin; otherwise a “wind-swept”, operated look will be the result.  I also tighten the muscles not to create tension, but to correct the aging and add volume at the same time.

It is important to note that a face lift will correct the underlying problem of aging.  However, the quality of the remaining skin is not going to improve dramatically with a face lift.  Imagine the leaning Tower of Pisa.  A face lift is similar to straightening the Tower.  However, only a fresh coat of paint will make the Tower look new.

Several options are available to address the skin.  For most patients I recommend the Mixto Laser to improve the quality of the skin. 

The recovery period for a face lift is shorter than most surgeries.  Majority of patients can attend a public event in two weeks, with make-up.  The swelling may take 2-4 months to resolve.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon and member of American Society of Plastic Surgeons, with over 10 years of experience.  His office is located in central Orange County, in the city of Santa Ana.

To schedule a complimentary consultation, please call 714-834-0101.

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BROW PTOSIS-WHAT PLASTIC SURGERY CAN DO FOR YOU

The eyes and the nose are the focal points of the face.  If you are interested to learn more about nose surgery, please click here.  This blog, however, will focus on the eye brows.

Aging and genetic factors can affect the upper eye lids and their associated structures.  The upper eye lid changes which may occur include excess skin and rarely protruding fat, and brow ptosis.  Brow ptosis or sagging of the eyebrows result in the eyebrows dropping at or below the level of the upper orbital rim (the orbital rim is the edge of bone which houses the eye ball).  With brow ptosis, the skin at the edge of the eye brow will be so low that a skin “hood” will be seen from side view.  Basically, the skin will hang over the lateral edge of the eyebrow, creating a hood.

The only correct way to address brow ptosis is with a brow lift.  As the name implies, brow lifting involves lifting the forehead skin so the eyebrows are positioned in their normal anatomical position.  Frequently, the frown muscles are also addressed at the same time, to provide a softer look to the middle eye brow.  There are three types of brow lifting:  open coronal, open hairline, and endoscopic.  Both open techniques involve making an incision either in the middle of the scalp (coronal) or in front of the forehead hairline (hairline), and elevating the forehead skin.  The excess skin and muscle is then removed and the brow is positioned in its new position.  The incision is then closed.  The advantage of open technique is its long term reliability.  The open technique is the gold standard and is a proven method.  In my opinion, the open technique is the only correct approach for heavy, droopy eye brows and thick forehead skin.  The disadvantage is the longer scar, and the loss of sensation in the scalp behind the incision.  Although in most patients some sensation returns, it may not be complete.  The endoscopic approach involves making several separate incisions in the scalp and elevating the forehead skin using an endoscope.  The amount of skin remove is minimal and the theory is internal scarring will keep the brow in its new position.  My opinion regarding endoscopic brow lift is that it may be useful for minor brow ptosis, and perhaps most patients receiving endoscopic brow lift did not require a brow lift in the first place.  I am not aware of a patient with moderate to severe brow ptosis having long term success with the endoscopic approach.  The advantage of endoscopic technique is less incisions, and the ability to maintain sensation in the scalp.

In the previous paragraph, I mentioned there is a correct way of addressing brow ptosis.  If one only removes the hanging skin without elevating the eye brow, the eye brow will eventually drop more.  The forehead muscle is used to the weight of the hanging eye brow.  If the weight is removed, the forehead muscle will weaken, causing worsening of the brow ptosis.  This may seem counter-intuitive.  Trust me; plastic surgeons many decades ago learned this the hard way!

Once the brow ptosis is corrected, there may be some or no excess skin remaining.  If excess skin is remaining, an upper blepharoplasty can be performed.  This involves removing any excess skin in the upper eye lid, resulting in smooth skin without folds or crease.   During a brow lift, it is usually very difficult to know how much excess eye lid skin is remaining.  This is due to swelling at the time of surgery, which will “lift” the excess skin.  Most of the time, therefore, I perform the brow lift and wait 4-6 months for the brow to settle down.  The upper eye lid surgery is then performed, resulting in a much more predictable result.

It is important to realize that the position of the eye brow is different in men and women.  With women, the eye brow is lifted above the orbital rim and a slight arch in the eyebrow is desirable.  The upper eye lid surgery also is more aggressive in women.  In men the position of the eye brow should be lower and removing too much eye lid skin will result in a feminine look.

I have attached before and after photo to illustrate the effectiveness of this procedure.

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Dr. Jazayeri is a board certified plastic surgeon with over 10 years of experience.  His office is located centrally in Orange County, in the city of Santa Ana.  If you like to schedule a complimentary consultation, please call 714-834-0101.

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AMERICA’S FIRST FACE TRANSPLANT-SCIENCE FICTION BECOMING REALITY

The first face transplant in the United States was performed this week at the Cleveland Clinic.  What is significant other than being the first face transplant in the U.S. is the amount of defect which was reconstructed.  Approximately 80% of the face (including skin and bone) was reconstructed with the transplant.  The previous three face transplants performed in the world only covered small areas of the face.
The surgery lasted 23 hours, involving multiple teams, which is predictable, given the complexity of the face.  Multiple small vessels and nerves have to be attached to the patient’s face to assure survival of the transplant, and to have some hope of facial movement.  These vessels and nerves are attached using an operating room microscope, using sutures which are thinner than a human hair.
As remarkable as this surgery is, several areas of concern remain.  We are not technologically at the level to obtain a result such as in the movie Face-Off, where Nicolas Cage had a face transplant.   In the movie, the new face looks completely natural, without any scars from the surgery, and the actor has perfect facial movement.  The result of this surgery is unpredictable.  There is no way to predict how much of the facial movement will return, and if it will be symmetrical.  There will be scars where the transplant is attached to the patient’s face and only time will tell if the scars will be noticeable or not.  There is also the potential long-term psychological effect on the patient.  We have to remember, the patient has lost 80% of her face, and, therefore, the new transplant will result in a drastic change in the patient’s facial characteristics.  How is the patient going to cope with this dramatic change?  Only time will tell.
The final issue which was not discussed in the article or the video is the long term effect of immunosuppression.  Since the patient has received a transplant from a different person, her immune system must be suppressed to minimize (not eliminate) the risk of rejection.  Therefore, she is at risk of infections and cancers typically seen in AIDS patients.  Even with immunosuppression, there is always the potential of graft failure or rejection.
Face transplant is and will remain a controversial topic until technology and surgical techniques improve.  However, I think we must push the envelope in order to progress.  This procedure was done in an academic environment, where the latest technology exists.  The patient was carefully selected and had a defect which permitted face transplant to be considered as a viable option.
Who knows what lies in the future: brain transplants any one!?

To read and watch the video about this procedure, please click here.

Michael Jazayeri, M.D. is a board certified plastic surgeon and member of American Society of Plastic Surgeons, with over 10 years of experience.  His office is centrally located in Orange County, in the city of Santa Ana.  To schedule a complimentary consultation, please contact 714-834-0101.

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RHINOPLASTY (NOSE SURGERY)-WHAT PLASTIC SURGERY CAN DO FOR YOU

Rhinoplasty (nose surgery) is one of the most challenging, yet satisfying procedures in plastic surgery.

Improving the shape of the nose has a dramatic and positive effect on the face.  Yet, nasal surgery is not as simple as it seems.  Many patients think that just “shave the hump and make my tip a little smaller” is easy to do.

In fact, rhinoplasty requires patience and attention to the smallest detail.  Remember, the nose is a small anatomical structure to begin with, so even a few tenths of an inch taken too much or too little will have a great impact on the final result. 

The nasal structures (both visible and not visible to the eye) are linked together like a chain.  If one loosens or tightens the chain at some point, it will have an effect further down the link.  For example, shaving the hump on the nose will almost always make the nose look wider from the front view.  Therefore, the nasal bones will need to be narrowed to give a balanced look.  However, if the inside of the nose is not addressed (patients frequently have crooked septum or enlarged structures inside the nose), then the patient’s breathing may become compromised.  Therefore, it is crucial for your surgeon to examine and address these issues during your consultation and the procedure.

Choosing the right surgeon for your nasal surgery will ensure the highest chance of success.  Rhinoplasty is a rewarding procedure.  Many of my patients have morphed from shy and quiet to confident and out going.  The other benefit of this procedure is its longetivity.  Nose surgery is not affected dramatically by weight gain/loss or the aging process.

I have enclosed before and after photos to illustrate the effectiveness of this procedure.

Dr. Jazayeri is a board certified plastic surgeon and a member of American Society of Plastic Surgeons.  He has more than ten years of experience in the specialty of Plastic Surgery.   Dr. Jazayeri’s office is centrally located in Orange County, in the city of Santa Ana.  To schedule a complimentary consultation, please contact 714-834-0101.

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