Skin Wrinkles

Description

Alternative Names

Plastic Surgery

In 2003 there were about 1.7 surgical cosmetic procedures, up 43% from the year before. Most of these surgeries were liposuction and breast surgeries. However, nearly a quarter of a million each of eyelid and nose surgeries were performed. Facial plastic procedures range from being fairly minimal, such as a browlift to a full face-lift.

Face-lifts (Rhytidectomy)

A number of face-lift procedures (called rhytidectomies) are available. Face-lifts can provide individuals with a more youthful, if not necessarily younger, look. The degree of improvement, however, depends on a number of factors including age, bone structure, skin type, and personal habits, such as smoking and sunbathing.

The Procedure. When a face-lift is a relatively simple procedure, it can take about two hours under local anesthetic in a doctors office. Complicated face-lifts are done under general anesthesia in a hospital and can take three to six hours. The face-lift procedure may be one of the following:

• SMAS (superficial musculoaponeurotic system) is the most common face-lift procedure. The surgeon makes an incision at the hairline and separates the skin from the underlying tissue and muscles. The muscles are tightened and excess fat and tissue, such as fat under the chin and neck, are removed.
• The endoscopic subperiosteal or subgaleal face-lift is a less invasive surgical technique. The surgeon raises facial structures rather than cutting away flaps of skin. Only a few half-inch incisions are made, and scarring is minimal. Not all individuals are candidates for this procedure, however.

Neither SMAS nor the endoscopic version is effective for the middle part of the face, particularly the deep lines (naso-labial folds) that run down from the nose beside the mouth. Some time after the SMAS face-lift, the upper face begins to age again while the lower area still retains its shape, causing the face to look imbalanced. Other approaches, such as one called composite face-lifts that lift most muscles in the face, are being investigated.

Recovery Process. Recovery normally lasts from several weeks to several months. Swelling and discoloration are common. Some patients report tingling or numbing sensations after surgery, which generally subside as damaged nerves regenerate.

Complications. Rhytidectomy is not without risks. A postsurgical hematoma is a collection of blood that can occur after a rhytidectomy. In one study, major hematomas occurred in 2.2% and minor hematomas in 6.65% of patients. They generally develop within two weeks of the surgery and require drainage. Even minor hematomas need fast treatment to prevent greater complications, including infection, changes in pigmentation, fluid buildup, and prolonged recovery time.

Other less common complications may include the following:

• Infection.
• Excessive bleeding.
• Asymmetrical facial muscles.
• Delayed healing.
• Scarring.
• Permanent injury to the nerves that control facial movements.

These complications are rare, particularly with a skilled surgeon, but the more complex the face-lifts, the greater the risk.

Procedures for the Eyes

Blepharoplasty. Blepharoplasty is the primary surgical procedure for eye lifts. Results usually last between five and ten years. Although simple, it has potential complications, including permanent difficulty in closing the eyes or making a stern expression. Newer techniques, however, are preventing this complication. Assuming the surgeon is experienced, laser surgery is now preferred to the standard surgical scalpel approach; bleeding and bruising are reduced, and both the operation and recovery are faster. Temporary blurred or double vision is common. More serious complications include infection, bleeding, dry eyes, difficulty in closing the eyes, and pulling down of the lower lids. Rare cases of blindness have been reported.

Transconjunctival Upper Blepharoplasty. An innovative procedure called transconjunctival upper blepharoplasty removes fat from the membrane that lines the eyelids (the conjunctiva) and is an effective technique for treating both the upper and lower eyelids. Unlike traditional blepharoplasty, this procedure does not cause scarring in the nasal area. In patients who have scars from previous surgeries, transconjunctival removal of fat can also make existing scars less obvious. Long-term side effects and efficacy of this procedure have not been studied.

Procedures for the Neck

Laser Liposculpture and Platysma Resurfacing. A procedure called laser neck and jowl liposculpture and platysma resurfacing may prove to be an alternative to face-lifts. The procedure requires only a one-inch incision under the chin and removing excess fat. After the fat is removed, the surgeon tightens the platysma, the thin muscular sheet under the skin of the neck, which improves the shape of the neck. Only local anesthetic is needed and the patient can return to normal activities in two days. The patient's skin should be elastic enough to be able to reform without sagging.