Face and Neck Lift
In 2007 I modified the Labbé neck lift to achieve better results in the area behind the angle of the lower jaw, below the earlobe, and in front of the big neck muscle (sternomastoid muscle). This results in such a dramatic improvement that I use to call this "The Perfect Neck Lift". The technique is in publication with the American Journal of Cosmetic Surgery.
As the face ages, the affects of gravity and the body's metabolism become more obvious: deep creases form between the nose and mouth (nasolabial folds); along the jaw line excess skin and fat deposits give a slack look; and the angle formed by the lower jaw and neck gradually flattens, losing its youthful sharp transition.
The facelift is designed to remove excess skin, and to remove or suspend accumulated fat, and to repair stretched out muscles, but cannot eliminate fine wrinkles or pigmentation of the skin associated with long term sun exposure. While a facelift does not stop the aging process, it is designed to "set back the clock".
The best candidate is a patient whose face and neck soft tissues have begun to sag, but whose skin still has some elasticity and whose bone structure is well defined. A facelift can make you look younger and fresher, and enhance your self confidence.
The usual facelift incisions begin in the natural creases of the ear; continue down around the earlobe, and behind the ear and into the lower scalp. Further improvements in the neck are made through a small incision below the chin. The location of the facelift incisions are specifically selected to restrict scarring to less obvious areas.
Local anaesthesia with sedation received through a needle placed in an arm vein, or general anaesthesia may be chosen and the procedure usually takes three hours.
After Care
The suspension bandage is removed after two days and then worn for another two weeks, but only at night. Swelling and bruising are very much patient dependent, but most are allowed to return to normal life patterns two week after the procedure.
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Forehead lift
The affects of aging on the forehead may include the following: frown lines, forehead furrows, drooping of the eyebrows and hooding of the upper eyelids. A forehead lift should achieve a more alert and youthful appearance without leaving a "surprised" look.
Forehead lifts may be performed by an “open sky” approach with an over-the-head incision, or with the use of endoscopic techniques. Then, the incisions are limited and always hidden in the hair-bearing scalp.
Personally, I perform only closed endoscopic forehead and browlifts, because possible complications, such as alopecia (hair loss) and loss of sensibility behind the over-the-head incision line, do not outweigh the more predictable result.
Direct browlifts, with an elliptical excision of skin above the eyebrow, are only indicated in men with receded hairlines. The Fogli procedure, which also addresses the tail of the brow and the upper eyelid, is based on an elliptical excision of hairbearing skin, located behind the hairline, and can be performed in both men and woman, when they have a low hairline.
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Eyelid corrections
The eyes have a tremendous impact on our outer appearance. Unfortunately, some of the earliest signs of aging are seen in the eyelids. The skin of the upper eyelids stretches out, causing drooping, while the lower eyelids are often characterized by bagging. When these features occur, they cause you to look older and more tired than you feel. Cosmetic eyelid surgery (blepharoplasty) can improve drooping of the upper eyelids and puffy bags below the eyes. The positive results of your eyelid surgery include a more alert, youthful, and refreshed look.
Typically, a blepharoplasty procedure, of upper or lower eyelid, requires 75 minutes when using a local anaesthesia. The incisions follow within the natural creases of the lids. Working through these incisions, the skin is separated from underlying fat tissue and muscle, allowing removal and redraping of excess fat, sagging eyelid skin, midface skin and muscle.
Tranexamic acid is prescribed to reduce bruising and the blood pressure is carefully controlled before surgery. Patients have to stop or restrict smoking and cannot take blood thinning medications for a period of two weeks prior to the surgery.
After care
It is important to rest the day that the surgery is received and to apply ice packs. Itching may occur after two to three days and is difficult to undo.
Most patients take one pain killer a few hours after the surgery, but have a burning sensation on day three. Most patients are up and around the day after the surgery. The sutures are removed after a week and the bruising and swelling rapidly subside.
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Lip augmentation
It is wise to choose initially for a non-permanent soft tissue filler and to discuss the properties of permanent fillers 1 year after.
After care
Bruising is likely to occur, especially in the upper lip when the vermilion border needs profile enhancement.
Botox
Botox is used for a variety of cosmetic purposes and functional disorders. The diverse benefits of Botox include its use for wrinkle reduction, reduction of oversized jaws, treatment of excessive sweating, breaking bad facial ticks, turning the corners of the lip upward, treatment of facial pain, among many other usages.
I owe most of my knowledge to Dr. Lam, who has an experience of injecting more than 30.000 IU per year.
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Hair transplantation surgery
Hair transplantation is a surgical technqique that involves transplanting hair follicles from one part of the body (usually posterior part of the head) to balding parts. It is primarily used to treat the male pattern of baldness, based on the fact that the transplanted hair follicles are genetically programmed to resist balding. The technique may also be used to reconstruct brows and lashes.
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Fat transfer to the face
Indications for fat transfer include any condition which results in the loss of subcutaneous fat and a resultant defect. For example, facial aging often is caused by the loss of facial fat. The lack of a youthful look is only partly because of sagging skin. It is also because of a lack of fullness under the skin. Fat transfer can sometimes restore youthful fullness in a way that standard skin tightening procedures, such as a facelift cannot.
Again, I owe most of my knowledge to Dr. Lam, who is performing more than 20 cases per month.
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Dermopigmentation
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If you think permanent makeup is solely about vanity, think again. "Cosmetic reasons are one area, but there are many more practical applications," says Charles S. Zwerling, M.D., F.A.C.S., director of the American Academy of Micropigmentation. For women who have arthritis, stroke, Parkinson's disease, multiple sclerosis, or other conditions that cause tremors, putting on makeup can be an impossible task. Permanent makeup eliminates their frustration. Women with vision problems, who are blind, or who have cataracts are also good candidates.
Cosmetic tattooing also helps women who have allergies or hypersensitivity to makeup. Female athletes and other physically active women are turning to permanent cosmetics, as are business women, entertainers, models, and housewives.
For women who have lost their hair because of chemotherapy or alopecia (a condition that can cause loss of body hair), permanent eyebrows and eyeliner can restore self-esteem and eliminate the need to reapply eyebrows every day.
Scars after trauma or surgery, as well as irregularities at the vermilion border (lining of the mouth) after reconstruction of cleft or tumour surgery, are challenging indications.
Feminisation surgery
Refined surgeries in the nose, forehead, lip and neck area are required.
This surgery is very much customized to the particular patient.
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