Facial Implants

• Chin Implants
  
  Chin augmentation, called mentoplasty, increases the projection of the chin. It is used to bring a receding chin into balance with the rest of the face. A receding chin can be perceived as a sign of weakness in both men and women; men often choose chin implants because a more prominent chin is also considered more masculine. Similarly, a weak chin can make the nose look larger than it is. Some patients who go to cosmetic surgeons inquiring about a rhinoplasty-a nose procedure-really need only a chin implant. When performed in combination with a facelift revision, the chin implant provides an extension of the chin, helping to create a more defined jawline.
  
  
• Cheek Implants
  
  Cheek implants, though not used as frequently as chin implants, can reduce a hollow or sunken look in your cheeks and can also correct underdeveloped cheekbones; the implants add fullness and lift to the cheeks, producing a healthier, more youthful look, especially for those with long faces.

Eyelid Lifts

In performing an eyelid lift, called a blepharoplasty, the surgeon lifts the lids by removing sagging eyelid tissues. This procedure can be performed on both the upper and lower eyelids. After an eyelid lift, the eyes are unburdened of excess skin and fat that have distorted their shape, and the result is a more rested, youthful, and alert look.

Most darkness under the lower eye is from shadow effect from the fat bulging underneath the eyes. Note that an eyelid lift alone is not intended to correct fine lines or wrinkles around the eyes. This explains the necessity of combining eyelift procedures with other rejuvenation procedures such as browlifts and skin rejuvenation treatments such as laser skin resurfacing. Also, an eyelid lift will not correct dark circles under the eyes if the circles are caused by the muscle and other tissues showing through thin skin. These distinctions can be defined during the consultation.

For the upper eyelid lift (blepharoplasty), the incision is hidden in the eyelid crease. This crease is hidden when our eyes are open. Excess skin and fat are removed proportionally to restore the original shape and contour. The upper eyelift does not 'open' your eyes, it recreates the eyelid depth. A brow lift reopens the eyes. In most people seeking eyelid rejuvenation, eyelid procedures are combines with browlifts and/or laser skin resurfacing to achieve natural, balanced and complete results. This is especially true of people over 45.

A lower eyelid lift can be accomplished by a procedure that has two distinct variations. The older procedure for a lower eyelid lift is transcutaneous/subciliary, which means the incision is through the external skin underneath the eyelashes, while the other is transconjunctival, on the inside of the eyelids.

Although the subciliary approach can tighten the skin without the need for adjunct procedures such as laser resurfacing, this type of incision can exacerbate dry eyes and alter eye shape. This is why the preferred approach in most people is transconjunctival, with the incision invisible on the inside of the eyelids. More important, this technique avoids creating an incision through the muscle that supports the eyelid, necessary in a subciliary procedure, in order to access and alter the bulging fat.

Brow Lifts

A brow lift is not about creating high eye brows. Often only upper eye shape is the goal. A brow lift, also called a forehead lift, is a cosmetic surgery procedure that elevates or tightens the soft tissue and skin of the forehead and brow. The brow lift smoothes lines in the forehead and rejuvenates the brow area, which may have become heavy looking, creating a tired, unhappy or angry look. It is especially effective in rejuvenating the upper eyelids. Many patients undergo a brow lift alone to treat perceived upper eyelid sagging.

Both men and women can benefit from brow lifts. A man typically has a heavier brow than a woman, but as a woman's brow begins to droop, her brow becomes more masculine. How so? The "shelf” on the outer half of the brow, where the skin drapes the bone, makes the eye feminine and youthful. As the brow droops, this shelf disappears.

It is often necessary to combine brow lifts with facelifts in order to create balanced, complete results. The better the facelift result, the greater the need for a combined brow lift to both balance the lower face and neck result and ensure the transition from the lifted repositioned lower face, so that it does not bunch or pleat as it meets the sagging, unlifted forehead.

It is common that people do not perceive their forehead aging changes as they notice jowl or a lax neck. The reason is that we have an unconscious reflex that does not let our eyebrows to become noticeably low in many people. This would cause limitations in our upward vision so our brain uses our forehead muscles to silently activate, lift our brows but creates the furrows instead. This is why Botox® has become popular to treat our forehead furrows.

Unfortunately, if the forehead has been affected by gravity changes and is truly sagging, Botox® injections will paralyze the forehead muscles causing the brow/forehead to fall and make our eyes appear worse.

If our lower faces have drooped and fallen enough for someone to need a lower facelift, their forehead has been affected similarly. Since the signs of a loose forehead can be around the eyes or hidden in furrows, prospective patients are not always aware that the upper face has been affected significantly by aging and unbalanced procedures will reveal noticeable discrepancies from the rejuvenated to the untreated area. In addition, bunching and pleating around the eyes is a hallmark of an imbalanced procedure, since folds are not naturally occurring in this area of the face. In circumstances in which a brow lift is not combined with a facelift it can be necessary to limit the result in the lower face and neck to avoid imbalances and disharmonies. The worse the neck or nasolabial folds the greater the need for a combined facelift and brow lift.

Since older facelift techniques did not reposition the drooping soft tissue as effectively as deep-plane facelifts do today, brow lifts were not always combined with facelifts as better facelifts necessitate today.

There are a few types of brow lifts. The decision between which specific type is based on individual facial characteristics such as hair type and hairline position.

A classic but older procedure, the incisions made for this lift is hidden in the hair and can extend from almost ear to ear. The forehead is tightened by removing excess tissue utilizing the strong deep layer in the forehead. No tension is placed on the skin. This lift offers better control of the brow position and a more long-lasting effect. Numbness will be present for about nine months behind the incision on the top of the head. Muscles between the eyebrows can also be treated.

Created by Dr. Gordon as an advancement of both coronal and endoscopic brow lifting, significantly shorter incisions similar in placement to those used with a coronal brow lift are made and endoscopes and instruments are used to complete the procedure. Similar lifting and between-eyebrow muscle work is accomplished. This produces consistently, natural brow lifts because the tension from the lift is distributed equally across the entire length of incision instead of being made at only a few points, a limitation of the standard endoscopic procedure. Since tissue is removed, this lift is longer lasting. Similar to coronal or endoscopic lifts, it will raise the hairline and also produce numbness behind it.

Threads or sutures can also be used to lift the brow. This is a 'short cut' procedure that places all tension of lifting on a few widely spaced sutures or threads. It has a high potential for creating unnatural results and can produce pain syndromes and does not produce a long lasting outcome.

As men and women age, their hairlines recede. Given this fact, it's important to note that this is the only brow lift that lowers, not raises, a forehead hairline. The incision precisely follows the front hairline, weaving in the first few hairs. Great care is taken to bevel or angle the incision, which allows hair to grow through the healing incision line. The incision is unapparent quickly and this technique gives the surgeon the most control over the brow position. As is the case with the coronal brow lift, numbness will be present behind the incision line for about nine months. Similarly, muscles can be treated between the eyebrows. Because of its ability to lower someone's hairline this is the most common brow lift and creates a fuller look to one's hair.

A temporal brow lift, also known as a lateral brow lift, lifts the drooping skin of the outer brow line. It does not lift the mid-forehead or allow work to be done on the midbrow furrowing muscles. It can be used to help avoid the pleating of a sophisticated facelift in a person who cannot have a full brow lift, such as bald men. The incisions from a temporal brow lift will be inconspicuous, however, this lift might not hold up as long as other brow lifts. It is often used to 'touch up' a previous brow lift.

Skin Rejuvenation & Fillers

• Laser Skin Resurfacing
  Laser skin resurfacing, commonly called a laser peel, removes the outer, damaged layer of skin to reveal a smoother, younger look. Laser resurfacing can reduce the appearance of sun damage, wrinkles, fine lines, uneven pigmentation and superficial scarring, usually on the face. A carbon dioxide (CO2) laser beam of precisely focused light vaporizes the surface skin and reveals the undamaged layer beneath. Procedure time varies depending on the size and condition of the area being treated.
  
  
• Nonablative Laser Treatments
  Lasers make it possible to perform high-precision and often painless procedures to reduce the appearance of wrinkles, scars, stretch marks, rosacea and spider veins on the face and legs. We use several lasers to provide optimal treatment modalities for a variety of skin conditions. Nonablative means that the laser is gentler and doesn't remove skin. This allows for a decrease in downtime and recovery.
  
  
• Chemical Peels
  Chemical peels remove damaged outer layers of skin on the face to smooth texture, reduce scarring, and remove blemishes and pre-cancerous growths to produce healthy, glowing skin. Peel formulas and strengths are tailored to each patient. Peels can be combined with other procedures such as facelifts for a younger look. They may be covered by insurance if they are performed for medical rather than cosmetic reasons.
  
  
• Microdermabrasion
  Microdermabrasion improves mild to moderate sun damage, scarring, wrinkles and other superficial skin problems. A gentle stream of tiny particles exfoliates the outer layer of skin and provides a fresh, glowing, younger appearance. Only a small amount of skin is removed, so sensitive areas such as the face, chest, neck, arms and hands can be treated. Results are comparable to a light chemical peel and should be immediately visible. Microdermabrasion is often performed in conjunction with other skin renewal procedures, such as laser treatment and chemical peels. Multiple treatments are recommended for full effect.
  
  
• Thermoplasty
  Bronchial Thermoplasty is a procedure in which heats the lining of your airways in order to prevent them from narrowing. The procedure uses the Alair® System.
  
  
• IPL Photo Rejuvenation
  The natural consequences of aging on our skin include sun damage, freckles, age spots, acne scarring, enlarged pores, and redness caused by broken capillaries and rosacea. Photorejuvenation reduces these signs of aging using non-invasive, painless pulses of light. Treatments can also improve the appearance of birthmarks and uneven pigmentation and stimulate the production of collagen. There is no recovery time and low risk of complications. Multiple sessions of about 20 minutes each are performed every few weeks until the desired result has been achieved.
  
  
• Soft Tissue Fillers
  Restylane, Hylaform, Radiesse, Sculptra, Collagen, Autologous Fat
  
  
• Other Fillers
  Artefill, Synthetic Implants