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Browlift

As the face ages, the brow usually descends with the rest of the face. Although the nose is relatively fixed, the central eyebrow usually does descend some. This produces some transverse creases at the base of the nose. The lateral eyebrow is less fixed, and usually descends more than the medial part. This causes two problems. First, all the tissues that were above the bony orbital rim are now in the upper eyelid. Secondly, the lateral eye muscle (the orbicularis) bunches and you develop “crow’s feet.” Generally you don’t even notice most of this. Instead, what you see is the formation of transverse forehead lines as the forehead muscle (the frontalis) tries to hold the eyelid up. Reversing this with Botox ® only risks having the eyelids fall to their lowest point.

A browlift elevates the brow back to its normal position, pulls the brow tissue out of the upper eyelid, flattens the “crow’s feet” and eliminates the need for the forehead muscle to contract. Frequently this eliminates the need for an upper blepharoplasty. We generally, therefore, recommend a browlift at the time of a primary MACS Lift, and one is almost always needed for secondary procedures if it was not done at the time of the original facelift.

The procedure is almost always done endoscopically through small incisions in the scalp in line with the nerves. This eliminates the numbness of the older type of browlift. The incisions are also much smaller, heal faster, and have much less hair loss. Like the MACS Lift, we fix the tissues to solid deep structures to prevent relapse and improve longevity. Usually you can hardly find the incisions by a week. There is minimal bruising and the browlift adds no recovery time to the MACS Lift procedure. Additionally, we remove most of the muscles between the eyebrows to eliminate those little parentheses that tend to form as we age.

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Blepharoplasty

Lower eyelid rejuvenation is usually done as a part of the Extended MACS Lift. This procedure elevates and supports the cheek and lower eyelid and anchors them deep lateral to the eye. Only the small amount of bunched skin under the eye is removed. Because of this and the support the lateral suture provides, there is less chance of post operative droop of the eyelid. This support also makes this procedure ideal for you if you have already had a lower blepharoplasty and now have a hollow or elongated lid.

The browlift is frequently all that is needed to rejuvenate the upper eyelid. This is especially true if you have already had an upper blepharoplasty. In fact, we rarely do anything to an already operated upper lid other than a browlift, since the skin is usually tight enough once the brow is elevated to its normal position. In primary MACS Lift procedures, however, there is frequently some excess skin that needs to be removed. Occasionally there is also some fat that needs sculpting, but most has slid around the eye and removal of much fat causes the eye to look sunken. In fact, for secondary procedures, fat injecting is necessary to truly rejuvenate the eyelid area.

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Lip and Mouth Rejuvenation

With time several things happen to our mouths. The upper lip elongates. This causes the lip to appear smaller. As the cheek descends, the corner of the mouth also droops and we look sad. As the skin thins and we lose fat, the underlying muscle has more effect and we get wrinkles. There are several things that can be done to correct these problems. The MACS Lift will generally correct the turned down corner, and help us look our happy self again.

Several techniques are available to correct the other problems. Injection of a filler or fat can smooth the lip and/or plump it. Fat has the ability to also reverse some of the aging effects on the skin itself. If this does not smooth the area enough, then laser resurfacing or a peel can help. The lip can be plumped with an implantable collagen sheet. This fills the lower part of the lip and makes the red portion more prominent. Excision of the skin just above the vermillion border or just under the nose can shorten the lip and also make the red lip more prominent. This is generally more reliable.

Earlobe Rejuvenation

As we age, the ear lobe stretches and enlarges. The MACS Lift corrects some of the sag. However, on occasion, the lobe is just too large. This is easily corrected with an inconspicuous scar along the edge of the ear.

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Volumization of the Face

Several things happen as we age. The most talked about is droop of the tissues. Skin aging, mainly from sun damage and muscle action, is also readily recognized. The problem that is least recognized is volume loss. This actually happens to multiple tissues. We lose fat, muscle and bone. By relocating the descended fat, the MACS Lift corrects some or most of the appearance of the loss. When this is not adequate, the tissue can be further filled, lifted and rounded with a product off the shelf (Sculptra®) or your own fat. The latter is more immediate (Sculptra® takes some time to stimulate growth of collagen) and natural. There is also increasing evidence that the fat injected contains multi-potent stem cells, and that these can further rejuvenate the overlying skin. We usually harvest the fat used from your tummy or thighs, places where everyone usually has too much anyway. The injection of either can be done at the time of the MACS Lift or under local anesthesia later.

Skin Rejuvenation

Even if we correct all the effects of gravity, you may still look old if your skin looks old. Fortunately, the skin is easily corrected to an equally younger appearance.

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Buccal Fat Pad Removal

There is a natural fat pad overlying the lateral teeth in the cheek. In most people, this simply provides a natural roundness to the cheek. It blends with the surrounding fat and cannot usually be distinguished from it. However, in some people, with absorption of the surrounding fat or thinning of the nearby fat from a conventional facelift, the Buccal Fat Pad becomes prominent. This produces a bulge on the cheek. Fortunately, this is easily corrected. The fat pad can be removed, or, frequently better, repositioned to provide bulk in the upper cheek, where it is needed.

Lifestyle Enhancement

What good is looking young and wonderful if you do not feel the same? We offer counseling on diet, exercise, smoking cessation, and general wellness. We also can provide advice and have available products to help protect you from the harmful effects of the sun.

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