Facial ageing appears in the skin and with the sagging of soft tissues. Correction is achieved by both medical and surgical techniques.

Ageing of the skin is seen as wrinkled unhealthy skin, pigmentation, spots, surface veins, lumps and bumps. The sagging down of soft tissues due to gravity with loss of facial fat and is seen as eyebrow droop, excessive skin folds in upper and lower eyelids, bags in the lower eyelids, heavy naso-labial folds, jowls and neck folds.

To look good both have to be corrected. Correction of the skin ageing is discussed under the heading "Looking good without surgery". Many patients only consider this in seeking correction.

Correction of the sagging downwards of the facial tissues and loss of facial fat is discussed under the heading of "Looking good with surgery"

As each new procedure is discussed firstly please read about that procedure on the Australian Society of Plastic Surgeons Website: www.plasticsurgery.org.au.

For further information and costs, please ring the Manly rooms on (02) 99771275 to arrange a consultation.

"Looking Good" with surgery

After 40 years of age, the excessive sagging of facial skin and fat, in the brows, eyelids, cheeks, jawls and neck require surgery for correction. This surgery must not be combined before and continued after with the techniques of skin rejuvenation.

Minimal Invasive Techniques: (30 - 40 age group)

Dermal fillers

• Restalyne and Perlane. Temporary lasting fillers to 12 months. Restalyne used around the mounth, nose labial fold and Marionette's lines
• Aquamid - a permanent filler. **tapped up at 4-5 years then lasting for life. Frown lines, around the mouth and Marionettes lines. All fillers look good and feel natural

Lipostructure

Fat filaments are harvested from abdomen/thighs, prepared, then injected into cheeks, lines, around eyes to correct wrinkling, skin folds and depressins. Also recently shown that inected fat contains **stem cells **wheck produce remarkable rejuvention of the aged facial skin. Performed under local anaesthetic in Day Surgery:

Dermarolling:

Please refer to this topic in the earlier section under "Looking good without Surgery".
Rolling the damaged facial skin with fine needles corrects the fine skin wrenkling in the cheeks, around the mouth and eyes. Skin tightening and lifting of sagging tissues occurs over six months. Then the Obagi skin rejuvenation programme is continued for life maintaining the correction. There is no downtime with this treatment, completely normal appearance the next day. Also cost is minimal compared to the laser, with long term similar results produced.

Laser Resurfacing of facial skin

The new fractional CO2 lassers produce dramatic rejuvenation of the aged facial skin, removing deep wrinkling and lines, skin tightening and lifting, with no downtime, no post operative problems or care. New skin is formed, without any damage to the epidermis. The new growth of skin continues over six months following treatment and maintained for life with the Obagi skin rejuvenation programme. The new laser is the Candela **Quadralase

Clean up

Removal of warts, moles, keratosis, scars, deep pits, and cysts, diathermy of veins/telangiectasia around the upper lip. Local anaesthetic procedure through the Day Surgery Centre.

Circumoral rejuventation

• Correction of the long upper lip - excision of excessive skin around base of nose to shorten upper lip, more teeth exposed on smiling.
• Lip augmentation - white line and vermilion augmented with fat injections.
• Deep Marionette's (bitterness) grooves from the corners of mouth, correction with fat injection, muscle toxin injection with excision of the depressor anguli oris muscle.
• Dermaroller and muscle toxin injection to correct the deep wrinkling on upper lip.

With the techniques above using some or all of them, surgery may be postponed indefinitely. As these procedures are discussed, firstly please read about that procedure on the Australian Society of Plastic Surgeons Website: www.plasticsurgery.org.au.

back to top

Cosmetic Facial Surgery

After about 40 years of age, the excessive sagging of skin and fat tissues in the face requires surgery to correct.

• Forehead Lift
• Lateral brow lift
• Blepharoplasty
• Total Blepharoplasty
• Browplasty
• Facelift - Meloplasty
• MAC'S Simple Procedure
• MAC'S Extend Procedure
• Face and Neck Lift Procedure

Forehead Lift

Generalised sagging and drooping of the eye brows combined with loose and severe wrinkling of forehead. The endoscopic brow lift is the ideal procedure, dramatic long lasting results are obtained.

back to top

Lateral brow lift

Very common problem is sagging of the lateral eyebrow from squinting in the sun. The lateral eyebrow falls below the level of medial brow. At an early stage, with the forehead muscle still strong, a muscle toxin placed just lateral brow will suffice. With time surgery is required. The French brow lift with incisional line in the temporal forehead area, general anaesthetic procedure Day Only simple uncomplicated procedure with excellent results. Corrects lateral brow droop, as well as sagging skin in lateral eye and cheek areas.

back to top

'Direct Excision' Browlift

Visiting Italian plastic surgeon Prof. Botti introduced a very simple, but effective 'direct excision' brow lift. Elevates the whole brow to a normal position and shape. Less invasive, simple, uncomplicated under local anaesthetic or general anaesthetic.

back to top

Blepharoplasty

Correcting aged eyelids with the eye brows in normal position. Upper eyelids loose skin sags down to rest on the eyelashes. Eyelids lack definition, and difficulty with eye make up.

In the lower eyelids, loose wrinkling skin, bags and grooves are corrected. The eyes become the centre of attraction. Upper eyelids can be performed under local anaesthetic with or without sedation, while lower eyelids require a general anaesthetic day only procedure.

Upper eyelids - with ageing on excess of skin develops with loss of loss of definition, fullness, wrinkling, and difficulty applying make up, progressing to excess of skin resting on eyelashes, obstructing vision.

Procedure Day only procedure 1-1½ hours. Eyes covered for 2 hours, driven home, 5th day suture tape removed

Cosmetic

Skin Hooding over pupil obstructing vision

Lower eyelids

In lower eyelids, loss of skin elasticity and slack muscles results in excesss of skin and fatty bags

Procedure genreal anaesthetic, Day only, 2 hours, eyes covered 2 hours, then driven home, 5th day sutures and tape removed.

back to top

Total Blepharoplasty

• Upper and lower eyelids
• Staying in hospital overnight.
• General anaesthetic
• 3-4 hour procedure
• Sutures removed 5 days

back to top

Medial Browplasty

Corrects medial brow droop and chronic spasm of frown muscles. Local anaesthetic 1 hour procedure.

back to top

Facelift - Meloplasty

With excessive sagging of facial skin and fat in the cheeks and lower eyelids, to form heavy naso labial folds, jowls and neck folds.

Correction requires 'lifting of the face'

Procedures

Mid face lift Isolated sagging of facial skin and fat in the upper cheeks and lower eyelids while the jawline, chin and neck remain youthful. The subperiosteal mid face lift is the ideal corrective procedure.

Short Scar Facelift In the younger person (35 - 50) with minimal sun damage of the skin with significant but not excessive ageing signs in the face and neck then this is the ideal procedure to consider

The short scar facelift also known as the MAC's lift lifts and suspends the deeper sagging facial tissues to a strong fixed point in the temple fascia using three internal sutures. The fallen muscle and fat tissues of the face and neck are lifted vertically to their original youthful position to correct cheeks, jowls and neck.

Procedure developed by Belgian plasctic Surgeons in 2003. More information google Dr Patrick Tonnerd.

The procedure was developed so as to obtain an excellent, natural long term facial regeneration without the concerns of a major operation, long post operative care and significant comlipcations.

back to top

MAC'S Simple Procedure

Applicable when ageing signs are confined to lower half of the cheeks and neck, connecting the jowls, deep and vertical neck folds, combined with liposuction to neck for excess fat.

back to top

MAC'S Extend Procedure

An extended procedure to correct generalised ageing over the whole face and neck, in a younger person (under 50) with healthy skin. Liposuction to excess of fat under chin, lower eyelid blepharoplasty, and excision of vertical neck muscle bands are analog procedure that can be performed. An additional procedure may be a lateral brow

The MAC'S procedures are performed under a general anaesthetic. in hospital, 3-5hours in length, staying overnight, dressings and drains removed next day, when hair is washed, home, recovery 4-5 days.

The incisional lines in the MAC'S procedure are short and inconspicuous, only in front of ear and under side burns, not behind the ear or into neck with no disturbance to hair pattern or growth.

back to top

Face and Neck Lift Procedure

For the more extensive ageing in the face and neck in the over 55 year old. The incisional line continues behind the ear into the posterior hair line. Ancillary and additional procedures as mentioned under MAC'S Extend may be performed.

Operation is 5½-6½ hours in length, staying in hospital overnight, washing hair next morning after dressings removed, recovery over one week.

back to top

Complications

Surgery does not come without risks. Facelift surgery, serious problems after surgery are very uncommon. Extreme detail of these complications can be needlessly frightening. Most people having this surgery will not have complications. If you have concerns discuss them with Dr Harper.

Post operative complications may need further surgery. Medicare / Health funds will cover the costs of these complications.

Below complications are listed to inform and not alarm.

General Risks of Surgery

• Haematoma (collection of blood). May need surgery for drainage, or if small aspirated with a suction canula
• Wound infection
• Nausea
• Slow healing
• Separation of wound edges
• Respiratory / cardiac problems
• Allergic reactions

Specific Risks of Facelifts

• Loss of skin minor or major
• Bruising and swelling
• Hair loss
• Numbness around the ear and cheeks settling over one month
• Slight asymetry of face - settles
• Damage to facial nerves - rare 1/200 usually temporary

back to top

Contact Peninsula Plastic Surgery today for the latest skin rejuvenation and skin care treatments at our offices in North Sydney, Manly, Norwa and Dee Why.

* indicates a required field



Message

Peninsula Plastic Surgery
7 West Promenade
Manly NSW, Australia 2095

Phone: (02)9977 1275
Fax: (02)9976 2802

infowharper@
ppsurgery.com.au