Face lift is the most fascinating procedure that I can think of, in the sense that it really has the potential to take away years and years from one's face. The key to face lift is to look natural. The bottom line is, if you are walking down the street and somebody compliments you on your face lift, pchh…not a good result. The bottom line is, to have a procedure that no one else knows you had, and after you have the procedure when you go back to work, people just will compliment you on how much more rested you look and they wonder what happened, did you lose weight, did you relax, did you sleep well, did you have nice vacation, what was going on but they really can't per se put a finger on the cosmetic surgery that you have had. And it is amazing you know when I was training in cosmetic surgery, one of the things that was the reason why I started looking around for my mentor to train me in natural cosmetic surgery was that, people who walked around the streets and had face lift procedures before, they looked like they had this sort of tunnel, you know, air tunnel or wind tunnel sort of look, you know, stretched look and I thought to myself, you know, yeah they looked probably not as wrinkled as they did before, they don't look so much better, so it is not the point of not necessarily having "wrinkles" or skin laxity per se, but it is to look more rested and natural and really more attractive overall and more useful of course. The technique of face lift at the New Me Institute is somewhat different than the techniques performed in other clinics perhaps, that you have talked to or been at, and depending on of course the surgeon that does perform the procedure. It differs to some degree, but the bottom line is, the technique that I speak about is the technique that I personally perform. It is the technique that instead of having the transverse looks or pull of the muscle it does have the lateral and superior, posterior pull. It is a very very natural lift, because the bottom line is when the muscles relax, because of the attachments of the muscle to the bone, there is a pivot. The muscle does not just vertically drop, but there is a pivot, in other words, it rotates, so when I do lift it, I rotate it opposite of its direction of drop, so it is the natural lift, that I would give in the deep tissue and I do tighten the muscle and also with the skin, the other difference is that of course first of all let me back tract, with the textbook it is more of a transverse pull, so if you have seen this look, it looks familiar to you. That is the typical textbook technique in the sense, where the natural lift is more of a natural lift and it does not really give you that pulled look or stretched look, the skin as well, one differences between our technique or my technique and the textbook technique is that instead of having that vertical incision here where it gives you the bald spot and then pulling back and giving you a lot of loss of hair in the lateral facial area, my incision is more right at the sideburn area or right underneath the hair growth area, where it is covered and I do bevel the scar or the incision so that hair grows through the scar and usually hardly ever noticeable unless you are really looking for it. It is just a very fine line and sort of hair grows right back through the scar, so there is very minimal, almost to no hair loss. Also, instead of doing the scar right in front of the tragus this little area, instead of doing it right in front of the tragus, I do it behind the tragus, inside the ear canal, so you hardly will see a scar there at all. Then you will follow around the ear lobe behind the ear, where it is not noticeable unless somebody is really looking for it and there is even at best a fine line usually and then he goes right in front of the hairline where the hair grows through the scar and hardly noticeable. The bottom line is, the scar is very naturally not noticeable. The direction of pull is very natural and not really a stretched look but a very natural redraping of the muscle and the skin over it and the outcome is usually incredible. Patients really come back and tell me, "I cannot believe, nobody noticed I had a face lift", and that is what I hear 99% of the time and that is really what my goal is. If somebody compliments you on your face lift, there is something wrong, and that is what I believe, so we do really our best to minimize any evidence of the face lift. I usually combine face lift with other procedures, because you know, obviously as we age, not only the face area; the face lift includes the cheek, face, jaw, and neck, that's the face lift, but not only the face area itself is affected by aging but also the lower and upper eyelid, brow area is also affected. So, I do combine these procedures. Also the nasolabial fold, this line here is affected, sometimes the Marionette line, the line here is also of concern, so we do address all of those areas. Face lift, per se, doesn't just completely take away the nasolabial line, so we do have to combine other procedures to help this area in certain patients. You may be a candidate for something like an Advanta implant or a SMAS implant, make sure you address that with the surgeon who comes in talk with you. Either myself, or one of my associates who have been trained by me, will talk to you about those procedures as well. Upper and lower eyelid procedures and brow lift is also another three procedures that I usually combine with this. We can combine a mid face lift or a neck lift additional neck muscle tightening. If you notice, some people have these bands of muscles. Two bands here are called platysma bands, and these are the folds of muscle that sort of start relaxing and they would need a tightening of this area. What we do is, there is natural fold under the chin, one tiny incision in that fold which will not be, you know, eventually visible in most cases, then lifting of the skin and tightening the muscles using absorbable stitches in most cases and then putting a stitching, basically across so that these patients get a very nice natural contour of the jaw or jaw line and tightening, so that is the neck lift which can be added to a typical face lift. The other thing is some patients have some fatty adiposity added here, fatty tissue added here, double chin or triple chin, I have a little bit of it and so that sort of is natural with aging, but in some patients it is really bothersome to them specifically and we can address that with liposuction or even through that same incision, manually, we can remove some this fat, if they need a complete liposuction we can do that before the neck lift. Upper eyelid procedure is a procedure in which we place a small incision in the natural fold of the upper eyelid, we take away any excessive skin laxity or excess skin in that area and then remove fat from the areas around the eye ball and we close that incision using fine sutures. Very hardly visible after procedure, my focus here is to leave it very natural, natural result. I don't want to do an excessive upper eyelid skin removal, because in those patients, patients cannot close their eyes. They sleep and their eyes are half shut, thank god, never had any complaints, knock on wood, and most surgeons who are performing the procedure are very careful to not create that type of a problem for patients. That's one of the things we train all of our surgeons at the New Me Institute to prevent. The other thing is that some patients who are aged and decide they may not have a fold, we can recreate the fold for these patients to look more westernized and occidental, so that is another that you could talk to the surgeons specifically about, who will be coming in to talk with you. The lower eyelid procedure; lower eyelid procedure can be performed in two different ways or a combination of the two. One is to place a very hardly visible incision right at the edges of the lower eyelid eyelashes and in the fold here, lifting the skin, removing the fat from the periorbital area from inside of the eye, especially if they are protruding and causing a swelling here. Removing the fat and then pulling the skin back and removing the extra skin and creating a very nice contour for patients. Some patients have obvious swelling and fullness in the lower eyelid area and/or they have some sunken, sort of a hollow dark color here, and those can be corrected with a lower eyelid blepharoplasty. Some patients who are quite young and/or they do not have excess laxity or excess skin in the lower eyelid area, would benefit from what we call a transconjunctival lower-eyelid blepharoplasty, what that means is, that we can go from the pink of the lower eyelid, from the area of the lower eyelid and the inside, make a tiny incision that heals very quickly within a day or two with no sutures, take out the fat very safely and that is all there is toward it. Probably by the half an hour procedure, it may sound a little more scary than it is but it is very safe. We obviously put some eye protectors inside the eye to prevent any injury to the eye and obviously the surgeons extremely skilled and we train them very well and make sure they perform these procedure very cautiously and we have never had any, thank god, complications associated with this type of procedure that are irreversible of any kind, so that is the lower eyelid blepharoplasty transconjunctival approach and these two can be incidentally actually combined along with other tightening procedures that may exists or may be needed for a particular patient. Again, no two patients are alike and no two procedures are going to be identical, and what we do is we try to absolutely find a most natural procedure for the individual and then combine these procedures in order for the individual to have the best outcome with the least amount of scarring, the most natural way with a fastest recovery and whether it is a transconjunctival blepharoplasty, the lower eyelid tightening, the lower eyelid blepharoplasty, the upper eyelid blepharoplasty or a brow lift, we can combine that with facial rejuvenation techniques and the face lift and neck lift and liposuction and so on, in order to give the patient overall a much more rejuvenated result with just one procedure, one downtown time, that we will address all those issues that the individual may have. This would be a good point. Now, stepping to brow lift, talk about brow lift after which we will be talking about facial rejuvenation, but let me step back a bit and talk about the periorbital areas around the eyes and what is possible is that you know some patients may not necessarily need per se a lower eyelid surgery and something like a laser peel, Botox, Restylane, or other fillers that actually address the issue of aging for the individual and not necessarily the need of full surgery, and if that is the case that is what I always encourage the patients to consider, because you know what, you can always have surgery later. It is no matter how good we are and no matter, you know, how safe the procedure that we perform or naturally it is, bottom line is if you can avoid surgery, I prefer doing things without surgery until such time that it is not avoidable, so make sure you talk to the surgeon who may be coming in and then you'll be able to decide if may be actually the rejuvenation technique is something that you may want to talk about. We will talk about rejuvenation at length in a little while.
Brow lift; there are multitude of approaches to brow and forehead lift, basically the simple things for a male may be different than for a female. Male brow lift could be just a small incision at the outside edge of the brow, at the hairline here, and eyebrows, and very very minimal if at all any scarring may actually result and nobody will actually know you had a brow lift except they would a lifting in the area. Some patients may even have difficulty with vision without knowing. Peripheral vision deficit because of ptotic or drooping brow and because of this, they keep lifting their forehead and they have very very deep lines in the their forehead, but the real result is in fact that they have brow ptosis or drooping and if that may be the case, you may want to talk to your cosmetic surgeon and just a simple brow lift would be what we offer you and that will take care of both if the excessive deep lines of the forehead that may be constantly getting deeper and also the cosmetic results that you may be looking for and enhancing nice eyebrow contour and appearance. For a female the other simple that we can do and/or for a male even this procedure can be performed is that the age of the hairline you can do what we call a direct brow, a little distant direct brow is just the small incision about may be 1-inch at the most in length usually and that could actually help lift the brow laterally and give him much more of wide awake look and a lifted-brow appearance. That may be sufficient with most patients and also not necessary than requiring the full incision of forehead or brow lift. Some patients regardless of how much we try to avoid scarring, they may need a more extensive brow lift or forehead lift. There are different approaches, some of these approaches I performed personally and I may choose, and have chosen to train some of other associate surgeons in would be a direct forehead lift which would require an incision right at the edge of the hairline and what I would do and I do very simply is by causing the scarring to allow the hair to go through the scar, you know you hardly will be able to see the incision line, but then I can actually give you a nice full forehead lift and may be even up to an inch or more of lifting, and in certain patients that is the idea of forehead lift. If some patients have very deep deep forehead sort of almost furrows or deep lines what I can do is simply just use the same lines and hide my scarring side the line and give a lift. I have done multitude of these cases and surprisingly no body can even see the scar because it hidden in your natural forehead lines. So, you may actually be a candidate for that if you do have forehead lines, so you make sure you talk to the surgeon or associate surgeons or myself about that. The other technique of forehead lift or brow lift are then becoming more extensive in our incisional needs, it would be what we call a temporal lift, there is a cut in the scalp area, and then what we do is we lift this scalp and remove extra skin and there would be a line that is hidden in the hair line. It is not per se my preferred technique, but if some patient is a candidate for it, you know I do not hesitate to offer that as an option. Again, if there is anyway to minimize the scar that is what I opt to do. I try to minimize the need for any invasive procedure as much as I can, minimize the scarring and cutting. The next procedure would be a coronal forehead lift and that is an incision from ear to ear lifting the forehead and the scar would be in the midline of the head or the scalp and we can actually lift up to two even inches if necessary in certain cases. The challenge with that is, you know, you would end up with a line of scar, some bald spot in that region we tried to obviously minimize it without any special techniques and there may be some changes in sensation. It is an older technique and you know still accepted by textbook standards, but to me that is not something I would like to do as much as I can avoid it I will try my best. Then there are endoscopic techniques, which I can perform using endoscopes, which are little camera tubes and are flexible. This way we can actually lift the forehead and avoid any damage to the nerves and structures in the area. You may be a candidate for that and you can talk to the surgeon who comes in later on to talk with you. There are other techniques to brow lift, some things as simple as brow, basically we call Aptos suture, which are special sutures or threads, surgical threads that could be used to lift your brow, and also Botox injection at this point, end of 2004 and beginning of 2005, still is used to cause somewhat of a lift of the lateral brows and then they combine with, you know, the relaxation of the forehead muscles taking away the lines in the forehead and the lateral, what we call, crow's feet that really help in rejuvenation of the forehead and the brow area. One more thing, I need to talk about here is buccal fat pad. Buccal fat pad is a small amount of fat on the inner part of the cheek area, some people actually have naturally by genes and by birth, chubby cheeks, and this may bother them, you know, they like to have more of a chiseled, more of a masculine look perhaps, or more of a contoured facial appearance, with a very tiny incision on the inner aspects of the mouth, a small fat pocket that really exists in this area can be removed two or three days at the most of heeling and two or three days later these individuals have an excellent, excellent result and very very happy outcome.
Facial rejuvenation, face lift and you know neck lift, lipo suction you know multitude of techniques that I talked about and the one that I did not really go into detail is called incision-free face lift using Aptos suture or feather lift and mid face lift. All of these procedures are a sort of like a multitude of tools in a tool box of a master artist and the bottom line is no one tool is a perfect tool for all the jobs. So, what has to happen is a combination of procedure depending on the patient's need with our philosophy at the New Me Institute to minimize any risk of complications to give you the absolute most natural results, you know, get you back on track and back to work as soon as possible and give you the most perfect outcome for you, so we will combine these tools and these techniques to fit you particularly. There is no cookie-cutter technique for every patient, so it is important for you to have a total when it comes to facial cosmic surgery and a total consultation with an expert, like the experts we have at the New Me Surgical Institute and then decide of all these procedures what combination is perfect for you.
Preoperatively, you have been instructed to or you will be instructed to don't take anything by mouth 24 hours before surgery or from 12 midnight on the day before surgery. You have to, in most cases, if your, you know, age is 40 and up and most patients with face lift are you have to have had a medical clearance, meaning you need to see a doctor, specialist in Internal Medicine and/or Cardiology to evaluate you, make sure you are a good candidate for this type of a procedure. You have to make sure that you do not take any alcohol, tobacco, or nicotine of any kind basically. No vitamins or herbs. No aspirin. No Motrin. Anything that thins your blood like ginkgo biloba, ginseng, you know garlic pills and so on or any other herbs, basically three weeks before surgery. The other thing is that, you know, preoperatively you need to make sure that you are clear as to if your medications need to stopped or not, so that needs to be discussed with your physicians specifically who is your Internal Medicine doctor or your cardiologist. If you have any other medical conditions, any other, you know, previous past medical history, you need to discuss that with your primary care physician, your internist, or cardiologist and that needs to be addressed prior to surgery and a note needs to obtained and that note in writing needs to be given to your surgeon. The surgeon will not perform your surgery unless you have a medical clearance from your physician. The bottom line is if your age is of 40, it does not matter what procedure you are having, all the preoperative instructions have not taken any alcohol, Motrin, herbs, vitamins and so on does apply to you. No matter what age you are first of all and then secondly if you are over the age of 40, EKG, you know you need evaluation of your heart. Basically, you do the electrocardiogram and you get the report read by an internist or a cardiologist and there has to be a signature on that EKG, otherwise we will not perform your perform your procedure. If you are over the age of 50, in addition to your typical blood test and the EKG, you need to have a medial clearance and that is the other thing preoperatively for all the procedure regardless of what procedure it is.
Postoperative care and complications of facial cosmetic surgery per se are extensive issues to the scars but you know in a summary we will discuss them and address them and you know please if you have any questions, anything that may not be addressed, make sure that you do feel free to contact us at any time, I have said this several times now. I want to make sure you feel comfortable. This is your home, anytime, any moment you feel that there is a question that you'd like to be clear about call us. We would rather know about it. We would rather answer it. We would address it and there are no silly questions. You know the point is, we want you have the best result. We want you to have the easiest healing process, postoperative course, and we want you have the confidence in us and then refer other people to us as well as you coming back for other procedures. So what are the postoperative care plans for the facial cosmetic surgery. The bottom line is, with face lift, neck lift, liposuction of the neck and so on you are going to have two days or so of bandages and dressings. After the second day, you are going to have these removed and you do not need to having anything else on as far as, you know, our recommendations are concerned here at the New Me Institute. Your particular case may differ. You need to talk to the surgeon who has performed the procedure but that is a general rule. You may have a drain, although 99% of the patients don't have one postoperatively after face or neck lift here at the New Me Institute with our technique, again those issues will be addressed with you, specifically if your particular needs differ from the usual. Again, you know no cookie-cutter techniques so, you know, it may be a little different for you. If you've had liposuction, generally there is some drainage and it just reddish fluid. It is not bleeding per se. The drainage is not tremendous but there is some reddish fluid that will be sort of extruding from the area, and that would be for a couple of days, may be 36 hours to 48 hours and it will stop automatically. The difference between bleeding and drainage is that blood clots, drainage doesn't. So, if it is clotting and you know globules or big chunks of clot, you know, it is bleeding, you call us immediately. If there are no clots, not to worry, it is normal. The other issue is with face lift, you are going to have a bandage and usually we use Ace bandages. The surgeon may prefer to use regular gauze bandages, the same, usually a couple of days and that is about it. You come back the next day for followup. You have been given interoperative antibiotics and you are going to get some postoperative antibiotics. You have to make sure you take those as instructed until you are asked to stop and then you will come back and we will do the wound check, we call it. Basically an evaluation the day after surgery to make sure everything is normal, there are no complications or issues, and definitely most patients do not have any complications or anything to be worried. It is pretty safe, usually 99% of the cases. Not to worry, it is a pretty simple procedure, as far as we have had the experience with hundreds and hundreds and hundreds and hundreds of cases later. Bottom line is, you are going to have some followup instructions in writing that you would be following. If you need to call back and get specifics on various questions, feel free at any time to call us. Complications of facial cosmetic surgery are very rare. Because of the tremendous blood flow to the face, infections are almost unheard and very rare in our practice. We do cover patients intraoperatively with antibiotics and postoperatively also with antibiotics. So that is another reason why it is very rare to have infections. Bleeding is extremely rate, why we do put pressure dressings on, and we do also make sure that the patients do not have any clotting problems, bleeding problems, they do not take anything that thins their blood, so bleeding is also extremely rare. Neural injuries; also unheard of any permanent of neural injuries, also unheard of in our practice, quite bottom line is quite very safe and that is one of the price that we have at the New Me Surgical Institute. We try to absolutely do the most natural, the safest procedure for patient and always function before form. So, the bottom line is we want to make sure that functionally we do not disturb anything, that you have a completely functional, you know, face and body after the surgery and you know obviously and we want to make sure that you have excellent safe outcomes from these procedures and of course cosmetically we want to make sure that you have the most natural results. So we don't do any risky procedures or any risky techniques for you, and you know, facial procedures, of course that is our primary importance, so don't worry. The other issues are the specifics of procedures, what kind of combinations of procedures may be used for you, dictate as to what kind of specific care plan you may have for example Advanta implant or SMAS graft or Aptos sutures techniques etc, etc, like peels and so on and so forth and those specific additional procedures that may be combined with your typical facial cosmetic surgery will be discussed with you and after care will be given to you by your surgeon and/or the nurse. So the bottom line is, as long as you know this is your home, we do want you to be safe, we do want you to be happy, we do want you to have a very very good outcome from your surgery, so we encourage you to call us if you have any questions. If anything is not clear, we do encourage you to ask. We do not care how long it takes for you to comprehend really, the extend of, you know, specifics of your postoperative care, don't be hesitant to call or ask and we assure you, we don't mind to answer every and all of your questions.
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