Facelift

facelift-pictureThe face is the most unique, recognizable part of the human body. It is the most important physical attribute we have that is capable of conveying our emotion. The well known saying “a look is worth a thousand words” summarizes the importance of our facial appearance in expressing our thoughts and emotions.

As we age the soft tissue in the face will often sag causing us to look tired, angry, or concerned. This is caused by several factors. Intrinsically, the skin looses elasticity, muscle atrophies, bone becomes thinner, and natural facial fat shrinks. Extrinsically, sun exposure, smoking, gravity, diet, and genetics can contribute to an undesirable appearance of the face as we age.

The facelift procedure is designed to lift the jowls and eliminate the banding in the neck. A facelift is more than trimming skin. A quality, lasting facelift entails tightening the muscle underneath the skin and anchoring it in its natural position. This results in a clean, defined jawline and a natural, yet dramatically more youthful appearance. Dr. Miller accomplishes this by using incisions that are hidden and avoids the stigma of an artificial “operated” face.

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Dr. Miller will tailor the procedure to meet the unique needs of each patient. During the consultation, he will give each patient a comprehensive analysis and develop a plan to meet their specific objectives.

Candidates

A good candidate for this procedure includes anyone who has evidence of jowling, sagging cheeks, excess neck fat and skin, and deep facial wrinkles. There is no specific or optimal age to get a facelift.

Procedure

The procedure takes about 2-3 hours and entails meticulously camouflaged incisions, anchoring of the SMAS layer, tightening of the platysma muscle in the neck, and removal of excess skin. The surgery can be performed in our state-of-the-art procedural suite or, if the patient requests general anesthesia, it can be done at an accredited surgery center.

Anesthesia

The procedure can be performed with local anesthetic and oral sedation, IV sedation, or, at the patient’s request, it can be done under general anesthesia.

Recovery

Patients are sent home the night of recovery and are given a set of informative post-operative instructions. Patients do have the option to stay at an accredited recovery facility if they choose. Swelling and bruising usually resolve within 2-3 weeks. Patients are advised to take between 7-10 days off of work and avoid strenuous exercise for 3-4 weeks.

compression-garmentA compression garment is recommended and is worn around the neck and face for one week and then at night for 2-3 weeks. The more often the patient wears the garment, the faster the patient will heal. Post-operative pain is usually managed effectively with oral pain medication and thorough instructions will be provided to the patient regarding medications. The patient will follow up on post-op day 1 for a routine check and on post-op day 7 for removal of sutures.

Additional Procedures

Facelifts are often combined with other procedures including…

Browlift

Blepharoplasty (Eye Surgery)

LipoSculpting

Chin implant

Laser resurfacing

Fat transfer

Botox and Injectables

Browlift (Forehead Lift)

Browlift1The face and its expressions often give initial impressions, sending messages regarding emotion, health, vitality, and age. Over time, the face and its features undergo age-related changes that make people feel as if they look tired, angry, sad, or older than they feel.

These changes often first start to occur in the brow, or forehead region, which include the formation of forehead lines, glabellar creases, and drooping of the brow itself.

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A browlift, or forehead lift, can help to lift the brow line to a higher position and reduce the appearance of lines and wrinkles, restoring a firmer, more youthful appearance to the upper portion of the face.

Dr. Miller offers different techniques that address the problem of brow ptosis. These techniques allow the brow and forehead to be placed in their more youthful, natural position. These techniques further focus on hiding all scars and preventing any loss of hair or movement of the natural hair line. Often times this involves the use of a small endoscope in order to ensure that all the tissue is precisely placed where it needs to be.

Dr. Miller also offers a lateral browlift which can be done under local anesthetic and is a great option for certain candidates. Dr. Miller will give you a detailed analysis and present you with several options in order to help you meet your objective.

Candidates

Patients who have sagging or heavy eyebrows and excess upper eyelid skin that makes them feel tired, angry, sad, or look older than they really are.

Procedure

Eyes

The brow lift entails a minimally invasive approach involving four small incisions that allow exposure to the entire forehead region. A small endoscope is then placed in the incision and the muscle is gently elevated and the brows are placed in a natural, more youthful position. If the patient has minimal brow ptosis (sagging), then it is possible to do a lateral brow lift which can be done under local anesthesia.

Anesthesia

Brow lifts can be done under local anesthetic, IV sedation, or general anesthesia. Dr. Miller will recommend the most effective form of anesthesia based on the type of brow lift that will meet your needs.

Recovery

The patient goes home the day of the procedure and recovery usually takes between 1-2 weeks. Patients may return to work as soon as one week post-operatively however, strenuous activity should be avoided for 3-4 weeks. The patient may have some numbness in the forehead due to stretching of the sensory nerves that resolves over time. The patient will follow up on post-operative day one and again on post-operative day 7 for suture removal.

Additional Procedures

Browlifts are frequently combined with other procedures such as…

Facelift

Mid-facelift

Blepharoplasty

Rhinoplasty

Neck lift

LipoSculpting

Laser resurfacing

Botox and Injectable Fillers

Temple Lift

TempleLift-4As people age the muscle and soft tissue in the forehead region can sag. The most severe areas of sagging are often in the temple and lateral brow. This can often create an expression of sadness and fatigue. In women, the brow should lie just above the supraorbital rim (bone above the eye). As the aging process progresses, the brow can sag over the bony rim onto the eyelid itself obscuring the natural eyelid appearance and creating an aged appearance.

The temple is the lateral region of the brow. This means that it is the outer portion of the eyebrow and the outer corner of the eye. This is typically the region of the upper face that ages the most rapidly. A temple lift is routinely combined with an upper blepharoplasty allowing for rejuvenation of the entire upper facial region. Elevating this region using a temple lift procedure can dramatically rejuvenate the brow and upper face region making people look younger and more refreshed.

Often, simply elevating the temple is all that the patient desires and a full browlift is not necessary. The temple lift does not address the medial brow. The medial brow is the region in the middle of the forehead that creates a surprised, hollow look when over corrected.

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The temple lift is capable of dramatically improving lateral hooding of the eye that can give people an expression of sadness. It can also raise the eyebrow and pull excess skin off of the upper eyelid. A temple lift is often performed in combination with an upper blepharoplasty. A distinct advantage of a temple lift is that it can be performed under local anesthetic making the recovery much easier. It is possible to do a temple lift and an upper blepharoplasty under local anesthetic. Another distinct advantage is that the recovery time is much less than a traditional browlift with less swelling, bruising and scarring.

Candidates

TempleLift-2Patients who have sagging or heavy eyebrows and excess upper eyelid skin that makes them feel tired, angry, sad, or older than they really are.

The best way to see if a temple lift would benefit you is to elevate your own temple and see if you like the look. Place the tips of your index finger at the hairline of your temple and elevate it gently; overdoing it will create too much elevation and look unnatural. Most likely, this will create a more natural, youthful, elegant appearance

Procedure

The temple lift is a minimally invasive procedure involving small incisions in the temple region with undermining of the soft tissue and elevation of the brow to its natural, youthful position. The incision is hidden in the hairline and typically heals with no evidence of a scar. The procedure is most often done under local anesthetic and combined with an upper blepharoplasty taking about 90 minutes.

Anesthesia

Temple lifts are most frequently done under local anesthesia. If the patient desires they can be done under IV sedation. This procedure can be done under local anesthetic, IV sedation, or general anesthesia. Dr. Miller will recommend the most effective form of anesthesia based on the type of procedure lift that will meet your needs.

Recovery

The patient goes home the day of the procedure and recovery usually take between 1-2 weeks. Patients may return to work as soon as one week post-operatively however, strenuous activity should be avoided for 3-4 weeks. The patient may have some numbness in the forehead due to stretching of the sensory nerves that resolves over time. The patient will follow up on post-operative day one and again on post-operative day 7 for suture removal.

Additional Procedures

A temple lift is routinely combined with an upper blepharoplasty allowing for complete upper facial rejuvenation. Other procedures that are frequently done with a temple lift include:

Facelift

Mid-facelift

Blepharoplasty

Fat grafting

Rhinoplasty

Neck lift

Liposuction

Laser resurfacing

Botox and Fillers

Blepharoplasty (Eye Surgery)

Blepharoplasty

eyes-blueThe eyes are an integral part of our facial expression. Often times they reveal more about our thoughts and emotions than we realize. As we age, the soft tissue in the eyes will often sag or bunch up making us look tired, sad, or apathetic.

The aging process causes the eyelid skin to lose much of its elasticity creating an appearance of bunched up excess skin, bags under the eyes, and bulging in the upper and lower eyelids. The eyebrows will often droop over the eye exacerbating the problem.

Dr. Miller performs several procedures that restore the natural, rested, youthful look to the eyelids. Using very small incisions in the eyelid, the excess skin can be removed and the underlying fat can be sculpted. Bags in the lower eyelids can be managed using small incisions either on the outside of the eyelid or on the inner surface of the eyelid making the incisions almost undetectable. These procedures can be done under local anesthetic, conscious sedation, or general anesthetic.

Blepharoplasty can be combined with a brow lift, a facelift, or all three. Dr. Miller provides each patient with a detailed analysis and tailors the procedure to meet their specific needs.

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Candidates for Blepharoplasty

A good candidate for this procedure includes anyone who has excess upper or lower eyelid skin with bags or areas that appear to bulge. There is no specific or optimal age for the procedure.

Procedure

Blepharoplasty entails a tiny incision in the upper eyelid skin crease. A small amount of skin is removed and the fat pad is sculpted. The skin is then meticulously closed. On the lower eyelid there is the option to make the incision on the inside of the lid which makes it invisible. The procedure takes about 1-2 hours.

Anesthesia

Blepharoplasty can be done using local anesthetic, conscious sedation, or general anesthetic.

Recovery

Although patients have unique healing experiences and no specific timeline can be guaranteed, most patients require 3-5 days in order to experience improvement in swelling and bruising. Sutures are usually removed on post-op day 3 or 4. Patients can usually return to work after 3 days.

Upper Blepharoplasty FAQ’s

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Am I a candidate for an upper blepharoplasty?
Good candidates for an upper blepharoplasty include patients who have excess upper eyelid skin, bulging in the upper eyelids, sagging of the eyelid skin over the eye, or reduced peripheral vision due to sagging of the eyelid skin.

What is the optimal age for an upper blepharoplasty?
Like all cosmetic procedures, there is no optimal age. The eyes tend to age faster than other areas of the face so it is not uncommon for patients to present with concerns about aging around the eyes earlier than other areas of the face.

Do I also need a brow lift?
This is a very important question. Brow ptosis (droop) can be a major contributing factor to the appearance of excess upper eyelid skin, bagginess, and puffiness in the upper eyelid. Dr. Miller always addresses the upper eyelids and brows together during the consultation and then educates each patient on the interaction between the two. He then presents options for the patient with the expectations of what each option can accomplish. These options usually include a blepharoplasty alone, a blepharoplasty combined with a lateral brow (temple) lift, and a blepharoplasty with an endoscopic brow lift.

What is the recovery time for an upper blepharoplasty?
The upper eyelids typically heal in a very timely fashion. Patients can usually anticipate 2-5 days of down time, depending on how important it is for them to conceal the surgery and how exertional their work is.

How long does the procedure take?
An upper blepharoplasty usually takes about one hour to perform.

Will I have stitches?
Yes. Very fine sutures are used for closure of the incision which are usually removed between three and five days post-operatively.

What kind of anesthesia is used?
It’s very reasonable to expect that most patients can tolerate an upper blepharoplasty under local anesthetic. At the patient’s request, we can offer conscious sedation or general anesthesia.

Lower Blepharoplasty FAQs

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Am I a good candidate for a lower blepharoplasty?
If you have bulging lower eyelids, the appearance of bags under your eyes, or too much lower eyelid skin that makes you look tired then you may be a good candidate for a lower blepharoplasty.

Other considerations for a lower blepharoplasty include conditions such as chronic dry eyes, glaucoma, poor lower eyelid muscle tone, and a sagging lower eyelid. Dr. Miller does a thorough history and physical exam to ensure that you are an optimal candidate for a lower eyelid blepharoplasty.

What is the best age for a lower blepharoplasty?
There is no optimal age for a lower blepharoplasty. Everybody ages at their own pace. Patients typically range in age from their 40’s to their 70’s however, some may fall outside of this range.

How is this procedure performed?
Generally, there are two ways this procedure can be performed. The first option is through an incision on the inside of the lower eyelid that allows access to the fat underneath the skin on the eyelid. The second option is through an incision just underneath the eyelash on the skin of the lower eyelid. Dr. Miller will give each patient options on the surgical approach after doing a thorough history and physical exam.

What is the recovery time for a lower blepharoplasty?
Patients typically require 3-5 days to heal from a lower blepharoplasty procedure. It is possible to return to work within this time frame as well.

What type of anesthesia is used for this procedure?
A lower blepharoplasty can be done under local anesthetic, conscious sedation, or general anesthetic. Each patient is educated about the different typed of anesthetic and options are thoroughly discussed.

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Meet Dr. Miller

Meet Our Surgeon - Dr. Todd Miller

What draws Dr. Miller specifically to Facial Plastic Surgery is being able to provide patients with a unique skill set involving the head and neck. He has performed a vast number of facial cosmetic procedures. He has authored articles for national publications and made numerous presentations at national and regional meetings. He is a board certified member of the American Academy of Otolaryngology/Head and Neck Surgery. More...

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