Facial Surgery

In contemporary Western culture, youth has become an object of admiration, and the desire to preserve a youthful appearance and make it eternal is insatiable. Young and beautiful have become synonymous.

Attempts to stop the aging process have not always been successful.
Pope Innocent VIII drank from the blood of young donors to rejuvenate his youth, but died a short while later.
Winston Churchill, Charlie Chaplin, Christian Dior and others underwent live cell therapy treatments using cells from sheep fetuses to help preserve their youth, though without much success, as far as we know.

The aging process is an ongoing process with many morphological and biochemical manifestations in the body’s tissues. Over the years, the skin sags, thins out, and shows signs of changing texture and color.
The number of cells and the way they are laid out throughout is in constant decline.
Protein concentrations, including elastin and collagen fibers, are reduced.
This manifests as weaker skin, on the one hand, and less elasticity and a reduced ability to withstand the mechanical forces it endures, on the other.
The skin tends to wrinkle, it shows discolorations and sometimes even growths, some of which are cancerous.
Over time, the face undergoes a transformation.
The eyebrows tend to descend from their natural position.
This along with excess skin and fat bags that form on the eyelids cause the eyes to appear smaller.
The tip of the nose gradually sinks, causing it to appear longer.
Excess skin forms around the mouth and cheeks, while the chin also dips.
The lower jaw-neck angle becomes more obtuse. The number and depth of facial wrinkles increases and the face transforms into its characteristic old age appearance.

These changes and transformations are characteristic of anyone getting older, and they only vary in when they appear and how severe they are.
There are various treatments to remove facial wrinkles, and they must be specifically adapted for each phenomenon and patient.
Injecting substances such as collagen, hyaluronic acid – Restylane, Juvederm, Botox, and Dysport – peeling, forehead lift, blepharoplasty, and face and neck lifts are all accepted and common treatments to treat facial skin.
Each method has its advantages and disadvantages, and none of these treatments provide an answer to all the effects of facial aging.
That is why when consulting the surgeon must choose the simplest, most recommended treatment together with the patient, in order to obtain the most effective result for their specific symptoms.

Facial wrinkling is most pronounced as a man or woman age.
Many men and women view their first facial wrinkle as the end of their youth.
Facial wrinkles, excess skin, drooping facial muscles, and fat bags forming in and around the eyelids, cheeks, and neck are all associated with age, gender, genetics, skin type, hormonal and metabolic activity, diet and exposure to the sun and smoking.
Of all the environmental factors, the sun is the most harmful to the face.
As UV radiation hits the skin it causes irreversible damage that only gets worse with time, resulting in serious biochemical changes.
These changes cause the skin to wrinkle and age prematurely, while often accompanied by spots and discoloration, or even cancerous skin tumors.

Plastic surgery to rehabilitate aging skin and appearance is very common in Israel and around the world.
Men and women alike undergo these procedures.
Such surgeries can be used to treat forehead wrinkles, sunken eyebrows, excess skin and fat bags around the eyelids, wrinkles, and excess skin and fat in the cheeks and neck.

Excessive skin and fat bags make the skin look tired and much older.
Swelling or fullness in the eyelid area at an early age may be genetic or associated with heart, kidney, liver or thyroid disorders, as well diabetes, coagulopathy, and various allergies.
Eyelid swelling worsens with age and is especially prominent when waking up or quite the opposite, when not sleeping enough or tired. Most people have this type of surgery after the age of 40, but it is sometimes performed much earlier, if the effects are truly serious.
Prior to surgery, find out if your symptoms are associated with one of the disorders or conditions listed above.
You should also check out other local symptoms associated with the eyes, such as dryness, burning, watery eyes, intraocular pressure and vision disorders.

Surgery is performed under local anesthesia and mild sedation, and takes about an hour to complete.
During surgery, the surgeon removes any excessive skin and fat bags from the upper and/or lower eyelids.
You should note that while it is possible to remove a large amount of excess skin from the upper eyelid, the amount that can be removed from the lower eyelid is relatively low.
You should also be aware that there is no room for eyelid surgery to be called a “facelift”, rather it is just the removal of excess skin from the eyelids, since undesired side effects may present as a result of ‘lifting’ eyelid skin.
In addition, it is worth remembering that some wrinkles will remain even after surgery, especially on the lower eyelid and around the temples.
The fat bags that give the eyelids that puffy look are also removed during surgery.
This skin originates in the eye sockets and usually appears in two separate clumps on the upper eyelid and three separate clumps in the lower eyelid.
In most cases, the eyelids appear swollen and bruised after surgery, but the recovery period is quite short and only lasts a few days.
The stitches are removed about 3 – 4 days after surgery and most of the swelling and bruising subsides over the next couple of days.
The final results can only be observed a few weeks later.
To accelerate recovery and healing, it is recommended that you cool down the eyelids using icepacks during the first 48 hours.
It is also recommended that you keep your head elevated with the help of a few pillows when lying down.
You can put on makeup about a week after the surgery, and you can put on sunglasses to conceal the eyes until then.

Side Effects
Prolonged swelling, asymmetry, pronounced scarring, milk spots around the suture line and ectropion. All of these are potential, but relatively rare side effects that occur after blepharoplasty.

Ectropion- A condition in which your eyelid turns outward, and it is a temporary side effect resulting from excess swelling of the eyelids, but it subsides as the swelling subsides. Ectropion is sometimes caused due to lack of skin or weakness of the orbicularis oculi muscle – a ring-shaped muscle that closes the eyelids. If this happens, and does not subside within a few weeks, surgical intervention is required. Ectropion stemming from muscle weakness is much more common in men. If milk spots appear along the suture line, they can be easily removed in the clinic. All other side effects are usually temporary and subside on their own.

Facelifts are very common in Israel and around the world.
Both men and women undergo facelifts. The purpose of this type of surgery is to remove excess facial skin and the wrinkles associated with it, to remove undesired fat buildups, to stretch and sculpt the facial muscles and the subcutaneous tissues, and give the face a refreshed, youthful exuberance while maintaining its natural appearance.
Most people have this type of surgery after the age of 40, though timing is very much dependent on the condition of the skin and how wrinkled it appears.
Generally, it is better to undergo this type of surgery relatively early, before too much excess skin and deep wrinkles appear, while the skin is still elastic and soft.

Preoperative Preparations

Prior to any fact lift procedure, the patient must disclose to the surgeon an accurate account of their medical condition, disorders, allergic reactions, habits such as drinking and smoking, and whether they are taking any regular medication.
In addition, the patient must undergo a series of routine blood tests, an EKG and photographs documenting their facial appearance (forehead, eyelids, cheeks and neck) from different angles.
A day before surgery, the patient must shampoo their hair and take a sedative as recommended by the surgeon.
Do not eat or drink on the day of the surgery.
When you present to the medical center where the surgery is performed, a nurse will greet you, make sure you are comfortable and wash your hair once again using an antiseptic solution.
You will then receive medication that will help you remain calm before and during surgery.

Anesthesia

Facelifts are performed under local anesthesia, but the patient is mildly sedated and given intravenous medications to keep them calm by the anesthesiologist monitoring the entire surgery.
The patient undergoes the surgery in a state of light sleep, though they can still be talked to and asked to move their face as needed by the surgeon.
However, some surgeons prefer to perform facelifts with the patient under general anesthesia.
In most cases, the patient cannot recall the surgery

Surgery

A facelift involves the surgeon peeling back the skin from the cheeks and neck through an incision starting at the scalp, continuing down the front part of the ear (through one of the naturally occurring wrinkles in the area), then behind the ear, and ending in the hair around the nape.
Excess fat is trimmed away from the cheeks and neck, and the superficial muscular aponeurotic system (SMAS) is manipulated to tighten and strengthen the muscles.
The skin is then lifted, excess skin is removed, temporary drainage tubes to help drain any excess fluid are temporarily placed behind the ear and the skin is sutured along the incision.
The face is tightly dressed with a soft bandage, and the patient is taken to their room for further observation.
The patient must lie down with their upper body elevated, to reduce the amount of swelling in the face.
The patient will also be given analgesics to help with the pain.

Sutures

The sutures are usually removed from the cheeks on the fifth day after surgery, and from all other areas on the tenth day after surgery.
You can wash your hair the day after surgery, including along the suture line, and get your hair cut after all the sutures have been removed.
Avoid using a hairdryer after the surgery.
It is recommended that you dye your hair before the surgery or put it off until a month after.

Recovery

Swelling and asymmetry is common during the first few days after surgery, though this often causes anxiety among patients.
Please be patient, as the initial results can only be observed around 2 – 3 weeks after the surgery, while final results can only be seen at least two or three months later.
In any case, remember that some wrinkles will always remain, especially those on the forehead, around the bridge of the nose, around the eyes, the lips and on both sides of the nose and mouth.
Remember that the whole point is not to transform the face into a stretched out and lifeless mask that conceals a person’s emotions and how they are expressed through the face, but rather to rejuvenate the overall appearance and make the patient look good for their age, while maintaining their natural expression and facial mimicry

Side Effects and Complications

Due to certain biomechanical properties of the face (creep, stress relaxation), the skin will exhibit additional slack following the facelift.
This is sometimes so prominent that a second facelift is required.
In any case, remember that not every single wrinkle can be concealed (and this is not the purpose of the surgery, either).
The surgery is only intended to make patients look refreshed and good for their age, while maintaining their natural expression.

1. Bleeding – Blood may accumulate in the surgical site beneath the skin. This usually occurs during the first few hours after surgery and is accompanied by pain and swelling. The blood must be drained immediately so that surgical results are not harmed.
2. Necrosis – This may occur in the skin behind the ear and is mostly seen in people who smoke, as they have decreased levels of blood supply to the skin.
3. Scarring – Scarring following a facelift is usually subtle and concealed.
   The top part of the scar runs inside the hair, along the temples, and is concealed by the hair.
   In the front of the ear, the scar fuses with a natural wrinkle and usually disappears within a few weeks.
   Behind the ear and the nape, healing is a bit more problematic, but the scar is concealed by the hair.
   It is therefore recommended that you do not cut your hair short around the cheeks and nape before the surgery, until the surgical scarring is well healed.
4. Nerve Damage – Even though this is very rare, it is the most severe of the side effects for this type of surgery.
   Damage can be caused to a sensory nerve, usually the one innervating the ear, or to a motor nerve innervating the forehead, eyelids or mouth, causing movement disruptions and asymmetry in these areas.
   Luckily, nerve damage is very rare and in most cases the nerves spontaneously regenerate.
   Please keep in mind that some nerve damage is a result of variations or anomalies in the natural, anatomical pathways of the nerve that cannot be identified before or during surgery.

Conclusion

Remember, facelifts do not stop time, nor do they prevent the aging process.
However, they can rejuvenate appearances and make a person look younger and better for their age, and maintain it for years to come.

Forehead wrinkles and drooping eyebrows can be surgically treated through an incision in the scalp.
During surgery, the forehead skin is peeled back and the frontalis muscle, which causes horizontal forehead wrinkles, is manipulated.
The surgery also involves manipulation of the muscle that contracts the area between the eyebrows producing the vertical wrinkles of the forehead, the corrugator supercilii, which is also known as the “frowning” muscle.
At the end of the procedure, the skin of the forehead is lifted, and excess skin is trimmed away, while making sure that the eyebrows are placed in the correct position and will not droop into the eye sockets. This surgery is often performed in women, who contact the plastic surgeon when they start to notice a lot of wrinkles around the eyes, eyebrow drooping and their eyes looking smaller.

Forehead lifts are the best way to get rid of forehead wrinkles, between the eyebrows and around the temples, and make the eyes appear larger, often preventing the need for upper eyelid surgery, repositions the eyebrows in their correct position and significantly enhances the overall appearance of the upper face. Slight swelling, especially around the eyelids, is common after this surgery, and recovery usually takes a few days.
The sutures are removed about 8 – 10 days after the surgery.
The suture line runs across the scalp and the surgical scare is usually very well hidden in the hair.
An effective and less traumatic method of lifting the forehead skin involves using an endoscope, a device inserted through a small opening into the subcutaneous tissues of the forehead, allowing the surgeon to perform the surgery through smaller incisions in the scalp.
Another option involves fixing the eyebrows in a higher position using wire or an Endotine fixation device.
The Endotine is inserted through a small incision in the scalp and underneath the skin.
One side of the device grasps the forehead tissue and the other side grasps the skull through a short pin, which is inserted into a small hole drilled in the skull.

Side Effects

Hair thinning along the suture line, itchy scars, and asymmetrical or tilted eyelids and eyebrows are potential, albeit rare, side effects of these procedures

The face, eyelids and forehead often look very well preserved, but the neck is loose and saggy, showing many signs of skin wrinkles.
This phenomenon is sometimes exacerbated by the presence of fat buildups underneath the skin, causing the corner between the lower jaw and neck to vanish.
Restoring a flabby, wrinkly neck to much better condition is possible through a relatively easy procedure to stretch the neck muscles and skin.
This is similar to a facelift, but is smaller in scope. In neck lift procedures, a small incision along portions in front of the ear, behind the ear and the nape is sufficient. During surgery, excess fat is suctioned from the neck and the muscles of the neck and the floor of the mouth can be manipulated, stretched and strengthened.

It is worth noting that while this procedure is intended to improve the appearance of the neck, it also allows for slight manipulation of the cheeks. The sutures are removed within ten days.
This procedure is not painful, though you may feel a slight pull around your nape for a short while.
You may resume regular activity within a week to ten days.
Double chin repair for young people, who have good, elastic skin, can often be performed by simple liposuction.
In such case, the incision is very minimal and positioned behind the ear or below the chin.

Side Effects

See the side effects explained under facelift procedures.

It is often necessary to combine several procedures and treatments in order to obtain the best results.
A facelift alone is not enough when looking to repair all the elements that need to be addressed, and that is why procedures involving the eyelids, eyebrows, forehead and neck are combined with the facelift.
Chemical or mechanical peeling is sometimes required to improve skin quality.
Certain wrinkles require filler injections or Botox. In any case, the desired treatments must be performed in the correct order and at the correct time for each patient.

More information will be made available during your consultation.

Additional wrinkle treatments – Fillers.

Peeling has made a comeback over recent years, and an idea that dates back to the times of ancient pharaohs is now increasingly popular.
The skin is made up of three layers: epidermis, dermis, and subcutaneous fat.

The epidermis (outer layer) is composed of several sublayers, the first is the basal/germinal layer and the rest are layers of dead cells.
The dermis (middle layer) is composed of connective tissue that contain the skin’s main components, such as blood vessels, nerves, hair follicles, sweat glands, and nail roots. The subcutaneous fat (third layer) is fatty tissue found underneath the dermis and it cushions the skin. The epidermis and dermis are crucial in protecting the body.

Peeling involves dissolving and removing the outer skin layer, the epidermis, and part of the middle layer, the dermis. The dermis contains epithelial cells and can therefore regenerate or product new cells, which then reform the epidermis. This process results in new, fresh and younger looking skin. Most facial wrinkles and spots disappear, and the face becomes smoother and tighter.

There are various peeling methods. Plants or chemical substances, such as trichloroacetic acid (TCA) and phenol, are often used for peeling.
Peeling can also be performed mechanically (microdermabrasion – where the skin is ‘sanded’ or ‘polished’ to gradually remove epidermal tissue) or using lasers. The peeling depth determines the result and recovery time. The deeper the peel, the more impressive the result, but the longer it will take to heal.

Superficial peels can be used to achieve relatively good results, with a short healing period that allows the patient to quickly get back to normal.
However, several treatments are sometimes necessary to achieve the desired effect.
Medium or deep peels will no doubt result in more effective outcomes, but they take much longer to heal. In these types of peels, the patient’s skin will remain red and the patient will feel a burning sensation and discomfort for several weeks after treatment.

Side Effects

The most common side effect following a face peel is lighter skin.
On the other hand, dark and irregular spots may appear in different areas of the face.
This is very common in people whose skin is darker and it is therefore recommended that they do not undergo face peels, as their skin has higher melanin concentrations.
One of the most notable disadvantages of peeling is that it does not remove the excess skin around the eyelids, cheek and neck.
Peeling cannot be used to treat the fat bags under the eyes and excess fat around the cheeks and neck, and in such cases patients will also need complementary surgery if they wish to obtain better results.
Another side effect, albeit rare, is scarring.
As mentioned, healing time depends on how deep the peel is and ranges from one week to several months.
In any case, peeling must always be performed under medical supervision and, when going for a deep peel, under hospital conditions to minimize potential side effects.
After the peeling is complete, avoid direct sunlight for a few months and regularly apply sunscreen at all times to prevent damage to the new skin. It is recommended and important to undergo peeling during the fall or winter, when sunlight is not as strong.