Facial Cosmetic Surgery

Facelift (rhytidectomy)

 

Traditional Facelifts

A facelift is rejuvenation surgery that goes beyond just tightening skin. Today’s full facelift extends below the skin to address the underlying facial muscles, creating a smooth, firm, and youthful appearance. Years of experience have led Dr. Louton to do even more. Fat and tissue contribute as much to facial appearance as the underlying muscle and the overlying skin. A facelift with the most natural outcome will reduce, redistribute and in some cases add fat to the face. The face does not stop at the jawbone, and a truly complete and comprehensive facelift also addresses the neck region.

Traditional facelifts are usually outpatient procedures performed in our on-site licensed surgical facility, but may be done at a local hospital if desired. Some patients may require a short inpatient stay. Anesthesia can be local with sedation or general.

Recovery

Back to work: 2 weeks or more. Healing is a progressive process. Within a week, stitches are removed, and despite some puffiness and noticeable incision lines, some patients are ready to venture out into the world. Within a few more weeks you will be looking like yourself, albeit a younger version. Activity limitations: Must limit strenuous activity for 3 weeks or more and sun exposure for several months. Bruising and swelling: 2 to 3 weeks. Sleeping with head elevated help relieve swelling more quickly. It is not uncommon, however, for mild swelling to persist for as long as two months. Duration of Results: 5 to 15 years. Much depends on individual lifestyle and genetics factors.

 

Limited Facelifts

There are alternatives to a traditional full facelift. These limited facelifts go by many different names, but fall into three basic categories: minimal incision, endoscopic, and suspension lifts. Incisions are for access, and minimal incisions mean minimal access and are most effective for minimal changes. There may be less downtime involved, but there is also a less dramatic result. These limited techniques may not be appropriate for every patient, nor do they mimic the dramatic results of a true facelift. The most appropriate candidates are younger patients with good skin elasticity and little neck looseness or those patients who have already had a facelift and require refreshing.

Minimal incision facelifts, sometimes called mid face or S lifts, address aging isolated to specific conditions such as lower eye area, nasolabial folds, and marionette lines. This is a ponytail friendly facelift as it offers our patients an incision that does not extent behind the ear or into the hairline. This procedure is performed outpatient in our on-site licensed surgical facility under local anesthesia with sedation. General anesthesia is available if desired.

Recovery

Back to work: 1 to 2 weeks. Strenuous activity: 2 weeks or more. Bruising and swelling: several days. Duration of Results: variable

Endoscopic facelifts are minimal incision facelifts performed with a surgical telescope, or endoscope. Dr. Louton uses the endoscope to further reduce the size of the incision and minimize potential scars. This procedure is performed outpatient in our on-site licensed surgical facility under local anesthesia with sedation. General anesthesia is available if desired.

Recovery

Back to work: 1 to 2 weeks. Strenuous activity: 2 weeks or more. Bruising and swelling: several days. Duration of Results: variable.

Suspension lifts(mini-lift, facial thread, featherlift, MAC lift, and APTOS) utilize specially designed suture threads to raise the skin of a low brow or a sagging cheek region. This procedure does not affect the underlying muscles or reduce excess skin. Suspension lifts are useful as an interim step to a facelift, but not all patients are good candidates. This procedure is performed outpatient in our on-site licensed surgical facility under local or light anesthesia with sedation. General anesthesia is available if desired.

Recovery

Back to work: 1 week or less. Strenuous activity: 2 weeks or more. Avoid excessive facial movement for the first 2 to 3 weeks. Bruising and swelling: minimal, lasting several days. Duration of Results: short term, variable.

Surgical Add-Ons

Lipo with your lift – Liposuction techniques can assist the facelift procedure by reducing excess fat pockets beneath the chin and in some areas of the midface, such as above the nasolabial folds or in the jowls.

Laser resurfacing can improve the appearance of surface wrinkles and skin discoloration. Areas commonly resurfaced at the time of a facelift include around the mouth, around the eyes, and across the forehead.

Botox is recommended prior to surgery to relax the underlying muscles, or following surgery to maintain post-operative results.

Lip augmentation is a common rejuvenation procedure performed using fillers. In conjunction with your facelift, lip augmentation can balance and refine your overall youthful appearance.

 

Please note that we have limited our before and after photos of facial  procedures so as to protect the privacy of our patients. More examples are available for viewing during your one on one consultations.  Call us at 949-7280 to schedule.

Eyelid Surgery (Blepharoplasty)

Does your upper eyelid overhang and droop? Do you have a puff or pillow in your lower lid? Do your eyes look turned-down or sad? Eyelid surgery may be the best way to a smooth, alert, appealing expression.

Cosmetic eyelid surgery removes the excess fat and wrinkled drooping skin of the upper eyelids that can make you look constantly tired or sad. It also eliminates bags under your eyes ad tightens your lower eyelid skin. The result is a more alert and rested appearance.

Eyelid surgery is often performed along with other facial rejuvenation procedures such as a browlift, a facelift, and laser resurfacing. Some people have inherited traits that cause them to have eyelid surgery as early as their 20s or 30s.

The View on Eyelid Surgery

Eyelid surgery is most often performed as an outpatient procedure with local anesthesia and sedation. The surgery can take from 1 to 3 hours depending on whether upper, lower, or both eyelids are treated. You may feel some discomfort at the incision sites for a day or two and may wish to wear dark sunglasses in the days that follow for enhanced comfort. Your vision may also be slightly blurred due to temporary swelling. Expect to sleep with your head elevated on several pillows for a few days to reduce swelling. Within 5 to 7 days of surgery, any or all of the stitches will be removed. When your incisions are healed, you are ready for a little concealer and eye contact with the world.

Recovery

Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activity, alcohol: about 3 weeks. Bruising and swelling: usually minimal and completely gone in a few weeks.

 

Forehead and Browlift

For a smoother, younger brow, a forehead or browlift offers two key outcomes. By removing the muscles that cause unsightly creases in the brow, a forehead lift acts like a permanent Botox™ treatment. Secondly, a brow rejuvenation can smooth the wrinkles of the forehead, and correct a low or hooded brow by raising it to a more naturally alert position.

Dr. Louton has perfected the technique of the scarless brow and forehead lift, or endoscopic forehead lift. Tiny incisions are made behind the hairline, and because they are not readily visible, the term “scarless” has been coined for this procedure. Within one month, your hairdresser will not be able to find the scars! The result is a naturally smooth appearing forehead and brow. This minimally invasive technique is well suited for patients with receding hairlines or thinning hair and is commonly done as a part of a midface lift or a Three-Dimensional full facelift.

Endoscopic forehead lifts are outpatient procedures performed in our on-site licensed surgical suite under local anesthesia with sedation. General anesthesia is available if desired.

Recovery

Back to work: 7 days to 10 days. Strenuous activity: several weeks. Bruising and swelling: minimal. Duration of results: 10 years or more. As an added bonus, you might find that chronic headache are a thing of the past because the muscles that cause them can no longer constrict.

Facial Rejuvenation

Time, heredity, hormones, sun, stress, and all of life’s little vices take their toll on the body’s single largest organ, the skin. Whether you want to prevent problems or remove signs of aging, or simply want to keep beautiful skin looking beautiful, the following non-surgical and minimally invasive procedures can a big role in achieving your goal.

IPL Photofacials are a series of gentle pulsed light treatments that enhance and rejuvenate skin, giving you a healthy, more youthful look without any peeling or sloughing.  Blair Plastic Surgery owns two Intense Pulse Light systems: Palomar Starlux and Lumenis IPL.  Call us to determine which system is located at the office most convenient to you.

Multiple wavelengths of light penetrate all levels of the skin to improve tone and texture. IPL treatments address a variety of benign conditions, including age-spots, sun-induced freckles, symptoms of rosacea, unsightly veins, acne scarring (mild) and other blemishes, even unwanted hair.  This quick and effective procedure can also soften fine lines, especially around the eyes and mouth but is gentle enough to be used on the neck and chest area to improve redness, flushing, and discoloration.  Photofacials often take no more than thirty minutes. Several IPL treatments are required to provide gradual, natural-looking improvement with very low risk. Results usually last a year or more.

 Skin Resurfacing

For truly clear, smooth, and youthful skin - devoid of the tell-tale signs of sun damage – remove it! And let fresh, new, healthier skin shine through to the surface.  The greater the amount of the epidermis removed, the greater the results seen in terms of reduction of wrinkles, brown spots, and other superficial imperfections.  With deeper penetration and removal of the epidermis, we see greater stimulation of the dermis which can react by rebuilding and restructuring lost collagen and elastin fibers. 

Stimulation of the dermis can also be achieved without removing the epidermis but rather by sending heat in the form of light through the epidermis directly into the dermis where collagen formation can be stimulated.  No peeling required!  This type of treatment may not show immediate results but rather a gradual improvement in texture and tightning of the skin over the followings months.  Multiple treatments may be necessary in order to achieve maximal results.

The following are the numerous modalities available at Blair Plastic Surgery for the overall improvement of prematurely aging skin usually seen in sun damaged individuals.  To determine which treatment is best suited for correction of your individual concerns, set up a consultation with either our Skin Care Clinic, Centre for Cosmetic Medicine, or with one of our board certified Plastic Surgeons.

Microdermabrasion  consists of a very gentle “sandblasting” of the skin using a flow of fine crystal to remove dead surface cells and clear the pores of debris. Over time and a series of  treatments, pigment gently fades and surface irregularities, such as fine wrinkles and acne scars, begin to soften. Treatment of the entire face takes about 30 minutes with very little discomfort. You may be pink for a few hours after your treatment but there is no flaking and make-up can be used immediately after your treatment.  Effects of microdermabrasion may be hastened and enhanced by the addition of a physician-directed home program individualized to your skin and concerns and/or pre-treatment of your skin with strong AHA’s immediately prior to the microdermabrasion.

Light to Medium Chemical Peels are used to refine and refresh the skin, as well as treat some pigmentation disorders and acne.  We offer; Illuminize Peel, a light mixture of alpha and beta hydroxy to brighten the complexion; Micropeel Plus, a strong beta hydroxy peel especially beneficial for the reduction of oils and acne break-outs; Vitalize Peel, a combination peel of alpha and beta hydroxy, resorcinol, and liquid tretinoic acid, to penetrate deeper into the epidermis and more effectively treat the look of sun damaged skin.  These peels may leave your skin pink for a day and may cause a bit of post-treatment inflammation and flaking, depending on the type and strength used. In general, these peels impart a healthy glow with little discomfort or downtime. A full face peel takes less that 30 minutes and is offered in cost saving packages.

MicroLaserPeel™, or “Weekend Peel”, is ideal for the individual looking for better results than what superficial microdermabrasion and chemical peels can offer and is willing to commit a long weekend to the healing process.  Because this procedure goes deeper into the epidermis, anywhere from 2 to 6 times deeper than microdermabrasion alone, it is the perfect step between superficial, no downtime treatments, and deeper peels that require much more healing time.

Blair Plastic Surgery owns and operates the Profile Contour™ Laser.  This Erbium:Yag Laser is a versatile system with unique technology that allows us to select precise levels of penetration into the epidermis, while the computer guided scanner ensures maximum precision and treatment uniformity.  It precisely removes the outermost layers of the skin and is individually tailored to the nature of the problem to be corrected: wrinkles, scars, keratoses, or pigmentation problems. The MicroLaserPeel™ is performed on Friday and most patients return to work the following Tuesday or Wednesday.  Immediately following the procedure you will feel as if you have a bad sunburn. You will have minor sloughing and itchiness the following day. By day two, redness will begin to fade and by day three any redness can be easily covered by makeup.  The results are immediate and long-lasting, from 6 to 12 months or longer, especially when adhering to your physician prescribed home program.  Schedule a private consultation to determine if the MicroLaserPeel™ is a good option for you.

  

Laser Skin Resurfacing

For those patients that are looking for a greater tightening effect and/or require a more aggressive approach to treat severely sun damaged and deeply wrinkled or scarred skin, an ablative laser resurfacing procedure may be the perfect solution.   Ablative resurfacing is performed in our on-site licensed surgical suite under local anesthesia with light sedation. The procedure can take minutes to one hour in length and may be limited to smaller areas such as around the mouth or eyes.

Since 1990, Blair Plastic Surgery has achieved excellent and consistent results in the treatment of deep wrinkles and sun damage with an Erbium laser.  The versatile Profile Contour Laser™ (www.sciton.com) is an Erbium laser that enables our surgeons to tailor laser resurfacing procedures to each individual patient.  It can be used in the traditional manner to ablatively remove the epidermis layer or the beam can be fractionated to send columns of laser light deep in the skin without the complete removal of the epidermis.  The latter technique allows for quicker healing time but may require additional treatments for equivalent results.

Dermabrasion is the gold standard treatment for deep acne scarring. A sanding disc is used to scrape away the skin’s surface. This is not to be confused with microdermabrasion which gently removes the most superficial layers of skin and does not require any healing time.

Results and recovery of Ablative Resurfacing
Back to work: 2 weeks. A new skin layer will form in 5 to 7 days, with full thickness skin by 5 to 6 weeks. Duration of results: Long lasting, but does not stop aging. Must stay out of the sun for 12 months following surgery.

Fractional Photothermolysis represents the latest in a series of technological improvements.  Ablative laser skin resurfacing is able to address very significant wrinkles and skin damage deep in the skin but requires healing time.  Non-ablative treatments address more superficial problems with no significant healing time.  Fractional technology can now be applied to either ablative resurfacing or non-ablative skin rejuvenation to enhance results, while dramatically decreasing healing times of the ablative treatments.

Fractional skin rejuvenation is designed to stimulate the production of new collagen in the skin.  This occurs over a period of time, usually months after the treatment, during which the deeper dermal skin layer is building and restructuring collagen.  The overall effect is an overall tightening and better supported outer skin layer.  Blair Plastic Surgery has been diligent in providing our patients with the most effective cosmetic treatments available.  We are currently researching and testing systems from multiple companies  in order to purchase the safest and best performing fractional system for our practice.  We expect to finalize our research by Fall ’08.  Please call us to obtain the most current information regarding this new and exciting technology.

There is no dispute. Botox™ is effective in treating frown lines and crow’s feet.Dr. Louton has been using Botox™ to treat muscular wrinkles for greater than 10 years. In his experienced hands, Botox™ can produce results that allow for some natural movement, yet still produces exactly the desired effect on wrinkles and furrows – almost painlessly. While there is no downtime, results are typically visible in two to three days but may take up to a week to fully develop. Results will last three to four months or more. Side effects are rare, including a mild post injection headache. But if you are like most recipients, you’ll experience a blissful break from headaches.

Botox™ is not a poison; it is a denervating protein. When injected into precise points in the facial muscles, Botox™ prevents the nerve reaction necessary for the injected muscles to contract. The result is not paralysis, it is the reduction in the ability to make specific facial expressions that create wrinkles and deep folds in the skin. Younger patients can halt the formation of frown lines and crow’s feet, while patient who have already developed these conditions will see varying degrees of improvement, from complete erasure to very visible softening.

At Blair Plastic Surgery, Botox™ may be injected into three individual sites; between the brow (glabella), the forehead, and the crow’s feet (outer aspect of the eyes). The fee for Botox™ injections is based on the number of sites treated. Please call our office (              814-949-7280       ) for the exact cost.

Botox™ is presently the only FDA approved neurotoxin for cosmetic use. Link to www.botoxcosmetic.com for more information.

 

Temporary Fillers are used to fill wrinkles, moderate creases and depressed scars. They are also effective for plumping up lips. The lack of permanence most fillers have is truly beneficial. With aging and weight gain, the face changes too. Temporary fillers allow Dr. Louton to address the subtle shifts in facial appearance as they develop. The cost of these temporary fillers start at $400 per syringe. Actual cost will depend on which agent selected and how many syringes are required to achieve the desired results.

CosmoDerm & CosmoPlast are derived from human collagen and therefore do not require allergy testing. Anesthetic is added to minimize the pain and there is no downtime. Results last from two to three months.

Hylaform & Hylaform Plus is hyaluronic acid derived from rooster combs. No allergy test is required, however, alert Dr. Louton if you are allergic to any type of water fowl. Topical anesthetic is applied prior to injection. Results last two to six months.

Restylane is non-animal hyaluronic acid. No allergy testing required. Topical anesthetic is applied prior to injection. Results last four months or more. Post treatment swelling and / or bruising is expected and can last for up to a week.

Partial Permanent Fillers
Put your fat to good use! Fill frown lines, crow’s feet and smile lines; provide definition to cheeks and chin; fill depressed scars. Autologous fat injections and/or fat transfer are terms used to define injectable soft-tissue augmentation using your own fat. Most commonly used in conjunction with other surgical procedures, your fat can be extracted, processed and re-injected into your lips, facial creases, or hands. There is no risk of allergy. Typically, the fat is extracted from the abdomen, buttocks or thighs through liposuction techniques. Fat transfer requires local anesthesia at a minimum, and will cause 1 to 2 weeks of mild swelling and bruising. Some of the fat will reabsorb over time, requiring additional treatments for long lasting benefits. Results can endure from several months to permanently.

The cost of harvesting and injection starts at $2000 but is much more affordable when performed in conjunction with another scheduled surgery.

Semi-Permanent Fillers  are used for deeper creases and wrinkles as well as sculpting the face. These are not intended for high-movement areas like the lips. Actual cost will depend on the amount needed to treat the desired area.

Radiance is calcium hydroxyapatite microspheres suspended in a polysaccharide gel. Radiesse™ requires a local anesthetic or anesthetic block and can cause swelling and bruising which can last for up to two weeks after treatment. Achieved results can last years.

Permanent Fillers
Artefill™ is the first and only FDA-approved non-resorbable wrinkle filler for the correction of smile lines.  First, ArteFill visibly corrects the wrinkle. Then the microspheres provide the permanent support your skin needs to correct the wrinkle and prevent further wrinkling.

ArteFill (www.artefill.com) is a dual-acting injectable wrinkle filler. The secret is in its patented formula, which contains 20% ArteFill Precision-Filtered Microspheres™ (made of PMMA, the same material used for dozens of medical implants over the last 50 years) and 80% ArteFill Purified Bovine Collagen™ gel with lidocaine, an anesthetic.  Where the results of temporary fillers end, the enduring benefits of ArteFill continue and are considered permanent. 

Discussion with our plastic surgeons regarding this and other filler material is essential for selecting the best options for your particular problem areas.

Nose Reshaping (Rhinoplasty)

Small Change Big Impact

Nose surgery does more than alter the appearance of your nose, it can transform the look of your entire face. Even a small adjustment made to your nose can result in a big improvement in overall facial harmony – and a big boost to your confidence.

The art of rhinoplasty is more than merely making noses smaller. Your nose needs to look natural and complement all your facial features, balancing size, width, and angles. Cosmetic surgery on the nose is a highly individualized procedure that focuses on one or more of the features that contribute to your overall appearance. The earliest recommended age for rhinoplasty is the mid-teens when the nose is near full development. As long as you are in good health, there is no upper age limit for nose reshaping.

Computer simulation or Video Imaging can provide a picture of how your nose may look after a rhinoplasty procedure. Dr. Louton uses video imaging as a tool to discuss your goals and to show how changing certain features of your nose may or may not complement your facial features. It is an easy way to quickly determine the possibilities available to you with nose reshaping surgery.

How it’s done

Rhinoplasty is generally an outpatient procedure performed under local anesthesia with sedation, or general anesthesia if desired. The length of the procedure varies from 1 to 3 hours. Alterations may include, removing humps and irregularities on the bridge, lowering a high bridge or raising a low bridge, changing the shape or tilt of the tip, changing the size and position of the nostrils, or changing the angle between the nose and upper lip.

Rhinoplasty is performed either as an open or a closed procedure. The best approach for you is determined by the structural changes to be made to your nose and by Dr. Louton’s preference. You will wake up with a splint covering your nose and possibly some packing to support your nose internally as it heals. The packing is removed in 2 to 3 days, and the splint is removed 10 days after your surgery.

Recovery

Back to work: 1 to 2 weeks. Strenuous activity: 2 to 3 weeks. Avoid hitting nose and sunburn: 8 weeks. Swelling: 90% of swelling in gone in 4 weeks. Final appearance: 1 year or more. If your wear eyeglasses, be ready to keep them in their case for several weeks. Contact lenses can be used once swelling diminishes. You should be back to your normal routine within a week.

Ear Surgery (Otoplasty)

Ear Surgery, or otoplasty, is performed to correct a flaw that is unrelated to the aging process. It can improve the positioning of your ears if they are large in proportion to other features or protrude more than normal. Otoplasty is especially beneficial for children with protruding ears when the problem is corrected prior to the child entering school. Otoplasty is possible at any age after age six when the ears have reached 90 percent of their adult size. This procedure is occasionally covered by insurance.

How it’s done

Otoplasty is a 2 to 3 hour outpatient procedure. It usually requires general anesthesia in younger children and local anesthesia with sedation in older children and adults.

Recovery

Back to work or school: 5 to 7 days. Strenuous activity, contact sport: 1 to 2 months.