Facial Rejuvenation

Facial Rejuvenation has many components to it. As the face ages, skin becomes looser and loses its elasticity while the underlying structures of the face weaken and are dragged down by gravity. Over time, exposure to Ultra Violet rays in sunlight also damages the skin. These factors usually result in excess skin and wrinkles on the face and neck, with ‘bags’, fatty deposits and wrinkles around the eyes and jowls. Surgical correction involves the removal of excess skin and fat and the tightening of muscle. This produces a smoother, more refreshed and youthful appearance.

Though facelift surgery does not include the eyes, (which are corrected with Blepharoplasty), it is not unusual to have a combination of facial procedures performed together.

Initially most people have one or two areas that cause concern - usually the eye lids and neck. These can be corrected first. Then if required, other areas such as the brow, temples, and cheeks can be surgically improved over the ensuing years.

There are two broad groups of procedures used for facial rejuvenation - skin tightening only, or skin and muscle tightening which is called ‘deep plane’ or ‘SMAS’ Facelifts. SMAS is an acronym for ‘Superficial Musculo Aponeurotic System’. Tightening the SMAS firms sagging neck and cheek muscles under the skin. This procedure is usually necessary for the more mature face (say over 50 years old) while a skin only lift can be quite adequate for someone with younger skin. There are also other specialised techniques such as sub-periosteal lifting which may be recommended for specific problems.

Skin only, and the less extensive ‘SMAS’ procedures are often performed under local anaesthetic with IV sedation on an outpatient basis. Longer, more extensive procedures are usually best done with general anaesthesia and an overnight stay in hospital.

Each patient is individually assessed during the consultation with the surgeon to establish which area is of the greatest concern and which would be the most effective technique to correct and improve the area. Also, your preferences about anaesthesia and your medical history are discussed.

Facelift surgery involves the removal of excess fat and stretched skin, and the re-positioning and tightening of deeper tissues. This smooths out the wrinkles and folds, tightens the skin, and produces a more refreshed, youthful looking face. These results are not achievable with laser skin resurfacing or chemical peels which only firm and smooth the outer surface of the skin, not addressing the ageing changes produced by gravity and tissue laxity.

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Skin & Wrinkle Fillers

Today there is a wide range of injectable dermal fillers available. These products are injected under the skin to improve and soften the appearance of wrinkles and lines in the skin, and to increase fullness to areas like the lips. Depending on the product used, the results achieved are either temporary, meaning they are absorbed by the body after a few months, or permanent, which means they are not absorbed, and remain present in the tissue.

Very deep creases and skin folds are not amenable to treatment with injectable fillers. Usually, implants like teflon strands (Goretex) or surgical skin tightening is the only way to smooth out these deep creases and folds. But for the treatment of fine to moderate lines and wrinkles, especially of the brow (frown area) lower lid/cheeks (‘crows feet’) and lips, injectable dermal fillers, either permanent or temporary are an excellent choice.

When patients request some contour augmentation (fuller lips) or smoothing of lines and wrinkles, we usually suggest that one of the temporary fillers be tried first. If the patient is happy with the results, when the temporary filler has been absorbed, a permanent filler can then be used to maintain the improved appearance. If the person doesn’t like the results after the use of a temporary filler, then once the product has been absorbed, the appearance returns to how it was before injecting and there’s no harm done.

The following describes some of the products available.

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Non-permanent dermal fillers:

1. Restylane and Juvederm are made from a synthetic non-animal product that is similar to hyaluronate gel the natural filler which occurs between the collagen fibres in the dermis of our skins. Areas treated with these products require further injections every 3 to 6 months to maintain the desired appearance.

2. Hylaform is a gel similar to the above, but it is made from the cock combs of chickens. Areas treated require further injections about every 3 months.

3. Collagen is a bovine derivative, and a skin test is required prior to treatment to ensure that there is no allergic response. About 3% of people have an allergic response to this product. Treated areas last about 4-6 months.

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Permanent dermal fillers:

Dermalive is made from a combination of synthetic hyaluronate and acrylic hydrogel particles. After injection, one’s own collagen and tissue cells grow around these particles to lock them into place so that they don’t move to other areas. They remain in place in the tissue, acting as a space filler, being too big for one’s cells to ingest and destroy, but small enough to pass through a fine needle for injecting. Dermalive is very well tolerated by our tissues so it remains permanently embedded in the tissue.

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Botox

Botulinum toxin has recently been approved by the American Federal Drug Administration for paralysing facial muscles to reduce deep frown lines and other skin wrinkles.

The frowning muscles that cause the vertical lines between the eye brows can be temporarily paralysed by injecting Botox into the muscle belly. This stops conduction of nerve impulses into the muscle, preventing it from contracting even if your brain is sending the signal to frown. The muscles stay relaxed, with the vertical crease lines (known as glabellar frown lines) becoming greatly reduced, and the unintentional ‘angry look’ is no longer apparent.

The ‘crows feet’ lines below the outer corner of the eyes can also be treated the same way.

The full effects of Botox take several days to a week to occur, with the maximum results achieved at about one month. This is when the skin appears the smoothest. Muscle strength and lines slowly re-appear after 3-6 months.

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