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Face Lift Facial Facial rejuvenation (and specifically facelift) can be one of the most demanding operations in plastic surgery. Just as everyone's face is uniquely different, so is every facelift. The face is characterized by its underlying bony structure (which gives the face its general shape), the overlying soft tissue and the outer layer, the skin. As we age, our skin and soft tissues change over the bony foundation. Since everyone's bones, soft tissues, and skin are different, facial aging changes tend to be as unique as we are. The goals of facial rejuvenation are not only to correct changes that have happened through aging, but also create a beautiful facial appearance after surgery. Techniques include: lifting of sagging tissues, restoring soft tissue volume in “deflated” areas (the lips or eyelids), removing unpleasant fat collections (such as the enlarging fat collection underneath the jawline) or restoring facial balance by building up a weak bony foundation. Any or all of these techniques may be appropriate on any given patient. A facelift is not just simply pulling the skin of the face tighter. It is a comprehensive evaluation of the structure and volume of the face, the relative proportion of the features, the changes related to aging and then a “prescription” to correct these changes or restore balance. The |
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following cases are examples of application of this philosophy to individual patients. If you review the procedures, you'll find examples of the different techniques, variably applied in each case as the patient's anatomy and particularly the patients concerns were addressed. |
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Eyelid surgery is a very frequent plastic surgical procedure, which can be done to improve the cosmetic appearance of the eyelids or to repair functional problems of the eyelids. It has been said “the eye is the window to the soul”. More than any other portion of the face the appearance of the eyes and the area around the eyes is responsible for having an awake, vibrant, youthful look. Patients who desire cosmetic improvement of their eyelids typically feel that they look angry, sleepy, or tired. They complain of hooded, wrinkled eyelids, wrinkles around the eyes drooping eyebrows and frown lines. Oftentimes patients are surprised to find this appearance in a mirror or in photographs because they don't feel it really reflects how they feel inside. The appearance of the upper eyelid is highly dependent on the position of the eyebrow. One of the earliest changes that occurs with aging or with weight loss is a lowering of the eyebrow, which allows excess skin and fat to be present in the upper lid giving the eyes a dark or hooded appearance. In the lower lids loss of muscle tone and loss of fatty tissue in the lower lid can lead to wrinkling, bulging of the lower lids, and dark circles under the eyes. Cosmetic interventions for rejuvenating the eyes include: 1. Brow elevation to reposition the eyebrow. 2. Structural fat grafting to replace tissue in the thinning eyelids to improve dark circles and wrinkling. 3. Weakening of the muscles that cause frowning and “crow's feet” in the lateral eyes with Botox. 4. Excision of excess bulging fat pads and excess drooping skin. Any or all of these interventions may be appropriate in any given patient depending on the appearance of the eyelids.
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Eyelid Surgery - Cosmetic
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Eyelid Surgery - Reconstructive Functional problems of the eyelids include: 1. Drooping upper eyelids may obscure a patient's vision. This creates a condition called “visual field obstruction”. It may be due to excess upper lid skin that hangs over the eyelashes, or by weakening of the muscle that lifts the lid, allowing the lid to droop over the pupil. Many insurances cover surgical repair of eyelids that impair the field of vision. 2. With age, the ligaments holding the eyelid can become more relaxed leading to a drooping of the lower eyelid called ectropion. The eyelid hangs out away from the eye, exposing the eye to air. This leads to dry eye and irritation. 3. The lid can also roll inward, brushing the lower lashes up against the cornea and creating significant irritation. This condition is called entropion. Examples of repair of drooping eyelids, entropion, and ectropion follow. |
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Nose Reshaping (Rhinoplasty) Probably more than any other plastic surgical procedure, rhinoplasty (nose reshaping) captures the need for surgical artistry and excellent technical skills to achieve a balance of both appearance and function. Rhinoplasty not only changes the shape and appearance of the nose, but also the function of the airway. In planning rhinoplasty, overall considerations such as facial shape and the relationship of the nose to the eyes, upper lip, chin, and overall facial balance are taken into consideration. A careful preoperative plan is created, often with the use of preoperative photographs which are modified or “morphed” to simulate the postoperative result of surgical interventions. Almost any portion of the nose can be changed including: 1. The bony nasal dorsum. 2. The nasal tip. 3. The nostrils. 4. Junction of the nose and the upper lip. 5. Nasal airway and movement of air through the nose and nostrils. Interventions may affect only the soft tissue or may change the soft tissue, the cartilages of the nose, and the bones of the upper portion of the nose. Surgery may be done under local or general anesthesia and may take anywhere from 1-3 hours. At your consultation a thorough inspection of the nose, both internally and externally, and the nasal airway are undertaken. Photographs are obtained and these are reviewed with you to determine exactly what changes are desired. These can be simulated with computer aided photography and expected postoperative results can be reviewed to generate a surgical plan. Typical characteristics that can be addressed at surgery include: 1. Irregularities of the nasal dorsum (crooked, dorsal hump, sloping nose, irregularities, or a wide upper nose) 2. Irregularities of the nasal tip (pinched or crooked tip, wide flat tip, or upwardly or downwardly plunging tip). 3. Areas of the nostrils including wide or flared nostrils or long narrow nostrils. 4. The relationship of the nose to the upper lip, teeth, and jaw can be addressed either through modifications to the nose or lip or chin. The following photos illustrate typical rhinoplasty results.
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Dr. Carpenter is one of the founders of the Allegany County Cleft Clinic, a team of professionals organized to provide the children of Western Maryland with services relating to cleft lip and palate. These services include surgical care of the cleft lip and palate, hearing and speech therapy, dental care, and social assistance. The clinic is organized through the county health department. Cleft patients have a variety of needs and Dr. Carpenter maintains a lifelong relationship with his patients to monitor speech, growth, and function after repair. The following photos are examples of cleft lip repair.
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Robert J. Carpenter, MD
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