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Monday, 11 September 2017

Facial rejuvenation - Restoring the triangle of Youth

Many of us are happy with the wisdom and composure we attain with age , But few are happy with the wrinkles, folds, jowls and deflation of the face. The pursuit for a youthful facial appearance may involve everything from healthy diet, exercise, facials, anti-ageing creams,  to lasers , skin tightening procedures, botox and injectable fillers. However with time the traingle of youth turns to the pyramid of age. Traingle of youth refers to the widest part of the face between the two cheek bones in young person with  the narrow point at the chin. With ageing, it reverses and the widest part becomes the jawline , with the narrow tip at the bridge of nose. This is because of the midface deflation, fat pad loss, bone resorption, skin wrinkles and jowls. Skin becomes thinner, collagen and elastin breaks down and hyaluronic acid is lost resulting in  crow’s feet, nasolabialfolds, tear trough and  marionette lines .Usually this starts around the age of 35 ,with further deflation and midface bone resorption at 45-50 years. Many of the non surgical procedures like botox, fillers , lasers help in defying the age, but are effective only upto a point.

Restoring the triangle of Youth

A modern face lift procedure is customized or individualized to patients needs because not every face  is the same. It not only lifts the deeper tissue and removes extra skin but also fills the midface volume loss with fat grafting. The windswept unnatural look  with lift-alone procedures has given way to the more pleasing and rejuvenated fuller facial profile with the current facelift surgery.

Mini facelift- Patients who exhibit a mild degree of jowling and sagging skin are often good candidates for a mini-facelift.This is a less invasive technique that allows to tighten deep facial tissues through shorter incisions, typically located along the natural creases surrounding the ear. It can be done under local anesthesia with sedation or under general anesthesia. Structural tissue around the cheeks are lifted and plicated to refine the jawline and restore the midface. Advantages include shorter scar, quicker recovery and lesser complications.

Standard face lift- This procedure will more fully address moderate to advance aging of the midface and neck .It involves incisions starting in the temple region extending  to ear running in front, around and then behind the ear and back into the scalp. Facial skin on the cheeks and neck is dissected free and underlying muscle and fascia of the face and neck is dissected and tightened. Excess skin is trimmed and the incisions are closed. It take around 4-6 hours for the surgery, recovery is longer but the outcomes can be rewarding.

Blepharoplasty or the Eye rejuvenation surgery-  Many a times the telltale signs of aging can first appear in  and around the eyes. This can be droopy upper eyelids and brows , puffy bags under the lower lids, or  sunken eyes and  tear trough. This can make you look old and tired and sometimes interfere with the vision too. Blepharoplasty is a surgery that removes excess skin ,plicates the muscle in upper lid to lift it up , and redistributes the fat in lower lid to attain a smooth lid-cheek junction. The incisions follow the natural creases of upper lid and just below the lashline in lower lid. A lateral canthopexy is also incorporated to tighten the outer part of eye.This can be combined with a brow lifting procedure for a sagging lateral brow.

Autologous fat grafting for facial rejuvenation- Fat transfer techniques using fat from the other parts of body and transferring it to elsewhere has become more widespread and established technique. It has been used for breast augmentation, buttocks augmentation( Brazilian Butt lift) , hand rejuvenation and also for facial aesthetics. Micro and nano fat harvested from abdomen or inner thighs are  injected in the planes of facial tissue with blunt cannulas. Clinical applications include  filling of the malar prominence, tear troughs, nasolabial folds and  fine lines along the lips. The  adipose derived stem cells in fat tissue are critical in tissue regeneration and repair. The effect lasts for 3-5 years unlike fillers which has to be injected every 6-9 months.

Adjuvant procedures for face

Thread lift- Bioabsorbablethreads with barbs or cones are inserted  underneath the skin in specific areas of face to lift the eyebrows, lift the sagging skin over cheek , reduce nasolabial folds, define jawline and reduce the neck folds. The procedure can be done with patient being fully conscious and they can approve the look of their thread lift while the surgeon works . This innovative technique assures a subtle yet a noticeable change .

Double chin Injectables- Submental fullness or  fat under the chin can be treated with injectable deoxycholic acid in 4-6 sessions spaced at 1 month interval. This treatment has been approved by FDA. Deoxycholic acid is a naturally occurring molecule in the body that aids in the breakdown of the fat cells resulting in a noticeable reduction in fullness of the chin.

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