I would like to get rid of the lines when I smile. Is a facelift the answer?

Dr. Dean Kane Q & A worried, frown lines Q. I would like to get rid of the lines when I smile. Is a facelift the answer? A. Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material. Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift. Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed. ​ ​A face and neck lift will pull on the bedspread and stretch the wrinkles and only remove the wrinkles excised with the skin (which is around the ear). Surgical lifts will NOT remove wrinkles. ​ ​It is the consistency and texture of your skin, fat and muscle which produces the laxity of the skin and creasing leading to wrinkles.  ​ ​In counseling my patients, I generally recommend the following order dependent on medical requirements, budget and recovery time:
  1. ​ZO Obagi Skin Health
  2. ​Face and neck lift; fat grafting, upper / lower eyelids and brow lift as desired
  3. ​Continued ZO Skin Health
  4. ​Patience to allow the tissues to soften and settle
  5. ​Botox to adjust expression lines and Filler to fill in or volumize
  6. ​Chemical Peels or laser tightening
  7. ​Sculptra firming yearly

​Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below. The most popular of thefillers,RestylaneandPerlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting “cousin”Juvederm Ultra Plusare similar skin fillers, used to soften and fill the nasolabial (“parentheses”) and marionette folds, the brow (“number 11”) lines and fill and lift the cheeks and lateral brow or chin.Volumais the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!. Non-surgical facial contouring is possible with fillers such asRadiesse, a bone mineral for the nose or cheeks, jaw and chin as well. Scuptrais the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent. BotoxandDysporttoo have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles! Dr. Obagi’s new, second generationZO Skin Healthprograms may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin. IPLand fractionatedlaserssuch asCO2 and erbium and now RF(radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation. If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin. You may consider: atraditional face and neck lift, short scar face and / or neck lift. The recent resurgence of the S-Lift (created in the early 1900’s), also called by other names as the Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others; are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck. The shorter scar, limited undermining and second layer lift achieve the “quicker” procedure but not necessarily the quicker recovery or the improvement you desire. Face lift and / or neck lift or any of the other procedures and their combinations should be discussed following a proper examination with a well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills.

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