Read an Excerpt
Your Complete Guide to Facial Cosmetic Surgery
By Jon Mendelsohn, William Truswell, Kriston Kent
Addicus Books, Inc.Copyright © 2004 Jon Mendelsohn, M.D.; Kriston Kent, M.D.; and William Truswell, M.D.
All rights reserved.
CONTEMPLATING FACIAL COSMETIC SURGERY
Are you among the thousands of Americans who are thinking about facial cosmetic surgery? Have you wondered how you might look after a facelift ... a nose job ... an eyelid lift? Are you brimming with energy on the inside but showing your age on the outside? If so, facial cosmetic surgery may be for you. Each year, more and more Americans are choosing to turn back the clock with cosmetic surgery.
Before we discuss the most common procedures, let's take a look at why our facial skin and tissues age. Not only will this help you understand how facial structure changes with age, but also it will give you insights about lifestyle habits that can help you maintain the results of cosmetic surgery procedures.
How Facial Structure Changes
Why does facial skin eventually start to droop? Consider this analogy: If you've ever had a lined coat or jacket cleaned, you may have found that the lining shrank during dry cleaning or laundering, making the outer fabric sag. Think of your facial skin as the outer fabric and your bones and supporting tissues as the lining. As those bones and tissues shrink and your muscles lose volume and tone, the skin slips downward, sometimes drooping much as your jacket's outer fabric drapes over the hemline.
Beneath your skin, the SMAS — short for superficial musculoaponeurotic system — also begins to sag and droop. Here come jowls, low brows, and other unwanted folds. The SMAS is the curtain of muscles of facial expression and the surrounding connective tissue. As the SMAS descends, the skin becomes less taut.
Layers of fat, called fat pads, under the eyes and under the skin on our cheeks also keep us looking younger. When gravity pulls at the cheek pads, it can create sagging skin and hollows under the eyes; it also deepens the nasolabial folds, the grooves that run from both sides of the nose to the corners of the mouth. As the cheek pads get longer, they become less rounded, the face appears flatter, and their weight pulls down the corners of the mouth. As muscles surrounding the eyes shrink and weaken, they sometimes develop small gaps through which fat protrudes, creating little bumps under the eyes.
In addition to changes in the underlying structures of the face, the skin itself changes. We start seeing broken capillaries, rough patches, discolorations, fine lines, and enlarged pores.
Why Skin Ages
Over the years your metabolic rate — the pace at which your body absorbs and processes nutrients — gets slower. As a result your system produces less of just about everything, including blood, bone, the skin proteins collagen and elastin, and natural skin oils. Skin-cell growth and replacement also slow down.
As the connective tissues in your body weaken, your skin's support structure is undermined. With less collagen, which acts as a glue to hold tissues together, and elastin, the fibrous protein in elastic tissues, your skin starts to lose its snap, kind of like an elastic waistband after years of wear. When you were younger, your skin bounced back from all types of stresses, but as the calendar pages flew by, so did your skin's resilience.
Compare the skin on the underside of your arm to that on the front. That's one way to see how the sun damages your skin. The skin on your under arm is white and unflawed, but the skin on the front of your arm is darker and has been affected by the sun. In fact, you've been bombarded for years with the sun's ultraviolet alpha and beta waves (UV-A and UV-B rays); the more time you've spent in the sun, the more your unprotected skin has been injured.
UV-A and UV-B rays are responsible for photoaging — sun-induced skin damage. UV rays are more harmful at high altitudes, in the summer, and closer to the equator. The sun causes almost as much damage as your biological clock does, sometimes more. Sunlight on unprotected skin penetrates several layers to stimulate pigment-producing melanin, which protectively comes to the surface and makes you tan or freckle. Tanned skin filters out some of the UV rays, but harmful amounts still get through. And over time those cute freckles may turn into liver spots, sun spots, or age spots.
Repeated sun exposure, beginning in childhood, accumulates to break down collagen and elastin, worsening wrinkles and fine lines. Sun exposure also breaks down blood vessels, resulting in spider veins. If you haven't protected your eyes properly, you may also have permanent squint lines.
You might see pink scaley lesions on your skin called actinic keratoses — small, hardened areas of sun-damaged skin that are often precancerous. Since sun exposure is the number one cause of skin cancer, ask your doctor about any peculiar or unexplained blemishes, especially if they grow or change shape.
You have a lot to thank your parents and grandparents for, including your facial bone structure, skin thickness and tone, and pigmentation. These ancestors may have passed along other factors that affect your skin, such as a tendency to gain weight or a medical condition such as hypothyroidism, which often dries out the skin.
Poor Nutrition and Hygeine
Nutrition plays a big role in the condition of your skin. The condition of your skin and hair can testify to this. A poor diet, inadequate fluid intake, and substance abuse are reflected in the appearance of your skin. The longer harmful habits continue, the greater the damage they cause to skin and overall health. Obesity can affect how early and how severely your face loses its youthful firmness. Not only is there more fat to slide into your chin and neck, but every time you lose weight only to gain it back, your skin becomes a bit more slack.
Proper cleansing and moisturizing of the skin is important, also. Too little hygiene is bad for the skin; similarly, over cleansing can remove natural oils, which is damaging to the skin.
Your body is rejuvenated every time you sleep, repairing the physical insults and psychological strains of the day. Tissues need a hiatus during which they, like you, get a new lease on life. Thus, chronic lack of sleep is a key contributor to premature aging.
Illness and Injury
Injuries and skin disorders such as acne and herpes can leave the face scarred and the features uneven. Chronic illnesses and long-term stress rob your skin of nutrients, especially when accompanied by inadequate self-care. Many medications and topical creams can also deplete nutrients, usually by making your skin more sensitive to the sun. The antibiotic tetracycline, the pain-reliever naproxen (Aleve), and skin-smoothing retinoids (such as Retin-A and Renova) are just a few examples of sun-sensitizers, which make you more prone to sunburn and resulting sun-damaged skin.
Use of Facial Muscles
You've heard of laugh lines, frown lines, even smile lines. Smiling and laughing are much more beneficial than harmful to your health, but repeated facial expression eventually can create lines and wrinkles.
Smoking, besides etching vertical wrinkles around your mouth, causes biochemical changes in skin tissues. Cigarette chemicals, when inhaled, constrict small blood vessels so fewer nutrients and less oxygen find their way to skin cells. Smoking also accelerates the aging process and interferes with healing, which is all important after plastic surgery.
Toxins and Irritants
A variety of toxins and irritants can affect the health of your skin. Like excess sunlight and smoking, such things as alcohol and air pollution affect your skin. How so? They stimulate free radicals, which are oxygen molecules that have become unstable. These unstable molecules may then attach to tissues such as collagen in the skin, causing damage. Overtime, this can cause the skin to lose elasticity and become discolored and wrinkled.
Fortunately, the body has defenses, called antioxidants, that fight free radicals. Vitamins C, D, and E are also thought to prevent free radicals from harming tissues. Selenium and green tea are also considered antioxidants.
Is Cosmetic Surgery for You?
If you want to look younger and more radiant, or improve a facial feature you're self-conscious about, you are probably a candidate for facial cosmetic surgery. In fact, most healthy adults could benefit from one or more procedures. Dramatic improvement is possible for men and women in their thirties to their seventies and even eighties, regardless of skin color, skin tone, or bone structure.
The best candidates for facial cosmetic surgery have realistic expectations, are well informed about the procedure, and are in good physical and emotional health.
Attitude and Expectations
Cosmetic surgeons will tell you that your expectations and attitude are the most important qualifications. If you like yourself and you're seeking improvement, not perfection, you'll most likely be pleased with the results of your surgery. Most patients experience enhanced self-confidence and a sense of well-being. Facial rejuvenation can make you look younger, but feeling younger comes only from good health. And although a more youthful appearance can boost your confidence and self-esteem, cosmetic surgery itself cannot make you happy if you are basically unhappy. If you are depressed or your life is a mess, you should probably postpone cosmetic surgery until you feel more stable emotionally.
When Cosmetic Surgery Might Not Be for You
If your goals are realistic, there could be yet other reasons that you are not a good candidate for surgery. Some chronic health conditions may mean that cosmetic surgery should wait. Examples of such health conditions include: uncontrolled high blood pressure; blood disorders, such as excessive bleeding or clotting, or a family history of blood disorders; a history of hypertrophic or keloid scars (types of severe scarring); connective-tissue disorders; heart, lung, kidney, or liver disease; long-term steroid use or use of other drugs (such as Accutane(tm) for acne) that can interfere with healing; endocrine disorders of the thyroid, parathyroid, or adrenal glands; diabetes; osteoporosis or another bone disorder; autoimmune disease, such as lupus or rheumatoid arthritis; and obesity or anorexia.
Overweight patients may need to take off pounds and stabilize their weight before surgery, and smokers will have to quit, at least for several weeks before and after the operation. The surgeon will caution patients with thicker skin that they might scar heavily.
If, in spite of a medical condition, you are committed to having facial plastic surgery, ask your doctor to recommend treatments or regimens that can make you a better candidate and probably a healthier human being as well.
What's the Next Step?
Arrange a consultation with an experienced, well-qualified facial plastic surgeon. Most patients, doctors report, are pleased with the growing range of treatment choices in facial plastic surgery. Many cosmetic surgeons urge prospective patients to become well informed. The best patients, they say, are those who understand how skin damage and wear occur, how cosmetic procedures can help, and why some people are better candidates for surgery than others.CHAPTER 2
CHOOSING A FACIAL COSMETIC SURGEON
Choosing a highly qualified, experienced facial plastic surgeon is the single most important thing you can do to ensure that your surgery is a success. Do your homework to find the right one. Ask for referrals from your family doctor, friends, relatives, your hair stylist, and your cosmetologist; however, don't rely completely on even the warmest recommendation. Learn all you can about the surgeon you're considering. Call the doctor's office and ask questions. Visit the doctor's Web site. Ideally, you would interview everyone you're considering; however, note that most facial plastic surgeons charge a fee for a prospective patient consultation.
The most important qualifications for a facial plastic surgeon are rigorous training, ample experience, board certification, demonstrated excellence, and compatibility. How can you tell if you and a particular doctor are compatible? Trust your instincts, but also try to judge whether he or she will patiently answer all your questions, treat you as an equal, willingly show you patients' before-and-after pictures, and give you names of former patients to contact.
How Much Experience Is Enough?
Almost all the literature talks about choosing a qualified facial plastic surgeon. Sometimes we are urged to ask a surgeon how many years he or she has been doing surgery, or, for example, how many rhinoplasties the surgeon does each year. However, as prospective patients, most of us do not know what the right answer would be. If a surgeon tells you he or she does 20 rhinoplasties a year or 100, which answer indicates proficiency?
There are no hard and fast numbers to go by here; however, you want to make sure that your surgeon has been trained specifically for the procedure you are considering. Ideally, this highly trained surgeon has been in practice for several years and is performing facial plastic surgery on a regular basis. You're probably in good hands if the doctor is performing the procedure you're considering at least several dozen times a year.
Finally, check to see whether the doctor is certified by organizations such as the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) or the American Board of Plastic Surgery. Surgeons must meet rigorous standards in both training and experience to be members of these organizations. Other upstanding organizations — known as "societies," "academies," or "colleges" — are typically involved in educational conferences and other continuing education activities; however, the organizations that are "boards" are the ones involved in certifying surgeons. (The Resources section, toward the end of this book, tells you how to contact these and other helpful organizations.)
When you're in the hands of a well-qualified surgeon, you will almost certainly achieve good or excellent results with very little risk. Still, remember that many cosmetic procedures are relatively new and involve important facial muscles and nerves. Make sure your chosen doctor has performed your intended procedure a great many times and kept up with advances in the field. Also, be aware that in many states any licensed physician can perform cosmetic surgery and legally claim to be a facial plastic surgeon.
It is critical that you do enough research — read books, search the Web, and conduct phone and office interviews, for example — to choose the right facial plastic surgeon.
You'll have at least one and maybe two consultations with your surgeon before your procedure. Whether the doctor is one of several you're considering or is the surgeon you've chosen after doing your research, go to the initial visit well prepared. Educate yourself about facial plastic surgery, particularly about the procedure or procedures that interest you. Be prepared to ask questions during your initial consultation. Some individuals are more comfortable if they take a friend or companion along for the consultation. A companion can help you take notes and be sure you've asked all the pertinent questions.
Determining Your Goals
As you contemplate facial cosmetic surgery, your surgeon may tell you about procedures you didn't realize were available. Or you may learn that the procedure you're considering may not do all you thought it would, and you may benefit more from another procedure.
As you contemplate which procedures would be best for you, keep in mind the three basic ways in which aging affects the face: sagging skin, loss of plumpness, and loss of smooth skin texture. Accordingly, three separate types of procedures are used to reduce these signs of aging. Sagging skin is treated by lifting facial skin and tissue. Loss of plumpness is treated with fillers, whether injectable fillers or implants. Skin texture is rejuvenated with skin resurfacing, either by laser or with chemical peels.
Excerpted from Your Complete Guide to Facial Cosmetic Surgery by Jon Mendelsohn, William Truswell, Kriston Kent. Copyright © 2004 Jon Mendelsohn, M.D.; Kriston Kent, M.D.; and William Truswell, M.D.. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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