Facial Rejuvenation:
Facial rejuvenation refers to various procedures that can enliven and revitalize the face. Our current understanding of facial aging has evolved. We now know that facial aging is a compilation of several factors including: changes in skin color and elasticity, sagging of skin and muscle, and loss of fat and bone. Facial rejuvenation, therefore, involves restoring skin color and texture, repositioning of sagging tissues, and restoring lost volume. Historically, facial rejuvenation only involved repositioning of the sagging tissues through procedures such as face and neck lift, forehead lift, and eyelid surgery (blepharoplasty). That historic approach has now been complimented with procedures to rejuvenate the skin (laser skin treatments, Botox injections), and remedies to restore lost volume (fat transfer/fat injections, filler injections, and implants).
Dr. Khosh firmly believes that the key to successful facial rejuvenation is correct diagnosis of specific factors that contribute to an aged appearance in each individual. Thus, he can formulate an individualized treatment plan for each patient. Equally important, is the realization that successful facial rejuvenation is synonymous with natural appearing results. Dr. Khosh is focused on providing the most natural look for each patient.
In the following sections, we will discuss various facial rejuvenation procedures. During the consultation meeting, you will have the opportunity to discuss Dr. Khosh's recommended procedures for you. After a thorough discussion, you can arrive at a decision regarding those recommendations and their timing.
Eyelid Surgery (Blepharoplasty):
The eyelids are one of the first facial features to show signs of aging. Sagging upper eyelids or puffy lower eyelids can belie a more youthful and energetic personality. Blepharoplasty is a relatively simple procedure, which can restore vitality to the eyes. Dr. Khosh utilizes perfectly hidden incisions to remove saggy upper eyelid skin. He often places the lower eyelid incisions inside the lid and thus avoids any scars. Swelling or bruising resolves by about ten days, and most patients return to a full schedule within two weeks. Dr. Khosh offers other procedures such as Botox treatments, laser skin resurfacing, and fat grafting to compliment the results from blepharoplasty.
Face Lift (Rhytidoplasty):
Facelift surgery has evolved significantly in the past twenty years. There are now several technical variations of the facelift operation. They include: SMAS face lift, deep plane face lift, sub-periosteal face lift, sub-cutaneous face lift, and Short Scar face lift. Subcutaneous face lifting is the oldest variation of this operation. Due to the short lived duration of results, this form of face lifting is not commonly practiced. The SMAS lift is the most common technique for the face lifting. In SMAS face lift, the deeper tissue layer under the skin is tightened, as well as the skin. This face lift technique results in reliable and long lived rejuvenation of the face. The deep plane face lift and the sub-periosteal face lift attempt to improve upon the SMAS lift by extending the scope of dissection. These two methods of face lift surgery entail slightly higher risk, and more porlonged recovery. The Short scar face lift represents a shift towards less extensive surgery. The surgical dissection and the incisions are more limited. The Short scar face lift is more appropriate for younger patients with less skin redundancy.
Irrespective of the surgical technique, Dr. Khosh believes that in the face lift operation, a “pulled” or “wind swept” look indicates a poor outcome. In most cases, Dr. Khosh prefers the SMAS technique to maximize the longevity of the results, while allowing skin incisions to heal without tension. In younger individuals with less skin redundancy, he advocated the Short scar face lift. In every case, excess fat from the neck is removed. All Incisions are totally hidden within the ear or behind the ear.
The most notable change after a facelift operation is the improvement in the neck and jowl line. Patients often note looking ten or fifteen years younger. The rejuvenated visage helps patients improve their self-confidence. Additional procedures such as Botox injection, blepharoplasty, laser skin resurfacing, and fat transfer can be combined with facelift surgery to further enhance the results.
Forehead lift, Brow lift:
A descending brow can impart a tired or heavy appearance to the upper face. Dr Khosh uses the endoscopic technique for repositioning the brow in a natural and pleasing way. This method minimizes the past risks of hair loss, numbness, long scars, and shortens the recovery significantly. Position of the brow impacts the shape of the upper eyelids, and brow lifting can be a critical part of complete upper eyelid rejuvenation.
Neck Liposuction:
Neck liposuction is a routine step in a facelift operation. In younger patients who don’t need a facelift, a “double chin” or a “full neck” can be successfully treated with an isolated neck liposuction. Dr Khosh can remove the offending fat through a small incision under the chin. In some patients Dr Khosh suggests a chin implant to augment the results of neck liposuction.
Fat Transfer, Fat Injection / Lipostructure:
With aging, loss of fat from the face results in a sunken, hollow appearance. Fat transfer is now accepted as a large component in comprehensive facial rejuvenation. In particular, fat transfer can be used to enhance the appearance of the cheeks, brow, and the orbital regions.
Using very small incisions, fat is harvested from the abdomen or thighs. It is then carefully injected in tiny aliquots into the face. Fat transfer has been noted not only to improve facial contours, but it also skin’s quality and texture. Frequently, fat transfer is combined with other procedures such as neck liposuction, facelift, and eyelid surgery for a natural overall result.
