Rejuvenation FAQs
How does Dr. Khosh rejuvenate the eyes?
Rejuvenation around the eyes (periorbital rejuvenation) is one of the most commonly requested facial rejuvenation procedures. Studies have shown that during normal social encounter, about 99% of time is spent looking at the other's eyes. Periorbital rejuvenation, therefore, has a large impact on ones appearance.In the upper eyelids, typically there is redundancy of the skin, which causes hooding and in severe cases obstruction to vision. In these cases, Dr. Khosh advises removing a small amount of skin to resolve the hooding that to be seen in the upper eyelid. When clinical examination shows descent or lowering of the eyebrow, a browlift procedure would also be recommended. This technique performed endoscopically will help to restore the normal position of the eyebrow along the orbital rim. The brow elevation will also have a rejuvenative effect on the upper eyelid proper.
In the lower eyelids, the main concern is protruding fat. In certain patients that appearance is made worse by descent of the fat in the cheek and by prominent appearance of the bony lower orbital rim. In older patients, redundancy of the lower eyelid skin and fine wrinkly appearance (crappiness of the skin) is also undesirable. Once Dr. Khosh has consulted with you he can determine which component is playing a role in the aged appearance of the lower eyelid. Treatment would thereafter include a combination of fat removal either through the inside of the eyelid skin or externally, pinching of the skin or laser treatment of the skin to remove crappiness, and potentially addition of fat to the orbital rim in order to minimize the skeletonized appearance of the orbital rim.
Overall, the intent of the surgery is to restore a more youthful and refreshed youth. It is therefore beneficial to Dr. Khosh to view some old photographs, which could provide a template or a working model to work towards.
What is the role of brow lifting (forehead lifting)?
Brow lifting is considered when the brow shows significant descent. In general, the position of the brow is different in men than in women. In men, the brow is more straight or flat across whereas in women it tends to have a gentle arch towards the lateral aspect of the orbit. Dr. Khosh is keenly aware that the position of the brow is highly individualized and as such old photographs should be studied to determine your brow position prior to surgical planning. Most importantly, the shape of a surprised or highly arched brow should be avoided since this is a telltale sign of "done eyebrows."
Dr. Khosh utilizes the endoscopic brow lifting technique because of reduced risks of bleeding, infection, scar formation, hair loss, and diminished sensation.
In certain individuals, brow lifting may not be necessary and instead fat grafting to the brow can be utilized to achieve a more youthful appearance to the upper one third of the face.
What is recovery for cosmetic eyelid enhancement?
Typically, some bruising ensues following eyelid rejuvenation. This bruising is dissipated after 10-14 days. When skin sutures are present, they are removed at 5-6 days following surgery. The patients may apply makeup following removal of the sutures. Eyelid surgery is usually not painful and patients do not require pain medication on following first day.
How does Dr. Khosh rejuvenate my cheek area?
The preferred method of cheek rejuvenation by Dr. Khosh is fat transfer. As a part of normal aging, one loses volume in the facial soft tissues. This aged look is further exacerbated by some descent of fat from around the lower eyes and the cheek. Addition of fat to the cheek area helps to restore a more youthful fuller face while it diminishes the skeletonized appearance of the orbit. Dr. Khosh does not ascribe to cheek implants as he finds the appearance of a cheek implant to be unnatural.
What is Dr. Khosh's facelift technique?
Facelift surgery has evolved significantly since its inception. Initially, facelift surgery included pulling of the skin of the face back towards the ears without providing support of the deeper tissues. As such, face lifting resulted in short-term benefit and had the consequence of causing the patient to look pulled or "windswept." Subsequently, newer techniques such as SMAS technique, which afforded stability to facelift and prolonged surgical results. Other procedures such as subperiosteal face lifting or deep plane facelift, also been described. Dr. Khosh's preferred method of face lifting is the SMAS technique.
He strategically pulls the SMAS (the fibrous sheet of tissue deep to skin) backward and upward to provide a natural lift to the facial structures. Dr. Khosh does not perform subperiosteal facelifts as this technique of facelifting entails additional risk without significant improvement in the immediate or the long-term results from facelift surgery.
What is the recovery for facelift surgery?
Facelift surgery usually results in bruising, which lasts close to 14 days and typically there are sutures present in front of the ear and within the ear, which are removed after five to seven days. Should there be any sutures behind the ear or in the scalp, those are left for 10-12 days. Because of gravity, the bruising in the lower neck is the last area to resolve.
Patients may experience some slight numbness around the incision sites in the face. This resolves over the ensuing several weeks. Understandably, there is swelling following surgery, which although improved at two weeks and may take several weeks before it resolved completely. Patients may feel tightness in the neck, which is due not only to tightening of the skin but also due to swelling of the face and the neck. The surgery outcome therefore is not clearly noticeable up to six to eight weeks following facelift surgery.
Could I have only liposuction of the neck instead of a facelift?
Dr. Khosh performs isolated neck liposuction only in the younger individuals. Skin quality plays an integral role in distinguishing which patients are candidates for neck liposuction alone. In older patients which lack skin resilience, removal of fat can lead to redundant appearance of neck skin. In the younger individuals, however, removal of isolated fat deposits will help to restore the neck and create more youthful neckline.
What is the recovery for neck liposuction?
Neck liposuction when performed in isolation has a short recovery. Patients may experience some mild bruising, which could last up to 10 days. Most patients do not require pain medicine after second day. The final results of the neck liposuction may take several weeks to be fully realized.
What is fat grafting?
Fat grafting, fat transfer, or autologous fat transfer is a means of restoring lost volume and fullness to the face. There are two major objectives when undertaking facial fat grafting: framing the eyes and creating a more youthful shape to the face. Framing the eyes means supporting the hollowed and deflated eyes and cheeks that occurs with aging. In youth, the face has a more heart shape or triangular shape, especially in females. As one ages; however, one loses that fullness in the upper face, which although subtle, has an impact in the overall perception of youth. Fat transfer helps restore a youthful shape to the face.
Since facial aging is a combination of skin changes, loss of volume, and descent of soft tissues and fat, ideal facial rejuvenation should be aimed at restoring of volume by fat grafting, and other rejuvenative procedures such as face lifting and blepharoplasty in combination with skin rejuvenation procedures such as laser treatments.
What is the recovery after facial fat grafting?
Although facial fat grafting does not require any incisions or bandages, there will be recovery time necessary. Typically, the first week following the procedure, there is swelling, which appears significant. The second week after fat grafting, swelling will subside to a significant degree. At the end of the second week, majority of patients can return to their daily work and social activities. In general, the final result can take upwards of several weeks to notice. Fat grafting in the long term can have other beneficial effects such as improvement of the skin color and texture. These improvements are not noted for upwards of six months.
What will happen if I gain or lose weight after facial fat grafting?
Generally speaking, gaining or losing approximately 20 pounds or so will not make difference in your fat in most cases. However, patients who are grossly overweight or those who have wildly fluctuating weight may not be ideal candidates for fat grafting. Discussing these concerns with Dr. Khosh will help you decide what your best options are.
Where does Dr. Khosh perform his procedures, and what kind of anesthesia or sedation does he use?
All facial rejuvenation procedures are performed under general anesthesia or deep sedation in an outpatient surgical facility with board certified anesthesiologists. Dr. Khosh believes strongly that safety is the number one concern when performing elective cosmetic procedures.
