I’m a 38 year old mother of three kids. With each pregnancy I noticed increased skin laxity over my belly and thighs. I exercise regularly and eat well but it seems that this excess skin and fat does not go away. I heard about the Tummy tuck procedure as well as the lower body lift. I would like to know the difference between the two procedures and which one would be better for me.
We would not be able to tell you which option would suit you best without examining you in person. Having excess skin and fat following multiple pregnancies or non-pregnancy associated weight loss is a common complaint. Abdominal bulging may be due to residual weakness of the underlying muscles following stretching from excess internal fat or a baby. In addition, not all stretched skin returns to its normal tension, and unwanted fatty deposits may accumulate or persist following pregnancy or weight loss.
Abdominoplasty (tummy tuck) deals mainly with the excess skin and fat in the front of the belly, and is the appropriate procedure in the vast majority of patients who present following pregnancy and without a history of massive weight loss. A tummy tuck consists of undermining the abdominal wall skin and fat, tightening the muscles, cutting away the extra, lower, anterior abdominal tissues and redraping the remaining skin. Liposuction may be used as an adjunctive tool to help sculpt the fat deposits in the flank or thigh areas, or as an isolated procedure if skin excess is not an issue. The lower body lift procedure deals with circumferential excess of fat and skin e.g. belly, thigh, and buttock. The posterior trunk, buttocks and thigh skin does not get stretched in an average pregnancy, and this procedure is usually performed on patients have lost in excess of a hundred pounds with a diet and exercise program, or following gastric bypass or stapling procedures. It is a more extensive procedure but yields good results in patients with excess skin and fat in these areas.
If you have any specific questions about cosmetic procedures, you would be best served to see a qualified plastic surgeon to review your options. At Orange County Plastic Surgery we strive to offer a caring and comfortable environment, combining it with the very latest advances in cosmetic surgery of the face and body. We believe we have created one of the finest cosmetic surgery facilities in all of Southern California. Please feel free to contact our office at 949-888-9700.
I’m a 48 year old female executive. I exercise regularly and I try to eat a healthy diet. In the last few years I noticed the onset of lines around my mouth, my lower eye lids developed bags and my neck now has some laxity. I feel that I’m not ready to have a full facelift yet, maybe in few years. I would like to have something done now that will address some of these changes without the need to do extensive surgery.
Thank you for your inquiry regarding minimally invasive, facial rejuvenation. You describe very typical signs of early aging. The different aspects of the changes you mentioned in your face can be addressed independently.
A full face lift is usually recommended when we have to address significant drooping of the brows, jowls and neck, but lesser degrees of aging can be addressed with a variety of techniques that fall into the category of minimally invasive facial sculpturing. These various techniques address separate components of facial laxity and are custom made for every patient, depending on the degree of facial aging. These techniques may include a combination of eye lid surgery, microfat grafting, chemical peels or laser resurfacing, midface and thread lifts, and a variety of injectibles such as Botox®, Juvederm®, Sculptra®, Voluma® or Radiesse®. A mini facial lift or a neck lift could be included as well. Addition of a chin implant can make a very significant change to a neck line in someone with a congenitally weak chin. The whole operative time is usually one to two hours. The downtime and the healing process are usually shortened when using these techniques compared to a classic face lift. We obviously cannot get too specific without seeing you in person, but based on what you said, hypothetically, the deep lines around the mouth could be addressed with a combination of chemical peels and filler injections. The lower lids could be lifted, injected with microfat grafts or both. The neck could be liposuctioned or plicated depending on the degree of laxity. Or perhaps a midface lift with Gortex threads would address your signs of early aging. You just have to keep in mind that the minor procedures are designed to make minor improvements – significant laxity, wrinkling, and so forth will require more aggressive procedures to provide improvement.
A good way for me to discuss this further is through photographs and I would like you to look at the accompanying pictures of a 35 year old female who chose to have her upper lids improved and neck contoured, all in a procedure that took less than an hour! Individual results may vary. Sometimes a very pleasing change over can be achieved with a relatively simple and minimally invasive procedure! One of the best ways to envision how you would look following such procedures is through the use of computer imaging. If you would like to set up a complimentary computer imaging session, please feel free to contact Orange County Plastic Surgery at 949-888-9700.
Can fat grafting be used to augment a buttocks or breast?
Answer: There are a couple of problems with fat grafting in breast and buttocks areas. I personally do not like to inject breasts because the fat that does not survive can calcify and cause little tiny drops of calcium to show up in your breasts, which will mess up a mammogram 15 or 20 years down the road. In the buttocks, it can be done more safely because you really don't care if you get a micro calcification in your buttocks because it is rarely necessary to X-ray the soft tissue of the buttocks. But the problem that I find from a clinical perspective with women wishing the buttocks injected is that most women who come in for this procedure are really thin, and don't have extra fat that can be used as donor material. When we fat graft lips, we need a tenth of an ounce, a very small amount of fat. Almost all of us have that much extra on us. But if you're trying to enhance a buttocks with fat grafts, you need a couple of cups or even a liter of fat for each side, but most of the very thin ladies who come in and ask for this procedure usually don't have enough donor fat to give up – most of these ladies are better candidates for buttocks implants.
How is a buttocks augmentation done with implants?
A buttocks augmentation is analogous to a breast augmentation, the main difference being in the construction of the implant. Breast implants are filled with either saline solution or silicone gel. Buttocks implants are made of a soft solid silicone implant, similar in texture to a chin implant. The beauty of buttocks and chin soft solid implants is that they do not wear out, break or leak and do not have to be exchanged regularly in the future. The implants are inserted through a vertical incision between the two buttocks cheeks and placed in a pocket, similar to placement of a breast implant in the chest.
How popular are buttocks implants?
I would not say that buttocks implants are very popular in our culture – many more ladies prefer smaller buttocks and are more inclined to inquire about a liposuction of a buttocks area than an enlargement. But some patients certainly do enjoy a fuller back side and this is a good procedure for them!
My upper lids droop over my eyelashes and I would like to have them fixed. I have seen two plastic surgeons, one who agreed that he could help me with my upper lids, another who told me I’d have to have a brow lift as well. My brows are fine with me and I do not understand why a brow lift would be necessary? Why would a surgeon recommend a procedure I did not ask for?
You really should go and have another talk with your plastic surgeons – if one recommended a brow lift, he should have explained why he did so. Rarely would we suggest a procedure about a body part not brought to our attention by a complaint originated by a patient. For example, we would never comment about very large or small breasts if a patient came in to discuss an abdominoplasty (i.e. “tummy tuck”). The two exceptions I can think of relate to chin implants and brow lifts, but in such a situation, I sure would hope that the patient left the consultation with an understanding of why we are recommending the brow lift or chin implant procedures! Patients with weak chins who come in complaining of a large nose or a droopy neck cannot get a great profile without addressing the weak chin because the chin, nose and neck all contribute to the profile. Likewise, if a patient complains of heavy upper eye lids, we have to analyze the balance between the eyelid and brow position. Our duty is to lay out the options for a patient and each person has to choose the procedure(s) that will give them their desired results. In a pure upper eye lid blepharoplasty, the thin skin excess of the lids is removed but the distance from the lashes to the brows is not changed. In patients with low brows, removing the thin, excess upper lid skin may not be appreciated unless the thicker tissues just below the brows are raised as well. This is not to say that every low brow must be raised when doing an upper lid procedure, but the patient has to understand that only the thin, upper lid skin excess will be removed, that the thicker brow hooding will be unchanged, and that the distance between the brows and lashes does not change with an isolated blepharoplasty. If a patient desires a more open – eyed look, this will only be accomplished if a brow lift is added to the eye lid procedure. Not only will the eye area look more open following a brow lift, but during a brow lift, the frown lines between the brows will be minimized because we can remove some of the muscles that cause these frown lines, called the corrugator and procerus muscles. And finally, occasionally I’ll see a patient with hooding caused by low brows who thinks they would like an upper eyelid blepharoplasty, but when I gently elevate the brows, I can see that this patient does not have an excess of thin, upper lid skin, just low malpositioning of the brows and I will recommend to this patient that a brow lift be performed without a lid procedure per say.
A brow lift is a minimally invasive procedure. In the endoscopic brow lift, a few half inch incisions are made behind the hair line, allowing the instruments to be inserted. The tissues are freed from the bone, the muscles sculpted, and the brows raised a few millimeters. The brows are fixed in their new position with a variety of devices. The incisions are rarely perceptible after healing has taken place. Occasionally, a brow lift will be performed as an isolated procedure, but more commonly it will be combined with a minimally invasive midface or thread lift, an eyelid procedure or a standard face lift. If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options.
What is micro fat grafting?
Answer: Micro fat grafting implies that the pieces that we are transplanting are very tiny in nature and have suitable blood vessels attached to them to allow the fat to revascularize and continue living. If you take a big blob of fat and move it to a different location, it probably won't survive because sufficient blood vessels will not be able to grow into it to keep it alive. By slicing a larger piece of fat into tiny little pieces like porridge, those tiny fragments will have a good chance of revascularizing and surviving the transfer.
What areas are most the most commonly recipient sites for micro fat grafts?
In my practice, most common areas where I inject micro-fat grafts are the cheeks, nasolabial folds, marionette lines and lips, and I usually do these injections in conjunction with a facelift. Other commonly grafted areas are the tops of the hands, because as in the face, as we age, our hands tend to lose fat, look sinewy and show veins more. You can also see brown spots on your hands as you age, but micro-fat grafting does not change the brown spots. Young people have a little layer of fat over the tops of the hands and this masks the veins and tendons. Micro fat grafting will fill up the hand a little bit so the tendons and the veins no longer show as much.
Which areas are used most often as donor sites for fat grafts?
I’d have to say that the most common site is the abdominal wall. But fat can be taken from any area where there is an excess. Examples aside from the belly include the neck, hips and thighs. If at all possible, it is nice for the surgeon to be able to harvest and inject the fat in the same surgical field without having to move the patient. For example, it is a lot easier to aspirate some fat from the tummy and to inject it into the lips or cheeks, instead of turning the patient over to aspirate from the back side, then turning the patient back and re prepping the skin and putting on new drapes before injecting a face.
I’m a 48 year old female, am fit and look pretty good for my age. I have worn sun blocks daily for the last few years but I did sit out in the sun a lot when I was younger. My neck is not drooping yet but I am getting many fine lines on my face. I have heard a lot about lasers but am confused as to which treatment would be best for me.
It would be impossible to tell you which treatment would be most beneficial to you without being able to see you in person and to learn your expectations. We offer a wide variety of lasers and peels to provide our patients with a complete solution for your skin condition. A different laser is used for removing hair and reducing enlarged blood vessels but it sounds like you’d be most interested in skin resurfacing. A facelift or blepharoplasty alone cannot remove wrinkles and are especially inadequate for the fine wrinkles around the mouth, eyes and forehead. The chemical peel and laser skin resurfacing procedures were devised to minimize these surface irregularities. The key word here is minimize (not eliminate), as none of these procedures can remove all of the lines, marks or surface discolorations. Also, it should be noted that such procedures are not appropriate for people who are sun tanned, continue to tan, who have darker skin tone, etc. The fall and winter are ideal times to have a laser resurfacing procedure. Minor skin resurfacing procedures can be done in the office without anesthesia, but more major resurfacings will be performed at a Surgery Center under sedation. These procedures remove the outer, scarred or sun damaged skin, attempting to leave the patient with a smoother and more youthful appearance. The chemical peel procedure consists of the application of an acid mixture to the skin, which creates a chemical burn. In the newer methods of laser skin resurfacing, various lasers can be employed to vaporize the outer layer of skin and induce a tightening of the remaining skin. The lasers tend to give the surgeon more precise control of the treatment depth and are the preferred method today in most instances. In patients with excessive wrinkling or scarring, a repeat procedure may be desirable, but complete obliteration of all lines, wrinkles and, in particular, acne marks will not be possible in any patient. Your surgeon will discuss with you the numerous options regarding treatment of wrinkles and other signs of aging. Generally, your surgeon will recommend the simplest methods that might give you the desired result. The IPL® (Intense Pulse Light), lighter laser or lighter peel procedures can be performed with little or no down time. However, the improvement will not be very dramatic and frequently, a series of treatments will be recommended. If your lines are deeper or a more significant improvement is desired, a deeper laser (like a fractional or CO2) and deeper peel procedure may be recommended. If you have questions about your skin your best bet would be to come in to see Dr. Bunkis for a complimentary consultation.
I have heard about the new mid facelifts. How do these differ from a standard facelift, and which procedure is better?
Mid facelifts are relatively new but we have been doing them for 10-15 years. Both types of facelift procedures are designed to turn back the hands of time but both address different aspects of the aging process. A standard facelift is still the ideal procedure to tighten a loose neck and to help with jowls. You are correct in saying that the mid facelifts are relatively new procedures, but they address an age old problem – drooping and hollowing of the cheek areas below the lower eyelids – creating a so called “tear trough” deformity. These mid facelifts can be done as an isolated procedure to freshen a face in the late 30’s or 40’s that is showing the earliest signs of aging – or combined with a traditional facelift in an older person – or as an isolated procedure in an older patient who has had a traditional facelift but the midface was not addressed. One of the beauties of a mid facelift is that is can be done through short incisions that are hidden behind the hair line and through a tiny stab wound in the fold between the cheek and the upper lip, just large enough to let us insert a few very long needles, which heals without a visible scar. The mid face lift will not alter your jowls or neck laxity, so if these are an issue, a traditional face and neck lift will also have to be performed to achieve optimal rejuvenation.
Facial rejuvenation is at the top of the list of the most common aesthetic surgical procedures performed here at Orange County Plastic Surgery. Most people feel physically and mentally vigorous and energetic long after their appearance has begun to deteriorate due to aging. A face, neck, brow or mid-face lift procedure is designed to provide you with a rejuvenated appearance. The degree of improvement achieved depends on the severity of the initial deformity, the age of the patient, tissue elasticity and the recommended procedure.
I want to get my boobs done – are breast implants safe?
Fashion may be fickle but women have been coveting fuller breasts for years. If you are considering a breast augmentation, or any surgical procedure, you have to understand that there are risks, as there are with any activity in life, but the trick is to keep the risks manageable. I’ll give you a little history of breast augmentation and review some of the refinements that have taken place to make this operation safe in the vast majority of instances.
Prior to 1960, many attempts at breast enlargement with large globs of patient’s fat, various sponges and liquid silicone injections caused many disasters and few, if any, natural feeling or looking breasts. The modern era of breast implantation began in the early 1960’s with the introduction of silicone gel implants. Silicone is a chemical element that occurs in combination as the most abundant element next to oxygen in the earth's crust and is used for many things in the medical and electronics fields. The original implants frequently ruptured. Another problem with early implantation attempts was the development of capsular contractures – an unnatural firmness of the breasts. Every type of implant inserted into the human body develops a thin layer of scar tissue around the implant, and even the softest, most natural feeling breasts have this layer of scar tissue surrounding the implants. With a breast implant, the idea is to create a large pocket under the breast tissue and to put an implant in the space which is significantly smaller than the confines of the space, allowing the implant to move and the breast to feel natural. Two factors can cause the breast to feel unnaturally firm: first of all, if too large an implant has been chosen for any given patient and the implant does not have room to move around, the breast does not have a chance to feel normal and will feel hard; and secondly, if an appropriate pocket was originally created for a given implant but the scar tissue contracts, shrinks down, the implant again will not have room to move and the breast will feel hard as well. Saline implants were introduced to counter these problems but were found to be less satisfactory because the saline filled bags just did not feel as good as a silicone implant in the average patient, and the contracture problems occurred anyway, thus proving that it was not the presence of silicone per say that caused the contracture. In the early days of breast augmentation, some saline implants had steroids placed within the implants in an attempt to control the scar tissue build up (and it did) but in some cases, the steroid caused tissue thinning and erosion of the implants through the skin, leading to removal of the implant – thus, that practice was abaondoned. Early implant patients also had a significant infection rate but by the 1980’s, most of these problems were solved, all patients given antibiotics for example, and very few patients today experience an infection.
Refinements in implant materials and surgical techniques lead to improving results throughout the 1980’s, and continued popularity of such implants. In the early 1990’s, a Connie Chung television show raised doubt regarding safety of breast implants, bringing to light that many patients were now walking around with ruptured breast implants and questioning whether breast implant patients had a higher likelihood of developing autoimmune diseases such as arthritis or lupus. Much publicity ensued and the safety of implants was reviewed by the FDA as well as other regulatory health agencies world wide. Most issued rulings that the safety of silicone breast implants had to be studied further and such implants were removed from the market. Hundreds of scientific studies were carried out, some retrospective, looking at the history of previously performed cases. Others were prospective, studying patients after new implants were inserted in carefully monitored situations. These prospective studies were set up by the major implant manufacturers in the United States, under the auspices of the FDA, and all data was presented to the FDA. I was chosen to be one of the investigators in these studies and was able to have access to silicone implants during the years that they were not available to non-investigators. After carefully studying all the data from these studies and other studies worldwide, the FDA concluded that silicone implants do not increase the incidence of any other diseases. We now know that all implants, whether gel or saline filled, will rupture eventually but the important thing to know is that with current implants and early detection, there is little likelihood of harm to the patient following a rupture of either saline or gel filled implants. In November of 2006, silicone gel implants were reapproved by the FDA for breast augmentation in the United States and this created a flurry of interest in breast augmentation with gel implants. More and more women opt for breast augmentation each year. 212,500 breast augmentations were performed in the year 2000 but the number had increased to 291,350 by 2005, a 37% increase, and in spite or our current weak economy, this number just continues to grow!
Today’s implants have two major changes compared to implants used prior to 1990.
The gel that was used in the 1960’s through the 1980’s was a thick, gooey liquid. The gel in implants today is “cohesive”, the consistency of a marshmallow – when cut in half, these implants stay in one piece and do not “leak”. Secondly, today’s implants contain thicker and more durable shells. And finally, surgical techniques, antibiotics and anesthetic agents have improved greatly since the early days of breast implantation, making the procedure a very safe one with low surgical risks. Incisions now are much shorter and more hidden, a variety of different approaches, including entry through the arm pit or nipple area, have been developed and placement of the implants above or beneath the pectoralis major muscle has been perfected.
Some patients today still choose a saline implant but most of these do not feel as natural as the average breast containing a silicone gel implant. Breast implant surgery is obviously very elective and prospective patients should not be in a hurry to make a decision before they have truly been educated regarding the various aspects of breast implantation surgery. The proper thing to do at this time is to go over all the indications, alternatives and risks and provide each patient with the pros and cons of all available implants types and to let them participate in the implant choice. But once my patients have had a full consultation, including an opportunity to see or feel both types of implants, most today choose a gel implant for themselves.
If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options.
What is the Natural Facelift?
In my last article, I mentioned that I had the pleasure of teaching at the Riga Stradins University in Latvia last week, where I was asked to perform two facial rejuvenation procedures, to give two talks on facial rejuvenation, and to review a video of the facial procedures I had performed to an audience at a Latvian Association of Plastic Surgeons meeting. This will be a brief summary of the introduction to my first presentation outlining the history of aesthetic facial surgery.
No one knows who performed the first facelift procedure, but they were being performed by a few German surgeons and the rare surgeon in the USA by 1910. These procedures were associated with much secrecy for a number of reasons. First of all, there was much public distain for surgery performed for vanity reasons, both by the general public as a whole and by the well known surgeons of the day. The top academic plastic surgeons, as late as the 1980’s, frequently published numerous articles about reconstructive surgery yet rarely published articles on aesthetic surgery – yet these same surgeons not infrequently performed aesthetic procedures to supplement their income. These same academic surgeons were less than complimentary of surgeons who chose to pursue a career doing solely aesthetic surgery. In the early 1990’s, there was also a secretive attitude by aesthetic surgeons – in part because of a desire to avoid the wrath of plastic surgery leaders, but also in an effort to keep their surgical techniques a secret from other surgeons! This combination of factors caused aesthetic procedures to be performed in private nursing homes and clinics, far from the eyes of peers or young plastic surgeons trying to learn the trade. Relatively few articles appeared in the plastic surgery literature about facelift surgery prior to the 1970’s. From a technical point of view, a rather primitive, skin only procedure was performed by most surgeons until the mid 1970’s. At that time, a very forward thinking Swedish plastic surgeon, Tord Skoog, analyzed the aging face and came up with the understanding that the main culprit in sagging facial tissues was a drooping of underlying muscles and deeper tissues – he came up with the idea of lifting these underlying muscles in an effort to produce a more long lasting and more natural facelift procedure. Unfortunately, Dr. Skoog did not live long after this ground breaking article and did not get to see how he revolutionized the field of facial rejuvenation.
In the last 35 years, there has been an explosion of articles and text books on facial aesthetic surgery and many top plastic surgeons openly have decided to pursue careers in aesthetic surgery, and aesthetic surgery is being openly taught in university centers to plastic surgery residents. Today, a plethora of techniques exist to address the aging face ranging from mini-lifts such as the “Life Style Lift” to skin only facelifts and a variety of deeper plane procedures which address the underlying sagging muscles. Interestingly, most of the procedures can produce a significant improvement in facial improvement but they vary greatly in longevity of the results. Yes, a lot depends on patient expectations, but most of my patients do expect a longer lasting result and a natural appearance, and this can only be achieved if the underlying muscles are lifted and repositioned where they were in youth. With so called mini-lifts or Life Style lifts, a small area is undermined around the ear and the skin pulled back for a very temporary improvement but the muscle sagging is not addressed – we see many patients who have chosen these lesser procedures and are in to see us a year later because the jowls have recurred or the neck laxity has returned, understandably so as the sagging muscles causing these issues have not been repaired. In order to achieve a long lasting and natural appearing facelift, we believe that is necessary to elevate the skin, replace the muscles where they were in youth, and to resect excess skin, but NOT to pull the skin tight. Young people do not have sagging muscles, but they do not have tight skin!
I WOULD LIKE TO HAVE MY NECK TIGHTENED AND JOWLS REDUCED BUT AM ONLY 42 YEARS OLD AND DO NOT FEEL THAT I AM READY FOR A REGULAR FACE LIFT YET. WHAT ARE MY OTHER OPTIONS?
Answer: I obviously cannot tell you what your options are without seeing you in person and having you show me your areas of concern in a mirror! Aesthetic treatments and surgical procedures are ALWAYS optional but it will be difficult to weigh your options without seeing a cosmetic surgery specialist. In general, however, your first option would obviously be to wait before you have any surgery. During this time, you might be able to enhance your appearance with good skin care and perhaps some of the filler injections or Botox® treatments – many patients buy themselves years with such treatments before they again consider a surgical option. And whether you wait to have surgery or decide to do a lesser procedure now, please remember to use sun blocks daily and to see an aesthetician to set up a good skin care program for yourself – we would be happy to help you set up an appointment with our skin care department.
I have operated on patients in their late 30’s who were good candidates for a facelift, but those instances have been few and far between, and usually with extenuating circumstances such as severely stretched skin from obesity and subsequent weight loss. You are correct in feeling that younger patients with early signs of aging usually are not candidates for a full face lift. Such patients can frequently be helped quite considerably with one of the newer minimal incision techniques including neck liposculpting, tightening the neck muscles through small incisions just beneath the chin and perhaps the ear, endoscopic forehead lifts, or some of the modern midface lifts that are performed through hidden incision inside the mouth and behind the hairline. Perhaps a series of one of the nonablative laser treatments or intense pulse light (“IPL”) treatments will remove surface blemishes and tighten the skin sufficiently to buy you some time. A lot of the decision making depends on your expectations as well and the degree of laxity you have. But to tell you the truth, as I stated earlier, I could not begin to tell you what your best option would be without evaluating you in person. Please call us at (949) 888-9700 and ask the staff to arrange a complimentary consultation for you and I will be happy to give you my best opinion as to your options.
I’m a 48 year old male and look pretty good for my age. But my neck is starting to sag under my chin. I am trying to educate myself about plastic surgery but most of the TV shows talk about females having plastic surgery. Is there anything a man can do to improve the appearance of his neck?
Plastic surgery is becoming more and more common among men but women still do make up the majority of patients in most plastic surgery offices. We have been doing plastic surgery for 30 years and must say that the popularity of such procedures, in both men and women, is at an all time high. People watch plastic surgery procedures on television, read about them in everyday magazines and feel free to discuss their personal wish lists with friends. In both men and women, during these challenging economic times, comes another incentive to proceed with facial rejuvenation, the desire to appear more youthful and desirable in the work force! When we first began in this field, it was unusual for patients to be so free with their questions or to share their experiences with their friends so readily after surgery. This openness and the availability of vast quantities of information about plastic surgery on the internet have lead to much better informed patients, and fueled both males and females with a desire to look better. In our personal experience, 30 years ago men constituted less than 10 per cent of our practice but today, this number has easily passed 20 per cent. Almost an equal number of men as women seek consultations regarding nasal surgery. Men frequently request information regarding eyelid surgery and facial rejuvenation. And as you mentioned, one of the most common complaints heard from men is a desire to remove laxity for the neck, often so that a shirt collar is more comfortable or a neck profile could be more pleasing. The desire for liposuction is also popular in both sexes but the areas men request suctioned differs from female patients. Most men have concerns in the abdominal, love handle or chest regions, while the most common area of concern in females is the hip and thigh area. In a nutshell, neither men nor women enjoy looking older or flabbier – those of both sexes who do not like what they see in a mirror feel free to call us. Here is an example of a 56 year old male patient who elected to have his neck recontoured and a chin implant inserted to better balance his profile. If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis.
What are the common ancillary procedures when doing a facelift?
An ancillary procedure is something that you do at the time of another procedure, and a good example would be the other smaller procedures we do at the time of a facelift (and I do more facelifts than anything in my practice). Examples include microfat grafting, chin augmentation, eyelid surgery or brow lifts. When we do a facelift, we will very frequently harvest and transfer a little bit of fat into areas from areas where an excess has built up to where fat has been lost. If you look at most normal, thin people as they age, their faces become thinner, and you restore a more youthful look by adding some fat to the cheeks, to the Marionette lines or nasolabial folds, and also to lips. Especially in females, if lips get thinner, the lady will look older. Adding some fat to the lips will restore a more youthful look.
For me, by far, the most common ancillary procedure during a facelift is microfat grafting, especially to the cheek areas to restore the ‘V’ look of youth with the fullness over the cheeks instead of the deflated tire “A” look with heaviness down in the jowl area. Well, the second most common area would be the nasolabial folds, the marionette lines and the lips. But if you ask what the second most common ancillary procedure is besides fat grafting, I'd say eyelid surgery and brow surgery. If you define a facelift and you're talking basically about the jowls and the cheeks, you're not addressing the eyes, but a lot of folks who come in to have their faces done have baggy eyes or lose skin around their lids or have low brows. Not addressing these issues at the time of a facelift is analogous to painting half of your room or remodeling and leaving one wall unpainted when remodeling the house – when you are done, all you will be able to focus on is the unpainted portion. Likewise when doing a facelift, if you leave baggy eyelids undone, most people will fixate on the eyelids after surgery until they come back to have them addressed. The ancillary procedures are designed to balance the final result.