Skin Rejuvenation

EYES

(1) EYE BAGS: A result of the aging process, they are caused by a two-in-one decline: the skin loses its elasticity and stretches; and globules of fat herniated through the weakened layer of tissue. This causes the puffiness in the upper and lower lids that we call ‘ bags’.

Solution

A cosmetic procedure known as blepharoplasty, in which the surgeon cuts away the excess of loose skin and the protruding fat then sutures the eyelid, making it taut and smooth again.

The scars get hidden in the natural folds of the eyelids.

In the younger patient who does not have too much skin laxity, and whose problem is limited to a protrusion of fat, the surgeon may go through the conjunctiva (membrane) of the eye, pick out the fat and put in a couple of stitches. This procedure (known as conjunctival blepharoplasty) can be done only for the lower lids.

Cautions/Risks

This is surgery that calls for finesse and delicate precision. The lower eyelids are particularly vulnerable to a heavy-handed approach: removing too much skin can result in a tension in this area that makes it difficult for the eye to adjust to the upward gaze.

(2) CROWS’ FEET

Solutions

• Injections of collagen (a synthetic version of the protein that gives skin its elasticity) can be used as “line fillers” which smoothes and even out the area.
• Where the lines are several and deep, the surgeon can cut away a slice of skin and suture the cut margins, which again has a smoothening effect in the area; the scar is hidden in one of the creases of skin around each eye.

(3) HOLLOW UNDER THE EYES

Solutions

(4) DARK CIRCLES

Solutions

They cannot be eliminated, but in older skin that are wrinkled and loose, they can be minimized: The surgeon stretches and cuts off the excess skin. The skin under the eyes becomes smoother and the dark area smaller in size.

(5) DROOPING EYEBROWS

Solutions

There are two possible treatments:

The first is the so-called “eyebrow lift”. The surgeon makes a small incision just above the eyebrow, cuts away an ellipse of skin and sutures the cut area, pulling the eyebrow higher up. The scar gets hidden in the eyebrow line.

The second approach is to lift the eyebrows as part of another procedure, the “forehead lift“.

EARS

(1) BAT EARS

This is a frequently-seen familial tendency, characterized by a large, deep conchal bowl that pushes the ear out from the head at an exaggerated angle.

Solution

Surgery which places permanent sutures in the back of the ear, literally pinning them back to the head.

The scars are generally hidden behind the ears.

Cautions/Risks

• The surgery can sometimes result in an asymmetrical look in the two ears. The distortion may be minimal and evident only on close inspection; but if it is very obvious, repeat surgery may be required to correct it.
• The final look can also sometimes be compromised by the collection of blood or fluid between the skin and cartilage. The possibility can be largely minimized by ensuring that the post-operative dressings are carefully maintained.

(2) FLOPPY EARS

This is an inherited deformity in which the hard outer rim of the ear has not properly formed. As a result, the top of the ear flops down like that of a rabbit-hence the alternative name for this aberration: “lop-ear deformity”.

Solution

Surgery involves creating a fold in the cartilage of the upper ear which will keep it propped up; this is done by putting in (permanent) stitches in this cartilage and tying them up.

(3) ENLARGED, DROOPING EARLOBES

These are a consequence of the natural aging process.

Solution

The excess can be trimmed, and a stitch or two can pull back lobes that may have jutted outward.

THE NOSE

(1) PROBLEM OF EXCESS IN THE NASAL REGION, INCLUDING:

• A hump, caused by an excess of bone
• A bulbous nose, caused by and excess of cartilage
• Flaring nostrils, caused by very thin cartilage
• Rounded nostrils (rather than the ideal: pear-shaped nostrils), caused by an excess of cartilage in the lower, lateral region.

Solution

Nasal surgery (known as rhinoplasty) can trim the excess and then mould the nose into its final shape.

It can take from 1 to 2 hours and is done under local anesthesia combined with sedation, or under general anesthesia in the case of a highly-strung patient.

The surgery is carried out within the nasal cavity and/or the mouth so that scars are not visible.

Cautions/Risks

• It is inadvisable to have nasal surgery done (unless the deformity is life-threatening or psychologically traumatizing) until the age of 16 or 17. This is when the nose has grown into its final shape. Carrying out surgery before this age may make it necessary to re-operate later because the shape of the nose will have altered again in the intervening years.
• Infrequent complications (of all nasal surgery) include:

          —-Haemorrhage, which is easily treatable

—-Infection, which is rare, occurring only if operating conditions are less than optimal or if the surgeon has not carefully “cleaned up” the area before surgery.

—-Poor healing, which generally cannot be predicted in advance. Dark skins are however more prone to scarring; and those with circulatory problems are likely to suffer from temporary or lasting discoloration.

(2) PROBLEM OF DEFICIENCY IN THE NASAL AREA, INCLUDING

• A bridge that’s too short
• A nose tip that’s too blunt

Solutions

A short bridge calls for the addition of something that’s solid and possesses strength-either bone from a hip or rib or a hard silastic implant.

If the tip (which is composed of cartilage) is small, you need to add something pliable or cartilaginous. This can be either the curved cartilage of the ear or a soft silastic implant.

CAUTIONS/RISKS

• It is difficult to predict how much of grafted bone will survive the process. Once surgically detached from its original place, it is no longer connected to the circulation: in its new position, it has to develop its own blood supply to survive. Sometimes 90% of the bone may survive, sometimes only 10%: the amount is unpredictable. So, a surgeon may have added 4 mm of thickness of bone to a nose, but six months down the line only 3 mm. may be still in, or perhaps only 1 mm. Correcting this may mean a second round of surgery, using either bone from the opposite hip or from another rib.
• Silastic implants do not get absorbed, but they can get dislocated in case of an injury such as a knock or a blow to the area. Also, you may not like the presence of a foreign body under your skin.
• If the cartilage is taken from the ear, the organ looks deformed; this is particularly visible in the case of men who wear their hair short.

(3) ELONGATED/DROOPY NOSE ARISING FROM LAXITY OF THE SKIN AS A RESULT OF AGING.

Solution

A surgical incision is made at the root of the nose (i.e. the place where it joins the forehead), and about 3 mm of skin is excised. Then the remaining skin is lifted upward and sewn into place (a “nose life” as it were). The scar is hidden by glasses which you need after 45 anyway.

CHEEKS AND CHEEKBONES

(1) HOLLOW CHEEKS

Solution

Injections of auto-fat, taken other areas of your body —- preferably an area like the abdomen which has thick, globuly fat —- can fill out hollow cheeks.

(2) OVER-CHUBBY CHEEKS

Solution
Minor liposuction can result in a slimmer, more accentuated look. Liposuction involves the use of suction to “suck out” far from different areas of the body with the help of a canula, a miniaturized one in the case of the face.

Caution/Risks

The surgeon has to be very precise and careful in suctioning out fat from the face where the layer lies more thinly than in, say the buttocks or the thighs. Over-correction (vacuuming out too much fat) can leave difficult-to-treat grooves.

(3) FLAT CHEEKBONES

Solution

Inserting a “malar” (cheekbone) implant, made of silicone and custom-shaped to suit the contours of your face, can provide greater definition to cheekbones. Most commonly, it is inserted through the mouth.

Cautions/Risks

• The risks of cheekbone augmentation with an implant include:
• Poor positioning
• Slippage
• Infection (rare since antibiotics are administered these days as a matter of routine). But if it does occur, the implant will extrude, in which case it can be replaced at a later date.

(4) NASO-LABIAL LINES (Laugh Lines)

These are lines that set in with age, running from each side of the nose down to the angle of the mouth.

Solution

Filler injections of auto-fat or collagen. If a face-lift is going to be done anyway, such injections may not be required in addition; this is because the pulling-up and tightening of the skin that takes place in a face-lift will itself smooth out laugh lines (though it cannot obliterate them).

Cautions/Risks

A test for a possible reaction to synthetic collagen must be carried out four weeks before it is injected.

LIPS

(1) THIN LIPS

Solution

Collagen is generally used to plump up the outline of lips, redefine this area (which lies at the junction of the skin and the mucous membrane of the lips). It can also create a Cupid`s bow. But collagen is not generally used for the meat of the lips: fat is preferred for this area.

(2) THICK LIPS

Solution

A cut is made on the inside (the mucus membrane area) of the lips, and a sliver of this membrane is cut off. The cut edges are sutured, taking the visible part of the lower lip up and in, thus reducing its thickness.

Cautions/Risks

Over-correction can skew the final look.

(3) UPPER-LIP DROOP AT THE CORNERS

Solution

Collagen injections can firm up this area and provide lift, which obliterates the sag.

Cautions/Risks and Comments

(4) VERTICAL LINES ABOVE THE LIPS

Solutions

• Collagen injections, or
• Light dermabrasion (sand-papering of the superficial layers of the skin, using a diamond-coated cutter or, sometimes today, a laser beam)

Cautions/Risks

Risks of dermabrasion include:

• Hyperpigmentation/Hypopigmentation
• Serious scarring if the deeper structures of the dermis (the skin`s lower layer) have been damaged.
• Inflammation

JAWLINE AND CHIN

(1) EARLY JOWLS

Very early sags that make it seem as if your jawline is disappearing are caused by gravity taking its toll on the flesh as a result of the weakening of the platysma muscle (which extends from the jaw to the neck), combined with the download shift of fat (which lies just below the skin.)

Solution

The excess of fat can be trimmed with liposuction, re-defining the jaw line. The entry point for the canula is behind the ears, where the scars of surgery then lie hidden.

(2) DOUBLE CHIN  

Solution

Liposuction, going in again from behind the ears.

(3) RECEDING CHIN

Solution

• A silastic chin implant can restore balance to the facial profile as well as impart a more youthful look.
• Some surgeons do a procedure in which they split the mandible (the lower jaw) and slide one portion forward to create a more prominent chin. New bone grows in the gap resulting from the split.