Q. How do I choose a facial plastic surgeon?
A. Selecting a facial plastic surgeon should begin with a consultation. This personal consultation is your time to explore your special needs and concerns. It is important to find a surgeon who you are comfortable with and one that will answer all your questions and concerns. When considering plastic surgery of the face, technical expertise is very important, as is artistic skill, as this portion of the body requires a keen sense of both.
Several resources are available including the Yellow Pages, hospital referral, advertising, etc. However, a surgeon’s reputation and, more importantly, referrals from other satisfied patients are of the utmost importance.
A surgeon’s credentials are very important. One may begin by talking with the surgeon’s office staff or the hospitals at which the surgeon has been granted operating privileges. The medical specialty boards which have certified the surgeon are also available. Although board certification is not the only indicator of competence, it does ensure that a surgeon has received extensive training in his or her specialty and has passed both written and oral examinations.
There are a number of Medical Specialty Boards, which test for competence in the various areas of plastic surgery. Some of these include: otolaryngology head and neck surgery, dermatology, ophthalmology, and general plastic surgery. The only board that sets standards, examines, and certifies surgeons exclusively in facial plastic surgery and reconstructive surgery is the American Board of Facial Plastic and Reconstructive Surgery.
Another way to assess the surgeon’s skill level is to review before and after pictures of his actual patients. These should be made readily available to you during your consultation.
Q. Why do lines appear on my face?
A. When your skin is young, the collagen framework is intact, keeping your skin moisturized and elastic. Young skin is resilient the facial lines that appear when you smile or frown simply disappear when you stop smiling or frowning. As we age, however, we begin to lose this collagen framework and, with it, the ability to shrug off lines and wrinkles. Surgery is a means of correction while daily skin care is a way of maintaining youthfulness and postponing surgical options. Many skin care products offer advanced ingredients that improve the collagen levels and elasticity of the skin. Choosing a quality skin care product and SPF are essential in warding off the signs of aging.
Q. Why should I consider a facelift?
A. When considering facelift surgery, one should assess the aging changes in the lower two-thirds of the face. The natural aging process requires the skin to lose elasticity. Muscles begin to atrophy and lose tone and bone begins to dissolve and lose mass. The result is that one begins to see jowling, deepening of the nasolabial folds of the cheek, and looseness of the skin and excess fatty tissue in the neck.
Facelift surgery addresses the lower two-thirds of the face. Specifically; it tightens the jowls and, to some extent, the nasolabial folds. It also tightens the neck skin and removes the excess fatty tissue in the neck.
Facelift surgery does not affect the eyes, brows, or corners of the mouth. These areas must be addressed with other surgical procedures.
Incision placement in facelift surgery is crucial. Not only does one want to maximally camouflage the scars, but one also does not want to alter the shape of the ear or change the hairline. If attention to detail is not present, these critical issues will have an adverse affect on the outcome. This is where a surgeon who specializes in plastic surgery of the face has an advantage over those who do not.
A small incision is first placed under the chin, which is used to provide access to the neck for liposuction (to remove excess fatty tissue), and to tighten the loosened neck muscles or to tighten the frequently noticeable muscle bands of the neck. All other incisions are hidden in the hair above and behind the ear. Rather than placing the incision in front of the ear with an often noticeable scar, the incisions are taken inside the ear for maximal camouflage.
After complete neck liposuction and muscle tightening, the surgeon goes deeper to tighten the supportive tissues that lie beneath the skin. This allows for a smoother, more natural look with longer lasting results.
Q. What happens after my surgery?
A. After the procedure, a soft gauze dressing will be placed around your head. This is left on overnight to decrease bruising, prevent bleeding, and to protect the incisions. The dressing will be removed the following morning and our staff will shampoo your hair. No further dressing will be needed; you are allowed to shampoo and style your hair as usual the following day. Most of the stitches used are of a dissolvable type and those that have not dissolved after seven days will be removed. You may have staples in the incisions within the hair, which will be removed at seven days. Makeup may be applied the following day, should you desire.
Swelling and bruising are usually minimal and diminish within the first week or two. Pain is usually very minimal. A good portion of the cheeks, however, may have numbness for several weeks. You may experience some tightening in the neck; however, this will loosen with time. Most people return to work after two weeks, although some patients have returned as early as seven days.
We prefer to follow our patients very closely postoperatively. Therefore, follow up appointments will be made for you at one day, seven days, fourteen days, one month, three months, six months, and a year. These follow up appointments are individualized, however, for our out-of-town patients. We also recommend that each surgery patient be put on a maintenance routine by one of our medical aestheticians to ensure long lasting results.
Q. Can I change the droopy look of my eyes?
A.The eyes are the one facial feature which people notice the most. The eyes are very important to our overall appearance. Excess drooping skin of the upper eyelids and excess fatty tissue in the lower eyelids can lead to a heavy or tired look.
Eyelid surgery helps to alleviate the heavy, tired look about the eyes by removing the excess skin, muscle, and fatty tissue. Tightening the skin of the lower eyelids can be accomplished either surgically by direct excision of skin or more commonly through the use of lasers or chemical peels.
Eyelid surgery does not address brow heaviness. This is corrected with a brow or forehead lift. Typically, the shape of the eye is not affected unless specific reasons to do so are present.
Upper eyelid surgery involves an incision placed carefully within the crease of the upper eyelid for maximum camouflage. The amount of excess skin is precisely measured preoperatively with the patient in the sitting position. After removal of the excess skin, a small strip of excess muscle is also removed, along with two small fatty deposits. The incision is then closed with very fine stitches.
In the majority of patients, when removing fatty tissue below the eyes, external skin incisions can be avoided, thereby eliminating the cutting of vital skin and muscle two support mechanisms of the lower eyelids. This is termed a transconjunctival blepharoplasty. This approach involves eversion of the lower eyelid and then the laser is used to make an incision inside the lower eyelid down to the excess fatty pads, which are recontoured. The laser provides for precise, nearly bloodless surgery, thereby minimizing the bruising and swelling. No stitches are required on the inside of the lower eyelid, as this incision will heal on its own within three to four days. The only time an incision is placed on the outside of the lower eyelid is if the lower eyelid has lost considerable tone requiring tightening or if one desires thinning of the eyelid muscle.
Tightening of the skin of the lower eyelids is often accomplished with laser skin resurfacing. Not only does the skin tighten, but the laser resurfacing also serves to smooth the lines of the lower eyelids and Crow’s Feet area. Surgical skin excision can also be performed through a small incision placed immediately below the lashes.
Q. What about heavy or droopy eyebrows?
A. The forehead and eyebrows play a very important role in the upper one-third of the face. The eyebrows are intimately involved in facial expression and overall facial character. Heavy or drooping eyebrows create a tired look. The shape of the eyebrows can also suggest other looks such as a cynical or inquisitive look. Brow or forehead lift involves elevating the brows, tightening the forehead skin, and improving the horizontal creases of the forehead.
There are several surgical approaches to brow or forehead lifting. The most commonly used approaches are the coronal, pretrichial, endoscopic, mid-forehead, and direct brow lift. Your Facial Plastic Surgeon can suggest which approach is best for you depending upon the degree of correction desired, the height of your frontal hairline, and the aging changes of the overlying skin. Dr. Caniglia believes the endoscopic approach to be the “gold standard” for most patients. This approach provides outstanding results with minimal downtime and nearly invisible scars with no alteration of the hairline.
The incision placement depends on which procedure is selected. Those with a very low frontal hairline may choose a coronal forehead lift, which involves an incision placed several centimeters back in the hairline. If one has an extremely tall or high forehead, then one is a candidate for a pretrichial forehead lift, which involves an incision at the hairline, so as not to raise the hairline further back. If this approach is chosen, a special bevel or back-cut is made along the incision line so as to bury hairs underneath and in front of the scar, which eventually will grow up through and in front of the scar for maximal camouflage.
In men who have lost hair and have deep horizontal wrinkles in the forehead, a mid-forehead lift is often performed placing the incision within one of these deep horizontal creases. A direct brow lift involves placement of incision just above the hairs of the brow. This is rarely indicated. A newer approach involves the endoscopic forehead lift. This procedure is performed through several small incisions placed within the scalp. This approach involves special endoscopes and cameras for visualization.
In any event, whichever of the above procedures is chosen, the ultimate goal is the same. That is, raising the eyebrows and releasing the muscles of the brows, which cause creases or lines in the forehead.
Q. What can I do about my nose?
A. No other feature on the face has such varied characteristics and differences among each individual person. Some noses are long, others are short, some are wide, some are narrow and some have a prominent hump. Nasal tips may be long and drooping or they may be raised and pointed. Other noses may be crooked secondary to previous nasal fractures.
Your facial plastic surgeon can help you evaluate your nose with respect to the rest of your face. A computer imager is often used to provide precise measurements and also to illustrate some of the possible outcomes of nasal surgery. Several views will be used by your surgeon, including a frontal view, a side or profile view, an oblique or 45 degree angle view, and a basal view revealing the nostrils. Your surgeon will also evaluate your chin, as on profile a small chin may create a larger appearing nose, and a simple implant will bring the profile into better harmony.
Your facial plastic surgeon has spent years studying the anatomy and dimensions of the face and the relationship of the features to one another, thereby making him very qualified to assist you in determining which surgical procedure is best for you. Nasal surgery can involve a change in the external appearance of the nose (rhinoplasty) or it can be functional in nature requiring straightening of the septum or middle strut inside the nose and addressing the turbinates within the nose to improve nasal breathing.
Q. My child’s ears stick out, what can I do?
A. Several procedures are available for altering the shape or size of the ears. Some ears protrude out too much and require the ears to be set back closer to the head. Other ears are too long or some earlobes are overly redundant. Other people suffer from torn earlobes often because of wearing pierced earrings.
Surgery that is performed to pin back the ears is often done in children as they begin their school years. This surgery involves removal of a small ellipse of skin on the backside of the ear. The delicate cartilage of the ear is then sculpted and set back in a more natural appearance closer to the head. The stitches that are used to close the incision are of the dissolvable type.
Q. Can anything be done with my hollow cheeks?
A. Cheek bones play an integral part of our overall facial harmony. Underdeveloped cheekbones provide for a flat or expressionless face. Placement of the cheek implants is often performed through incisions just underneath the upper lip on both sides of the mouth. Through this incision, a pocket is created over the cheekbone and the implant of choice is placed. The stitches used to close the incision are the dissolvable type. Swelling and bruising are usually minimal. Most patients can return to work within a week.
Q. I have very thin lips. Can this be corrected?
A. Lips are not immune from the aging process. Because lips are large muscles, they atrophy or shrink with age. Full, sharply defined lips are a sign of youth.
There are several techniques available for lip enhancements. Some of these techniques simply involve filler material, such as Restylane®, Juvederm®, Radiesse™ (formerly known as Radiance™), and fat. Although not permanent, these fillers provide an immediate, soft, natural lip enhancement.
If one desires permanence in lip fullness, a surgical lip advancement can be performed. In this procedure, a small excision of skin above and below the lip is performed, thereby allowing the red portion of the lip to be advanced outward. The fine stitches used are removed at seven days. Makeup may be applied the following day. Permanent makeup applied anytime after six weeks often enhances the overall surgical result.
Q. What can I do about hair loss?
A. There are many different types of hair loss. There are those of male pattern baldness and even thinning in females. There is hair loss that is secondary to surgery and/or trauma. Today’s hair restoration techniques are much more advanced and sophisticated than in the past, creating a more natural, fuller appearance.
Often, mini and micrografts are placed rather than the traditional “plug-type” grafts. The mini and micrografts involve implantation of single hairs, up to three or four hairs at a time. The transplanted hair is usually permanent. There is very little to no discomfort from hair transplantation surgery. Other techniques available for hair restoration include scalp flaps and/or scalp reduction. The Age Intervention® Hair Revitalizing Conditioner targets thinning, aging, or chemically and environmentally challenged hair.
Q. What about sun/age damage to my skin?
A. Skin care and skin treatments involve a wide range of procedures. Procedures range from daily skin care to light chemical peels often performed by aestheticians, medium and deep peels, dermabrasion, and laser skin resurfacing. In evaluating one’s skin, one should address the amount of sun and age damage to the skin. Specifically, one should address the number and depth of the lines throughout the face, the looseness of the facial skin, and any skin blemishes or differences of color throughout the facial skin.
Chemical peels involve the use of varying strengths of acids that peel the top layers of skin away, allowing smoother regenerated skin to emerge. Chemical peeling is performed in three basic strengths, light, medium, and deep chemical peels. Mild peels are often performed by aestheticians for routine skin maintenance. The deeper the peel, often the better more long lasting the result. Some of the common light chemical peels involve Glycolic and Salicylic acids. Medium peels often involve Trichloroacetic Acid. Deep peels involve Phenolic Acid.
Another form of skin resurfacing is dermabrasion. Dermabrasion involves the use of high speed, rotating diamond burrs to remove the top layers of damaged or scarred skin.
The newest technique available today for improvement in skin appearance is laser skin resurfacing. The most common laser used is the Carbon Dioxide (CO2) Laser. The lasers today are pulsed lasers, which allow for increased safety over prior lasers. The laser is also a very precise tool with very precise depth control, which is often lacking in some chemical peels and dermabrasion. Dr. Caniglia uses one of the newest, most advanced lasers on the market today, the Ultrapulse Encore. This laser has the unique capacity of performing a lighter fractionated laser (Active/Deep FX) as well as being able to adjust the laser to higher settings for deeper wrinkles.
Most light and some medium peels can be performed without anesthesia. Deep chemical peels, dermabrasion, and laser skin resurfacing are often best performed under intravenous sedation. Postoperative care can vary among surgeons. Some elect to occlude the skin with an occlusive bandage, while others elect to use ointments and creams to keep the skin lubricated during its healing period. With medium and deep chemical peels, dermabrasion, and laser resurfacing, it is usually recommended to wait two weeks prior to makeup application. The redness may persist up to two to three months or longer in some cases. However, after a few weeks, special camouflage makeup usually suffices, allowing one to return to work.
Skin care begins with a proper evaluation of the patient’s skin by a qualified aesthetic provider. The attending physician will recommend a skin care regimen that may include treatments and will most definitely include a daily skin care protocol. Additionally, it is important for patients to use quality, medical-grade products to receive lasting results. The Caniglia MD Skincare line is an excellent option for patients looking to improve their overall appearance as well as target problem areas. Key ingredients that patients should look for in skin care products of all kinds are natural extracts, retinol, hydroquinone, AHA’s & BHA’s, as well as a good SPF.
Q. Can I do anything about my double chin?
A. Yes, this procedure in known as neck liposuction. Excess fatty tissue in the neck can cause a heavy or double chin appearance to the neck. This area is often addressed during facelift surgery with neck liposuction. All necessary liposuction is performed through a tiny incision just underneath the chin. A very small cannula is inserted through the incision to remove the excess fatty tissue with suction.
One must be cautioned, however, that neck liposuction alone in some patients will not be adequate to obtain the desired result, as the looseness of the skin plays a critical role in the overall result. If the skin has lost a good deal of elasticity, the excess skin must be removed and the underlying tissues tightened, as in a facelift. Your surgeon can evaluate this for you.
Healing time is very quick with neck liposuction only. A dressing is applied overnight and removed the following morning. Patients are often able to return to work within a few days following their procedure.
Q. What about a “weak” chin?
A. Your chin plays an important role in the overall facial symmetry and harmony of your face. Your surgeon will evaluate your chin specifically from the lateral or profile view. A vertical line is drawn from the edge of the lower lip inferiorly. Your chin should meet this line. If the chin does not meet this line, it is considered weak, which creates the illusion of a larger nose and also a shorter neckline. Some people, on the other hand, have a prominent chin and these patients may need a reduction mentoplasty or surgery to reduce the size of the chin. Chin augmentation is commonly combined with nasal surgery and/or facelift surgery.
The chin implant may be placed through a small incision just underneath the chin or through an intraoral incision behind the lower lip. There are numerous shapes and implant materials available today. Your surgeon will be able to assist you in customizing the one that best fits your needs.
Q. What about anesthesia?
A. Three types of anesthesia can be used. The first is what is referred to as local anesthetic. This is simply an injection of numbing medicine to anesthetize or numb the area to be worked on. This is used for very minor procedures. The next type of sedation is p.o. or oral sedation. This requires the patient to take several pills to relax and sedate the patient. Often this is combined with local anesthetic to numb the area to be operated on. This too, is used for minor procedures. There is also intravenous conscious sedation. This involves sedation administered intravenously to provide a deeper level of relaxation. It is very common for the patient to take pills, such as in the oral sedation method, an hour and a half before their intravenous conscious sedation. The oral pills prior to the IV sedation help to relax and provide a long steady state of pain free anesthesia.
All of the anesthesiologists at Caniglia Facial Plastic Surgery are board-certified and are here and available to monitor you throughout your surgical case. All vital signs are monitored with state-of-the-art equipment found in any local hospital.
Q. Can old scars be “fixed”?
A. Unsightly scars can have an affect on one’s overall appearance and self-image. There are numerous procedures available to better camouflage an existing scar. Although a scar can never be removed in its entirety, it can often be camouflaged to a point where it is barely perceptible.
The chosen procedure depends on the location and orientation of the scar. Scars which are wide, depressed, or running against what is referred to as the relaxed skin tension lines or laugh lines, often need surgical excision and re-closure in hopes of improving the scar into a fine line. Also, the orientation of the scar, at times, is changed to fall within the relaxed skin tension lines for better camouflage. Other techniques that may be used in conjunction with scar revision surgery are skin-resurfacing techniques, such as dermabrasion and laser skin resurfacing. These help to smooth and contract the scars for further camouflage.
Q. What are soft tissue fillers?
A. At times, deep wrinkles, traumatic scars, acne scars, or other skin depressions can be filled in with injectable materials such as Restylane®, Perlane, Juvederm®, Radiesse™ (also known as Radiance™), and fat. There are also synthetic implants such as Gortex™, which can be used.
Restylane®, Perlane, and Juvederm® are a safe and natural cosmetic dermal filler that restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, as well as to enhance lips. They are cosmetic dermal filler made of non-animal-based hyaluronic acid. Hyaluronic acid is a natural substance that exists in the human body.
Radiesse™ is a safe, long-lasting treatment unlike any other. Radiesse™ is a completely synthetic compound comprised of calcium hydroxyappetite, a natural substance already in the body. Radiesse™ is soft and natural with no history of allergic reactions. Results are immediate and may last for a year or more.
Collagen is a gel-like substance that is derived from purified human or animal tissue, the latter requiring skin testing prior to receiving injections. If no allergic response is identified, it is safe to then proceed. Collagen injections are typically performed in an exam room without anesthesia. Since collagen is derived from animal tissue, it is recognized as a foreign substance by the body and eventually absorbed. It may last anywhere from three months to a year.
Fat injections tend to last longer than collagen injections. The issue of permanence of fat injections has long been debated. It is suggested that up to 20% of each injection may be maintained permanently. Fat injections often require local anesthesia and/or light sedation.
Gortex™is a synthetic implant that is often used to enhance facial features, such as cheeks, chin, lips, and at times, augmentation of the nose. It is a very good implant with very low reactivity or rejection. The implant is permanent; however, it can easily be removed if the patient desires.
Q. What does Dr. Caniglia offer to promote and enhance healing?
A. Dr. Caniglia utilizes some of the most advanced surgical techniques and products available. Tisseel VH, a natural fibrin sealant is used with all facelift procedures to minimize and decrease the risk of bleeding and to dramatically reduce postoperative bruising. Tisseel VH also eliminates the need for surgical drains and pressure dressings, making the immediate postoperative period very comfortable. In addition to Tisseel VH, all patients receive Arnica Montana, a natural homeopathic medicine which reduces post-surgical bruising and swelling. Last, but certainly not least, each surgical patient is given a maintenance protocol by one of the attending aestheticians as well as pre- and post-surgery skin care kits to promote a better surgical experience as well as maintenance for their enhanced face. The above products, combined with Dr. Caniglia’s precise surgical techniques, allows his patients to return to normal activities much sooner.