Aging of the face is inevitable. As the years go by, the skin on the face and neck begins to loosen. The jaw line softens into jowls and excess tissue forms at the front of the neck. The rhytidectomy, or facelift, could improve your looks and self-confidence. As with all facial plastic surgery, good health and realistic expectations are prerequisites. The goal of the facelift is to improve the overall facial appearance. A facelift cannot stop aging, nor can it turn back the clock. It will not improve fine wrinkles. What it can do is help your face look its best and give you a healthy, more youthful appearance. A facelift is usually performed under general anesthesia, or in some cases, local injections of anesthesia with intravenous sedation can be used.
The neck is addressed initially. Liposuction is used to remove excess fat. If the neck muscle under your chin (platysma) is sagging, it is re-contoured into a more natural position. The facelift incision is begun in the area of the temple hair, just above and in front of the ear, and continues around the lobe, circling the ear, ending in the hairline behind the ear. In all cases, the incision is placed where it will fall in a natural crease of skin for camouflage. For men, the incision is aligned to accommodate the natural beard lines. The skin is raised outward, followed by repositioning and tightening of the underlying muscle and connective tissue. After trimming the excess skin, the incisions are closed with fine sutures and metal clips, and a dressing is placed to protect the entire area. The surgery takes approximately four hours.
Following surgery, an overnight stay in an after care facility is recommended. Alternatively, an overnight nurse at your home may suffice. The dressing is changed the next day and then reapplied for one more day. The fine sutures are removed in approximately one week, and the metal clips are removed in two weeks. Even though most patients experience very little pain after surgery, the surgeon will still prescribe pain medication. Some degree of swelling and bruising is unavoidable, and you may be instructed to use cold compresses to keep swelling to a minimum. A short course of post-operative antibiotics and steroids are given to help prevent infection and excess swelling.
“ANTI-GRAVITY” FACELIFT (ENDOSCOPIC MID-FACELIFT)
The endoscopic mid-facelift is a procedure that lifts cheeks vertically opposite to the pull of gravity and creates a natural, younger and more rested looking appearance. Unlike other face lifts the endoscopic mid-facelift leaves patients with no visible scars. The endoscopic mid-facelift helps rejuvenate hollow lower eyes, pulls up the corners of the mouth and softens smile lines. In addition this technique has been known to restore fullness in the cheeks while helping to reposition sagging cheek lines. This is an ideal procedure for those in their late 30’s to early 60’s.
Endoscopic Midfacelift: Lifts cheeks vertically opposite to the pull of gravity
- Flat, Sagging and/or Hollow Cheeks.
- Deep Smile Lines (nasolabial folds).
- Can be in late 30’s or early 40’s.
- Hollow lower eyes.
- Down-turning of the corners of the mouth.
- Done under general anesthesia, administered by a board-certified anesthesiologist.
- Performed through tiny incisions placed inconspicuously within the hairline of your temple and inside your mouth.
- The fat pads of your cheeks are repositioned up and over the cheekbones.
- Fat and deeper tissues are elevated to give a more youthful appearance.
- Tiny fiberoptic camera (endoscope) visualizes surgical field.
- This procedure is frequently performed in conjunction with eyelid surgery, endoscopic browlift or a necklift to achieve optimal results.
- The head needs to be elevated for several days following surgery to minimize swelling.
- Following surgery, discomfort is minimal and easily controlled by oral medication.
- Swelling and bruising subside over a few weeks.
- Sutures are removed in seven days.
Every year, over half a million people who are interested in improving the appearance of their nose seek consultations with Los Angeles Plastic Surgeons and Beverly Hills Plastic Surgeons. Some are unhappy with the nose they were born with, and some with the way aging has changed their nose. For others, breathing may be a problem, or an injury may have distorted the nose. A slight alteration of the nose can greatly improve one’s appearance. Rhinoplasty (reshaping the nose), can improve one’s looks, self-confidence or health. As with all facial plastic surgery, good health and realistic expectations are prerequisites. The goal of rhinoplasty is to improve the nose aesthetically (without creating a “surgical” look) in order to create harmony with other facial features. Additionally, many patients have a chin augmentation in conjunction with rhinoplasty to create a better balance of features. Rhinoplasty is usually performed under general anesthesia. In some cases, it may be performed using local injections of anesthesia with intravenous sedation.
In rhinoplasty and revision rhinoplasty, the majority of incisions are made inside the nose, where they are invisible. In some cases, a small incision is made in the area of skin separating the nostrils. Certain amounts of bone and cartilage are then removed or rearranged to provide a newly shaped nose. If the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose), a septoplasty may be simultaneously performed.
With a septoplasty, all incisions are placed entirely inside the nose. The septoplasty removes portions of cartilage and/or bone that are causing the obstruction. The incisions are then closed with fine sutures, followed by placement of a splint to the outside of the nose. The splint helps retain the new shape while the nose heals. Inside the nose, Beverly Hills plastic surgeon Dr. Donald B. Yoo prefers to use thin silastic splints instead of uncomfortable nasal packing. The nasal splints are typically removed seven days after surgery. The majority of the bruising is resolved two weeks after surgery. The swelling is 70% resolved after the first three months, and the remainder goes down over time. The final result will be evident 18-24 months following surgery. Cold compresses are used to help reduce the bruising and discomfort. A short course of post-operative antibiotics and steroids are given to help prevent infection and excess swelling. Although discomfort is minimal, pain medication is available if required. Vigorous activity is to be avoided for four weeks following surgery. Sun exposure and trauma must be avoided.
During your consultation, Dr. Yoo will discuss factors that may influence the outcome of the surgery, such as skin type, ethnicity, age, and degree of nasal deformity.
Beverly Hills Elite Rhinoplasty Surgeon
- A nose which does not “fit the face” whether due to birth, trauma or disease.
- Breathing problems associated with cartilage and/or bone obstruction inside the nose (deviated septum).
- A chin implant may be needed to bring the nose and chin into proportion to facial features.
- Rhinoplasty is performed under general anesthesia or local anesthesia with sedation in our outpatient state licenced surgery center in Beverly Hills. No overnight stay is required.
- Most incisions are made inside the nose. In some cases, a small external excision is required. Cartilage and bone are removed or rearranged to alter the appearance of the nose.
- The head needs to be elevated for several days following nose surgery to minimize swelling.
- Recuperation time is approximately 7-14 days during which time some bruising and swelling may be present.
- A nasal splint, applied to hold bone and cartilage in the new shape while the nose heals, is removed in seven days.
- Following nose surgery, discomfort is minimal and easily controlled by oral medication.
- A natural and aesthetically improved nose (without a “surgical” look) in proper proportion to your other facial features.
- Improved breathing with septoplasty.
- Ideal candidates for any facial plastic surgery are those seeking improvement rather than perfection.
POST-OPERATIVE INSTRUCTIONS RHINOPLASTY
These instructions should be carefully read and followed. They are designed to answer the most commonly asked questions regarding post-operative care for rhinoplasty, revision rhinoplasty, Asian rhinoplasty and Korean rhinoplasty.
Activity: The First Week
Limit your activity sharply during the first week following Beverly Hills plastic surgery. You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects. If you overexert yourself, bleeding may result. When you rest or sleep, keep your head elevated on 2-3 pillows and try to avoid turning on your side. Keep your emotions under control. It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better. Anger or crying will only add to the swelling or initiate bleeding. Restrict your diet to plenty of fluids and easily chewable foods. Hard to chew foods (like steak) should be avoided for one week.
You may carefully clean around the nostrils with a Q - tip and hydrogen peroxide three times a day. Immediately afterwards, place a bit of pure Vaseline or antibiotic ointment around the nostrils to keep them from drying out. Swelling for at least two weeks will obstruct your nasal passages. A humidifier may help you sleep by allowing you to breathe through your mouth more comfortably.
Do not blow your nose or sniff excessively as this will only irritate the healing tissues. If you must sneeze, open your mouth. Also, avoid picking up babies, small children or pets; a flailing little arm may strike your nose. You probably will hit your nose one or more times during the first week. This will hurt, but will cause no problem unless the force is excessive.
With assistance, you may bathe in a tub, showering is allowed on the second post-operative day. Cover the nasal cast so that it remains dry. If the cast becomes wet, use a blow dryer to help dry it. It is all right to carefully wash your face with a mild soap and a clean washcloth or cotton balls.
Avoid cigarette smoking or even being in an area of excessive smoke as this irritates the nasal tissue and impedes healing. Also, avoid alcoholic beverages the first two weeks following surgery as this may increase your chances of bleeding.
Activity: The Second Week
It takes six weeks for the nasal bones to fully heal. Slowly resume your activity. After the first week, let your body tell you how much to do. Strenuous exercise may be resumed in 5-6 weeks. Build up to this level slowly. Semi-contact sports are to be avoided for four to six months. Swimming is allowed after six weeks.
Do not let your nose become sunburned for six months after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with a SPF of 30 or greater.
Pain, Swelling, Bruising, or Bleeding
The first day or two, you may have some minor bleeding. Do not swallow the blood, as it will make you nauseated. Most patients complain more of discomfort from nasal and sinus congestion than from pain. Any pain should be controlled with the prescribed medication. After the first day, the pain may subside enough so that plain Tylenol or Extra Strength Tylenol may be sufficient. If not, call our office and we will prescribe a stronger medication. Swelling and bruising about the eyes and cheeks is variable. Swelling maximizes at about two days then subsides over the next week. An ice pack to the eyes for the first 48 hours may help decrease the swelling about the eyes and cheeks. This will clear completely and will not adversely affect the result. Bruising (discoloration) may persist a few days longer. Remember, this will all subside in time and has no bearing on your final result.
It is normal to have mild bleeding over the first 12 hours after surgery. It may be necessary to change the gauze a dozen or so times over this period. It is normal to have a pinkish-reddish discharge from your nose and throat for the first 3-4 days. This will gradually subside. If you have profuse nasal bleeding after this time, immediately lie down with your head elevated on 3-4 pillows. Iced washcloths on the back of the neck and over the eyes may help. Using nasal decongestants (such as Afrin) as directed will often help with bleeding. Please call Dr. Yoo or our Beverly HIlls office if these measures do not suffice.
Avoid medications such as Vitamin E, aspirin or ibuprofen for 2-3 weeks. Pain medication will be prescribed. Take it as needed. Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. If the prescribed medication does not control your symptoms, please let us know. Nausea may occasionally be related to the above medication. Taking the medication with food may help alleviate the nausea. After the first 24 hours, Extra-Strength or regular Tylenol may be sufficient.
Infection in unusual after rhinoplasty, but occasionally occurs. Fever over 100° F, excessive pain and swelling with redness may signify a developing nasal infection and should be reported. Infections generally clear up quickly with appropriate antibiotic treatment.
The nasal packs will be removed on the next morning after surgery. The cast and any sutures will be removed after one week. Brown paper tape will then be applied to your nose. Dr. Yoo will remove the tape in one week. When the cast is removed, the nose will be quite swollen and the nasal tip may be slightly turned up. This will settle down over the next few weeks, then more gradually thereafter. Remember that the nose does not assume its final shape until many months after surgery, depending upon the type of nasal skin you have. It will probably look better than prior to the operation within two or three weeks, but the final result takes longer. Be patient. Occasionally, an injection is necessary to reduce the swelling in one area. Any touch up surgery that may be necessary is not preformed for at least six months.
WHAT TO EXPECT FOLLOWING NASAL SURGERY
Certain physical changes are expected following nasal surgery. Some individuals experience all of the following and others only some. The degree to which each person is affected is variable and unpredictable. You may experience changes that are not included in this list.
Bloody drainage is common in the first 48 hours after surgery. Blood-tinged nasal discharge may persist for 1-2 weeks following surgery. Profuse bleeding is unusual. Should this occur, pinch your nostrils together firmly for 10 minutes without interruptions. If this does not stop the bleeding, call our office immediately.
Nasal swelling is expected and may not be readily noticeable until after the splint is removed. Most of the swelling subsides in 4-6 weeks, but subtle swelling may persist for 6-12 months. In certain situations, the doctor may inject a small amount of steroid into your nose to help reduce the swelling.
Bruises following nasal surgery usually manifests as “black eyes”. Most bruising will resolve in 2-3 weeks and may be concealed with makeup if desired.
Nasal breathing may be difficult for 2-3 weeks after surgery due to swelling inside the nose. This “stuffiness” will subside gradually and IS NOT improved with nasal sprays. Decongestive nasal sprays may actually cause damage to the nose and impair healing.
As noted above, blood-tinged nasal discharge is common following surgery and may persists for 1-2 weeks.
Itching, numbness and a “wooden feeling” to the nose are common. All of these do subside, although, it may take months for your nose to feel completely “normal”.
Endoscopic Browlift (Brow Enhancement)
The eyebrows play a vital role in an individual’s appearance. The descent of the eyebrow in youth or as one ages produces a tired look and causes a fullness to the upper eyelids. Physicians have devised many procedures, such as a browlift, to elevate the eyebrows in order to improve one’s appearance, and often times alleviate the need to perform upper eyelid surgery.
Cosmetic eyebrow elevating procedures or browlift in Beverly Hills, have traditionally involved large incisions, usually from ear to ear, with extensive surgery and post-operative rehabilitation. While excellent results have been obtained with this technique, patients have often developed redness, irritation, itching, and loss of hair along the incision site. In addition, significant, although temporary, loss of sensation to the forehead and scalp may occur.
Beverly Hills plastic surgeon Dr. Donald B. Yoo prefers the minimally invasive but maximally effective endoscopic browlift. Endoscopic brow elevation is the most current and state-of-the art method of forehead and eyebrow lifting. The procedure, which is minimally invasive when compared to traditional surgery, involves making very small incisions behind the hairline and uses a specialized lighting system and camera to perform surgery. With this technique, post-operative rehabilitation is simpler, and the time necessary to get back to normal daily activities is greatly reduced. Most importantly, surgical results have been extremely successful and patient satisfaction has been very high.
- Droopy brow and/or furrowed lines above the nose.
- Overhanging brow affecting appearance of the upper eyes.
- Three very small, puncture-type incisions are made in the hairline. The endoscope (a mini TV camera with a probe attached) helps guide the surgeon to weaken the muscles that produce frown lines and reposition the eyebrows to a higher level.
- To minimize swelling after a browlift, the head needs to be elevated for several days following surgery.
- Following your browlift surgery, discomfort is minimal and easily controlled by oral medication.
- Some swelling is inevitable, even around the eyes and cheeks. Bruising and swelling should begin to disappear in a week or so.
- Surgical staples are removed in seven days.
Blepharoplasty / Eyelid surgery
Blepharoplasty, sometimes called “eyelid lift”, is the surgical procedure performed to improve and enhance the appearance of the upper and lower lids. Excess and unwanted skin and fat above the upper and lower eyelids is one of the most common concerns of patients desiring cosmetic surgery of the eyelids. Blepharoplasty surgery helps restore a more attractive and youthful appearance.
In upper eyelid blepharoplasty, a fine incision is made in the pre-existing crease above each eye. A crescent of excess skin is then removed, as well as all fat (puffiness) that is present. The incisions are then closed with fine stitches, which are removed in one week.
In the lower lids, the incision is completely hidden on the inside of the lid. The fat under the eyes is accessed through this incision and mobilized. It is then repositioned to fill the tear troughs (to prevent a hollow look).
In some instances, when there is excess skin that needs to be removed, a skin pinch is performed with an incision placed under the lashes so as to avoid a conspicuous scar. As with the upper lids, fine stitches are used to close the incision.
The typical post-operative recovery period (the time necessary for bruising and swelling to resolve) after cosmetic eyelid surgery is 10-14 days. It is important to avoid strenuous activity for the first week after surgery. Antibiotic eye drops are prescribed for several days after surgery, and patients cannot wear contact lenses for approximately two weeks after surgery, as the eyelids may be stiff and sore. Makeup can be worn after 10-14 days, and the resultant fine scars, which follow the natural contour of the eyelid, tend to fade in about two to three months.
- Excess, baggy eyelid skin that in severe cases may interfere with vision (may be covered by insurance).
- Bags and/or dark shadows under the eyes, frequently caused by excess skin or fat in the lower eyelid which interferes with the patients sight.
- Asian “double eyelid” surgery and creation of an eyelid crease.
- Incisions are made where the natural crease exists in the upper lid and inside the lower lid. Excess fat and/or skin are removed or repositioned and, if needed, the muscles are tightened.
- The procedure normally takes only one to two hours for upper and lower eyelids.
- To minimize swelling after eye lid surgery, the head needs to be elevated for several days following surgery.
- Following surgery, discomfort is minimal and easily controlled by oral medication.
- Swelling and bruising subside over 1-2 weeks.
- Sutures are removed in seven days.
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Fat Grafting / Fat Transfer
Fat grafting or fat transfer is a medical procedure in which a patient’s own adipose tissue (fat) is taken from one area and transplanted to an area to which the patient would like a decrease in the appearance of wrinkles and shallow areas or an increase in volume (often the lips or areas with wrinkles and fine lines). It is generally a minimally invasive procedure and is a common alternative to popular collagen treatments and Botox. Patients commonly choose fat transfers to address the lines between the nose and the mouth, crows feet, and forehead wrinkles. Unlike the effects of dermal and facial fillers, which are temporary, the results with fat grafting and fat transfer can be much longer lasting and permanent.
With the increasing popularity of liposuction and the subsequent innovations in liposuction technology, it has become far easier to access fat and remove it from the body. While dermal fillers are often absorbed by the body in an average of 6-12 months, only a percentage of fat from a patient’s own body will be absorbed and more lasting changes can be achieved by fat transfer.
Some of the best and most frequently used donor sites for fat transfer include the inner thighs and lower abdomen. Beverly Hills Plastic surgeon Dr. Donald B. Yoo will gently perform liposuction in those areas to harvest fat. Fat transfers are often performed to augment the cheeks, chin, and lips. Asian plastic surgery, and especially Korean plastic surgery patients will seek out Dr. Yoo for forehead augmentation with fat transfer for a more-rounded, less flat look. Fat can be transferred to many of the same areas usually addressed with Botox and dermal fillers, and is common for patients who want a more permanent solution. Although reactions to synthetic fillers are rare, the body does not react to its own fat cells in the same way.
Studies show that the body may absorb 40% – 60% of transplanted fat, so in anticipation of this Dr. Yoo will initially add slightly more than is necessary. With the most advanced fast harvesting Adivive liposuction system available in our Beverly Hills plastic surgery suite, the need to overcorrect is minimal. Many patients are able to resume working after about a week.
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