Contact Dr Seckel

Unfortunately, as I mentioned in Chapter 2, we age first in our eyes, most commonly in the 30s, and some of us in our late 20s. Eyelid rejuvenation is by far the most common and early plastic surgery operation I perform. The results are usually dramatic, pleasing and successful.

Blepharoplasty is intended to correct or partially correct the following aging changes:
· Hooding or hanging skin of the upper eyelid
· Puffiness (fat herniation of both upper and lower eyelids)
· Laxity or looseness of the lower eyelid
· Tear trough deformity (that line under the lower eyelid often called dark circles under the eyes).

A blepharoplasty alone cannot correct:
· Brow sagging
· Eyelid wrinkles
· Aging damage to eyelid skin
· Crow’s feet

Personally, I use the laser for my eyelid rejuvenation procedures. There is less bruising and quicker recovery. Also, I don’t make an incision on the outside of the lower eyelid. I use the laser to make an incision on the inside of the lower eyelid, the pink part (transconjunctival blepharoplasty.) From the inside of the lower eyelid, I remove or reposition the fat to remove the bulge and partially correct the tear trough deformity. I also use the laser on the inside to shrink or tighten the underlying muscle. Following these maneuvers, I frequently do what is called a canthopexy. The canthopexy is a procedure done through the upper eyelid incision to tighten the tendon of the lower eyelid, re-creating the nice curved, upward slanting lower eyelid appearance of our youth.

I then do laser resurfacing on the skin of the lower eyelid to rejuvenate the appearance of the skin and remove crow’s feet. What’s the point of tightening the lower eyelids and removing the bags, if the patient still has sun damaged aged skin on the eyelid? Patients must go through a period of healing during which the lower eyelid is red, but when the eyelid has healed and the patient sees brand-new smooth skin on the eyelid, they are very happy. (Figure 9-5).

igure 9-5. Before (left) and after (right) laser blepharoplasty.

Eyelid wrinkles and crow’s feet are also caused by the pulling of the muscle underneath the skin. Therefore, in my practice, I use Botox® to quiet the muscle after surgery and encourage the patient to continue to have Botox® treatment of the “crow’s feet”.

The laser is a marvelous, technologically- advanced tool that can create optimal results in eyelid rejuvenation. Not all surgeons are comfortable with or competent in the use of the laser. You should find a doctor experienced in and comfortable with the use of the laser.

Complications are rare, but you must be informed: Bleeding, infection, scarring, dry-eye syndrome (very serious), and ectropion, a sad-eyed or “hound dog appearance” more common with the external scalpel incision on the lower eyelid. (Just walk down Rodeo Drive or Fifth Avenue and you will see it!) Other complications include loss of eyelashes, damage to the eye or even blindness (1 in 800,000 operations.) These complications are rare, but serious. Your surgeon needs to discuss them with you.

The above procedures are the most common and effective plastic surgical operations to correct facial aging. In the next chapter I will try to help you to make a very important decision if you are considering having plastic surgery. Contact me by email for further information or read Save Your Face.

Dr Seckel

References
1. Seckel, B. R. Aesthetic Laser Surgery, 1st Ed.

Contact Dr Seckel

More importantly, with early intervention and new facial anti-aging techniques most people can prevent skin aging and facial aging and maintain a youthful skin and facial appearance and avoid looking older.

However, the shear number of new, heavily marketed facial skin rejuvenation techniques and the often-complex methodologies involved can be very confusing for the lay reader and physicians alike. To better understand the new facial rejuvenation treatments it is very helpful to first understand facial skin aging changes and then review how these changers can be reversed and the skin rejuvenated.

Facial Skin aging – Is that my mother I see looking back at me in the mirror?

The earliest skin aging changes most of us notice on our face, are fine lines and wrinkles around the eyes often referred to as crow’s feet and later deep furrows on our forehead called the frown lines and worry lines. These changes occur for most of us in our 30’s. We also begin to see brown spots and red spots or small blood vessels on our face and around the nostrils of our noses. Later the skin becomes dryer and loses the fresh glowing appearance of our youth. These superficial or surface changes are called type 1 skin aging or facial aging changes and are caused by sun damage and free radical damage from other inflammatory agents in our diet and environment and our heredity.

Later, in our late 40’s and 50’s we begin to see sagging facial skin. Usually the first sign is loose skin beneath our chin on the neck often called the turkey wattle. Later we see loose folds beginning along the jaw-line, often called jowls. As the skin sags we begin to see deep lines on either side of the mouth, called the nasal-labial fold lines and marionette lines. Aged skin also can begin to droop over the eyes and the eyebrows can begin to fall. These later skin-aging changes are called type 2 facial aging changes and are caused by the loss of skin elasticity. Sun damage, inflammation from free radicals released by our diet, and our heredity are the basic causes.

6-Step Facial Skin Rejuvenation – Help is on the way

Today we do not have to stand by and helplessly watch our skin age. With sun block, a healthy diet and lifestyle and new facial skin rejuvenation technology we can prevent or correct most skin aging changes. But first let’s understand what is meant by the term “skin rejuvenation.

To rejuvenate means to “make young or youthful again or restore to an original state”. To me this means correcting or removing not only wrinkles, but also the brown spots, red spots and dry skin, but also tightening sagging skin that is all of the facial aging changes, not just one or two. Wrinkle removal is only part of the process.

Filler-Contact Dr Seckel

True facial skin rejuvenation is possible with today’s new technology, but skin rejuvenation must be performed in a logical, comprehensive, step-by-step process that addresses all of the major skin aging changes. Most skin rejuvenation treatments offered today only address one or two changes and as a result are ineffective. A laser can remove brown spots and blood vessels, but the skin is left with wrinkles and sagging skin. A face-lift can tighten the facial skin but leaves you with a tight old looking face.

For effective modern skin rejuvenation I offer my patients a 6-step facial rejuvenation program® which addresses each of the facial aging changes described above. The result is true facial skin rejuvenation that makes the face truly look young or youthful again. The 6 steps to non-surgical facial rejuvenation are:

Exfoliation – removes dead dry skin cells and superficial pigment restoring a youthful glow to the skin and helping removewrinkles.

Stimulation of new collagen production – New collagen must be restored to replace the collagen damaged by sun and aging. New collagen plumps the skin, helps remove wrinkles and firms the skin

Removal of pigment and blood vessels - This step removes the brown spots and red spots or blood vessels from the facial skin

Relax muscles of facial expression – Frown lines, worry lines, and crow’s feet are caused by the pull of some of the facial muscles. When these muscles are relaxed, the lines disappear and wrinkles are removed.

Botox-Contact Dr Seckel

Fill deep facial lines – The deep nasal-labial fold and marionette lines are plumped up to make them less noticeable. These are deep lines, not wrinkles.

Tighten facial skin – The facial skin is tightened to improve the jowls, sagging brow and neck skin. Skin tightening also helps with wrinkle removal.

This 6-step facial rejuvenation program® is a comprehensive, scientific medically proven method for true facial skin rejuvenation, wrinkle removal and skin tightening.This is modern non-surgical method for effective true facial skin rejuvenation. The details of the program are carefully outlined in Chapter 5 of my book Save Your Face. For further information contact me.

Dr Seckel

Boston, Massachusetts

Facelift-Contact Dr Seckel

While Plastic Surgery is truly a much more comprehensive field including reconstructive surgery following burns, cancer surgery, and birth defects, the image most often projected in the media is that of image or beauty enhancement and non-surgical and surgical facial rejuvenation of otherwise normal people by surgery.

Blepharoplasty-Contact Dr Seckel

Revolutionary technological advancements in the past decade have significantly impacted the field of Plastic Surgery creating a shift from traditional surgical procedures to new non-surgical methods for correcting aging changes and improving appearance.

Laser Resurfacing-Contact Dr Seckel

Today Botox® injections can remove crow’s feet, frown lines, worry lines, and help lift the sagging brow. Prior to Botox® major facial surgery such as a brow lift and blepharoplasty (eyelid lift) were performed to correct these aging changes.

Botox-Contact Dr Seckel

New fillers such as Restylane® and Radiesse® are injected into the nasal-labial fold, lips, and marionette lines, those deep lines running from the lips down around the mouth and chin. Previously, a face lift was performed to correct these lines.

Fillers-Contact Dr Seckel

Skin tightening technology such as aluma, ActiveFX, LuxIR, Titan® and Thermage® are becoming better and can improve facial sagging in 30% patients if used early before the sagging is severe. Many patients choose to have one of these techniques rather than a face-lift. Many other new exciting techniques for laser restoration of skin collagen (Laser Genesis®) and improvement in skin wrinkling, removal of pigment, and removal of red spots and blood vessels on the face are already in use today.

These dramatic advances coupled with increasing public awareness of the importance of sun protection, a healthy anti-inflammatory diet, exercise, stress reduction, and a healthy lifestyle undoubtedly will impact the Plastic Surgery practice of the future. The Plastic Surgeon of the future will still have to be a highly skilled, knowledgeable surgeon, but I predict he/she will need to be an expert in the newer laser, light, pharmacological, and lifestyle therapies as well.

Plastic Surgery is becoming more non-surgical with every new technological advancement. The 6-step facial rejuvenation program encompases all the new non-surgical facial rejuvenation techniques. For questions read Save Your Face, or contact me.

Dr Seckel

I use this exciting new technology to treat fine lines, sun damage, brown spots, blotchy pigment, uneven skin tone, and acne scarring with excellent results.

Unlike so many widely advertised non-ablative, photofacial laser and IPL treatments that require 5-7 months to see a result, the results of the MicroLaserPeel are evident immediately. Better, the beneficial effects of the MicroLaserPeel, new collagen formation, and softer more uniform younger looking healthy skin continue for months after the treatment.

MicroLaserPeel removes the outer dead skin cells from the face and stimulates the deeper skin layers to from new healthy young skin cells and new collagen in the deeper skin layers. The result is fresher looking, glowing new skin with fewer fine wrinkles and fewer brown spots and pigment irregularities.

The first step in any skin rejuvenation program is exfoliation, the removal of the dead skin cells covering the outer surface of the facial skin. None of the many non-ablative laser and IPL therapies offered today provides this important first step. Only the MicroLasaerPeel using the Erbium laser provides this important basic first step facial rejuvenation process, in a uniform manner, with minimal down time.

The MicroLaserPeel is the perfect minimal down time alternative to the “gold standard” laser resurfacing for facial rejuvenation.

Contact my office via e-mail, or call 978-369-4499 for more information on any of the above procedures, or read Save Your Face.

Dr Seckel

Boston, Massachusetts

Contact Dr Seckel

A startling 12.4 million cosmetic plastic surgey operations were performed in this country last year and estimates are that nearly half of them were to correct facial aging and this does not include the millions of non-surgical facial rejuvenation procedures.

Contact Dr Seckel

As the baby boomers reach their 50’s everyone wants to look younger but no one wants to have surgery. Most people do not want to have surgery especially if it is not for serious medical reasons.

However, revolutionary advances in technology have made it possible for many people to reverse facial aging changes using new non-surgical facial rejuvenation techniques without having to undergo plastic surgery.

This past Wednesday, September 28, 2005, I spoke on a panel entitled Non-surgical Facial Rejuvenation at the meeting of the American Society of Plastic Surgeons in Chicago, Illinois. My topic was Botox, the soft tissue fillers including Restylane and Radiesse and the many skin peels used for exfoliation to remove wrinkles and signs of facial aging. I came away from that meeting very excited and enthused about all the wonderful new non-surgical facial rejuvenation therapies that are safe and effective for patients today.

Botox-Contact Dr Seckel

Fillers-Contact Dr Seckel

There are so many new wrinkle removing and skin tightening non-surgical facial rejuvention options available that the patient must understand exactly what facial aging change it is that they want to correct. Usually the patient just feels that their face looks older but cannot pinpoint exactly which facial aging change is causing concern. It is important to seek consultation with an experienced board certified Plastic Surgeon or Dermatologist who understands all the options so that the correct option is chosen for your very unique face. I advise you to avoid doctors who only do one or two facial rejuvenation procedures and tend to push patients to have the procedure that he/she performs rather than customizing the procedure to the patient’s needs.

The 6 Step Facial Rejuvenation Program™ consists of:

Step 1-Exfoliation-topical cremes, microdermabrasion, superficial skin peels with various fruit and salicylic acids to produce exfoliation to freshen the skin and give it a youthful glow and remove wrinkles. These treatments also stimulate the skin to form new collagen to replace the old damaged aged collagen, and help rejuvenate and tighten the facial skin.

Step 2- Stimulation of new collagen production- Controlled inflammation of the deep skin layer called the dermis causes the dermal skin cells called fibroblasts to manufacture new collagen to replace the collagen lost by sun damage and aging. Topical RetinA and the deep exfoliative process in step 1 start this process. Newer technological interventions like the Lux1540, Fraxel, Lux294o, Sciton Profractional, and Lumenis bridge therapy are powerful stimulators of new collagen production.

Step 3-Remove pigment and red spots-In addition to exfoliation new light and laser therapies such as IPL, Photo facial, Lux1540 and Fraxel® can be used to remove brown spots, pignent, broken blood vessels called telangiectasias, and rosacea from the facial skin. Pigment and blood vessels are a classic sign of facial aging and the non-surgical removal of these skin discolorations provides noticeable facial rejuvenation. These high tech yherapies can also remove wrinkles.

Step 4-Remove lines of facial expression wrinkles- Botox can be used to relax the muscles of facial expression and remove crow’s feet, worry lines, frown lines, and bunny lines and dynamic wrinkles, all of which are very early signs of facial aging. Botox® effectively removes these lines in most people for 6 to 9 months after a simple nearly painless injection.

Step 5-Fill deep facial lines called the nasolabial fold lines and marionette lines make the face look tired and old and coupled with the frown lines often make people look angry. Deep facial lines are deeper than wrinkles, and I do not use fillers for wrinkle removal. New soft tissue fillers can soften the nasal labial fold lines and marionette lines when they are injected into the skin beneath the aging lines. Commonly used soft tissue fillers are Restylane, Radiesse, Zyderm, Zyplast, Juvaderm, Sculptra®, Fascian®, Cymetra®, and Isolagen®. Each of these fillers has different characteristics and are better for some facial aging changes than others. For a thorough discusion of fillers consult Chapter 7 “No Down Time Facial Anti-aging Procedures” in Save Your Face, available on line at www.saveyourface.com.

Step 6-Skin Tightening. The final facial aging change to treat is loose sagging skin. While the plastic surgical operation called a facelift is still the “gold standard” for facial rejuvenation, several new technologies are evolving which can tighten aged facial skin. LuxIR and Titan®, devices using infrared waves, and Aluma and Thermage® which use radiofrequency waves, are all being used to heat the collagen in the deep layers of the skin called the dermis causing the collagen to shorten and tighten the skin. While these technologies are new and only about 30% effective and require multiple treatments, they will most certainly be improved in the future and effective skin tightening of aging facial skin will be possible. Some wrinkle removal is seen following successful skin tightening.

Non-surgical facial rejuvenation is here and is getting more effective as new products come out every month. One of my common expressions whenever I speak about the new non-surgical options for facial rejuvination is “plastic surgery is becoming non-surgical” and try to encourage my fellow plastic surgeons to embrace the new technology. I still believe that an experienced board certified plastic surgeon is the best doctor to provide the non-surgical facial rejuvenation procedures to patients because these doctors are the facial aging experts and they have the ability to do what is necessary for the patient whether it is Botox or a facelift. Each face is unique and a “one size fits all” approach just does not work in facial rejuvenation.

Contact me for more information on any of the above procedures, or read Save Your Face.

Dr Seckel

Boston, Massachusetts

The threads are placed beneath the skin using a needle attached to the “thread’. The needle is passed through the skin at a point low in the cheek, passed under the cheek skin up to a point higher on the face and then passed back out through the skin. The “thread” has small barbs sticking out which attach to the undersurface of the skin and pull up on the skin as the “thread” is tightened from above creating a face lift.

Although the Feather lift, Thread lift, and Russian lift are being marketed as a non-surgical face-lift, a no down time face-lift, a lunch time face-lift, and other such terms, you must understand that these are surgical procedures. In fact they are a surgical implant procedure, and complications can and do occur.

Before undertaking a Feather lift, Thread lift, or Russian lift you need to be aware of several potential problems:

1. bruising and down time
2. infection
3. extrusion – that is the thread pushes out onto the surface of the skin
4. Injury to the facial nerve – this can paralyze your face
5. “divits” or visible dents or depressions in your face
6. scarring
7. failure to lift the face
8. Excess skin bulge above the exit point of the needle and thread

Bruising and Down Time

Injecting a local anesthetic (required for these procedures) and passing a needle and thread beneath the skin for a facelift damages blood vessels and causes bleeding. Bleeding under the skin causes bruising. You will have bruising following this procedure. Some of you I know can go to work with bruises and swelling on your face, but most people don’t want to. If you have one of these procedures be prepared for swelling and bruises that can last up to 10 days, sometimes 2 weeks.

Infection

Anytime you enter the skin with a needle or other foreign object bacteria can be pushed into the skin and cause infection. Good surgical technique-scrubbing with an antiseptic solution and using sterile techniques- and antibiotics help, but infections happen in spite of these precautions.

Placing an implant, such as a thread, under the skin introduces a “foreign body” under the skin and greatly increases the chances of an infection.

Extrusion

Our bodies recognize and try to reject or push out foreign material. A splinter is a good example, notice how the splinter becomes infected and the pus eventually pushes the splinter out. When the body rejects or pushes an implanted material out it is called an extrusion

Although medical devices such as breast implants and the facelift “threads” can be implanted safely, the implanted material musty be inert-hard for the body to recognize-and must be perfectly sterile and placed with meticulous sterile surgical technique. In addition, the body tissue around the implant must be healthy, and generally the deeper the implant is placed in the body the better the chance that it will not be rejected.

Since the threads used in facelifting techniques like the feather lift, thread lift, and Russian lift are placed close to the surface of the skin the chances of infection, rejection, and extrusion are greater than implants placed deeper in the body.

Injury to the Facial Nerve

This is the most dreaded and debilitating of all complications of any facial surgery, including a face lift. Damage to a facial nerve branch is often permanent and causes paralysis or sagging of the face, inability to smile or raise your forehead, and can cause difficulty closing your eyelids.

Board certified plastic surgeons spend many years learning how not to injure these nerves during face lift surgery and understand and recognize the locations of these nerves so that they are avoided and not injured.

The feather lift, thread lift, and Russian lift are Blind Procedures, meaning that the needle and thread are passed beneath the skin without the surgeon being able to see the structures, under the skin, that the needle is passing through. If the needle is passed a little too deep or through an area where the facial nerve is close to the skin, the nerve can be injured and facial paralysis can result.

Divits or visible dents or depressions on your face

One problem that surgeons have had with the feather lift, thread lift, and Russian lift face lift techniques is that on occasion, the barbed thread catches hold of the underside of the skin tightly in one location on the face. When this happens, the upward pull on the cheek is entirely placed at that one spot. The cheek is “hooked” from underneath at that one spot and creates a dimple or depression on the skin of the cheek creating an unsightly deformity.

Scarring

When you break or enter the skin whether with a scalpel or a needle the skin always forms a scar. Of course a needle puncture creates a smaller scar than a scalpel. However if the needle, a large one in the case of the Feather lift, thread lift, and Russian lift, passes through the skin it will always leave a mark.

If the needle needs to be passed through the skin several times to get the right position, and at the exit point where the thread is tightened and tied, a scar is likely to be larger.

If the thread becomes infected or a divit or depression forms, the thread will need to be removed surgically, and a larger scar will result.

Failure to lift the face

Threads can fail and the face can drop.

Excess skin bulge above the exit point of the thread

Take your hands, place them on your cheeks and push your facial skin up to tighten the face to make it look younger. Do you notice the excess skin bulging above your hands high up on your face and around your ear?

This is what you will see if you have a face lift and the surgeon does not remove or cut away the excess facial skin.

This is the biggest limitation and drawback to the feather lift, thread lift, and Russian lift facelift techniques. Although with proper surgical technique the threads can be used to pull the cheek up, if you don’t do surgery to remove the excess skin you will be left with an unsightly bulge of excess skin. Most websites recommending this procedure say it is only for younger patients who don’t have much excess skin for this reason.

Summary

The feather lift, thread lift and Russian lift facelift techniques may well in the future be useful techniques for younger patients with minimal skin sagging when performed by board certified plastic surgeons in an appropriate safe surgical facility. At present this technique is not recommended by the major plastic surgery societies. I would recommend waiting until this procedure has been studied further.

I certainly feel that much of the web advertising I have read is misleading especially when ads refer to this facelift procedure as “lunch time”, “no down time”, “no bruising” and “non surgical”.

As always “caveat emptor” let the buyer beware. Always seek the opinion of a surgeon certified by the American Board of Plastic surgery. (215-587-9322, www.abplsurg.org)

Also read chapter 10 of my book “Save your Face – The Truth About facial Aging, Its Prevention and Cure? entitled “Don’t Let Just Anyone Touch Your Face”. Contact me for any questions.

Dr Seckel

Boston, Massachusetts