Every human face and body is unique and successful plastic surgery results require that your surgeon approach you as a person with unique anatomical characteristics and specific aesthetic goals in mind. While standard or “cookbook” surgical procedures may have a place in heart surgery or gallbladder surgery, the “one size fits all” approach does not work for eyelid surgery, face lift surgery, breast and body surgery. Your plastic surgeon needs to listen carefully to you in order to understand your personal aesthetic goals. The face lift pictured below is an example of good doctor patient communication.

Plastic surgery is truly an art and a result oriented plastic surgeon must have the artistic sensibility, perceptual flexibility, and technical ability to create beauty and symmetry on the human form in the many diverse shapes and configurations in which it occurs.

I try very hard to practice result oriented plastic surgery, which means that I attempt to perform plastic surgical procedures with a shared mental image of your desired final result in mind and work very hard to achieve that image as closely as possible.

If I don’t feel I can achieve your expected result, I will advise you that your expectations are unrealistic or that I am unable to achieve the result you desire.

My goal is that your expectations become a reality. This requires good communication and honesty. You need to help me understand your goals and I need to communicate to you what I can and cannot achieve. It also requires skill, hard work, and yes, luck, the good fortune of good healing with no complications.

This has been my goal all of my professional life. I am not perfect and am not able to achieve every patient’s expected result all of the time. There are no guarantees when modifying biological structures-we all heal differently and complications can occur with any surgery.

However, if you and I decide to undertake a plastic surgery procedure, know that I will make every effort to help you achieve the result that you desire. Please read my book Save Your Face to better understand my philosophy. You may contact me for a consult and I will be happy to give you a copy of Save Your Face. You may also sign up for my free email newsletter to keep up to date on new discoveries.

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

978-369-4499

Effective treatment for removal of dark circles under the eyes must be directed at the underlying cause of the dark circles. Millions of people complain of dark circles under the eyes but the underlying cause of the dark circles varies greatly. Treatments for dark circles that do not correct the underlying cause of the dark circle do not work. There is an incredible array of treatments for dark circles including cucumber slices, tea bags, vanishing creams, bleaching creams, lasers, surgery, more sleep, avoid TV and computer, drink 2 liters of water a day etc, yet few of these regimens seem to be directed at the underlying cause of the dark circles under the eyes.

To better understand the treatment of dark circles under the eyes I will discuss the various types of dark circles under the eyes that I encounter in my plastic surgery practice and my understanding of the cause of the dark circles, and what I feel is the most effective treatment to remove the dark circles under the eyes.

Understand that the eyelid skin appears darker than the surrounding facial skin in all people-this is the normal condition and is caused by shadows created by the overhanging brow and the fact that the eyelid skin is much thinner than the surrounding facial skin. Below I am talking about exaggerated dark circles under the eyes that cause people to be unhappy with their appearance.

Causes of Dark Circles under the Eyes

Thin Eyelid Skin

The eyelid skin is the thinnest in the body and many people with dark circles under the eyes have extremely thin skin on their eyelids and around the eyes. This thin skin is an inherited trait. The dark circles under the eyes are caused by the fact that the purple color of the underlying eyelid muscle shows through the thin skin and creates a bluish or purple color. The color is darkest near the nose and on the lower eyelid near the nose.

Treatment of dark circles under the eyes caused by thin skin is very difficult because it is very difficult to make your inherited skin thicker. Cover up make up like Jayne Iredale Eye Cover, Dermablend, and Covermark are very helpful and my first recommendation. Frequent microdermabrasion and Retin A cream over a long period of time will build new collagen in the dermis will thicken the skin and provide some improvement.

There are new lasers on the horizon which are very effective at stimulating new growth of collagen in the dermis and these new technologies may prove very beneficial. Be sure to sign up for my free newsletter to be informed when these new technologies are available.

The Arcus Deformity discussed below creates a very severe dark circle in people with thin eyelid skin and correction of the Arcus deformity with Arcus release and fat grafting can be very helpful treatment for dark circles under the eye in these individuals.

Prominent Eyelid Blood vessels and Veins

Everyone has veins and blood vessels called capillaries in their eyelid skin. In many people however the veins are very prominent and the blood vessels add to the dark color of the eyelid.

To diagnose this cause of dark circles look in a mirror with bright light on your face and gently pull the skin of the lower eyelid tight. You will see many tiny branching red and blue lines which represent blood vessels.

You need blood vessels and veins to keep your eyelid healthy and alive. However when there is an abundance of smaller vessels which create a bluish or purplish hue to the lower eyelid some new IPL (Intense Pulsed Light) or laser therapies can be used to treat dark circles under the eyes in people with an excess of small capillaries and blood vessels. The very large veins cannot be treated.

Laser blood vessel treatment is a serious and potentially dangerous treatment for dark circles under the eyes and must be performed by a physician who is experienced in the use of lasers and IPL. Most importantly the eye must be protected by placing a shield over the eye during treatment so that the laser or IPL light cannot hit the eye. The laser and IPL light can damage the retina and destroy vision if the beams hit the unprotected eye.

Pigmentation of the Eyelids

Hyper pigmentation, too much pigment in the skin of the eyelid is a very common cause of dark circles under the eyes. Treatment of dark circles under the eyes caused by hyper pigmentation is very effective, but the pigment frequently returns after sun exposure.

Hyper pigmentation of the lower eyelids occurs because of sun exposure and prevention with sun block, sun glasses, and a hat are the most important first treatment for this type of dark circles under the eyes.

The treatment of hyper pigmentation begins with bleaching creams such as a combination of Retin A and 4% Hydroquinone, Obagi Blender 5, Epiquin or other prescription bleaching cream combined with microdermabrasion.

After the above treatments have lessened the pigmentation causing the dark circles under the eyes, if necessary I proceed to IPL (Intense Pulsed Light) treatments. These treatments do effectively remove pigment causing the dark circle but again experience and eye protection are very necessary to prevent eye injury.

Hollow Eyes

Many people have a deep hollow beneath the lower eyelid which creates a dark shadow beneath the eyelid which people call dark circles under the eyes.

This deep hollow beneath the lower eyelid is caused by an inherited deficiency of fat and or bone and treatment of this type of dark circle under the eye requires surgery.

The hollow eye occurs more commonly in people from Central Asia and the Middle East but it certainly occurs in all races and from people in all regions of the world.

To treat dark circles under the eyes in people who have hollow eyes I do a laser procedure called an Arcus Marginalis release and fat grafting. The Arcus Marginalis is a structure which tethers the lower eyelid to the bone and creates a dark circle when the eyelid skin above the dark circle falls over the dark circle creating a shadow. Releasing the Arcus Marginalis releases the eyelid skin and eliminates the crease or dark circle.

I then transplant fat to fill the hollow in the bone and plump the dark circle and correct the hollow eye appearance.

Usually, to treat the dark circle under the eyes caused by the hollow eye I have to take fat from around the belly button on the abdomen to have enough fat to adequately fill the hollow eye deformity. The incision to remove the fat is well hidden down inside the belly button and is usually not visible.

Treatment of dark circles under the eyes caused by the hollow eye usually takes me 45 minutes to an hour, can be done with you asleep or awake, and recovery is usually 10 days. Patients do not complain of pain afterwards. The main recovery is waiting for bruising to go away and blurred vision from eye ointment that I have you use for the first week or two. Most importantly after this treatment you need to be calm, rest and not exert yourself. Working out or heavy lifting can raise your blood pressure and cause bleeding. Although you will be up and around the first few days with sunglasses to cover your bruising, I do not want you to exercise or lift heavy objects for at least 2 weeks.

The Arcus Deformity-the True dark Circle under the Eye

The most common cause of dark circles under the eyes in patients who seek treatment of dark circles under the eyes in my plastic surgery practice is the Arcus Deformity.

The Arcus Deformity is a dark crescent shaped circle or depression which occurs beneath the lower eyelid starting beside the nose in the corner of the eye and running out toward the side of the face and curving upward towards the outside corner of the eye.

The Arcus Deformity is caused by the fact that a small structure beneath the lower eyelid called the Arcus Marginalis is attached to the bone of the eye socket and also attached to the lower eyelid from underneath. This attachment tethers or holds the eyelid close to the bone of the eye socket while the rest of the lower eyelid is loose and free to move. The normal fat which is beneath the eyeball pushes out against the lower eyelid which creates a visible bulge on the lower eyelid. You can see this by closing one eye and gently pressing on the closed eye. With your other eye you will see the bulging of the fat against the closed lower eyelid on the other side.

The eyelid skin that is tethered by the Arcus Marginalis cannot move or bulge, and as the fat bulges the lower eyelid above the Arcus Marginalis it creates a shadow or dark circle beneath the eyelid where the Arcus Marginalis is attached to the lower eyelid skin. This is the true dark circle under the eyes.

As we age and our eyelid skin becomes loose or lax, the eyelid skin also falls or sags over the depression caused by the Arcus deformity and the dark circle gets worse. With aging and excess protrusion of fat against the lower eyelid the Arcus deformity can become quite pronounced.

The Arcus Deformity is the true dark circle under the eye and I use the term Arcus Deformity to differentiate it from the Tear Trough Deformity which is different. The Tear Trough Deformity starts near the corner of the eye in the same location as the Arcus Deformity but the Tear Trough Deformity runs down into the cheek rather than up toward the outside corner of the eye.

The Tear Trough Deformity is a sign of advanced facial aging and is caused by the sagging or descent of the cheek into the middle of the face which occurs with facial aging in your 50’s and 60’s. Tears run down the cheek and out the side of the face through the Tear Trough instead of straight down the cheek as they do in a child.

By contrast the Arcus Deformity occurs in much younger patients including children. Most people seeking treatment for dark circles under the eyes in my plastic surgery practice are in their 20’s and 30’s. Doctors often misdiagnose the Arcus Deformity as the Tear Trough Deformity which is a major problem if a Tear Trough Implant is used to treat the dark circle. The Tear Trough Implant is designed to plump or correct the depression in the cheek out toward the side of the face, and in my experience the Tear Trough Implant cannot adequately correct the dark circle under the eye where it is deepest, near the corner of the lower eyelid near the nose.

The treatment for dark circles under the eyes caused by the Arcus Deformity must include release of the Arcus Marginalis and fat repositioning or fat grafting to plump the area of the dark circle.

The traditional plastic surgery treatment for eyelid rejuvenation called the blepharoplasty, during which fat is removed, can actually make dark circles under the eyes worse and create a hollowed eye appearance.

Treatment of dark circles under the eyes that are caused by the Arcus deformity requires a modern blepharoplasty approach which includes release of the Arcus Marginalis and fat repositioning or fat grafting.

I use a very specific treatment for dark circles under the eyes called the transconjunctival blepharoplasty with Arcus release and fat grafting. This treatment is done through a tiny incision on the inside of the eyelid called a transconjunctival incision because it goes through the conjunctiva, the pink tissue on the inside of the lower eyelid. I also use the laser to make this incision.

The benefits of the laser transconjunctival incision are:

1. No visible scar or incision on the outside of the eyelid
2. No change in the shape of the lower eyelid-the traditional scalpel blepharoplasty through an external incision usually weakens the lower eyelid and causes a sad eyed look
3. Less bleeding during surgery
4. Less bruising after surgery
5. Quicker recovery

My results following treatment of dark circles under the eyes with the laser transconjunctival blepharoplasty with Arcus Marginalis release and fat grafting have been very successful. Most patients have recovered within a week and many who do not bruise are comfortable being seen with make up after 5 days.

Summary- Treatment of Dark Circles under the Eyes

To summarize, effective treatment of dark circles under the eyes requires that you correct the problem that is causing the dark circle under the eye. To accomplish this you must understand what type of dark circle under the eye you have and what is causing it. The following is a summary table:

Treatment of dark circles under the eyes is possible; the key is understanding the underlying cause of your dark circles. With proper diagnosis and treatment of dark circles under the eyes caused by the Arcus deformity beautiful results can be achieved with the transconjunctival Arcus release and fat grafting.

For more information on dark circles under the eyes contact me and feel free to send me photos of your eyes and I will tell you what I see after reviewing them.

Be sure to sign up for my free email newsletter as I often write about dark circles under the eyes and other topics on facial rejuvenation. I suggest you read my book Save Your Face which explains facial and eyelid aging and how to reverse and treat facial aging changes.

Dr Brooke R. Seckel

Concord, Massachusetts

Consequently many people seek plastic surgery to reverse the eyelid aging changes with a procedure called a blepharoplasty also known as an eyelid lift or eye tuck. This is one of the most frequently performed plastic surgery procedures performed in the United States and usually the first facial rejuvenation procedure that people seek.

The operation involves removing hooding or excess skin from the upper eyelid (upper blepharoplasty) and removing puffiness or bags from the lower eyelid (lower blepharoplasty).

Unfortunately most people do not really understand what these operations can and cannot correct and many people undergo the surgery only to be disappointed with the results achieved during the typical blepharoplasty as done in the United states today. The purpose of this article is to educate the consumer by exposing commonly held myths about the plastic surgery operation known as the blepharoplasty so that people considering eyelid rejuvenation will seek the appropriate treatment to correct the particular eyelid aging changes which are occurring on their own unique face.

Blepharoplasty Myth 1- Blepharoplasty will remove crow’s feet. Crow’s feet occur because of the repeated movement and contraction of the eyelid muscles that surround the eye and upper cheek. When we smile, blink etc, the muscle contracts and causes a wrinkle in the skin. After many years these lines become permanent. The blepharoplasty removes fat that causes bags, and can tighten the eyelid skin, but the muscle continues to contact and cause crow’s feet. Blepharoplasty does not correct crow’s feet. Fortunately Botox can remove the crow’s feet from the cheek very effectively although Botox® needs to be repeated.

Blepharoplasty Myth 2- Blepharoplasty will remove wrinkled aged skin often called “crepiness” and restore the lower eyelid skin to fresh, young looking smooth skin. The Blepharoplasty can tighten the lower eyelid skin, but blepharoplasty alone leaves the eyelid skin looking old and damaged. The ActiveFX Laser Peel when done at the time of a blepharoplasty can resurface the lower eyelid skin and leave it fresh looking-but blepharoplasty alone cannot achieve this

Blepharoplasty Myth 3- Blepharoplasty lifts the cheek and corrects puffiness below the eyelid. Many people have excess skin that creates a bulge or swelling on the cheekbone just below the eyelid. When you take your finger and pull the lower eyelid up this bulge, which is called a “festoon” smoothes out. Blepharoplasty alone will not improve the festoon. In fact if during a lower eyelid blepharoplasty fat, which is causing puffiness of the lower eyelid, is removed the festoon actually looks worse. This is a very common problem and can be a very unhappy result of a blepharoplasty. Festoons are hard to treat but can be improved by doing a cheek lift in some people. The important thing is to avoid worsening them by not doing fat removal during blepharoplasty in people who have festoons unless the cheek lift or other procedure is done at the same time. Other procedures such as canthoplasty or orbiculopexy done during the blepharoplasty can help.

Blepharoplasty Myth 4- Blepharoplasty will remove dark circles under the eyes. Many people have dark circles under the eyes-a dark shadow overlying the bone just below the eyelid technically called a tear trough deformity. In many people a blepharoplasty will make the dark circle worse if too much fat is removed. To remove the dark circle under the eyes a special procedure called the arcus marginalis release and fat grafting must be done to correct the dark circle.

Blepharoplasty Myth 5- Blepharoplasty will remove hooding of the upper eyelid caused by sagging of the eyebrow. Many people have hooding of the upper eyelids that is caused not only by loose upper eyelid skin but also by the fact that the eyebrow has sagged as well. In these people an eyebrow lift must also be done to restore the upper eyelid to a youthful look.

Blepharoplasty Myth 6- A lower eyelid blepharoplasty must leave a visible scar on the lower eyelid. While traditional scalpel blepharoplasty does use an incision on the lower eyelid, more modern contemporary blepharoplasty is done with a laser through a small opening on the inside of the lower eyelid and leaves no visible scar. This technique, called the transconjunctival laser lower blepharoplasty not only avoids a scar but also preserves the beautiful natural shape of the eyelid. The traditional scalpel blepharoplasty done through an external incision often damages the supporting muscles of the lower eyelid and as a result the outside corner of the lower eyelid turns down into a “sad eyed” or ”hound dog” look.

Beautiful eyelid rejuvenation is possible today using advanced new laser techniques, and additional new variations such as the arcus release, canthoplasty, and orbiculopexy. However these techniques are new and not widely practiced yet. It is very important that you understand what the eyelid rejuvenation techniques called blepharoplasty or eyelid lift or eyelid tuck can and cannot achieve and also that you have knowledge of the newest, safest, and most effective techniques. Only by being well informed can you hope to be happy with your result and not be disappointed or worse, have a different problem than you had before surgery. For a more information read Save Your Face or contact me.

Dr. Seckel,

Boston, MA

Contact Dr Seckel

Initially, laser resurfacing of the eyelids and peri-ocular region produced stunning wrinkle removal and smoothing of skin. Although this procedure is still popular in selected patients, prolonged recovery times and the tendency for hypopigmentation or lightening of the treated skin has dampened enthusiasm for this procedure. Laser resurfacing remains a very effective technique for lighter skinned individuals who can afford the 2-week down time. Botox® with its striking effect of correcting crow’s feet and virtually no down time has surpassed laser resurfacing in popularity for correction of peri-ocular wrinkles. However, the new ActiveFX CO2 laser has all of the advantages with few disadvantages of the old CO2 laser, and peri-ocular Active FX peel is currently the choice for surface rejuvenation of the eyelid.

The major controversial argument about eyelid rejuvenation however, remains whether a surgical steel scalpel or the laser should be used for the incisions required for blepharoplasty, the eyelid tuck or eyelid rejuvenation procedure.

Blepharoplasty involves making an incision on the upper eyelid and removing the excess skin or hooding that hangs down over the eyelid as we age. This procedure is called an upper blepharoplasty. The incision can be made with either a scalpel or a laser.

The lower blepharoplasty is done to remove eyelid bags, puffiness and excess skin from the lower eyelids. An additional procedure called an arcus marginalis release can be done during the lower blepharoplasty procedure to remove dark circles under the eyes (also called the naso-jugal fold)– but this is not a part of the routine blepharoplasty.

The lower blepharoplasty may be done through an incision on the outer skin of the eyelid with a scalpel or through a laser or scalpel incision through the inner pink tissue on the inside of the eyelid called the conjunctiva, thus a transconjunctival blepharoplasty. The advantage of the transconjunctival blepharoplasty is that the supporting muscles of the eyelid are not cut through and the natural shape of the eyelid is preserved. Often when the outer eyelid incision is used the weakening of the muscles caused by the incision causes the eyelid to turn down into a sad eyed or “hound dog eyes”. Typically a laser is not used when the outside lower eyelid incision is used.

The proponents of the laser blepharoplasty cite the following advantages:

· Less bleeding
· Better visibility of vital structures
· Faster surgery
· Less bruising and swelling
· Equal scar

Proponents of the scalpel blepharoplasty cite the following:

· The laser requires special training and precautions
· The laser is expensive
· Healing time is slower

If you are planning on having a blepharoplasty done you should ask your surgeon which technique he/she uses and why.

The most important issue is for you to seek consultation with a board certified surgeon who has a lot of experience in eyelid surgery. Ask to see his/her results and talk to other patients who have had experience with this doctor.

Ultimately it is most important that you feel comfortable with and trust the doctor you choose.

Personally I use the laser for all of my blepharoplasty operations and have for over 10 years. I prefer the clean bloodless field that allows me to see and avoid injuring all of the vital structures that are exposed during the operation. I also like the speed of the laser, 15 minutes for an upper blepharoplasty with the laser compared to 45min with the scalpel. Upper and lower blepharoplasty can be done in less than an hour with the laser, yet some surgeons take as long as 1 ½ to 2 hours with the scalpel.

The most important issue in blepharoplasty is preserving the shape of the lower eyelid. I always do a transconjunctival blepharoplasty to preserve the natural shape of the lower eyelid and avoid the sad eyed or “hound dog look. Contact me for further information, or read Save Your Face on how to find a good doctor, Chapter 10.

Dr Seckel

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

Facelift-Contact Dr Seckel

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.

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 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:

Any time 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 “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 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 facelift. 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 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 facelift 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. 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 techniques may well in the future be useful face-lift 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 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 “Don’t Let Just Anyone Touch Your Face”.

Contact me for more information or questions you have on any of the procedures mentioned above.

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