Wednesday, 9 April 2008

Wrinkle Removal

MALE FACE LIFT

The Cosmetic or Aesthetic (Esthetic) Surgical Procedure of ‘Face Lift’ is commonly done on the Female Client. However, it is not restricted to them only and it can also be done on the Male Client, to Enhance their Looks or to Restore their Youthfulness.

In PNG, ‘Face Lift’ is a commonly used term, especially in the newspapers to refer to renovation of old buildings and facilities to give a new, better look as well as inclusive of the functional aspect of the structures referred to in those cases.
Furthermore, the term ‘Face Lift’ originated from the cosmetic surgical techniques attempting to restore the youthfulness of the aging face. 

One of the earliest signs of human aging can be thought of as the bulging of the ‘Jowl’, or 'Jowling' or obliterating the Straight Mandibular Line Profile, giving it a curved, unnatural look (a bulge), defining early aging. The ‘Jowl’ composes of ‘Premalar or Cheek Fat Pad’ dropping downwards, due to the effects or pull of gravity and also due to damage or wearing out of collagen components of the structures that hold the fat pad in place.

Other early signs of aging would be:
1-   ‘Crow’s Feet’ and Other Fine Facial Wrinkles
2-   Baggy and Saggy Lower Eye Lids
3-   Low Set Eye Brows
4-   Facial Hollowness and/or Boney Prominence

It is not true that with collagen damage, all structures drop straight down, due to gravity. Therefore, the term ‘Face Lift’ is not true for all procedures done to restore youthfulness. The classical or traditional method of doing ‘Face Lift’ was stretching only the skin laterally (sideways) to the sides of the face and the excess skin excised off and the wound is closed off leaving a fine scar line around or in front and at the back of the external ear (auricle or pinna). As you can see, this is Not ‘Face Lift’! Literally, this is ‘Face Stretch’. The modern ‘Face Lift’ technique of ‘MACS’ Lift is a True ‘Face Lift’ technique, because it lifts up the saggy structures vertically, upwards, against the effect of gravity. However, the set back here, is that the lift is not done directly on the sinking structures such as the ‘Jowl’ (Premalar Fat Pad), but it is done indirectly on the ‘Platysma’ (the muscle layer under the skin of the neck that helps to hold structures or tuck them neatly in place, giving that region a youthful contour) under which the sinking structures sit. Even then, it is more like tucking these structures in; to hide them and not lifting them back into their original positions. They may pop out later on (later on means more than 10 years if MACS lift is done properly/correctly).

The modern approach is to stimulate local collagen production by innate processes and directly lifting the dropping structures back into their original positions without leaving behind any obvious scars. The main cell responsible for producing collagen is the ‘Fibroblast’. The stimulation can by done by one of the following physical processes:
1-   Radio Waves - travels through the skin and stimulates collagen production with almost no side effects
2-   Laser - Concentrated Light of different wave lengths are used; when it reaches the dark areas of the skin the light is absorbed & changed to a low temperature heat. The heat then stimulates collagen production by various mechanisms. The main side effect is a little bit of pain & soreness and skin swelling for 3-5 days before subsiding
3-   Dermabrassion - physically scratching and removing the top superficial layer of skin, composing mainly of keratin (dead cells). This stimulates formation of newer components of skin including collagen as well as Hyaluronic Acid. The main side effect is a little bit of pain and soreness and skin swelling for 3-5 days before subsiding. The procedure is done in the office after applying a local anesthetic cream to numb the skin. The client can go home on the same day.

'String Lift' may also directly & locally pull up structures into their original position by inserting a tiny string with hooks on it that may be firmly fixed into place without any surgical incisions. These strings are absorbable & they only stimulate local collagen production & then disappear over time, while the job of holding structures in place, is transferred to the newly formed collagen. The cosmetic or esthetic effects of 'String Lift' are astounding.

Another cause of wrinkle formation, especially in the younger client (less than 40 years of age), is hyperactive facial muscles causing forehead wrinkles, naso-labial grooves and posterior neck skin folds. The treatment of such wrinkles is different. The classical ‘Face Lift’ techniques Can Not be applied here. For such wrinkles, ‘Botox’ is injected, to relax these muscles so that they do not contract excessively to pull the skin, to form these wrinkles.

Dehydration (lack of water within the body tissues) may also cause the formation of fine wrinkles, facial dryness and in extreme cases, facial hollowness. It is important to rehydrate well (drink plenty of water).

In summary:
1-   The fine wrinkles are early signs of aging and it may be best treated by local collagen stimulation by physical methods. Sometimes it may best be treated by Botox injection, such as ‘Crow’s Feet’.
2-   The facial hollowness (from disappearance of fatty tissues) may be considered a late sign of aging (it may also be a sign of disease and malnutrition in the young client) and it is best treated by nutritional support and injection of fillers such as ‘Restylane’ and autologous fat transfer or implants (removing one’s own fat from another part of the body and implanting or inserting them into area of devoid).
3-   The coarse or large wrinkles or grooves arise because of Hyperactive Facial Muscles and they are common in the younger client (less than 40 years of age).
4-   The original facelift technique of lifting tissues against gravity is best applied for displaced structures that are dropping downwards, due to the effect of gravity and damage to collagen components of the structures that hold them in place, such as Saggy Lower Eyelids, Jowls, Submental or Chin Fat Pads, etc.
5-   Sinking and Low Set Eye Brows are unattractive because they make the client look tired, aggressive and less friendly. The main cause is pulling downward and inwards by medial (midline) eyebrow muscles. Therefore, injection of Botox may help, as well as lifting the eyebrow up against the effect of gravity.
6-   The simplest and most cost-effective procedure, we can do (at least in our experience) in PNG, is Dermabrassion. The physical scratching of the top layer of skin stimulates Collagen and Hyaluronic Acid production/formation. With increased Hyaluronic Acid, more water is trapped and accumulated within the skin, giving the skin a chubbier look. In PNG the sun is strong, therefore, we may encounter temporary Pigmentation of scratched (dermabrassed) areas. To prevent this we advise up to 1 month of avoiding exposure to the sun, use of sunscreen and skin lightening creams.

Finally, when clients come in for consultation, we will examine the face as well as the overall condition or health of the person and recommend the most cost-effective, suitable and safest method, to enhance the youthfulness of the client's facial features.

EARLY FACIAL FEATURES/SIGNS OF AGING:


JOWLING OBLITERATES THE MANDIBULAR LINE:









WHAT IS FACE LIFT & HOW IS THE PROCEDURE DONE?

FIRST CASE OF MALE FACE LIFT IN PNG:


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WHAT IS RESTYLANE?
A TYPE OF TISSUE FILLER, CONSISTING OF HYALURONIC ACID (HA). IT FILLS OUT THE HOLLOWNESS, DEPRESSIONS AND GROOVES IN THE FACIAL REGION THAT DISTORT THE NATURAL YOUTHFUL CONTOURS. THE HYALURONIC ACID FUNCTIONS BY TRAPPING AND HOLDING WATER WITHIN THE SKIN, TO GIVE THE SKIN A CHUBBIER, FRESHER AND MORE YOUTHFUL LOOK. THE EFFECTS LASTS LONGER AND HAS ALMOST NO SIDE EFFECTS, COMPARED TO ALL OTHER TISSUE FILLERS.
<40 age="" amp="" by="" caused="" constantly="" excessively="" facial="" hyperactive="" is="" muscles="" of="" on="" p="" pulling="" skin="" the="" usually="" years="">

<40 age="" amp="" by="" caused="" constantly="" excessively="" facial="" hyperactive="" is="" muscles="" of="" on="" p="" pulling="" skin="" the="" usually="" years="">

*THE ABOVE MALE CLIENT, WAS UNMARRIED FOR MORE THAN 10 YEARS. HOWEVER, A FEW MONTHS AFTER UNDERGOING THESE PROCEDURES, OUR CLIENT FOUND A GIRL FRIEND AND GOT MARRIED AFTER A FEW WEEKS OF MEETING


ANOTHER MALE CLIENT, WHO UNDERWENT NECK LIFT


-Wrinkles are baggy, skin lines and depressions occurring as a result of collagen damage that holds the skin tightly together or as a result of pull by over-reactive underlying muscles or as a result of fat atrophy (disappearance of fatty tissue) & excessive dehydration.

-The collagen is damaged mainly by the process of aging & prolonged exposure to sunlight. Fat tissue may disappear as a result of aging, malnutrition or any other systemic disease.

-Modern techniques to compensate the collagen loss & also to stimulate the production of collagen as well as relaxing of the underlying muscles may help to restore youthfulness.

-Apart from fat transfers, we emphasize the importance of nutritional rehabilitation. This is a holistic approach.


A Story of Someone Who Defied Death & Has Renewed Life Itself
'An Inspiration to Appreciate Life & to Live it to the Fullest'
It is usual to have 1 or 2 life-threatening illnesses throughout our life time. With a strong heart and passion for life, we may conquer these illnesses & live on. Here is a story of someone who fought so many wars with many major life threatening conditions and situations but refused to give in to all these adverse circumstances. She had conquered all battles & then took a big leap forward to undergo the first facelift surgery in PNG at the hands of Dr. Mol, at 55 years of age. The following is a summary of her story:

1. Had tuberculosis of the neck glands (TB lymphadenitis) in childhood and has completed TB treatment daily, for 6 months
2. Had marriage related problems; the first husband committed suicide, she also attempted suicide; overdosed herself with a prescribed medication; she had dilated pupils and had cardiac arrest; she was resuscitated successfully at the PMGH, emergency department in 1978
3. Right ovarian cyst; had it removed (Oophorocystectomy)
4. Left ovarian cyst & twisted fallopian tube; had part of the ovary removed
5. Inflammation of the appendix (Appendicitis); had it removed (Appendectomy)
6. Inflammation of the gal bladder (cholecystitis); had it removed (cholecystectomy)
7. Had the abdomen opened up (Laparatomy) for severe abdominal pains & adhesive bowel obstruction
8. Had her last 2 children on whatever was left of her left ovary
9. During her job as a flight attendant, she wrestled with someone twice her body size, who deliberately tried to opened the aircraft door during flight; she successfully overpowered the man & closed the door, saving her own life as well as the life of all others on board
10. Had a cyst in the uterus; had total removal of the uterus (abdominal hysterectomy)
11. Had left breast cancer in 2004; completed chemotherapy & radiotherapy in Australia by the end of 2005
12. Had endoscopy for peptic ulcer disease & inflammation of the duodenum during the breast cancer treatment; completed treatment & was cured completely
13. Had severe depression & attempted suicide; took 50 tablets of valium (250mg in total) and went into respiratory arrest & was resuscitated at the PMGH, emergency department
14. Underwent plastic (cosmetic/aesthetic) surgery in May 2011 at Goroka General Hospital at the hands of Dr. Mol
-had mid, lower face & neck lift
-had skin resurfacing (chemical peeling &
dermabrassion ) for acquired nevus & melasma (hyperpigmented/dark areas of the skin) & small wrinkles around the lip
15. Currently undergoing major change of lifestyle
-diet, exercise, making new friends etc.

She is a renewed person now. Her motto is:

'Living Life to the Fullest'

Dr. Mol did the first face lift surgery in PNG on this brave & determined person. Face lift is basically an attempt, to try & restore the youthfulness of the face. The early signs of aging, manifests as follows:
1. Hollowness due to loss of fat (atrophy/dystrophy or migration), collagen loss/damage & severe dehydration
2. Collagen damage & migration of skin resulting in formation of wrinkles & excess/baggy skin

Face lift surgery mainly involves:
1. Repositioning of fat or autologus fat transfers/graft or sometimes fascia/muscle sheet grafting
2. Stretching & repositioning of skin

The overall aim of face lift surgery is to restore the youthful, facial contours of the face, as well as to remove wrinkles. Muscles of the face attach to the skin to create facial expressions. Some wrinkles arise from hyperactive muscles, exerting excessive pull on the skin, even at rest (when not attempting to make a facial expression). In such cases 'botox' may be indicated to relax these muscles. Excessive use of 'botox' may cause 'mask-like' or expressionless face. Furthermore, excessive removal of facial fat & multiple facelift surgeries may cause mask-like or skeletonized face (loss of normal facial contour, resulting in prominent, and show of facial skeletal features).



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