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3252 Holiday Court, SUITE 206, La Jolla, CA 92037 | Phone: 858.658.0595

SAN DIEGO Endoscopic Brow lift

As we age, the skin and soft tissues of our brows and forehead tend to drop, sometimes giving a tired, droopy look to the upper third of the face. Occasionally, low-set brows may impart an "angry" appearance to the upper face in younger patients. Brow lift, or forehead lift, can be performed as part of a facelift, or as a separate surgery. There are several common techniques for raising the brows, some of which involve rather long incisions. The endoscopic technique, commonly used by San Diego facial plastic surgeon Dr. David, involves several short incisions which are made posterior to the hairline, and usually heals rapidly with no obvious scars.

Good candidates for endoscopic brow lift include patients with average hairlines and good hair density in the forehead and temple regions. Occasionally, it can be hard for patients to determine if they should consider a brow lift, upper eyelid surgery, or both. Generally, a brow lift is indicated when the brows are falling below the superior orbital rim: this is the "shelf" of bone over your eye socket.  In women, attractive brows may lie slightly above the  superior orbital rim, especially laterally or toward the outer edge of the eyebrow.

 

The surgical technique for endoscopic brow lift is generally performed with intravenous or general anesthesia and may take approximately one hour to complete. Three small vertical incisions measuring approximately two centimeters are made posterior to the frontal hairline, and two additional curved incisions are made in each temple region, again inside the hairline. The skin and muscles of the forehead are then lifted away from the underlying bone with special instruments. An endoscope, or thin telescope attached to a video camera, enables the surgeon to visualize the entire forehead region through these small incisions.

Once the forhead tissues have been separated from the bone, they are lifted, along with the brows, to more asthetically pleasing position and secured in position.  The "frown" muscles or corrugator muscles between the eyebrows are often cut by  the surgeon at this point to allow better brow elevation, and also to decrease the frown lines that are often treated with botox. 

Recovery from endoscopic brow lift is generally rapid, with patients resuming activities within one to two weeks. There may be some swelling and rarely bruising in the eyelid region.

 

Not all patients are good candidates for endoscopic brow lift, and our San Diego practice employes other techniques in these instances. Examples include bald patients, patients excessively high foreheads or receding hairlines, and patients with very deep prominent horiontal forehead creases. In these cases other options may be discussed including mid-forehead lift, direct brow lift, coronal, or trichophytic brow lift.  Occasionally these involve longer incisions and slightly longer recovery times. Please contact our La Jolla office for more information!

 

Example of Endoscopic Browlift

 

		Patient was concerned about tired look of upper face and eyes. Note how elevation of brows imparts a more youthful, alert appearance.
Before	After

 

For an endoscopic browlift in San Diego or La Jolla California contact Dr. David today at 858.658.0595.

 

 

SAN dIEGO LIPOSUCTION and Fat transfer

 

Neck Liposcuction , or Cervical Liposculpture, is performed to remove unwanted fatty deposits from below the chin. Ideal patients have good skin elasticity and have achieved a stable overall body weight. Liposuction can be performed during facial plastic surgery to complement other procedures such as rhinoplasty, chin implant, and facelift or necklift. Recovery time is generally one week.

 

Neck liposuction can be performed at our San Diego practice with either light intravenous sedation or with local anesthetic and oral sedation. A small incision is generally made beneath the chin, and occasionally additional tiny incisions are made behind the earlobes. Through these incisions small microcannulas are used to remove fat in an even and criss-crossing fashion from beneath the chin and to the sides of the neck.

 

Following surgery the neck is wrapped in a "pressure" dressing for one night. This is removed the next morning and patients are advised to use a removable chin strap  for one to two weeks, which encourages the neck skin to remain tight in its new position.

 

Example of neck liposuction:

 

Before	After (Liposculpture, rhinoplasty)

 

Fat Transfer involves harvesting fat from areas of the body such as the abdomen, "love handles," or thighs, refining the harvested fat, and transfering it to areas of the face and neck.

 

Common areas for fat transfer in the face include the lower eyelid boney margin, the nasolabial folds or "smile lines," the submalar region (hollow area below the cheek bones), or the cheek prominences.  Fat transfer has grown in popularity as we have come to recognize that fat loss or "volume loss" is an integral part of the aging process, along with skin laxity or wrinkling. Fat transfer can complement a facelifting procedure to give an overall more enhanced, natural and youthful appearance.

 

A majority of transplanted fat is expected to survive and become permanent, effectively increasing the volume of the cheeks, lips, temples and remainder of areas affected by aging and fat loss. The key to successful fat transfer is the use of specially designed micro cannulas, which transfer small parcels of fat that are more likely to survive. The harvested fat is also carefully cleansed prior to injection. Fat transfer is always accompanied by some degree of swelling, however within one week appearance is generally quite pleasing. Complete resolution of swelling may take several months or more, however this process is gradual and generally not noticable. At six months, retained facial volume is considered permanent. 

 

Excess fat may be stored frozen for up to one year following fat transfer in our La Jolla, San Diego office. This fat may be used for touch up injections when necessary.

 

Example of Fat Transfer:

 

		Patient had fat transfer to cheeks, submalar hollows, lips, smile lines. Note increased fullness of face.
Before	After

 

For a necklift or fat transfer in San Diego or La Jolla California contact Dr. David today at 858.658.0595.

 

Lip Enhancement

 

Full, well-shaped lips represent a desirable sign of youth and good health. There are several permanent, as well as temporary, methods of lip enhancement or lip augmentation which are used in our San Diego practice. Permanent methods of lip enhancement include lip advancement surgery, as well as implants such as alloderm or gortex and newly-developing permanent injectables. Lips may be enhanced using one's own harvested fat, as well as "extra" fatty tissue removed during a facelift. Various forms of collagen can be injected into the upper and lower lips to produce dramatic changes that generally last three to four months. Usually, lip augmentation can be performed under local anesthesia in our San Diego practice.

 

Permanent Lip Enhancement

The Lip Lift

 

Surgical lip enhancement, also known as a lip lift, is performed in one of two ways. For younger patients who have a slightly ptotic or droopy nasal tip (which hides the region of the nasal sill) an incision is made along the bottom edge of the nose, and tissue excised thus "lifting" the upper lip. The scar generally hides well in this region. This technique is commonly called a subnasal lip lift. In older patients who may have vertical wrinkles along the upper lip, the incision is instead made along the upper border of the red lip. The result of both methods is that the red portion of the upper lip is increased in size, and the distance from the nose to the lip is decreased.  This can be especially useful in patients who have an overly long upper lip, completely hiding the upper incisors.

 

Lip Implants

 

Lip implants are used to permanently enhance lip volume and projection. The procedure involves small incisions at the corner of the mouth which are hidden in the red lip. A tunnel is created under the lip mucosa and the implant material is introduced into position and trimmed, and the incision is then closed with fine suture. Common materials used for lip augmentation using implants include alloderm and gortex.

Click here for a case study on permanent lip enhancement

 

Fat Injection or Fat Transfer

 

Lip enhancement using one's own fat is a procedure commonly performed in our San Diego office . Fat is typically harvested from the abdomen or hips and placed in submucosal fashion as well as into the muscle of the upper and lower lips. While some fat may resorb or disappear over time, patients typically obtain good long term results with this technique. Fat that is present after six months is considered permanent.

 

Temporary Lip Enhancement

 

Synthetic Fillers

 

Lip augmentation using fillers is perhaps the most popular choice for patients because of the reduced cost, no downtime, and safety of commonly used fillers. Hyaluronic Acid fillers are perhaps most popular due to the above reasons: the material is naturally occuring, and resorbs or dissolves over six to twelve months. Examples of hyaluronic acid lip fillers include Restylane and Juvederme.  Permanent fillers such as artefill may be used in the lips, but with caution to due the greater risk of lumpiness or complications over time.

 

[Click photo to enlarge]
Before	After (Restylane® lips)

 

 

For lip enhancement or lip augmentation in San Diego or La Jolla, contact our office today at 858.658.0595.