Platysmaplasty (neck lift): A surgical procedure to remove loose, baggy skin in the neck area and tighten the neck muscle

People seeking to remedy the effects of aging such as a fleshy neck, jowls or turkey wattle can consider two types of neck lifts: Cervicoplasty — or a skin-only procedure — and Platysmaplasty, during which skin is removed and the neck muscle, or platysma, is removed or altered. The procedure can be done on its own or in conjunction with a face lift (rhytidectomy). During platysmaplasty surgery, incisions are made under the chin and/or behind the ears to access the neck muscle (platysma) and manipulate or remove it. Permanent stitches may be used to hold the tissue in place. In some cases, the surgeon may be able to make smaller incisions and use an endoscope for a less invasive procedure. This is a newer option and may not always be available.

This surgery takes two to three hours, possibly longer if other procedures are done at the same time. Most people can return to work or regular activities in 10-14 days, and to sports or other excessive physical activity in three weeks. The incision will be bandaged and your head and neck will be fitted with a compression garment for several days after the surgery to hold the sutures in place, but also to improve circulation, minimize swelling and promote healing. Swelling and bruising of the lower face and neck will last several days after surgery, and sensations of burning, tingling and numbness are typical for several weeks post-op. You will also have to avoid turning your head and stretching your neck for awhile. Costs for this type of neck lift range from $3,000 to $8,000, but can go significantly higher when combined with other procedures. The results of the surgery are reported to last 5-10 years, having about the same duration as a face lift.

• The Realself.com satisfaction rate for this surgery isn’t particularly high.
• A step-by-step accounting of the surgery can be found here.
• Dr. Michael Walker talks about the difference between the surgery for men and women.

In an article published in Reconstructive and Plastic Surgery, a number of patients who had forehead lifts not only looked younger but also received the added benefit of an end to those debilitating headaches from Hell.

The link was first reported in that journal in December of 2004 and revisited again last summer.  In the most recent study, the 49 patients having a forehead lift – or brow lift – more than half (57 percent) also reported an end to their migraines.

There are reportedly 30 million migraine sufferers in America, and according to relieve-migraine-headache.com, 25 percent of women and 8 percent of men experience migraines in their lifetime.

The brow lift procedure severs the nerves and muscles in the forehead which may be migraine triggers.  Some patients in the most recent study were injected first in the forehead with Botox, which temporarily paralyzes the muscles and nerves.  If the recipient not only reaped the rewards of a fresher, wrinkle-free forehead, but also stopped having migraines, they also had a brow lift. The doctors who did the procedures would like to see further trials done, but the results are promising.

And while we jest, we are well aware that migraines are no laughing matter and would love to see this as a reasonable and relatively simple solution to a problem that afflicts so many.

That said, who do we talk to about a clinical trial to see if a butt lift will eliminate lower back pain?

• WebMD, which knows EVERYTHING medical, weighs in.
• Everything you want to know about migraines is here.
• Of course, plastic surgeons think this is VERY good news.

Brow lift: A surgical procedure in which the skin of the forehead and eyebrows is tightened to eliminate sagging eyebrows or correct frown lines in the forehead.

Also called a forehead lift, this procedure wipes your worries away – or at least those pesky worry lines that aging and stress tend to grant to many of us. Ranking 22^nd among all cosmetic procedures, the brow lift has only been around since 1995. There are several different types of procedures:

• “Coronal” involves making an incision at or just past the hair line and removing excess skin and possibly some muscle from the forehead area. A plus is that the surgery may result in a lower hairline, however, there could also be noticeable scarring.
• A newer approach is endoscopic surgery, which involves several smaller incisions as opposed to one longer incision. This surgery adds some time to the one- to two-hour procedure, but is less invasive and there is a smaller chance of temporary scalp numbness.
• A subcutaneous lift involves incisions made at the hairline and scarring may be visible.
• A temporal brow lift, sometimes called a lateral lift, involves pulling the skin horizontally rather than vertically, and sometimes results in an exotic, cat-like look, but may also eliminate crow’s feet or wrinkles around the eyes.

Brow lift surgery is sometimes combined with bletharoplasty (eye lift). Sutures are removed in 7-10 days. The average recovery time is two weeks, and the after-effects are swelling and numbness, which can also affect the eyes and cheeks. The cost for this procedure varies widely, anywhere from $3,000 to $8,000, depending on the type of procedure and area of the country you’re in.

RESOURCES:

• Here is a straightforward look that explains the different types and subtypes of this procedure.
• How about a video of an endoscopic surgery?  First pictures, then surgery footage.  It isn’t bloody – sort of like cutting up a chicken – but it’s probably not for the faint of heart. 

It gets worse.

Noses play a central role in many people’s self esteem. It is the focal point of our faces, second only to the eyes.  But you have to get beyond the nose to even get to the eyes, and if yours is larger than life or crooked as a creek, it is going to draw attention and probably affect the outcome of your psychological growth.  So the person gets a little obsessed – big deal?  But hypochondriacs, they say?  Well, if your nose is the size of Wyoming or the shape of a left-hand turn sign, a simple cold is going to be much, much worse, don’t you think?  And if you’re already obsessed with the damned thing and it doesn’t work right…well, you know what I mean.

But as I said, it gets worse.  As LookinGood went nosing around for more information on this peculiar psychological phenomena, we discovered that one of the side effects of rhinoplasty – aside from the pain and expense – is depression.  No one knows why nose job patients experience uneasiness or a slump after surgery.  Some say it’s the side effects of anesthesia, but I’ve never heard of a person getting depressed after an appendectomy, have you?  Others say it’s because of sleep deprivation – patients have to sleep sitting up for a couple weeks after surgery. A recent report from Pharmacology & Physiology in Anesthetic Practice, has a physiological explanation:  “Disrupting the sensitive receptors … which moisten and control the temperature of the air which you breathe … can lead to minor disorientation and depression for several weeks and sometimes months after rhinoplasty.”

Whatever the reason, it just seems plain unfair.  And at the risk of pointing out the obvious – why the hell did they name it “rhino”- plasty, anyway?  Conjures up the image of circus animals, for heaven’s sake!

All plastic surgery comes with some price, but this seems a bit much, I think.

So I say to to those people suffering the snide remarks and self-consciousness about their schnozzes; the mental anguish of making a decision about plastic surgery, along with the depression that might come as an after-effect, just remember these important words:

“It’s not the size of a nose that’s important. It’s what’s in it that matters.” (Steve Martin)  I hope that helps.

We all know that our faces change as we age, with “change” just being a nicer word than “sag.”  A new study led by physicians at the University of Rochester Medical Center, however, suggests that changing bone structure is as big a contributor to the problem as aging skin.

And this, my friends, is bad news for our boys.  Their future facelifts may not just be skin deep, but cut right to the bone.

That’s what Dr. Oscar Ramirez is banking on, anyway, touting his Mandibular Matrix Implant System.  It sounds like something from a Keanu Reeves science fiction movie, but really it’s just fancy words for implants to the entire lower jaw (a.k.a. the mandible).

The idea is to give men, and sometimes women, a stronger jaw line, enhancing the shape of the face and making it look younger.  Mandibular implants aren’t new, though as with most cosmetic procedures, advancements are always being made.  Dr. Barry Eppley, at exploreplasticsurgery.com, notes that creating a strong jaw is not simple.

The mandible has three sections, the chin, the body (side), and the jaw angle. Because this is an area unique to each individual, implants have to be custom-made in advance, or carved during surgery.  They can be done in one, two or three pieces. They are inserted through incisions at the bottom of the chin or sometimes through the mouth.  They are held in place with sutures and screws.   Often, a neck and/or jowl lift should be done at the same time.

Ramirez’s system “is composed of an articulated wraparound geniomandibular chin implant and a wraparound gonial angle implant,” according to the website, and appears to be two overlapping plastic pieces attached to each side of the face.  The accompanying picture looks like a skeleton wearing a heavy-duty chin strap.

And of course, this is considered cosmetic, which means no insurance.  The cost could range from $4,000-$10K.

This is some seriously facial engineering, here folks.  Really manly kinda stuff.  Women might be accused of taking our facelifts too lightly, but leave it to the guys to do it big.  No nip/tuck here, this is structural demolition and reconstruction.

So what is it?  A good way to explain what it is, is to explain what it is not:  it is not a modern facelift.  Technically, facelifts require that the surgeon reposition and cut away muscle, fat and fascia, known as SMAS, under the skin of the face, then lay the skin over the uplifted muscle and cut away the excess.  That sounds simple and, of course, it isn’t, given that in order to correctly reposition the SMAS you must pull a good deal of the person’s skin away from the face first, cut and sew muscle, then sew everything back up without any scars.  When facelifts were first invented in 1904, surgeons merely pulled skin tighter, meaning the skin just looked pulled, and couldn’t possibly last as it stretched out again under the pressure of the sagging muscle. In some ways, according to physicians interviewed and on RealSelf.com, that is what the Lifestyle Lift is – minimal SMAS repositioning, if any, and mostly skin work.  Although the procedure can be done in an hour under local anesthesia, the results are not as long lasting since the underlying problem isn’t addressed.

Still, there are 40 different Lifestyle Lift clinics around the country, many doctors who do the procedure, and some satisfied customers.   Cindy P., from San Diego, told LookinGood “I’m glad I did it and don’t regret it.  Recuperation was not a problem… People tell me that they can’t even tell I had one.”  She adds, however, “that could mean it didn’t work or they never thought I needed one in the first place.”

The cost of the procedure is approximately $4,000-$5,000, half of what a full facelift costs, but getting solid information from the company about exactly what IT IS doing is next to impossible.  Dr. Karen Horton, a San Francisco plastic surgeon warns, “I am skeptical about any procedure that makes claims about fantastic results, without [giving consumers] details of the technique itself and the science behind the operation.  Buyer beware… “

We have to give Heidi Montag credit for knowing when to say when. After ordering up 10 cosmetic procedures in a single day, LookinGood thinks she showed great restraint in deciding against the eye whitening surgery.

Yes, you read it correctly: eye whitening surgery. Dr. Brian Boxer-Wachler, an eye surgeon in (where else?) Los Angeles, performs what he calls the I-Brite Eye Whitening System – a surgical procedure that removes a thin, discolored membrane from your eye, revealing the brighter white underneath.  A new, supposedly clearer membrane grows back, and the patient is left with whiter eyes. In theory anyway; the procedure is fairly new to the U.S., so the results are expected to be long-lasting, but that remains to be, um, seen.

Why, or how, would our membranes be discolored in the first place, you might wonder? It could be due to pollution, too much sun, cigarette smoke. dust – or what Grandma used to call “liver strips.” those yellowish strips that appeared after a night of too much alcohol.

Currently Boxer-Wachler’s Vision Institute is the only place in the United States that performs the controversial surgery for cosmetic purposes. His website calls Boxer-Wachler the “inventor” of I-Brite, but doesn’t sound much different from conjunctivoplasty, any eye surgery to remove pterygium, or growths in the eyes – usually red or brown spots, on the membrane.

I-Brite also sounds a lot like the Cosmetic Eye Whitening Surgery Dr. Bong-Hyun Kim started performing (and trademarked!) 13 years ago in Seoul. Next up for Dr. Kim, who has performed more than 13,000 of the surgeries on people from around the world, is establishing a practice in the U.S.

But really, is cutting a piece of your eye out really the best way to remedy bloodshot eyes? Some eye surgeons would say no, not without having a medical reason.

An ophthalmologist in LA, Dr. Allan Berg, told a local ABC station there that the membrane (conjunctiva) is there for a reason: the blood vessels supply oxygen to the eye. Removing them could result in dryness (it’s awful – imagine taping sandpaper inside your eyelids), scarring and possibly infection.

And consider the cost: $3,000-$5,000 per EYE, and insurance doesn’t cover it. The procedure itself takes about 20 minutes, and downtime is a day, although there could be scratchiness, redness and irritability for several weeks as the new membrane grows back.

If we here at LookinGood were making a list of things we won’t try, conjunctivoplasty (or I-Brite or Cosmetic Eye Whitening Surgery) would be one of the few things on it. Heck, it might be the only thing on it. We will stick to eye drops, dark glasses and our well-rehearsed vows never drink that much again.

Blepharoplasty (eye lift): A primarily cosmetic surgical procedure that reduces bagginess from lower eyelids and raises drooping upper eyelids. The procedure involves the removal of excess skin, muscle and underlying fatty tissue.

The University of Tennessee Health Science Center reported a couple years ago that when judging the age and vitality of a person, we look at their eyes.  Drooping eyelids, puffiness and circles, tell our audience that we’ve either had a rough night out, or we’re simply getting old.  Some ethnic minorities have eyelid surgery to make their eyes larger, and it is also done when people experience such extreme ptosis (drooping eyelid), that the condition impairs their vision.  So it stands to reason that blepharoplasty is the No. 3 surgical procedure for women and men.

For a trained professional, this is a pretty simple procedure, and is sometimes done in an outpatient setting.  Don’t be surprised, however, if your physician recommends anesthesia and an overnight stay in the hospital or clinic.  To repair sagging eyelids, the doctor makes an incision along the crease of your eyelid, cuts away the excess skin and fat tissue and sews the lid back together along the natural crease again, which results in an almost invisible scar.  Treatment for underneath the eye is done the same way, with the incision line hidden under the lower eyelashes.

To have both uppers and lowers done runs about $6,000 – half that for one or the other – and does not require a total facial rejuvenation. When choosing a doctor, make sure it’s someone who listens to what you want, and doesn’t try to sell you a whole new face just because you want to look less tired.  Down time will vary by how prone you are to bruising and how quickly your body heals, but most people are up and around the next day, heading to the store in sunglasses two days later.  Stitches are removed in 3-5 days, but bruising may be apparent a week or more. In some cases, it can be several weeks before puffiness is completely gone, but only the eagle-eye in your family will notice.

Resources:

• The majority of the videos on YouTube are posted by plastic surgeons. The surgeon in this video – Dr. Payman Simoni of Beverly Hills – explains an eye lift in understandable terms while he talks with his patient DURING the actual surgery.
• Satisfaction rates after this surgery are higher than after many other cosmetic procedures – on www.realself.com, it’s at 80 percent. Read comments and see pricing here.
• Got eyelids? Dr. Frank Meronk has a comprehensive resource guide on his website, including an owner’s manual. He also details the differences in eyelid surgery for men.

Otoplasty: A surgical procedure done to correct misshaped or protruding ears.

Did you know that regardless of the size of your head or the rest of your body, your ears are full-grown by the time you’re 4 years old?  Explains a lot doesn’t it? Including why otoplasty was the 10th most common cosmetic surgery performed in 2008 and ranked 26th among all cosmetic procedures.  The majority of these surgeries are done on children between the ages of 4 and 14, but adults, too, opt for this procedure to either reshape or lessen the protrusion of their ears, often in conjunction with other facial surgeries.

Regardless of age, it is done primarily for cosmetic reasons, to make the patient less self-conscious and boost esteem. Remember the beginning of the Disney movie “Dumbo”?  Yeah, kids and grownups alike can be mean when your ears are too big.

The age of the patient has no effect on the risk associated with the surgery.  In the procedure, an incision is made behind the ear and cartilage and skin are removed to achieve the desired shape and result.  In some cases, permanent stitches are used to hold the ear in position.  Because the incision is made in the fold where the ear meets the head, the resulting thin scar is rarely noticeable.  To maintain symmetry, it is always performed on both ears.

Otoplasty is usually outpatient surgery lasting one to three hours, and the cost ranges from $2,000 to $5,000.  Younger children usually receive general anesthetic, but it can be performed using local anesthetic with older children and adults.  This surgery also has one of the quickest recovery times.  The patient’s head is wrapped in bulky bandages for a couple of days after surgery for healing purposes and to help hold the ears’ new shape. That dressing is replaced by smaller bandages or a headband, possibly for two weeks. Sleep could be disrupted because no pressure can be put on the ears, and there is likely to be some throbbing and pain for up to seven days following the procedure. Both adults and children can resume normal activities after a week, but should be careful to avoid situations in which the ear may be bent for at least a month.

• Before and after pictures clearly demonstrate the difference otoplasty can make in all age categories.
• More before and after, but tfun videos:  YouTube Video 1 and YouTube Video 2.
• And if you’re really nostalgic for Dumbo, here’s a clip you can watch.

The Queen of all procedures, the facelift really isn’t as popular as folks think, basically because there are so many different variations, that few ever have to admit that they’ve had one.  Ranked 17th in popularity in 2008, this surgery can knock off 20 years, but if overdone, it can also make you look ridiculous (picture in point.) There are many different types to choose from now.  Partial rhytidectomies, for instance, where only parts of the face are lifted, like the forehead, or just the cheek and jowls, are quite popular.  There are endoscopic facelifts, using laser technology that is mildly less invasive.  The much-hyped “Thread Lift” uses hooks and strings to pull skin taut, but no underlying muscle, or SMAS tissue.  There are “Deep Planing facelifts,” where the surgeon really lifts the deep tissue of the face, and “Short Scar” facelifts, which result in, well, shorter scars.  Each doctor has their own specialty, so if you are contemplating such a move, talk to several of them.

A full facelift involves cutting the skin around the ears and up the scalp along the hairline, and pulling the skin away to get at the SMAS, or superficial musculoaponeurotic system.  That’s the deeper tissue of the face that will be pulled and sewn in place so that the lift will hold.  The skin is then smoothed back over the lifted SMAS and re-attched, with the excess clipped away.  (Early facelifts were performed just stretching the skin, and that only proved that yes, leather can stretch.)  Swelling and bruising are major, and an overnight in a clinic or hospital should be expected.  Recovery is dependant on the patient, but most information suggests 3-4 weeks.

The cost runs $10,000-$15,000, and here’s a kicker that not that many people hear about:  if you are a smoker, most surgeons will not perform the surgery until the patient has been smoke-free for a period of 2-4 weeks.  Nicotine and smoking dramatically retard healing.

• There are countless videos on YouTube from plastic surgeons all over the country.
• The American Society for Aesthetic Plastic Surgery gives a good explanation and can help you find a surgeon.
• HowStuffWorks.com actually has a great section on the procedure, too.

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