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BLEPHAROPLASTY
WHAT IS A BLEPHAROPLASTY/EYELID SURGERY?
The eyes are one of the most obvious places on both the male and female face where aging is visible. As we age, the thin skin of the upper and lower eyelids stretches and wrinkles, creating loose and sagging skin that makes us appear tired, the application of makeup difficult, and can even disrupt vision is severe. Excess fat deposits make the eyes appear “puffy” and can accentuate the appearance of dark circles under the eyes. Lastly, the lower eyelids become loose over time, giving the eyes a rounded, sad appearance. Conservative measures such as creams or injections do little to correct these issues. An Eyelift or Blepharoplasty is an outpatient surgical procedure that helps to restore a youthful and rested appearance to the face and eyes.
WHO IS A GOOD CANDIDATE?
Ideal candidates for a Blepharoplasty include both men and women who are healthy, non-smokers, and who exhibit the signs of eye aging as described above. Patients may require an examination by an Opthomologist prior to surgery.
WHAT IS A TEAR TROUGH DEFORMITY?
A tear trough deformity is a term used to describe the hollow appearance of the medial lower eyelid, where the lower eyelid meets the nose and cheek. It becomes prominent in some individuals for a number of reasons including protruding fat in the lower lids and thinning of skin in the area. Tear troughs can be treated non-surgically with fillers depending on their depth. During a Blepharoplasty, Dr. Megan can address the tear troughs through a number of mechanisms-- direct removal of excess fat in the lower lids, releasing any adherent retaining ligaments making the lid/cheek junction more apparent, and adding fat to the thinned, hollow area.
THE PROCEDURE:
During the initial patient consultation, Dr. Megan will carefully evaluate the perio-orbital area to assess all of the structures (upper and lower lids, eyelid skin, protruding fat, tear trough deformity) which will require correction. All variations of a Blepharoplasty surgery can be safely done as an outpatient surgery but will require varying levels of anesthesia depending on which areas will require correction. In the upper eyelids, the incision is camouflaged in the natural eyelid crease approximately 1cm above the lash line. In the lower eyelids, fat is removed through an incision on the inside of the eyelid and skin excision is done with an incision 1-2 mm below the lash line to hide it.
Before surgery the patient is meticulously marked while awake and in the sitting position to ensure that the precise amount of skin will be removed. Once in the operating room, anesthesia is given by our outstanding team of Anesthesia providers. Protective eye shields are placed over the eyes to avoid inadvertent damage. A local anesthetic is infiltrated in all areas of skin to be removed. A fine scalpel is then used to remove the redundant skin as previously marked. Care is taken to ensure symmetry between the sides. Excess fat of the upper lids can be removed through the preexisting incision. If correction of the tear trough deformity is needed in the lower lids, this portion of the procedure is performed first through an incision on the inner aspect of the lower eyelid. Through this incision, excess and protruding fat can be removed or rearranged. After this step, any extra skin on the lower lids is directly removed.
Lastly, if it was determined preoperatively that tightening of the lower lids was also necessary, a permanent suture is used to anchor the lower lid to the surrounding bone. All external incisions are closed with a non-dissolvable suture that will be removed at one week. Once the procedure has concluded, eye shields are removed and ice packs are placed on the eyes. The patient will then be discharged home to recover.
AFTER SURGERY:
Any surgical procedure on the face can be difficult for patients because of how visible the recovery is. To help prevent swelling, patients will apply ice packs and elevate the head for the first week after surgery. Eye drops are prescribed to help with any swelling of the tissues around the eyes. Eyes may feel irritated and dry as the swelling progresses. Swelling generally peaks around 3-4 days after surgery and will rapidly improve after that. Sutures will be removed at one week post-op in the office. We ask that patients keep the incisions moisturized for the first couple of weeks after surgery to help facilitate the healing process. Patients should avoid eye makeup for at least 2 weeks after surgery. Many patients take 1-2 weeks off work depending on how comfortable they are returning to work with such a visible recovery
BUCCAL FAT PAD EXCISION
The Buccal Fat Pad is an area of fat in the cheeks that contributes to a fuller, more rounded face. In order to achieve a slimmer contour, the fat pad can be removed through an incision on the inside of the mouth. This is a permanent way to slim the face.
The procedure itself can be done under a local anesthetic with the patient awake. Much like going to the dentist, numbing medicine will be injected into the cheeks through the inside of the mouth. Once the area is numb, a small incision will be made and the fat is gently removed. Both cheeks are assessed for symmetry, and once the desired contour and symmetry has been achieved a simple absorbable stitch is placed to close the incision.
After the procedure a patient may eat and drink. They want to avoid hard, crunchy foods which may disrupt their sutures for the first couple of days after the procedure. Pain control is best achieved with over-the-counter medications such as Tylenol and ibuprofen.
LIP LIFT
WHAT IS A LIP LIFT?
Proportions and balance are key to the harmony of facial aesthetics. When the distance between the base of the nose and the upper lip are excessively long due to genetics or aging, it can throw off the balance of the entire face. A Lip Lift is a surgical procedure that removes a strip of skin from the base of the nose to shorten this distance. In doing so, it will also cause the upper lip to evert, adding more projection and definition. This is a fantastic procedure for patients both young and old as it is easy to perform under a local anesthetic, there is little to no downtime, and there are no non-surgical options that can produce the same harmonizing results.
AM I A GOOD CANDIDATE?
Good candidates for a Lip Lift are both young and old. Age definitely plays a factor for the development of a long, flat upper lip but this can also be caused by genetics as well. Patients should be in good overall health and non-smokers.
THE PROCEDURE:
A Lip Lift can be performed under a local anesthetic. The skin beneath the nasal floor is meticulously measured and marked prior to injection to ensure that the optimal amount of skin is removed. Once the skin is removed, two layers of sutures are placed for skin closure.
AFTER SURGERY: Patients generally report minimal pain with this procedure. The incision should be kept moist with ointment beginning immediately after surgery but cannot be washed for 48 hours afterwards. Sutures will be removed 5-7 days after the procedure in the office. Meticulous and diligent scar care is required for this procedure to avoid an obvious scar in such a visible area.
OTOPLASTY (EAR PINNING)
WHAT IS AN OTOPLASTY?
Prominent, large or asymmetric ears can be a significant source of insecurity that is difficult for patients to camouflage. Women can often use longer hairstyles to cover the ears but men typically cannot. Ear Pinning (Otoplasty) is a surgical procedure done to permanently correct prominent, protruding ears. Ears are typically prominent when the cartilage fails to fold correctly. There may also be extra or redundant cartilage present. During an Otoplasty, the cartilage is reshaped and any extra tissue is removed.
AM I A GOOD CANDIDATE?
Good candidates for Ear Pinning are in good overall health and do not smoke. This procedure is often performed on Men, Women and on Children, as children often report significant self-esteem issues secondary to prominent ears from being teased by other children. It is important to determine surgical expectations preoperatively as some elements of prominent ears can be difficult to correct and possibly even recur after surgery. Patients must also understand that while Dr. Megan always strives for symmetry, true symmetry in the body is never possible.
THE SURGERY:
An Otoplasty can safely be performed in an outpatient setting in our Ambulatory Surgery Center. Varying degrees of anesthesia can be used depending on the age and comfort level of the patient. The surgery itself can be performed in under 2 hours. A local anesthetic is first injected to help minimize bleeding. An incision is then made on the back of the ear, right where the ear meets the posterior scalp. Through that incision, the cartilage is exposed and marked where stitches will be placed to reshape it. Permanent, non-dissolving sutures are placed to fold and reshape the cartilage sequentially, with care taken to observe both ears simultaneously for symmetry. These same sutures are then used to pin the bowl of the ear to the posterior scalp if indicated for prominence. Lastly, excess cartilage can be removed and the ear lobe size reduced if needed. The incision is closed using a dissolvable suture and dressings are placed over the ears. A head wrap is used to hold the ears in position. This will be worn until the first postoperative visit. The patient is discharged home to recover.
AFTER SURGERY:
Patients will go home after surgery to recover and typically follow up 3-4 days after surgery. With an Otoplasty, patients generally report minimal pain. Patients will be responsible for obtaining their own athletic headband to be worn after the initial dressings are removed during the first visit. A headband will be worn at all times for the first week and at night for the next two weeks to protect the ears while they are healing.
BROW LIFT
BROWLIFT:
As we age, gravity takes hold of many features of the face and the eyebrows are no exception. As the brow lowers, it gives a tired and even angry appearance to the face. An Eyebrow Lift is a popular cosmetic procedure which helps to elevate the eyebrows to a more youthful position and restore a refreshed look to the eyes and face. This procedure is often combined with injectable wrinkle relaxers, fillers, or done in conjunction with other rejuvenating procedures such as an Eyelid lift (Blepharoplasty) or a Facelift. The ideal position and shape of the eyebrows has subtle but distinct differences between men and women that must be taken into consideration when devising a surgical plan.
AM I A GOOD CANDIDATE:
A good candidate for a Brow Lift has the signs of peri-orbital aging including deep forehead wrinkles and a low brow. They are in good overall health and are non-smokers, and they desire a realistic and refreshed look to the face.
THE PROCEDURE:
There are multiple types of Brow Lifts available depending on the individualized patient anatomy and goals. A thorough consultation and physical evaluation will help Dr. Megan develop an individualized surgical plan. Regardless of the type of Brow Lift performed, the incisions are always camoflouged within the hair, in pre-existing wrinkles, or in an upper eyelid incision.
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Traditional Brow Lift: This procedure is best suited for patients who require significant elevation of the eyebrows, have significant forehead wrinkles to reduce, and/or need shortening/lengthening of the forehead height. The incision is placed either right at the hairline or a couple centimeters posterior to it. The forehead skin is elevated to gain access to the eyebrows, the wrinkles of the forehead are smoothed, the brows are internally tacked to a more youthful position, and any redundant skin is excised.
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Endoscopic Brow Lift: This technique involves 3-5 short incisions placed just behind the hairline through which an endoscopic camera and tools can be placed to gain access to the eyebrows, elevate them and release wrinkles.
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Direct Brow Lift: In patients who deep forehead wrinkles or well-defined eyebrows, an incision can be placed in the skin directly above the eyebrows to elevate the brows and remove excess skin.
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Temporal Brow Lift: Some patients have isolated lateral brow decent and only require a small amount of outer lift to recreate a more youthful brow arch. For these patients, a single incision on either side of the scalp can be placed in the hair above the top of the ear.
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Brow Pexy: This technique is performed through an upper eyelid Blepharoplasty incision in order to tack the brow into a higher position.
All Brow Lift procedures can be safely done in our outpatient Ambulatory Surgery Center. The length of procedure can vary depending on the type of procedure performed and whether there are other procedures being performed simultaneously. Patients will be discharged home to recover.
AFTER SURGERY:
After a Brow Lift, patients will be sent home to recover. Patients may experience bruising and swelling for which ice and head elevation is recommended. All sutures are removed at one week from surgery.
FACE/NECK LIFT
COMING SOON!
CHIN AUGMENTATION
IN SEATTLE
The structure of the jawline is a key feature to the face. A weak or poorly projected chin can often be a source of insecurity for patients. Jawline Augmentation with either fillers or a surgical implant can be a great option to help build projection and strength to the chin and lower face, to help bring harmony the face, and to boost a sense of self-confidence in patients.
FILLERS:
Fillers can be a great way to temporarily add volume to the lower face and jaw line. They are injected in the clinic with immediate results and minimal downtime. The downside of fillers is that they require maintenance in order to maintain results. Typically, fillers last anywhere between 9 to 18 months. Fillers commonly used in the chin or along the jawline are usually injected deep to the skin, even on the bone, and provide long-lasting structure and volume. Common fillers used for this indication include:
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Voluma
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Restylane Lift
SURGICAL CHIN AUGMENTATION:
An alternative way to increase projection of the chin and add structure to the jawline is the surgical placement of a silicone chin implant. This is done through a small 2cm incision on the undersurface of the chin in the submental crease. The implant is placed in a pocket just above the bone, and it is secured to the bone to avoid malposition or migration. The incision is closed with dissolvable stitches. Pain and discomfort is minimal following a Chin Augmentation. The patient may eat and drink like normal immediately after surgery
AM I A GOOD CANDIDATE?
Ideal candidates for Chin Implants should be in good overall health and non-smokers. Patients with a true under development of the mandible are poor candidates for Chin Augmentation alone and should seek Orthognathic consultation for correction.
FOLLOWING CHIN AUGMENTATION SURGERY:
Placement of a surgical chin implant is a relatively short plastic surgery procedure which can typically be done in under one hour. For maximal comfort, a patient is placed under anesthesia to perform the procedure. All stitches are placed below the skin, and a patient can go home after they have completed their outpatient recovery.
A patient will be placed on antibiotics after surgery for 7 days and will be provided with pain medication for discomfort. Follow up will typically be at one week from the surgical procedure to check the surgical site. Final outcome can be determined when all the swelling has resolved, which may take 6-9 months to complete. Scar remodelling will occur upwards of a year, so diligent scar care is advised.