Facial Plastics Procedures
Forehead Lift / Browlift
A forehead lift, or browlift, is a surgical procedure that can revitalize a drooping or lined forehead, helping you to look less angry, sad or tired. Performed in our state-of-the-art Beverly Hills and Los Angeles facilities using either traditional (open) or minimally invasive (endoscopic) methods, browlifts involve the removal or alteration of the muscles above the eyes to smooth lines and raise the eyebrows for a more youthful and refreshed appearance. The browlift procedure is often combined with other operations such as blepharoplasty (eyelid surgery) and facelifts to improve the look of the eyes and other areas of the face.
While browlifts are typically performed on patients aged 40-60 to counteract the effects of aging, anyone with lined or inelastic skin on the forehead – whether it’s caused by repetitive muscle activity or inherited conditions – is eligible. The browlift procedure is usually performed in our Los Angeles or Beverly Hills facilities under local anesthesia and sedation.
If you are unsure of whether or not you want a browlift, try standing in front of a mirror and placing the palms of your hands to the sides of your eyes above the eyebrows. Then pull the skin back from the eyes, raising the forehead. This is approximately how the procedure will make you look.
Browlifts may be performed in one of two ways: with conventional methods, in which the incision is hidden beneath the hairline (for patients with thinning or receding hair, who are bald or who have had previous surgery in the area, the incision will likely be moved somewhere less conspicuous); or with a minimally invasive endoscope, in which a tiny camera and instruments are inserted through a few small incisions. Both techniques produce similar results of a youthful, smoother appearance. You and your surgeon will discuss which option is better for you.
Note: Patients with very short hair may want to let it grow before surgery to better camouflage the healing scar.
For a traditional browlift procedure: First, the patient’s hair is tied with rubber bands near the incision site. Then the surgeon makes a coronal (headphone-shaped) incision behind the hairline, stretching between the ears and across the top of the forehead. The incision may be placed further back or made along the skull bone joints to minimize visibility in patients with thinning hair or those who are bald. Then the forehead skin is lifted, tissue is removed, muscles are adjusted and the eyebrows may be lifted. Excess skin is trimmed and the incision is closed with stitches or clips. The site is washed and the rubber bands are removed. Some surgeons will protect the stitches with gauze or bandages.
For an endoscopic browlift procedure: After the hair is tied as with the traditional procedure, the surgeon makes three to five short incisions (less than an inch long) behind the hairline. The endoscope is placed in one incision so the surgeon can see beneath the skin without having to make a large incision, while he or she lifts the skin and adjusts muscles through the other incisions. If the eyebrows are lifted they will be stitched or screwed (temporarily) into place. The site is washed and the rubber bands are removed. Some surgeons will protect the stitches with gauze or bandages.
Traditional browlift surgery patients may experience some numbness and discomfort at the incision. Numbness could be replaced by itching, which will subside within six months. Your head may need to be elevated for two to three days to reduce swelling. Bandages are removed in one to two days, and stitches or clips are taken out in two weeks. Hair near the incision may fall out or thin, but normal growth should return within weeks or a few months.
Endoscopic browlift surgery patients may experience some numbness, discomfort and swelling around the incisions, though there is less itching than with traditional surgery. Stitches or staples are removed in a week; temporary fixation screws are taken out within two.
With both browlift procedures, you will be on your feet and able to wash your hair in a day or two, and many patients return to work or school in 7-10 days or less. Swelling and bruising should fade by the third week.
Blepharoplasty (Eyelid Surgery)
Eyelid surgery, also called an eyelid lift or blepharoplasty, can rejuvenate puffy, sagging or tired-looking eyes by removing excess fat, skin and muscle from the upper and/or lower eyelids. Eyelid surgery may be performed at either of our two California locations for cosmetic reasons, to restore a smoother, more youthful appearance, or to improve sight by lifting droopy eyelids out of the patient’s field of vision.
Blepharoplasty at Osborne Head & Neck Institute is ideal for the correction of:
- Loose, sagging and/or folded upper eyelids that may limit vision
- Puffy fat deposits in the upper eyelids
- Under-eye bags
- Sagging lower eyelids that may show the white of the eyes below the iris
- Excess skin in the lower eyelids
- Fine wrinkles in the lower eyelids
Blepharoplasty cannot raise the eyebrows or reduce the appearance of deep wrinkles, crow’s feet or dark circles under the eyes. However, eyelid surgery can be combined with other procedures such as browlifts, BOTOX® Cosmetic treatments and laser procedures to achieve these results.
The best candidates for blepharoplasty:
- Are generally healthy
- Do not smoke
- Have realistic expectations
- Do not have any serious eye conditions
One of our experienced doctors will talk to you about whether you are a good candidate for eyelid surgery.
Eyelid surgery is performed in either or Los Angeles or Beverly Hills facility, usually with local anesthesia and IV sedation. The procedure often takes less than 45 minutes to perform.
Incisions are made along the eyelids in inconspicuous places: in the natural creases of the upper lids for upper eyelid blepharoplasty and just below the lash line on the lower lids for lower eyelid blepharoplasty. If no skin needs to be removed, the surgeon will likely perform a transconjunctival blepharoplasty, where the incision is made inside the lower eyelid and there are no visible scars.
In all cases, your surgeon then removes excess skin from the eyelids using a scalpel, laser or radiofrequency (RF) tool. Fat may be removed as well. He then closes the incisions with fine sutures, tissue glue or surgical tape.
Bruising, swelling and a sense of tightness in the eyelids are common after eyelid surgery. These should subside within 2-4 weeks. Most patients resume activities in 3-5 days, when non-absorbable stitches are removed, and return to work in about 10 days. By one to two months after surgery, you should see the true results of your eyelid lift: a more awake, youthful and cheerful look around the eyes, and greater self-confidence.
Contact lenses may not be worn for two weeks. Eyes can be sensitive to light and wind and may be slightly irritated for a short while; your surgeon may prescribe eye drops and cool compresses to ease any discomfort.
As time, gravity, sun exposure, and the stresses of daily life take their toll on our faces, deep creases appear beside the mouth, the jawline slackens, and folds and fat deposits appear on the neck. Facelifts counteract these problems by removing fat and tightening skin and muscles, giving your face a fresher, youthful and more energetic look — after facelift surgery, some patients appear as much as ten or 15 years younger.
Facelifts in our Los Angeles and Beverly Hills facilities are most often performed on people in their 40s-60s, although those in their 70s or 80s can have facelifts as well. The facelift procedure can be combined with others (browlift, eyelid surgery, nose reshaping) for more dramatic results, or it can be restricted to the neck (necklift) if the patient’s problems center there.
Patients who smoke, take medications, or have certain medical conditions such as high blood pressure, blood clotting problems or the tendency to form excessive scars should discuss potential risks with their surgeons at Osborne Head & Neck Institute. Patients with short hair may want to consider letting it grow before surgery to better conceal scars.
Facelifts are usually outpatient procedures performed at one of our two California locations, typically under local anesthesia combined with a sedative. The facelift procedure itself varies depending on the patient’s facial structure (i.e. where the incisions are placed, whether one or both sides of the face are worked on at once, in which order the steps are performed).
In most facelift procedures, incisions are made from the temples down in front of the ears and back behind the earlobe to the lower scalp. Your surgeon lifts the skin, suctions fat, tightens muscle, trims excess skin and then stitches the incisions closed. Sometimes metal clips are also used to hold incisions firmly closed on the scalp, and bandages are often wrapped around the head to reduce bruising or swelling. Patients may temporarily need a thin surgical drainage tube which is placed behind the ear.
Any numbness, bruising, or thinned hair around the scar after facelift surgery will fade in a few weeks; bandages, stitches and clips are removed within a day to a week. Most patients are back on their feet in a day or two, although the face may appear distorted and feel stiff, and many return to work within two weeks. At first you should be gentle with your skin and hair, and men may need to shave behind the neck and ears where areas of beard-growing skin have moved.
In addition to being located in inconspicuous places such as behind the hairline and in natural folds of the face and ears, scars from facelift surgery fade to near invisibility in time.
The results of a facelift do not last forever; you may want to have another procedure in five or ten years. But in another sense, the effects are permanent; years later, your face will continue to look better than if you had never had the facelift procedure.
An alternative to the traditional facelift for some patients is the “S-Lift”, “mini-facelift” or “weekend facelift.” Named for the S-shaped incision hidden in front of the ear, the S-Lift procedure provides an overall lift to the lower third of a patient’s face and cheeks. Compared to a facelift, a mini-facelift is a quicker operation with a shorter recovery, allowing patients to get back to normal life sooner.
At the Osborne Head & Neck Institute, the S-Lift may be combined with liposculpting, where excess fat is removed from the cheeks, chin and neck, and the skin and underlying tissues are tightened. Then the incision is closed using fine sutures to minimize scars.
Facial liposuction, also called submental or submentum liposuction, is the removal of fat from under the chin using suction. The facial liposuction procedure can significantly reduce excess facial fat, which may cause an overweight appearance or a poorly defined or double chin. The excess fat is often a result of aging, obesity, or heredity and can now be corrected through this minimally invasive procedure that leaves the face looking slimmer and more youthful.
Facial liposuction at our Los Angeles or Beverly Hills facility involves either an intra-oral incision through the mouth or a transdermal incision just under the chin. Scarring is often minimal because the incision is made in a crease of the skin.
Some patients may benefit from a chin implant in addition to liposuction. This makes the chin more prominent and adds balance and symmetry to the face. Facial liposuction can also be done in conjunction with buccal fat extraction, a surgical procedure that extracts excess fat from the cheeks.
The neck may sag as a result of aging or weight loss, and is often affected before the face. Loose neck muscles can lead to an appearance of bands on the neck or drastic drooping of the skin. A neck lift is a surgical procedure that can smooth and tighten the skin on the neck and provide a more toned, smoothed and youthful appearance. The results of the neck lift procedure offer a drastic improvement to the appearance of the neck and subtle changes to overall appearance as well. A neck lift at the Osborne Head & Neck Institute may be performed alongside a facelift, or may be performed alone, after which your friends and family may not even realize that a surgical procedure was performed.
A neck lift procedure includes both a cervicoplasty to remove excess skin and a platysmaplasty to remove or alter muscles in the neck. Liposuction can also be used to remove excess fat during a neck lift. This procedure takes two to three hours and may be performed under general anesthesia or local anesthesia with sedation, depending on the preference of the patient. Most procedures are performed within an outpatient basis in either our Los Angeles or Beverly Hills facility.
Swelling and bruising may occur shortly after the neck lift procedure and last up to ten days. Most people can return to work and other regular activities within two weeks after a neck lift procedure.
There are certain risks involved in a neck lift, as there is with any surgical procedure, including problems with anesthesia or infection. There is also a risk of facial nerve damage that may occur during surgery and can result in muscle paralysis. Although these complications are rare, they emphasize the importance of choosing a skilled and experienced surgeon for your cosmetic procedures.
Whether or not we notice it consciously, full cheeks are often a part of how we judge a person’s face. Cheek implants can have a major impact on the appearance and self-confidence of patients whose cheeks have thinned or sunken due to age, illness or other causes. Likewise, the chin helps provide harmony and balance to other facial features. Often, patients come to one of our California offices desiring a smaller nose when, in fact, a chin augmentation provides a balance to the facial features. Implant sizes and shapes to augment the cheek and chin are tailored to each patient’s desired appearance.