SmartLook Lid Refreshening
Aging occurs in two primary ways that are especially noticeable in the facial areas, Gravitational and Soft Tissue Wasting (also called Deflation). These affect the skin and underlying supporting structures of the face and neck. Gravitational forces provide a continual downward traction force. The result is a lengthening of the deep SMAS network that attaches to the facial skeletal structure. The overlying skin is unable to resist such force. The skin is dynamic and a continually renewing organ of the body. It, therefore, grows to continually cover the underlying continually stretching SMAS.
Deflation is relative to the effects of the aforementioned aging factor on all the soft tissue structures of the face. There is musculature atrophy. The SMAS loses tensile strength. The skin including the subcutaneous fat and dermis thins. The resulting lack of support for the epidermis creates new lines, wrinkles, and skin folds, all signs of aging.
To counteract the gravitational aging effect, numerous lifting techniques have been designed over the decades. Whether considered “deep, superficial, SMASectomy, plication, imbrication, ‘S’, ‘J’” or whatever, all have the same desire to result in lifting the supporting structures of the face and anchor them to the skeletal structures of the skull. The next step in almost all techniques involves the removal of an amount of extra skin that results from the effect of the lift procedure and then skin incision closure. The loose excessive skin surface area is reduced. Some deep folds are removed and heavy lines softened. Aged thinning skin, although less loose and better draped on the surface of the SMAS is still thin, poorly toned and allow in surface appearance. It appears dull and lacks the youthful glow created by the reflection of ambient light on tones skin. The fine crepe-like rhytids are primarily unchanged, because although stretched and redirected the skin is “dynamic” and will grow to its natural resting tone for its age. No significant new collagen stimulation occurs from surgical lifting.
Counteracting the wasting/deflation effects of aging has traditionally relied upon some topical or external forces being applied directly to the skin to stimulate collagen growth or by injection of “filler” substances. These are ever increasing in number as FDA approval occurs. The external forces for skin replenishment include; external beam lasers and IPL (intense pulse light), LED devices, and chemical solutions such as TCA, Jessener’s, Gordon-Baker, Retinoids, Glycolic, Lactic and other fruit acid peels. These skin replenishes all attempt to effect the actively growing primary source of skin renewal, the Dermis. The Dermis supplied by a vascular plexus is THE source of epidermal cushioning and support. Even dermabrasion is known to have a wounding effect that stimulates the dermal plexus to grow and by better oxygenation result in dermal growth stimulation. In more simple terms “the dermis is where the action is.” Unfortunately, every one of these techniques also requires a trans-epidermal crossing of the media. This means greatly less total energy/material delivery to the Dermis due to a dissipation of energy in the epidermis or failure of penetration of media. A worse problem is that too much epidermal absorption of energy can then cause it to be permanently damaged creating scar tissue and/or color change. What has been needed is a means of bypassing the epidermis safely and effectively to directly deliver media to the Dermis.
Now there has been for the first time, by Cynosure, the development of a safe and dependable system for the under the skin delivery of laser energy. The negative effects of through the skin laser delivery are eliminated. The full amount of energy is directed to the best location for skin replenishment and therefore, skin support is maximized. Two techniques were designed; one is a stand alone procedure for the face and neck skin. This is named ‘SmartLook’ Skin Refreshing. The second is an adjunct to face lifting techniques to create heretofore unobtainable safe full face skin rejuvenation without compromising skin viability that may cause tissue loss by damaging the dermal plexus. This is named the ‘SmartM.A.C.’ Couture Lift.
Numerous surgery techniques have been postulated in the advancement of facial rejuvenation. Deep plane, superficial plane, SMASectomy, SMAS plication/imbrication, FAME lift, long flap, short flap, “S” lift, “J” lift and the multiple trademarked facelifts on the market are all technical changes meant to achieve superior results. These have been techniquedriven advances. The use of Cynosure’s Smartlipo 1064nm laser to safely deliver under the skin thermal energy is a major technological advance that we believe has created the next generation of improvement in facial plastic surgery results. This manner of collagen synthesis stimulation and reorganization has not been achievable previously. The results of improved facial skin tone and elasticity combined with skin shrinkage we feel are truly revolutionary in our field.
All subjects treated have shown no negative effects on skin pigmentation. Treatments have been performed on multiple skin types including subjects of Caucasian, Black, Hispanic, Middle Eastern, Scandinavian, Eastern European, and Asian heritage. No hyper- or hypo-pigmentation has developed or any sign of keloid formation. In actuality, if the subjects had areas of melasma, actinic induced depigmentation, or rosacea there were was objective visible improvements in most all cases.
Bruising is generally mild in laser alone patients and reduced in lift/laser cases when compared to average facelift alone patients. The pain was reported as mild to none. Patients having surgical lifting concurrently had noticeably less utilization of pain medication than the usual face lift alone patient.
Observed changes in the skin are as follows. Pore size is reduced. The improved skin ambient light reflex results in a more youthful glowing complexion. Improved skin tone/elasticity provides a gentle lifting effect on the treatment zones whether surgical lifting was performed or not. Treatment zones can include all areas of the face and neck excluding the nose and upper eyelid skin. Skin improvement is evident as early as 2 weeks. The first 3 months post procedure are when the majority of skin changes are seen with mild further improvement noted up to 6 months. Improvement is then stable. Longevity of results will be affected by all the same aging factors that were present at the time of procedure as with any rejuvenation technique. No procedure stops the aging process.
With demand for maximum cosmetic results with minimally invasive procedures and rapid recovery time, this new application of a well-studied technology will have a central place in my practice of aesthetic plastic surgery.
SmartLook Lid Refreshening - Real Patient Before & After Photos
Eyelid Surgery (Blepharoplasty)
Droopy eyelids can make you look older and can also impair vision. Blepharoplasty corrects these problems and also removes puffiness and bags under the eyes that make you look worn and tired. This procedure cannot alter dark circles, fine lines and wrinkles around the eyes, nor can it change sagging eyebrows. Though blepharoplasty is often performed as a single procedure, you may also have recommended a browlift, facelift, or skin resurfacing to achieve the best results.
If you are wondering how blepharoplasty can change the way you look, you need to know how eyelid surgery is performed and what you can expect from this procedure.
Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Dr Moretz can answer specific questions about your specific needs.
Is Blepharoplasty For You?
As with all facial plastic surgery, good health and realistic expectations are prerequisites. Blepharoplasty removes the excess fat, muscle, and skin from both upper and lower lids. The results can be a refreshed appearance, with a younger, firmer eye area.
People with circulatory, ophthalmological, or serious medical conditions must rely on the diagnostic skills of their own personal specialists to determine whether blepharoplasty is an option to consider. Dr Moretz might recommend planning a simultaneous forehead lift to correct a drooping brow and smooth the forehead, or SmartLook Lid Refreshing to remove the fine line wrinkling in the eye area.
Making the Decision for Blepharoplasty
The patient must make the commitment to follow the pre-surgical and post-operative instructions. During the pre-surgical consultation, you will be examined or asked to answer queries concerning vision, tear production, use of lenses, and your desires for surgery. Dr Moretz will explain what you can expect from blepharoplasty and you will have to provide a complete medical history. Factors to be weighed include age, skin type, ethnic background, and degree of vision obstruction. Furthermore, you can expect an open and honest exchange, which will establish the basis for a successful outcome.
After a mutual decision is made, the technique indicated for your individual surgery will be discussed. The type of anesthesia, the surgical facility, any supportive surgery, and the risks inherent in the procedure will be outlined.
Understanding the Surgery
In upper eyelid surgery, Dr Moretz first marks the individual lines and creases of the lids in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar.
In lower eyelid surgery, the surgeon makes the incision in an inconspicuous site along the lashline and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine sutures. Under normal conditions, blepharoplasty can take from one to two hours.
What To Expect After the Surgery
Immediately after the surgery has been completed tiny sterile bandages will be applied. It is not crucial that the eyes be covered. However, an ointment to prevent dryness of the eye area may be used. A certain degree of swelling and bruising is normal. Cold compresses, as well as head elevation when lying down, will enhance healing and relieve discomfort. Dr Moretz will prescribe medication for discomfort.
For a week and a half following blepharoplasty, you will clean the eye area (the eyes may feel sticky, dry, and itchy). Eyedrops may be recommended. Dr Moretz will also list activities and environments to avoid in the weeks immediately following surgery. Permanent stitches will be removed in five to seven days after surgery. Self-absorbing stitches will dissolve on their own.
Eyelid Surgery (Blepharoplasty) - Real Patient Before & After Photos
What is a Browlift?
A Browlift, also called a forehead lift, surgically corrects drooping eyebrows and softens worried or angry expressions that result from frown lines. During the procedure, commonly performed on men and women between the ages of 40 and 60, the surgeon elevates the skin and underlying tissues of the upper face, and may remove part of the muscle that causes frown lines between the brows. The forehead is then pulled tight and secured in a new, elevated position. The result is a more youthful, relaxed, and refreshed appearance.
Am I a Browlift Candidate?
If you have sagging eyebrows that create a tired or sad appearance, excess upper eyelid skin, deep horizontal creases across your forehead, or frown lines or furrows between your eyebrows, you may be a good brow lift candidate. To get a glimpse of the potential results, you can try a simple test on your own. Place your fingertips at the outer edges of your eyebrows and gently raise the skin upwards. This will give you a good indication of what the procedure might do for your appearance. Of course the best way to determine if an endoscopic Browlift is right for you is by a thorough consultation with your plastic or facial plastic surgeon.
How is an Endoscopic Browlift Performed?
The endoscopic Browlift technique uses a small, pencil-like camera device (called an endoscope) connected to a television monitor. The endoscope is inserted into several small, 1 to 1.5 inch incisions placed just behind the hairline, providing the surgeon with a clear view of the muscles and tissues beneath the skin. The surgeon then inserts another instrument through one of the small incisions to lift the skin and remove or alter muscle, if necessary. During an endoscopic procedure, the eyebrows can be lifted and secured into their desired height through the use of a new, sutureless mechanism called the ENDOTINE Forehead fixation device.
A Browlift procedure can also be performed using a traditional “open” method, where an incision is made slightly behind or at the natural hairline, beginning above the ears and continuing toward the top of the head. The surgeon works through the incision to secure tissue and modify or remove excess skin and parts of the muscle that cause wrinkling and frown lines. The incision is closed with stitches or staples.
How Long is the Procedure?
A Browlift procedure can take typically between 45 and 90 minutes, depending on a number of factors.
What Side Effects Can I Expect from Surgery?
Immediately after surgery, you will experience some temporary swelling and bruising in your eyebrow and forehead areas, which may last for approximately 10 days. The first night, it’s important to rest with your head elevated. You can use a cold compress to help control swelling. You may also experience mild discomfort at the surgical site, which is typically controlled with doctor-prescribed oral medications. Head dressings and drain tubes (if used) are removed within a few days after surgery. You can usually take a shower and wash your hair a few days after that. When healing begins, you may experience numbness and itching at the incision sites. Most patients recover from traditional Browlift surgery in about 2 weeks. Recovery time can be even faster with endoscopic Browlift surgery. At this point, the ability to feel the ENDOTINE Forehead device under the skin and some increased sensitivity in the area may remain until the bioabsorbable material goes away.
How Long Will My Browlift Last?
The length of time your Browlift lasts will vary. A number of factors, including heredity and lifestyle, all play a role in your long-term results. Although you will appear younger, remember that you are still continuing to age. In the future, you may also want to make additional surgical improvements.
What Are the Surgical Risks?
Each year, thousands of men and women undergo endoscopic Browlift procedures and experience no complications. Although problems are rare and usually minor, it’s best to discuss possible complications with your surgeon. And, remember that you can help minimize risks by following the advice and instructions you receive from your health care professional, both before and after surgery.
What Other Fixation Alternatives Do I Have?
All other fixation alternatives require the use of either a suture or a staple to grasp the forehead tissue. These are then anchored to the bone using either a screw or a tunnel which is drilled into the bone. Sutures and screws provide just a single point of contact which may tear through tissue and lead to relapse of the brow. Metal screws also protrude through the skin and require an office visit 7 to 10 days after surgery to have them removed. These can also cause hair loss around the site of implantation.
What is the advantage of the Endotine Over the Others?
The Endotine does not require sutures, screws or staples. It is designed to grasp the tissue at multiple points. This reduces concentrations of stress that can damage the tissue and cause re-descent of the brow. Also, since it does not protrude through the skin, there is a lower chance of experiencing hair loss. Finally, because it is made of an absorbable material, there is no need to have it removed.
Will I Be Able to See or Feel the Device? For How Long?
The Endotine is quite thin and is usually placed beneath the hair bearing scalp. As such, it is unlikely that it will be visible. It is probable that you will be able to feel the device under the skin if you press hard enough since scalp is relatively thin, but typically, this is not overly bothersome. Once the device absorbs, the ability to feel the device should cease. This should last several months to a year.
When the Device Goes Away, Will My Brow Start to Sag?
By the time the device has gone away, the brow tissue will be fully healed and securely re-attached to the bone.