*Section 2 continued
Double Eyelid Incisional vs Non Incisional
Both methods are considered non invasive procedure. However, commonsense will tell you that the non incisional is the less invasive of the two. Scarring is a concern for those who consider the incisional method. There are things to do to alleviate scar formation. Some options are applying kelocote or using kenacort scar dissolving injections. Anyways here are a few points to take note of:
a) Incisional is more suitable for individuals with excess fatty tissue and thicker skin.
b) Ptosis can also be done with non incisional.
c) For the non incisional method, risk of stitch coming loose is not significant but can happen. However, the dual stitch method greatly reduces the chance for this to occur. This method applies the stitches like that of a net which firmly secures the tissues in place.
Note: regardless of whether it is incisional or non incisional, there will always be natural asymmetry. No one's eyes are perfectly symmetrical.
Jaw/Mandible Reduction
This procedure can be done using different methods, depending on the degree of correction warranted. Note that this procedure only changes SHAPE not width UNLESS the muscle is physically excised out too. Many surgeon would not want to do this as it poses further risk of complications for an already invasive procedure. To add, botox works perfectly well to shrink the muscles by temporarily paralysing them, therefore reducing width of the lower facial region. Things to note about this procedure:
a) You must do an x-ray and ct, preferably a 3d ct scan to determine that you are a candidate for the procedure
b) Sagging is guaranteed. The degree to which sagging occurs depends on whether the patient is a candidate and how much bone has been resected. Remember the way your facial tissues is currently is due to your preexisting structure. Reduce it and sagging is bound to occur. Your concern in this respect should be the visibility of sagging. For example, younger patients will have sagging but less visible than older patients as their muscles are stronger. However, sagging will occur faster with age since the bone structure has been manipulated.
c) Find a conservative surgeon as even the slightest bit that has been over reduced can increase the sagging effect. I was 19 when I first had this procedure done. The surgeon removed too much bone AND I was not a good candidate for the procedure. What occurred was significant sagging and I later had to get a concentric malar lift to the mid face region to shift the sagging tissues in the lower facial region to the mid face region. Essentially it took another invasive procedure to alleviate the problem caused by the first invasive procedure.
d) Be mindful that surrounding the jawbone, are plentiful motor and sensory nerves. There are risks to temporary damage and permanent damage. Permanent damage of motor nerves will leave the patient in a stroke like condition. So again, find a specialized surgeon to perform this procedure and really understand the dynamics of this procedure before going ahead with it.
Zygoma Reduction
This can involve the lateral (side), 45 degree and or the front cheekbone. Can be done by shaving, fracturing or resection depending on the patient's requirements. Refer to the above points I made regarding things to note of for mandible reduction as they all apply to zygoma reduction too. Again, select a conservative surgeon for this procedure and really understand the dynamics of it before going ahead. Your facial bones are like a tent. When the central structure is erected, the tent is held in place. However when the central structure is removed, the tent falls downwards. Same principle with your cheekbones. Some surgeons will also lift the facial muscles at the same time as the reduction but this is not guaranteed to alleviate sagging.
Fat Graft
Fat is taken out from harvest sites, processed and then transplanted into the targetted region. Harvest sites tend to be most commonly from the abdomen and/or thighs. I chose to harvest mine from the abdomen as I experience frequent hyperpigmentation and keloid scar formation. By having the harvest performed at the abodomen, the incision is done through the belly button and hence poses no risk of noticable scarring. Often is the case where after 3 months, whatever remains belong to the patient. I personally retained around 60-70 percent of my fg at the 3 month mark. That is why this procedure is said to be semi permanent. A few things to note about fatgrafts:
a) Individual resorption rates vary from patient to patient. Surgical technique obviously plays a factor too but the unpredictability lies with the patient's body.
b) When areas with frequent muscle movement have been transplanted with the fat graft, there is a risk of the graft being dispersed and dying. Depending on the area, botox helps. I experienced dents on my post op day 3 for my forehead fatgraft. This is due to my habit of frowning and squinting my eyes while i give people the evils lol...Dr Park's solution was to temporarily paralyse the muscle with botox. The result was 2-3 days later the dents were gone.
c) DO NOT SMOKE. Fat graft requires ample circulation for survivability. Smoking will guarantee you to lose significant volume, even after the 3 month mark!
d) *Important: Find a clinic which provides a free or heavily discounted FRESH 2nd top up within at least 8 months. The gimmick for many clinics is that they provide a free top up through COLD STORAGE within the first 3 months. Fat survivability is much lower when taken from cold storage. It is the same principle behind the coolsculpt "fat freezing" weight loss machines. Also, if a patient requires a top up within 3 months then the surgery was not performed properly. A top up should only be required at least 6 months down the road.
Concentric Malair Lift
This is a midface lift performed through either the lower eyelids of intraorally. It grabs the surrounding sagging soft tissues/muscles and secures it to the mid facial region. Individuals with thicker skin should be mindful that it can cause chipmonk cheeks (mariah carey much?
). Healing process is also long. When I had it done, while most superficial swelling dissipated within 3 weeks, the residual swelling took nearly 8 months to fully go down. This recovery period was much like my jaw reduction. Note however can results can be seen after 3 weeks. An issue we should be mindful of with the mid face lift is the slanting effect it can cause on the eyes. So for individuals with thick skin and fatty tissue should find another procedure more suited to them. Just look in the mirror and gently push your midface upwards. You should notice a slight slanting on the eye.
Hydroxyappatite Granules
This type of implant can be used for the chin, jawline and other facial regions for contouring. It is an extract from corals (which is structurally similar to bone), turned into a fine granule form and mixed with the patient's blood into a putty form. The surgeon then moulds the putty into the patient's facial structure. Great thing about this implant is that it can be scuplted by following the patient's facial structure. Limitations is that few surgeons can perform it and thus if for whatever reason removal is warranted, few can remove it too. Anyone considering this method should look to Bryan Mendelson, the surgeon who pioneered the technique. I had it done as a chin revision, jaw line contouring and inconjunture with my mid face lift with excellent results.
Buccal Fat Removal
This procedure is performed through an incision at the inner cheekwall. The fat pad of a golf ball size is then slowly teased out. It cannot be physically pulled out because the surrounding areas has too much sensory and motor nerves. Doing so may risk rupturing. This procedure can cause premature sagging depending on the condition of the patient. For example, individuals who do not have really fatty faces to begin with, who seek the gaunt haute couture look will find themselves aging faster. Facial fats at the end of the day do help maintain a youthful appearance. Also, those with NOTICABLE assymetry (everyone's face is somewhat assymetry to varying degrees) should avoid this procedure as it can exacerbate the assymetry.
Acculift
Effective procedure for facial fat reduction. Performed through a fine wire and tiny incision made at the nasal labial creases should the procedure be targetting the cheek or lower jowel region. It is minimally invasive and works by melting the fat. While some of the fat is removed through a suction, most of it is melted. What occurs is that your body naturally flushes out the melted fat as excretion within the coming weeks. When I had this procedure done my face began to contour and slim down for the course of the following month. While I am very satisfied with this procedure I must add that those who expect a true lift out of this surgery should look elsewhere. You will find a concensus of its effective as a facial fat reduction method. You will find disagreement, especially that of western surgeons (check realself) and asian surgeons on its effectiveness as a lift procedure. From my experience having done the acculift, the supposed lifting effect or the "shrinking of soft tissue" is merely superficial due to swelling and heat from the laser. Individuals looking for a true lift should look at other procedures.
