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Cosmetic Surgery

Robert Kotler, MD, FACS, is here to share the secrets of a Beverly Hills cosmetic surgeon. He has tips and information about aging well, skin care, facelifts, rhinoplasty and more.

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WebMD Health News

Monday, October 22, 2007

The Neck is the Most Important Part of a Facelift
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One of the most misunderstood issues in facial cosmetic surgery is "the neck". The word "facelift" is bandied about when discussing reversing the outward signs of aging. But what is a facelift? Is it lifting the jawline? Elevating the cheeks? Tightening the temples? Opening the eyelids? Raising the eyebrow? Smoothing the forehead?

In fact, depending on the patient's desires and the surgeon's philosophy and talents, the blanket term "facelift" might include some or all of the above elements. Remember that there should not be "one size fits all". Your operation should be customized, not a cookbook copy of the last patient's procedure. A great cosmetic surgeon is an artist, not the operator of a production line. So, ask for a list of the component elements of that particular doctor's "facelift".

Decision making, a joint effort between doctor and patient, follows attentive analysis by the doctor and, ideally, computer imaging to show the prospective patient the predicted result in that doctor's hands.

So, what about the aging neck? The double chin, jowls, sagging vertical platysma (muscle) bands, and the wrinkled, crepy, discolored, sun-damaged skin? There can be a lot of extra baggage there.

My 38 years of consulting with thousands of patients has taught me that the public is fixated on the face, yet the neck is where the biggest victory is always won.

Of all tell-tale signs of aging above the collarbone, most often the neck demonstrates the first. The main reason is that the neck skin - thinner and less elastic than that of the face - succumbs earliest to the forces of gravity. Among the earliest signs of aging are, in fact, some jowls and the "double chin".

One of the reasons so many patients are dissatisfied with their "facelift" is that it did not include an aggressive neck lift. Often, what was done on the neck, perhaps only liposuction, was inadequate. For most women over 45 and men over 55, the facial rejuvenation effort must include a "neck lift". The neck lift is performed simultaneously with the facelift. The skin of the cheeks, jaw, and neck may be lifted from its attachments as one large sheet. Ultimately, after liposuctioning of excess fatty tissue and removal and/or tightening of the lax neck muscles and tightening of the below-the-skin layers of tissue, some of that broad sheet of skin will be discarded after being "lifted" or re-draped.

Those heavily-advertised, promoted, and marketed shortcut facelift operations give no attention to the neck. Hence, a higher patient dissatisfaction rate after these shortcut face-pulling procedures. The cheeks may look better, but there is no way that doing surgery via only incisions in front of the ears can improve the folds, sags, and loose skin of the neck, particularly the lower half of the neck above the collarbone. It is disingenuous for anyone to propose that such a minimal, quick, and shortcut procedure can do it all - and have longevity.

Yes, it sounds good to have a cheap, one-hour facelift. But, like most things in life, you not only get what you pay for, but the result is proportional to the time and effort put in. Shortcuts in surgery are notorious for short-term benefit. My advice: When consulting, your menu of questions should start with the neck. Your questioning should "work up" to the face. You may find that the neck - not the face - is the area that needs the most help.

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Posted by: Robert Kotler, MD, FACS at 10/22/2007 03:27:00 PM

Tuesday, October 9, 2007

As You Grow Older, the Nose Grows?
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Not really, but it does appear that way. It does not grow; but, it drops, droops and elongates.

Here's why. The nose is subjected to two "downward forces" over one's lifetime.

First, gravity. Not unlike other body structures, particularly those that may be deemed "attached", e.g. earlobes, breasts and men's genitals, the nose is another victim of gravity. By the fifth or sixth decade of life, the skin and soft tissue underneath the skin will have naturally stretched and thinned. Under the unrelenting force of gravity, the nose hangs down, looks longer and is misinterpreted as having grown.

The second influence is one particular smile muscle that, when contracting, visibly pulls the tip of the nose downward. That depressor septi muscle runs vertically from the upper lip to the front part of the nose. In a good percentage of men and women, such involuntary depression of the tip of the nose will occur with every smile. One cannot deliberately prevent that specific muscle from contracting. Thus, the years of smiling take their toll as the nose, subjected to innumerable smiles over decades, suffers from the same stretching and lengthening that gravity fosters.

Because some seniors are perturbed by the eldernose's longer, larger appearance, it is appropriate to perform very conservative elevation of the droopy nose to its original and more youthful location in conjunction with facelift and eyelid surgery.

Only those who have had rhinoplasty or cosmetic nasal surgery escape their nose's downward journey. As Nature heals the nose after such surgery, a thin layer of internal scar tissue is created. This tissue, stronger than the natural internal tissue resists the forces of smiling and gravity and prevents the nose from being seen as "growing".

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Posted by: Robert Kotler, MD, FACS at 10/09/2007 06:12:00 AM

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