face lift and fat graft of face

Facelift and Fat-Injection Operations.

Do you ask yourself why am I considering undergoing a plastic surgery? The answer we usually get for this question is that, as you get older, some physical attributes start to change in your appearance, making you look older, and you usually feel that it has happened too soon. So you start thinking, how can we fix this? You see old actors and actresses looking better day-by-day and you see that time has not yet taken its toll on their appearance, so you would like to enjoy that same privilege.

Ageing starts showing on the face due to a number of reasons, some internal such as: the changing tissue on the skin and the sub skin layers due to a quantitative and qualitative decrease in the amount of natural collagen that helps keep your skin flexible, malleable, and unwrinkled. Other internal reason is the decreased amount of wax-like secretions, which makes your skin dryer than it was Also, the increasing number of black spots, dark halos under the eyes are not making you look any younger. External factors include exposition to sunlight, excess lighting, computer screens, and bad sleeping habits; these will make the ageing process a lot quicker than usual.

All these problems are easily solved by plastic surgeons, but to know whether you really need a surgery, or is it possible to replace the surgery with easier approaches, refer to the table on the following page.

For face lift operations, mark the table on the next page with what you observe.

Table 1.1 Dr. Fouad Ghareeb’s table for Face beautification.

Attribute Conservative Surgery Simple Surgery (Local anesthetic) Surgery
Transverse creases Botox Forehead stretch Using speculum Surgical Forehead Lift
Vertical creases (between eyebrows Botox Weakening the muscle (speculum) Surgical Forehead Lift
Dropped Eyebrows Botox Eyebrow lift (Using speculum) Forehead Lift
Short External transverse Botox, Filler, Laser - Facelift
Swollen upper eyelids - - Upper eyelids plastic surgery
Swollen Lower eyelids - - Lower Eyelids plastic surgery
Cheek atrophy Filler injection Fat graft Facelift+ cheek enlargement.
Appearance of two lines between cheeks and nose Filler injection + Laser Fat graft Face Lift
Wrinkles around the mouth. Filler Injection + Laser - -
Lip thinning (or atrophy) Filler injection Fat graft Lip enlargement surgery
Flaccid neck skin Laser (Mild improvement) - Neck lift
Presence of grease under and around the chin Grease dissolving by injections Liposuction Neck lift and liposuction
Presence of spots Laser,Mesotherapy,Chemical pealing Dermabrasion Surgical abrasion

In the following section, you will find more details about injecting fillers, Botox, fats, as well as abrasion, laser, and chemical pealing. These procedures are classified as Resurfacing procedures, unlike operations such as face, neck and forehead lifts, which are not carried out except with a surgery. Do not fall for misleading advertisements promoting “Facelift by chemical pealing,” which is a misnaming, as chemical pealing is just a remedy for spots, light wrinkles around the eye and mouth. Laser, however, has become a very efficient and popular method for light face-lifting and improving skin condition.

  • 3.1 :Face Lift Surgeries

    Before Surgery

    1. Patients should discuss what thery are expecting from the surgery with the surgeon and see his or her historical record and see similar cases to theirs to know what to expect.
    2. Patient must not be suffering from psychological or organic diseases such as diabetes, blood pressure, lung, liver, or kidney malfunctions. As mentioned earlier, patients should complete full medical check up, along with the required tests before surgery and provide full medical record to surgeon. Also, patients should refrain from smoking for up to four weeks before surgery. So is the case with aspirins.
    3. Patient should also know where they would prefer the scar to be.

    How It’s Done:

    This surgery could be performed under local or full anesthesia; the latter is preferred. The surgery consists of three parts that could be fully or partially performed:

    1. Forehead lift to improve dropped eyebrows, horizontal wrinkles in forehead, and vertical wrinkles between eyebrows. This is done by lifting the forehead through a cut in the scalp, managing the forehead skin to lose wrinkles, relax muscle causing the wrinkles, excising flaccid skin and finally sewing up the cut.
    2. Face lift to improve flaccidness in cheek, and wrinkles around the eye and mouth, which is performed by pulling the face’s skin and towards the ear through a cut inside the hair. Also, the muscular layer and (SMAS) is pulled to improve the surgery and give it a long-lasting effect. Then flaccid skin is excised and cut is sewn closed.
    3. Neck lift is performed through a hole behind the ear to improve wrinkles in the skin by pulling tighter the neck’s skin and the SMAS layer through the hole before excising flaccid skin and closing the cut. Darnaqa?

    Post Surgery:

    1. Light bandages should be applied around the face. Patient will not feel any excessive pains after the surgery. However, swelling of the face is expected and cold foments should be applied and replaced by warm ones after few days.
    2. Sneezing and coughing should be controlled to avoid any sub-skin bleeding.
    3. Patient is allowed to drink two hours after the surgery, and can eat on the evening of the surgery. Patient is also advised to limit speech during the first 3 days for optimum results.
    4. Patients are allowed to leave on the same day, but should preferably leave the next day to have nurses and staff checking on them during the night.
    5. Pillow should be elevated during sleep time to minimize swelling .
    6. After two days, patients can use shampoo and soap to wash up and apply anti-biotic creams to the scars.
    7. “Darnaqa” is removed after two days, and stitches are removed after six days.

    Side Effects And Possible Complications

    1. Light bruises and swelling are side effects that disappear after a while.
    2. A possible complication is blood accumulation, which needs discharging and occurs in the first 6 hours after surgery.
    3. Another unlikely complication is the injury of the seventh nerve, the one responsible for the face’s muscles; this causes inability to move the lower lip, but gradually improves.
    4. Scars usually heal in a satisfactory manner, however, in some cases, scars are more resilient and this is due to different skin types as not all patients heal in the same way.
    5. An even more unlikely complication is the decrease in blood circulation, which delays the recovery from the scars.

    Some measures are taken to increase the chances of success:

    these measures are:

    1. fat injection
    2. Laser
    3. Abrasion
    4. Surgical lifting threads: (two types) (Discussed in further details below)
      • Type1 (Aptos)

        As stated earlier, as time passes, gravity takes its toll on skin and leaves it in a lesser state. We see that the fats that were once on the upper side of the cheek have dropped between the nose and the cheek , causing the infamous lines on both sides of the nose. Based on this, Russian doctor Sulamanidz adopted the idea of putting threads in the deeper part of skin to lift these parts. This minor surgery is done under local anesthesia, using a specific needle to apply six threads on each side of the nose. This procedure has two disadvantages: first one is that these threads are felt by the patient and cause distress, and the second disadvantage is that the effects last for just a year or a little more than that. Threads are easily removable in case of inflammation or loss of effect.

      • Type 2 (Curl lift)

        This type of threads is more efficient and practical as patients do not suffer from feeling the threads, as the threads are applied underneath the skin to lift the face

  • 3.2 Fat Injection

    This is one of the simple procedure that we perform under local anesthesia, and has not been popular but lately despite its simplicity and success rate. If you start feeling that your cheeks are losing their glow, posture, and are getting slouchy, this procedure is your simple, go-to procedure.

    The procedure could be summarized in a few simple steps:

    1. Extracting some fats from the stomach or hips
    2. Treating the fats by getting rid of liquids, blood an adding antibiotic.
    3. Injecting the fat in the cheek using a specific needle.
    4. Experienced* doctor specifies the location and amount of injection.

    Fast recovery and results are guaranteed, despite some swelling, which disappears in a few days. The bonus to this procedure is that the patient’s skin gets a new glow due to its expansion by fat injection.

    A frequently asked question is: are these results long lasting or just a result of suction of injected fats? The answer is that suction occurs between 30% ad 70% depending on doctor’s expertise.

    So, if you compare this procedure to injecting fillers, which needs re-injections almost every year with an imported needle, this procedure seems quite worthwhile.

    This procedure can also be used for lip, but I personally prefer fillers for that due to the specific needle accuracy, which intricately improves the final shape of the lip.

    The only possible complication of this surgery is post- surgery inflammation, which can be predicted from pain, excessive swelling and high body temperature. This is dealt with by the use of anti-biotics, and, in rare further complications, injected fat is removed.

© 2016 All Rights Reserved MAADI PLASTIC CENTER.IITC