Facial Procedures

Face Rejuvenation

As we get older, fine lines and wrinkles begin forming on our face. Collagen has been used to help soften the appearance of aging skin. Some people choose to have collagen injected into the face to reduce fine lines and wrinkles. However photo facial rejuvenation gives patients a softer and gentler option. This is done by light energy actually stimulating the production of collagen. The energy is gently delivered through a special handpiece to the targeted area. Then the targeted damaged tissue absorbs the light energy leaving the skin looking much younger. This procedure can even take care of red complexion, irregular pigmentation and large pores.

Photo facial rejuvenation is non-surgical and offers minimal amount of pain. When the light pulses are delivered to the needed areas, most patients have compared it to the snap of a rubber band on the skin. Patients can choose to have topical anesthesia to minimize pain even further. There is rarely any post-operative discomfort after treatment. A flushed look may follow, but that soon fades away. The doctor may have some instructions for the patient to follow, including avoiding harsh skin cleansers and to use sunscreen.

Even after just one treatment of photo facial rejuvenation, the skin will have a more even tone with a smoother look and feel. Also pore sizes decrease in size, as do fine lines and wrinkles. Depending on the area treated, there will be a series of five to eight treatments. However, the treatments only take 15 to 30 minutes for the doctor to administer. The results of each treatment will steadily increase the improvements. Photo facial rejuvenation treatments offer patients a quick, safe, and painless way to regain a youthful look.

Face Lift

THE MYTH OR MISCONCEPTION OF THE FACELIFT - by Alexander Carli, MD

The facelift sounds like the magic “fountain of youth”. Most people anticipate significant changes visible to everyone and a frequent question is, “How much younger will I look?” Usually these women or men are in their forties and need something done for different areas of the face. Aging is becoming a problem and they want to do something about it. In many cases, a facelift is not necessary and other, less extensive procedures can be combined to obtain as good of a result as a facelift.

The facelift does not cover most areas of the face. It usually helps little in the area of the mouth and does not do anything for the texture of the skin. It is an extensive procedure but still limited in terms of rejuvenation. Rejuvenation is a completely different concept. It means a combination of all of the different procedures that can be done to maximize the rejuvenation of the face at any age. The older the patient is, the more procedures need to be combined for the patient to look his or her best. I cannot over-emphasize the need and the necessity to understand the difference between a facelift and facial rejuvenation. The facelift is the most extensive procedure of facial rejuvenation but it still excludes the forehead, the eyelids, the texture of the skin as well as the bone structure of the face and the loss of soft tissue. Rejuvenation is the combination of procedures that specifically addresses the needs of each individual face. It includes improvement of bone structure, liposuction, soft tissue augmentation with fat transplant or other fillers, texturing of the skin as well as usually more surgical procedures such as eyelid surgery—the most common facial procedure in the United States.

The facelift alone cannot accomplish all of these things and, therefore, can only eliminate and tighten up the excess of skin of the cheek and the neck. The tightening procedure is an effective tool of facial rejuvenation but it cannot by itself accomplish facial rejuvenation in most cases. A facelift can be disappointing to patients seeking facial rejuvenation who expect improvements in areas other than sagging of the cheeks and neck. Another cause of disappointment with the facelift can be the skin of the patient. The younger and more elastic the skin is, the better the results will be. Indeed, if the skin has reached a point where it has lost some, or most, of its elasticity the result will not be as good, regardless of the technique and ability of the surgeon. The more the skin loses its elasticity the more it will stretch back after surgery and the results will not be as lasting. The durability of the result varies mostly with the type of skin—the better quality of skin, the more durable the result.

The technique of the facelift is important and within the past 25 years has become more extensive and sophisticated but it cannot compensate for the type of tissue the surgeon has to work with. Besides, though techniques have improved tremendously, they are not perfect tools, hence, we cannot obtain a perfect result. Whenever we consider a facelift in a patient we must consider the needs of the whole face and not just the sagging of the cheek and neck.

We must evaluate the type of skin and tissue as well as the technique for each atient. Practically, in all cases the techniques no longer consist of simply tightening the skin. It includes tightening of the muscle as well some liposuction of areas of the face. The modem facelift is no longer a skin procedure. It treats skin, muscle and facial fat.

All of these considerations should not discourage the proper candidate from having a facelift—for it is an excellent procedure that pleases over 90 of patients nationwide. However, this extensive procedure has to be looked as a tool toward rejuvenation of the face, and cannot be equated with rejuvenation of the face. If patients do understand these different concepts their chances of satisfaction with the result are much better. It is mandatory for my patients to discuss and understand these points that I will clarify as best I can during the 2 consultations we have to cover the procedures, the technique, the risk and the limitations. If the patient does not feel clear about these points, the facelift should not be performed.

It is also a fact that this extensive procedure will require some psychological strength and support. The immediate post-op recovery takes at least a couple of weeks and the end result will take at least 3 months. After the first couple of weeks, people can usually go back to a normal social and professional life by using makeup, modifying their hairstyle and some kind of clothing that will help camouflaging the residual swelling or bruising. The skin of the face that has been lifted in the face and neck area will remain numb for a minimum of 3 months. The sensation will come back gradually, and at around 3 months the sensory is generally pretty good, but for normal sensory to come back it can take over 3 months, in most cases, and in some cases up to a year, as described in literature. For all of these reasons, the patient must be prepared psychologically to go through the post- operative period and usually needs a spouse or a friend for support.

We can compare the facelift patient to a dental patient who goes to the dentist for the first time after 40 years old. The older we are when we go to the dentist the first time, the more work we will need done on our teeth. The younger we go, the less work is needed, and the better the result. As we know, going to the dentist later in life is always a necessity and we always get an improvement, but our teeth are fixed with tools and techniques that cannot restore a perfect look.

Talking about teeth, it should be emphasized that the facelift like facial rejuvenation in general, does not require reaching a certain age. It should be started when the face starts aging—for some people it will start earlier than for others. Like with teeth, we treat a condition and not an age.

If we wait until age 50 to go to the dentist for the first time, we could never get the same improvement as we can by starting earlier, as a problem occurs. The analogy between teeth and skin is real. People need to treat a problem when it develops, and not wait for an arbitrary age, letting the problem go without treatment and allowing it to get worse. Plastic surgery, like dental care, is not age related but condition related.

An example is skin care, which has allowed, with the advent of different Skin Care Treatments and the laser, preserving and improving skin in way that was never possible before. However, that type of aggressive skin care must be started early in life to minimize or reverse the aging of the skin. In other words, like with teeth, we have to start taking care of our face early in life if we want to look our best as we age. The time for a facelift is when the cheek and the neck start sagging.

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Most Common Questions

1. How much younger will I look?
It cannot be determined but we can guess that usually you will look younger.

2. What about the scars?
This depends upon the way you heal and how extensive was the surgery. As a rule the more skin removed the more extensive the scar will be. They usually fade away within 4 to 6 months after your surgery but will never disappear completely.

3. How long will the result last?
On the average, 5 to 10 years depending upon your age and the quality of your skin.

4. Will I have a natural look?
A facelift gives a fresher younger look and not an unnatural look. This has been my experience with the technique I use.

5. Anesthesia, Should I be put under?
I do my facelift under general anesthesia. It is better for the patient. There is no pain or discomfort and no risk of claustrophobic reaction during the procedure. Indeed, it is a long procedure.

6. Does laser resurfacing substitute a facelift?
No. The laser can only improve the texture of the skin, the fine wrinkles and small scars such as acne scarring. It will also cause a light tightening of the skin. That tightening of the skin cannot get rid of excess of skin. Skin excess can only be eliminated by surgery whether it is a facelift, forehead lift or eyelid surgery. The laser is an excellent tool but it only complements the result of the facelift. The facelift lifts and tightens up the skin whereas the laser improves its texture. Both can be done at the same time in some cases. Usually they are done separately because lifted skin may not sustain a laser resurfacing if it is deep. However, in all cases, a partial laser can be performed at the time of the facelift safely.

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A Few Recommendations

  1. Take advantage of our esthetician consult at no charge.
  2. Please no makeup on at the time of your second visit and on the day of your surgery.
  3. Do not choose a time of crisis or depression to have your surgery.
  4. Shampoo your hair the night before and the morning of surgery with hibiclens.
  5. Make sure you have good psychological support from your spouse or a friend.

Once Again,

  1. The scars will fade within 4 to 6 months usually, but will remain permanent, though practically not visible.
  2. The more skin to remove the longer the scar. The length of the scar is not the main problem. The position and the shape of the scar are more important than the length. A long scar behind the ear can be virtually invisible as long as it's positioned well within the fold behind the ear. In the rare case of conspicuous scar if it is well positioned it is usually easy to do a scar revision and practically get rid of the scar. I rarely have to do it. It is a simple procedure without down time and I do not charge for it.
  3. The 2 sides of the face do not look alike. It is visible pre-operatively and to the patient it might become more visible post-operatively because usually the patients look at themselves much more closely after the surgery than before. However, that difference we can notice in everybody is usually so subtle that it is not noticeable.
  4. After a facelift the face will look better and fresher, although a little different but in no case you will look like a different person. The technique I use is extensive but it will not give you a mask or surgical look. Your face will feel tight for a while but should not look unnatural.
  5. Most importantly, you need to understand the difference between facelift and facial rejuvenation. I covered that difference above and I reiterate the need to understand it. If you want or need a facelift only.. .great! But it only corrects the sagging of the cheeks and neck. It doesn't mean facial rejuvenation which entails the other aforementioned combined procedures.

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    Forehead Lift

    A forehead lift, also known as a brow lift, minimizes some of the most visible signs of aging, such as drooping eyebrows, "hooding" over the eyes, forehead furrows, and frown lines. In a forehead lift, the muscles and skin that cause problems are removed and/or altered to smooth the forehead and raise the brows and reduce frown lines. The surgery is performed under general anesthesia and takes approximately 2 hours. The skin is lifted so portions of muscle and excess tissue can be removed. You will have stitches that will dissolve in about 2 weeks as well as a dressing. You may experience some numbness but that will subside.

    Pre-operatively, lab work and possibly an EKG an/or chest x-ray will be performed. These tests are included in the price of the procedure. After surgery , you will recover for about 2 hours and then go home. You will be supplied with pain medication, antibiotics, and other medications needed for your recovery at home.

    You may shower after Dr. Carli removes you dressings. Most normal activities may be returned to in about 2 weeks, but strenuous activity may be on hold for 3 to 4 weeks. You will have some swelling and bruising, the majority of which should be gone in 10 days to 2 weeks.

    The forehead lift result lasts for about 5 years, usually.

    Thread Lift

    This breakthrough is another tool for facial rejuvenation. The main advantage is making the lift less invasive. The main problem is the tendency to believe that it replaces a conventional lift. This confusion leads to dissatisfaction.

    To avoid dissatisfaction, the main consideration is the indication. This point is central.

    The surgeons and the patients must discuss what these threads can do for each case. There are different threads and different techniques. Techniques and technology will keep advancing. But the main question will remain; how much should we cut? The threads do not eliminate cutting, but only minimize the amount of dissection. The basic concept is the more the aging, the more the cutting. Vice versa; the younger the face the less cutting. This means, the more aging. The less the threads can do. The company making the threads says it on the cover of their pamphlet, “The minimally invasive approach to a refreshed new you”. You notice the two key words: “Minimally invasive” and “refreshed”. That’s right, refreshed, and not drastic.

    Between young and old are the majority of people who need threads and cutting combined for the best result. Example: A 40-year-old woman with “little sagging” of the face requires only the cutting that it takes to place the threads. The same woman twenty years later still has indications for the threads, but she needs more than the threads. She needs more surgery to obtain a good result; something closer to a convention lift.

    In summary, the more the aging, the more the surgery.

    The main source of dissatisfaction is a failure to realize the above concept.

    Beware of the media. The threads are new, and as usual, gross misinformation prevails. This misinformation leads the public to believe things that are incorrect. In turn, expectations are high until they find out about the limitations.

    Complications are very rare, but still possible. The recovery time is usually shorter than conventional, but there is still a down time. People cannot expect to go for this type of procedure as they would go to a salon or hair dresser.

    The threads are gaining popularity. They are a real breakthrough, but it is still surgery with risks, benefits and limitations. If you go to a surgeon offering the threads, verify that he has been certified in their use. A certificate proves it such as the one shown below.

    The cost is less than with conventional techniques, however not by much. Indeed, the threads are expensive and each thread raises the cost. The number of threads needed for each procedure can be calculated preoperatively to determine the surgical fee. This needs to be discussed and agreed upon preoperatively.

    In conclusion, I endorse the threads. The best compassion would be with the advent of the mesh to treat hernias in the early 1980’s. Herniorrhaphy (hernia repair) remained surgical, but the mesh made the repair less invasive while better and more durable.

    Facial Implants

    Facial implants are used to improve and enhance facial contours. The surgery is performed under general anesthesia and can last from 30-60 minutes. After which you will have some bruising and swelling that should subside in less than 10 days.

    Chin Implants:

    Dr. Carli will select the proper size and shape implant to use to enhance you appearance and insert it into a pocket over the front of the bone. A small incision to create the pocket and insert the implant is made inside the mouth (along the lower lip) and heals up within 5 to 7 days.

    Cheek Implants:

    As with the chin implants, a proper size implant is selected to enhance your cheek bones. An incision will be made either inside your upper lip. A pocket is made and the implant is inserted and secured with dissolving stitches.

    Jaw Implants:

    Jaw implants are place directly on the jawbone to create a stronger, more defined jaw-line. Intra-oral incisions are made on either side of the lower lip to provide access for creating a pocket and dissolving sutures are used to close the incisions.

    During the healing phase, your activities and diet may be restricted for 4 to 5 days. Give yourself plenty of time to get used to the new look and be patient with the healing process.

    Laser Resurfacing

    SKIN RESURFACING WITH THE DERMA-K LASER

    Definition of skin resurfacing: Skin resurfacing is a term used as opposed to re-contouring and re- draping. Re-contouring means changing the contour of the tissue underneath the skin, Re- draping is tightening of the sagging skin with a face-left. Skin resurfacing amounts to making wrinkles less visible and improving the texture of the skin. Ten years ago the only tools to resurface the skin were chemical peels and dermabrasion. These two modalities work pretty well. However, a chemical peel can be either too superficial or too deep, because the depth of the burn inflicted to the skin cannot be controlled well. The result of the deep chemical peel was fraught with complications and a long recovery period. Dermabrasion has its merit, too, but again the depth cannot be controlled that well, cannot do certain areas on the face and the recovery period is also long.

    Within the past 10 years, the CO2 laser has become useful. With technological advances it became the most popular tool for skin resurfacing. In spite of its improvements there were some adverse effects resulting from the thermal injury to the surrounding tissue inherent to the CO2 laser. That thermal injury was a source of complications as well as of a prolonged recovery. The main advantage the CO2 laser has over a chemical peel and dermabrasion is that we can control the depth of the skin ablation better, That's why we were waiting for a newer, more advanced laser that would cause less thermal injury, i.e. less complications with a more rapid recovery. In 1996, a newer more technologically advanced laser emerged: The Derma-K laser. The Derma-K laser delivers a combination of CO2 and Erbium wavelengths resulting in less thermal injury to the surrounding tissue as compared to the straight CO2 laser. This gives us a larger safety margin with accurate control of the treatment delivered to the skin. Therefore, the Derma-K laser provides more safety and a faster recov3ry than the CO2 laser.

    For the same re4ason, a second treatment can be done earlier with the Derma-K laser than we could with the CO2 laser. The treatment with the Derma-K laser can be repeated at 3 months as opposed to 6 months with the CO2 laser.

    During the laser treatment, the surgeon carefully passes an activated laser beam back and forth over the skin until the safest level is reached. Deep wrinkles and acne scars require more than one laser treatment to achieve the best results. Also, as your face continues to age after a laser treatment, you may repeat the treatment to maintain a more youthful appearance.

    The factors that will influence the result, like with the CO2 laser, are technology dependent, technique dependent, skin dependent and patient dependent. Indeed, the patient like with the chemical peel and dermabrasion will have to be compliant and follow instructions in order to avoid complications and maximize the results.

    The way to enhance the result of the laser resurfacing is as follows:

    1. At least 2 to 3 weeks of skin pre-conditioning with a laser prep cream is required prior to treatment.

    There are 3 stages you will need to go through:

    • Pre-conditioning of the skin before laser treatment, - This pre-conditioning will help obtain better and faster results from the laser treatment. It consists of applying special creams containing Retin-A, hydroquinone and kojic acid. It will be given to you and explained during your pre-operative visit.
    • Laser treatment. Performed in the operating room, under general anesthesia to avoid any pain during the treatment. It takes about an hour. Afterwards, Vaseline will be applied.
    • Post-laser treatment. - The acute phase of healing usually takes 10-14 days. During this time you will be applying Vaseline on the treated area several times a day to keep moist. Usually at about 10 days post-op make-up can be applied to camouflage the redness pf the skin that lasts about two months. Absolutely NO SUN EXPOSURE. You must wear a total sunblock and hat for at least 6 months after the laser treatment.

    It may sound like a long process, but it is worthwhile. Another advantage the Derma-K laser has over the CO2 laser is the cost for treatments. The cost of treatments with the CO2 laser is more expensive than with the Derma-K laser due to the extended post-operative follow-up care with more risks for the patient and the surgeon that is inherent to that type of laser. At first, it was believed that the CO2 laser triggers more skin tightening, but further studies showed that the Derma-K (Erbium/CO2) laser does the same.

    In conclusion, skin resurfacing with the Derma-K laser has definitely lowered the risks as compared to the CO2 laser with this advanced technology, complications have become very rare and are usually related to over-treating.

    SUMMARY: CO2 laser vs. Derma-K laser

    The Derma-K laser provides a more precise beam of laser energy for more control of the laser treatment, meaning less risks and a shorter recovery than the straight CO2 laser. I cannot over-emphasize the fact that it is far better treating a patient for 3-4 months without problems than spending 6 months or longer treating a patient with a complication resulting from technology that is less advanced than the Derma-K laser.

    The skin is our bodies' largest organ. It protects us from infection and shields us from harmful substances. However, as we age, the effects of wind, time, and hormones begin to show. At first, fine lines appear, after which, as the collagen beneath our skin wears out, deeper wrinkles appear. Surface irregularities may also occur, such as pigment discoloration and acne scarring.

    The Derma-K state of the art laser combines erbium and CO2. This laser is used for treatment of aging and sun-damaged skin. The Derma-K laser provides a safe, accurate, and less painful method of restoring softer, smoother, more youthful-appearing skin. This laser is designed to remove superficial and moderately deep lines and wrinkles on the face. It produces less heating or burning of the surrounding tissues than many other lasers used for resurfacing, allowing Dr. Carli to remove the damaged skin cells layer by layer. The procedure is done under general anesthesia and takes about 1 hour. After surgery the skin is red, and swelling is normal. Normally patients can return to most normal activities in about 2 weeks with make-up on to camouflage the redness that can last for over 3 months.

    Sun block must be applied if you will ever be in the sun, and makeup can be worn after the first week or 2. Over the next few weeks, your fresh, new, pink skin will fade to a normal tone revealing a softer, smoother, younger look.

    Rhinoplasty

    Rhinoplasty can be performed on men and women of almost any age, but it is usually recommended that young people wait until facial growth is completed, usually about 13-15 years of age. Rhinoplasty is used to correct numerous nasal deformities, including but not limited to bump or depression on the nasal bridge, a nose that appears to large or too wide, a nasal lip that droops or plunges, or a nose that has been altered due to an injury. Rhinoplasty can also be done to correct a nose that makes it difficult to breathe.

    The technique used in the surgery will depend on the desired results that you want to achieve. Incisions may be made inside the nostrils only or outside as well. Working through these incisions the nose framework of bone and cartilage is sculpted to the desired shape. Surgery is performed under genera) anesthesia and takes approximately 1.5 hours to complete, after which you will recover for about 2 hours. Nasal packing may be placed which will stay in about 2 days and a splint on the nose for 1 week. You will also have a nasal drip pad under your nose to collect any drainage from your nose. Bruising and swelling are to be expected and may last about 2 weeks. Keep your activity to a minimum for the 2 to 3 weeks. After 6 weeks you can resume most normal activities.

    Pre operative lab work will be performed and possibly an EKG and/or chest x- ray. All these tests are included in the price of your procedure.

    It is normal to feel a bit anxious while you are healing, but be patient.

    While you may see definite changes in your appearance immediately after surgery, as each month passes you will notice gradual improvement until healing is complete. It takes a minimum of 6 months for all of the swelling to be gone.

    Otoplasty

    Otoplasty is done to set prominent ears back closer to the head or to reduce the size of large ears. The surgery is performed under general anesthesia and takes approximately 2 hours, although it can vary. Normally, the incision is made behind the ear to expose the ear cartilage. Dr. Carli will then sculpt the cartilage and bend it back toward the head. Sutures are placed and they will dissolve in about 2 weeks. A dressing will be applied, and the patient must be careful not to apply any pressure to the ears. The ears may throb or ache a bit, but pain medicine is provided for your comfort. A headband may be required for a few weeks.

    Any activity in which the ear might be bent should be avoided for a month or so. Most people can go back to work a few days after surgery.

    Lip Enhancement

    Two major characteristics dominate esthetic surgery today. Both have to do with significant advances in technology and techniques that have taken place over the past 10 years. These 2 characteristics are:

    1. Combinations of procedures.
    2. Less need for very invasive procedures to obtain some beautiful and youthful changes.

    The lip enhancement, like most plastic surgery procedures today, proceeds these 2 characteristics.

    In the past, the most popular procedure for lip enhancement was the injection of collagen. The injection of collagen was temporary, fraught with some omplications, due to the fact that it was heterogenous collagen and since it could last only 4 to 6 months maximum, the cost was another consideration. Within the past 10 years, fat transplant has become available in the U.S. and it is a good alternative to collagen since it is the patient’s own tissue. However, usually the fat transplant has to be repeated at lease 2 or 3 times to become permanent. The procedure is more extensive than the collagen and the recovery time much longer. Patients were reluctant to go to a surgery that would give them a result that wasn’t permanent.

    Within the past 2 years, after a lot of studies, a new homogenous material is available.

    This new material is called alloderm. It is the first of its kind since it is live homologous collagen and therefore, permanent. It is today’s filler. There is practically no risk and it is permanent. The only disadvantage is the fact that it requires a little surgery but the recovery time is shorter than with the fat transplant and it doesn’t need to be repeated as opposed to the fat transplant.

    Methods of enhancements of the lips, particularly the upper lip:

    Part of the aging process of the lips is to get longer, thinner with a less visible vermilion. At the same time, small vertical wrinkles tend to form all over the upper lip. This stems from the aging of the skin, the contraction of the lip muscles and the loss of bulk in the upper lip.

    Knowing this, the methods that are presently available to restore a youthful upper lip are as follows:

    1. Filling with permanent filler such as alloderm.
    2. Try to evert the vermilion by performing a so-called w-plasty on the mucosa of the upper lip. This procedure consists of making a W-shaped incision within the mucosa of the lip; that is to say no scar will form nor be visible. The mucosa is advanced so that the vermilion in continuation with the mucosa will be everted to some degree, thereby becoming more exposed and youthful looking. This procedure is simple. There is practically no recovery time, little bruising and some swelling. The patient has to be somewhat careful 5 to 7 days after the procedure not to pucker the lips, not to use a straw, no sucking, no heavy chewing and less vigorous teeth brushing.
    3. If vertical wrinkles are present, treatment with the erbium laser which is the state of the art for resurfacing would take care of them with a recovery time that is much shorter than it was with the CO2 laser. Within a week to 10 days, make-up can be reapplied and you can go back to normal daily activities at work as well as social.
    4. In cases where the upper lip has lengthened or has reached a vertical length that is not in proportion to the size of the other facial units, a shortening procedure can be performed just as the base of the nose. It means a small surgery with a quick recovery and practically no visible scar later on.

    These are the 4 most recent advances that are available for rejuvenation of the upper lip. The same principles can apply for the lower lip but usually the lower lip ages differently from the upper lip and it requires less treatment. The enhancement of the upper lip results from the combination of filling, resurfacing, and working on the mucosa of the inner lip. All of these procedures are rather minor, non-evasive, inexpensive with short recover and provide usually a beautiful long lasting result. The fact that the incidence of complications is very low and the recovery time very short, makes it quite appealing. The benefit of such a relatively minor procedure is surprising. It is part of the facial rejuvenation.

    Alloderm

    Alloderm is normal human tissue donated to U.S. tissue banks in much the same way that other transplantable organs are. It is put through a special process for safety, while retaining all of the components your body needs to make it your own tissue. Alloderm provides the collagen structure and proteins beneath the skin that help you own body's tissue re-grow. Once in place, it fills-in the missing tissue and is eventually integrated into you own. Alloderm is extremely safe and has been used as tissue filler for over 7 years.

    Alloderm can be used to fill-in deep nasal labial folds or "laugh lines". It can be used in enhancing lips, and can also be used on other areas of the face.

    Alloderm is done under local anesthesia. A small incision is made to the area and the alloderm is placed. Swelling and bruising are to be expected and the treatment site may be a little firm during the healing process.

    After the procedure is completed, a small amount of antibiotic ointment will be applied and you will be free to return to home. There is no down time, and you may return to work and activities as normal, except that you may not use straws or chew heavy food for a few days so that the site has time to heal.

    Fat Transfer

    Creases and facial wrinkles begin to appear due to the aging process as collagen and elastin fibers break down. Fat transfer uses the patients' own fat to plump up facial features. It is a safe, natural and non-allergenic procedure. With fat transfer, it is possible to have fat removed from such areas of the body as your abdomen, thighs or gluteal folds, and then have it transferred to the area of your face needing recontouring or definition. Fat transfer may be used for a variety of facial areas. It may be used to fill in facial lines or wrinkles, provide definition to your cheeks or chin and enhance your lips.

    How is this procedure done?

    The procedure is performed on an outpatient basis, once the fat has been removed from the area it is processed to remove any excess fluid, a process called centrifuge. Once this process is completed the fat is placed into a needle that is placed just under the skin of the area being treated, and the fat is injected.

    What can I expect after my fat transfer?

    There is very little to no down time with this procedure. Most patients are up and around immediately following the procedure. Any discomfort may be controlled with over the counter pain reliever such as Tylenol. The patient can expect some swelling and numbness to the area for approximately one week and any bruising may be covered with make-up. Fat transferred to the face may last up to 3 years and there is no chance of an allergic reaction. However, in most cases the fat transfer needs to be repeated once or twice to obtain the expected permanent result.

    Injectable Fillers

    Collagen

    Squinting and other facial muscle movements can take a toll on the eye area, leaving noticeable lines. Collagen is a naturally occurring protein that provides support to various parts of the body. Before performing treatment with collagen a skin test determines if you are allergic to the substance. Once this is determined Dr. Carli will inject the collagen using a fine needle that is inserted at different points along the edge of the area.

    Restylane®

    This is the first and only cosmetic dermal filler made of non-animal Hyaluronic acid and is used to provide volume and fullness to the skin. Restylane can last up to nine months.

    Fat Transplant

    This treatment involves extracting fat cells from the patient and reinjecting in the facial skin. Fat is mostly used to fill in cheeks or minimize wrinkles, some patients also wish to enhance their lips.

    BOTOX®

    Frown Lines

    WHEN WE FROWN FOR ANY REASON, we gather the tissue between our eyebrows into a fold. In some of us, this causes a chronic furrow. This produces a frustrated, discouraged, angry look on our face. This can be distracting to others, and a bother to ourselves.

    Now you can eliminate these frown lines without surgery and without scars, by a simple treatment with botox.

    What is BOTOX®?

    BOTOX® IS THE TRADE NAME OF BOTULINUM TOXIN TYPE A, a purified toxin produced by the bacterium Clostridium botulinum. In large amounts, this toxin blocks the nerve impulses to muscles, causing a form of paralysis called botulism.

    By using extremely small doses of BOTOX®, injected directly into a specific muscle, only action of that muscle will be paralyzed. Therefore, the problem that muscle cases, like a twitch, spasm or frown line, will be stopped.

    Where do you put the BOTOX®?

    THE FROWN LINE between the eyebrows is caused by the action of a muscle called the corrugator. You can feel this as a thickening just below the inside of your eyebrows, when you purposefully make yourself frown.

    Injecting BOTOX® directly into this corrugator muscle stops your ability to draw your eyebrows together when you frown. Once the muscle is paralyzed, it cannot contract, and the frown line gradually fades away.

    Will it last?

    THE ACTUAL TREATMENT takes only a few minutes and the BOTOX® takes effect in three to four days. Gradually over three to five months the BOTOX® effect will fade, and the muscle action will return. When the frown line starts to reappear, a simple repeat treatment is all that is necessary to maintain the desired result.

    Can BOTOX® be used for other wrinkles?

    BOTOX® IS ALSO EFFECTIVE in the treatment of crow's feet, forehead wrinkles, and neck folds.

    Who can perform BOTOX® been tested?

    BOTOX® HAS BEEN USED since 1980 for the treatment of strabismus (lazy eye), and blepharospasm (uncontrolled eye blinking). The use of BOTOX® for forehead wrinkles was pioneered in 1989 by Dr. Carruthers of Vancouver. A major study of this technique was completed in 1995, and a review published in The Journal of the American Academy of Dermatology.

    Side Effects?

    THE SIDE EFFECTS of BOTOX® are related to the local injection of the solution. There will be a slight discomfort from the needle entering the skin, and a small chance of a bruise at the site of the injection. There are no reports of damage to the eye, with injections to the eyelid. There have been no permanent side effects from the use of BOTOX®. Approximately 1% of patients will develop a slight lowering of ptosis of one eyelid. This is temporary and may not even be noticed by the patient.

    Eyelid

    Blepharoplasty or eyelid surgery, can enhance your appearance and your self-confidence by eliminating droopy or sagging eyelids. As people age the eyelid stretches, muscles weaken, and fat accumulates around the eyes, causing "bags", or excess skin to become prominent. During your consultation with your doctor, will assess which of the four eyelids (top and bottom for both eyes) require the procedure.

    The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Generally patients for this procedure are 35 years or older. However, if sagging eyelids run in your family, it may be advisable to have eyelid surgery at a younger age. Eyelid surgery is performed under general or local anesthesia. If your doctor chooses local anesthesia, he will numb the area around your eyes, along with giving you a mild oral or IV sedative. The actual surgery takes one to three hours. The incisions made during the surgery follow the natural lines of your eye. As with any procedure there may be complications. These include infection, or a reaction to the anesthesia used. Minor complications that commonly follow eyelid surgery include double or blurred vision for a few days, which is caused by swelling at the corner of the eyelids, and slight asymmetry in healing or scarring. Following surgery, some patients may have difficulty closing their eyes when they sleep*. Adhering to the physician’s advice on pre and post op care will greatly reduce the risk of complications.

    After you surgery, you will feel a tightness n your eyes. An ointment and a bandage will cover your eyes. A cold compress and elevation will help keep the swelling and bruising down. For the first few weeks following your surgery, you may experience excessive tearing, sensitivity to light, and temporary changes in your vision such as blurring or double vision. Your stitches will be removed 2 to 7 days after your surgery.

Dr. Carli, a leading plastic surgeon in the greater Los Angeles area, would be happy to help you achieve your aesthetic goals! Feel free to call us at (951) 688-8660 with any questions or concerns that you may have regarding Dr. Carli, the Magnolia Surgery Center, or cosmetic surgery. We also offer the option of filling out our online contact form. We look forward to speaking with you!