Your face is your introduction card wherever you are. There are several surgical procedures to improve its appearance , such as: *BLEPHAROPLASTY (eyelids surgery) *RINOPLASTY (nose surgery) *OTOPLASTY (ears surgery) *CERVICOPLASTY

  (neck surgery)

*CHIN SURGERY

*FACIAL LIFTING
 

There are several complementary procedures, in order to achieve a more youthful face look , such as LASER RESURFACING, BOTULISM TOXIN, CHEMICAL PEELING and DERMOABRASION .


BOTULISM TOXIN Up  

Type A Botulism toxin is one of seven toxins produced by Clostridium Botulinum, and is synthesized for medical purposes at laboratories. This toxin produces a temporary paralysis in the muscle that is injected with it.
The toxin has been widely used for treatment of neurological spastic illnesses, and has been very recently used for treatment of facial wrinkles. Muscles of the face are in charge of the expression of our emotions (anger, joy, sadness…). These muscles are located just beneath the skin, and are responsible for the different grins. But their continued use in time makes different parts of the face clearly marked and wrinkled, even when muscles are not used. The most common expression wrinkles are the ones in the forehead, due to the frontal muscle, the wrinkles in the space between eyebrows, due to the corrugator muscles, and crow´s –foot wrinkles near the eye, due to the orbicular muscle.


Botulism toxin is injected , in the right amount, in the muscle which causes the wrinkle. A very fine needle is used, and this procedure can be done at the doctor’s office. Doses are very small, and, therefore, harmless. This toxin affects the connection between the nerve and the muscle. It stops production of “Acetilcolina”, the substance responsible for the transmission of the nerve impulse to the muscle. This effect is only temporary because Nerves protect themselves by producing new connections to the muscle.

This means that three months after the injection, muscular activity starts to normalize. Effects start to be noticed 4-5 days after the injection, and last for three to six months. After that, a new treatment is needed. However, it seems that after several injections, muscles get weaker and smaller doses are needed, to achieve more lasting results.
These are the most suitable zones to get this treatment:

  - Space between eyebrows
  - Forehead wrinkles
  - Crow’s foot wrinkles near the eyes
  - Neck wide wrinkles or lines

Patients must realize that results are very good, but only temporary. To get permanent results, surgery is needed: ( frontal lifting, neck lifting, surgery of Corrugator muscles)
Complications are extremely rare, the most frequent undesired effect is the appearance of an hematoma or inflammation just close to the injection point. These effects last for a few days. If the toxin spreads, there can be a temporary paralysis of a muscle nearby, for example, a fallen eyelid.

Therefore, botulism toxin is a good treatment to fight wrinkles without surgery , but results are not permanent.


OTOPLASTY (ears surgery) Up  

This surgical procedure corrects deformities in the ears, the most common one is an ear that resembles a cup handle. There are some other deformities, and also, deformities due to accidents, hematomas, etc. In general, each deformity has a colloquial name.

Handle shaped ears consist of an external ear that is very separated from the head. Also, the ear fold (antehelix) is not well defined. It is the fold which is located just next to the edge of the ear.
This kind of surgery is usually practiced when small boys are victims of mocks , etc., at school and realize that they have that problem. Usually, six or seven years old boys).

ANESTHESIA
Small boys require general anesthesia, but older boys and adults usually require a local anesthesia.

PROCEDURE
The easiest way consist of stitches that shape the cartilage , without scars. Recovery is extremely fast . However, the usual procedure is this:

A fine skin spindle is extirpated from the back of the ear;. this way, it is fully hidden.. The doctor marks the place to fold the ear and weakens the cartilage, to be able to fold it. The “antehelix” is created by folding the cartilage with some suture stitches. (Mustarde’s Technique).

The auricular shell, if necessary is sutured to the mastoids bone (Furna’s Technique).

We try to achieve a very natural result and appearance . We do not like to extirpate fragments from the cartilage nor to cut it because edges or corners are formed, instead of the natural curves.

RINOPLASTY Up  

Nose surgery is practiced a lot by plastic surgeons.. This surgical procedure can produce changes in the appearance, form, structure and function of the nose. Rinoplasty can reduce or enlarge the size of the nose , change the form of the front end , reduce the width of the wings or change the angle between the nose and the upper lip. This surgery can help reduce or correct birth defects, nose lesions or injuries, and some respiratory problems.

There is not a unique , universal type of rinoplasty that serves the needs of all patients. Doctors design a procedure for each patient, depending on his particular needs. Incisions can be practiced inside the nose or concealed in hard to see points of the nose, in case of an open rinoplasty.

An inner nasal surgery can be practiced, to improve breathing at the same time of the rinoplasty. The best candidate for nose surgery is the patient that is seeking for an improvement , not for perfection, in the shape of his nose..

To be a suitable candidate for a rinoplasty , patient must have realistic expectations, good health, and psychological stability..

ANESTHESIA
General Anesthesia.

PROCEDURE
Purposes are to improve both the shape and the respiratory function of the nose, or to keep a good respiratory function. On the other hand, no one should notice that the nose was operated..
Surgery is carried out through small cuts inside the nose, which allow us to

 - narrow the point by extracting part of the      cartilage in the wings
 - to reduce the spine making it straight
 - to narrow the nose
 - to make the point more turned up or retroussé
 - to put in place some cartilage grafts in order to    fill or improve certain parts of the nose.
 - to correct some nasal deviations

Open rinoplasty is only used in difficult cases, such as noses with complex shapes and structures. A small cut is practiced at the columela (small bridge of skin between the upper lip and the nasal point that separates the two nasal windows or nostrils.).
After the surgery , nose is protected from any problem by a plaster , which also helps keep the new shape of the nose. Small tampons are also put on.

It is not a painful surgery. One or two days after surgery, tampons are removed. The plaster is removed one week after surgery.

There is usually an inflammation and tumefaction, which last for about one month.

FACIAL LIFTING Up  

INTRODUCTION
Facial lifting or ritidectomy is a surgical procedure to improve the visible signs of aging , both in face and neck.
As person grows older , skin and muscles start to lose tone and firmness. Facial lifting can not stop the aging process but improves the most visible signs of aging, dealing with the deep structures, readapting the skin of face and neck , and removing some selected fat areas. A facial lifting can be practiced with or without another surgeries., like eyelids surgery , for example.

ANESTHESIA
A facial lifting can be carried out with general anesthesia, or with local anesthesia combined with sedatives. Choices depend on the kind of surgery to be done and on patients’ wishes. For example, fat can be removed from eyelids or some skin from the eyelids can be extirpated raising or lifting the eyebrows to get a more youthful look. All this can be done with local anesthesia.

FRONTAL LIFTING Up  

Frontal lifting has three main goals: To eradicate forehead wrinkles , wrinkles of the space between eyebrows, and raise eyebrows. This way, patients also get a happier look and expression. Wrinkles are produced by an hyperactivity of frontal and corrugator muscles. (the last ones are responsible for frowning) Treatment consists on partially extirpating these muscles, in order to weaken them so that they stop forming wrinkles. At the same time, the forehead skin is stretched, to raise eyebrows and get a younger looking face.

We carry out this procedure by an ENDOSCOPY. Instead of the incision at the frontal bone, at the scalp and from ear to ear, we make two small cuts (1.5 cms. each) , inside the scalp, so that cuts are not visible. With the help of an stereoscope and specially designed tools, these muscles are located and partially extracted. There is just a small scar, recovery is faster, and aesthetic results are very good. Recently, we are treating wrinkles at the space between eyebrows through incisions of blepharoplasty in the upper eyelids. Eyebrows can be raised properly by making an incision at the temporal zone and a dissection., which is limited only to the side of the forehead and eyebrow..
If tissues of the third half of the face are somewhat lax, we can treat them with an endoscopy , without the need of making cuts around the ears.

CERVICAL-FACIAL LIFTING Up  

It is the proper treatment for laxity and wrinkles of the medium and down thirds of the face, and also of the neck.

Incisions are done around the ears, so that, they are not visible. The skin of the face is disjoined, in order to smooth it.

Stripes that appear at the front of the neck are also treated with this kind of lifting.. These stripes or wrinkles are produced by the platisma muscle, that is located just beneath the skin. When the skin is stretched and the stripes treated, the neck recovers a youthful look, and forms a new better looking angle with the chin.. By a liposuction, the fat that concentrates under the jaws is removed..
Lifting must be done in such a way that the lobule of the ear is not deformed, and that the scar is not visible.

Current trends include not to stretch but reposition tissues in a way that neck and jaws get a new shape,a youthful look, and cheeks get volume.
Filling with fat (Coleman) helps obtain these results.

ANESTHESIA
It can be general or local, with sedatives.

BLEPHAROPLASTY (eyelids surgery)
Up  

his surgical procedure consists on removing some excess skin and muscle from the eyelids, both superior and inferior. Some fatty tissues are also removed. This surgery improves lax skin, gives it firmness , corrects “bags” in the eyelids, and could also improve sight in old people, by lifting the upper eyelid, which sometimes obstructs vision. It can create a fold in the upper eyelid of Asian patients , but can’t help change racial or ethnic features.

This procedure doesn’t eliminate “crow’s foot wrinkles “ or other wrinkles nearby. It can’t remove dark circles around the eyes. It is not practiced to raise fallen eyebrows.

Eyelids surgery is often designed to meet the needs of each patient. It can be done at superior or inferior eyelids, or both of them. The procedure can be combined with other surgeries such as eyes, face, eyebrows , and nose surgeries. It can not stop the aging process, but can give firmness to the skin, and eliminate “bags” in the eyelids zone.

Different procedures are needed, to deal with alterations that affect natural functions of eyelids, such as downfallen eyelids (eyelid ptosis) , due to muscular problems , or laxness between the eyelid and the ocular globe.

ANESTHESIA
This type of surgery can be done with local anesthesia , local anesthesia plus sedatives, or general anesthesia.

PROCEDURE
The doctor draws at the upper eyelids a fine skin spindle , that consists of the excess quantity.. Patients must be stood up and raising their eyebrows.
Please note that downfallen eyebrows require forehead lifting.
After extracting the skin, excess of fat is removed from eyelids bags. Through this incision, the doctor is able to extirpate the muscles that cause wrinkles at the zone between eyebrows. Tissues extracted from eyelids can be used to fill and improve wrinkles.

Scars are located in the eyelids folds.
Surgery of inferior eyelids is done by different techniques. The classical procedure consists on cutting just beneath the eyebrows, so that the scar can not be seen.. There are three fat “bags”, that must be removed. A very small amount of skin is extracted. If a big amount is extracted, the inferior eyelid contracts , going backward, and changing the natural look of the eye.
We are currently extracting fat from bags of eyelids through an incision inside the eyelid, in such a way that there is no external signal. So, there is no harm to the orbicular muscle , which is responsible for closing eyelids.
In case of patients with blue circles around the inferior eyelids, these circles are disguised by filling the orbital border . (Loeb’s Technique)
A cantopexy is practiced most of the time. The outer border is one or two millimeters above the inner border.
A stitch can be done , in order to raise the inferior eyelid; or the inferior eyelid can be also reinserted, to get the same look. (external cantopexy). This last procedure gives the eyelid a more youthful look and avoids contraction of the inferior eyelids.
Through this incision, fat at the cheeks can be raised , getting a youthful look for the medium third of the face.
CO2 laser and peeling are being currently used to eliminate external wrinkles.

POSTOPERATIVE PERIOD
Hematomas can be reduced very much if the patient places ice on the eyes for two to three hours after surgery . Stitches are removed 4 to 5 days after surgery. A massage is needed at that time to reduce the edema and provide elasticity to the skin.

Up