Many plastic surgeons, including myself, try to determine right away what best fills a patient’s needs when he or she first sees the patient. When it involves the head and neck area, the assessment questions what feature ages the patient the most.
Most commonly it’s the eyelids or the jowl and/or neck, but, of course, it can be any feature from the bottom of the neck up to and including the hair.
After the “first look” when entering the room, the patient is asked the reason for their consultation.
For the eye area, the problem may be upper or lower eyelids or both. With upper eyelids, typically there is excess skin, which can be so excessive that the skin rests on the lashes. Surgery may be indicated, even in less severe cases.
These require a procedure called an upper lid blepharoplasty, a minor procedure that can be done under local anesthesia. Basically, the skin to be excised (removed) is marked with ink and local anesthetic is injected into the skin very slowly to minimize discomfort.
The excess skin is removed, and the skin edges are brought together with fine sutures. Sutures are typically removed on the fifth day after surgery.
If the problem is lower eyelids, it is usually “bags,” which are pseudo-hernias of orbital fat, and these bags result in shadows under them, making a person look tired and older. There can also be excess skin, causing wrinkles.
When the “bags” are the only problem an incision to remove the fat is made inside the lower eyelid. If there is also excess skin, the incision may be in the skin just under the eyelashes or the skin can be tightened with a laser or proper chemical peel. Lower eyelid surgery can also be done under local anesthesia or general, according to the patient’s preference.
For necks, there is excess fat and/or skin or, in those with excess sun damage, fine wrinkles. The treatments vary according to the problem. In patients in their 20s to 40s, liposuction may be all that is needed to remove fat.
If skin is saggy, tightening skin is accomplished with probes that emit heat, e.g., Renuvion or ThermiTight. The intense heat tightens the skin with one treatment. These instruments are usually used with liposuction. For severe face and neck sagging, a facelift might still be indicated.
In younger patients who are concerned with sagging of the jowl area, fillers to the cheek area and/or PDO threads may result in a refreshed look without having to undergo surgery.
These are some of the many options for addressing signs of aging without major surgery. A patient must be properly assessed, and options explained in detail in order for patients to choose what’s best for them.
E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com