FacialPlasticSurgeonBlog.com

What exactly do we mean by Facial Rejuvenation?  Is it a facelift or minilift, a facial resurfacing, laser treatments, some facial fillers, skin care products or just Botox®?Well, actually, it can be some of the above, a combination of a few treatments, or all of the above.  At Bentkover Facial Plastic Surgery & Laser Center we take a comprehensive approach to your face.  We will evaluate all the affects of aging on your face and put them in perspective for you.  There is always room for education in the consultation process.  The internet is a wonderful educational tool, but no amount of education from our website or other websites can really tell you what will make you most satisfied with the appearance of your face.  That is the role of a good, old fashioned.  During your consultation, Dr. Bentkover will thoroughly evaluate how factors like the sun, heredity and smoking have affected the aging of your face.  He will often recommend a number of different options to help you achieve your goals; but most importantly, we want to make sure that whatever you choose will make you happy.    When Dr. Bentkover first started in practice almost 30 years ago, the options for facial rejuvenation were much more limited.  When you saw a cosmetic surgeon in those days, the consultation usually focused on surgery; because that was really all that there was to offer.  The main focus at that time was on facelifting, eyelid surgery and brow surgery, procedures still actually in their technical infancy.  The only facial filler available at that time was collagen (FDA approved in 1979), and lasers were rarely used on the face.  Today we can offer you a much more comprehensive approach, from skin care to quick in-office procedures to more sophisticated surgical options.  We have a much better idea about what works and what does not work. That is why your consultation will take about an hour.  Your face ages differently at each of five distinct tissue layers, and Dr. Bentkover will evaluate the aging process in your face at all five of these layers.  He will make suggestions for treatment at all the layers where he thinks the treatment will truly be of benefit.  Basically, he will present you with a smorgasbord of options, and you can pick what you want and what fits your budget.  While he will make suggestions about which treatment or treatments he thinks will most benefit your appearance, the choice is always yours.Throughout our website are numerous articles that cover just about all of the aspects of how to make your face look refreshed and more youthful.  How you look as you age may depend a lot on your genetic code (Yes, you may look like your mom.).  However, everyday we see patients whose major aging issues have been caused by the ravages of excessive sun exposure and smoking.  Making you look more youthful may require some lifestyle changes.  Continuation of smoking and poorly protected time in the sun (or worse, time in tanning booths) will pretty much negate most of what we can do for you.  Pale really is in.  Time to throw away the sun reflector mirrors.  Time to get serious about throwing out the cigarettes.  Make a bonfire with your cigarettes and say good bye to them. If you are willing to make these sacrifices, you will be much happier with the results of any treatments to your face.   Well, enough lecturing.  What can we offer you?It all starts with your skin (the first layer).  Good skin care and skin health are key components to your appearance.  Keeping your pores clean and protecting your skin from the sun is very important.  Our ProCyte® and Neova® skin care lines can help you in this regard.  Younger looking skin has a nice glow.  Replacing dull, tired looking skin with vibrant skin that glows may do quite a lot to improving how you look.  This is called luminescence, and our Obagi® skin care regimens can do quite a bit to restore luminescence, rejuvenating your skin from bottom up and eliminating unwanted facial pigment and brown spots.  Regular deep cleansing facials can also be very important.Wrinkles and deep creases can be treated in the office with fillers and Botox®.  These treatments need to be renewed periodically but give quick, very effective results. The scowl lines between your brows and the crow’s feet lines at the corners of your eyes and lower eyelids can be treated in the office in a few minutes with Botox®.  If the scowl lines are very deep we often treat them also with Radiesse®.  Radiesse® is our favorite filler for deep creases because of its longevity (10-14 months) and cost effectiveness.  Even more commonly, we also use Radiesse® to fill deep cheek-lip grooves (also called nasolabial creases) and to fill the hollows that develop below your eyes as you age, the hollows that can make you look so tired.  We can treat fine lines of the upper lip or give you fuller, younger looking lips with Juvéderm™ or Restylane™.  If you want more permanent improvement in the appearance of fine lines and wrinkles of the face, we can offer you carbon dioxide (CO₂) laser resurfacing or the newer, breakthrough plasma technology of Rhytec Portrait® Skin Regeneration.  Portrait® also removes unwanted pigmentation, tightens and refreshes your skin, often with dramatic results.  It is usually an office treatment and can also be used to tighten the skin between the décolleté.  Treatments with the V-Beam laser and Intense Pulsed Light (IPL) can remove unwanted red lines in your face (telangiectasias, often from Rosacea).  We also use the IPL to treat unwanted pigment of the chest.As you age, you lose fat volume in your face.  This is the second layer that ages significantly.  This loss of volume is what creates hollow areas that might need to be filled (usually with Radiesse®)  The next layer down, (the third layer) often moves “south” in a fairly predictable manner.  This strong fiber-like sheet of tissue under the subcutaneous fat is called the SMAS (subcutaneous muscular aponeurotic system).  It is actually the extension of the platysma muscle (the fan-like muscle of your neck) up on to your face.  It was during Dr. Bentkover’s training with the renowned Dr. Richard Webster in the late 1970’s that Dr. Webster first demonstrated the importance of the SMAS in aging, and therefore, in facelifting.  Now, almost 30 years later, the most effective and longest lasting techniques for facelifting all involve tightening and moving the SMAS.  Procedures under the SMAS (Sub-SMAS or extended sub-SMAS surgery into the “deep plane”) seem to provide the most natural and longest lasting results.  Simply tightening the SMAS without cutting or moving it under local anesthesia does not seem to be as effective or as long lasting a procedure.        A full lower facelift can give you back your jawline and your neckline by rearranging and tightening the SMAS and the platysma muscle.  But now we also have various minilifts that may achieve what you want with a bit less surgery.  A submental platysmaplasty is a minilift of the area of the neck just under the chin (the submental triangle) that takes about 20-30 minutes and can easily be combined with a chin implant to lengthen a naturally short jawline.  A necklift combines the submental platysmaplasty with further tightening of the entire neck through an additional incision hidden in the creases around the ear.  Both procedures can include liposuction (or liposculpture) of fat overlying the platysma.  A necklift takes between 2-3 hours depending on the amount of tightening needed.A cheeklift is a minilift that lifts the SMAS and skin of the cheeks in a vertical direction to tighten the jaw line and the jowls.  It is the upper half of a full lower facelift   A cheeklift takes about 2 hours.A midface lift is a newer minilift that elevates your cheeks and the area under your eyes. As you age, the middle of your face generally descends at about a 45 degree angle. A midface lift elevates this in such a way as to correct the hollows and washed out appearance that can develop in the middle portion of your face.  The procedure takes between 1-2 hours.  In a midface lift, the fourth layer of the five important layers, the coating over the bone (periosteum) is pulled and tightened at about a 45 degree angle.  If you have not already figured it out, a full lower facelift is just a cheeklift plus a necklift.  When adding a midface lift to a full lower facelift, it is called a triplane facelift, because the operation involves elevation of three separate types (or planes) of tissue: skin, muscle/SMAS and periosteum.  This is all explained in detail on our website (www.DrBentkover.com).Any of these procedures can be combined with a brow or forehead lift.  Often this procedure is an endoscopic forehead lift.  They can also be combined with upper and lower blepharoplasty.  These eyelid lifts often involve removal of excess skin from the upper eyelids and rearrangement and/or removal of the fat of the lower eyelids.  Fat transposition and a SOOF lift are variants of the lower lid procedure.  If your chin is short or your cheek bones flat, these can be augmented with implants.  This changes the shape of the architectural framework of your face, the fifth important layer, your underlying bone and cartilage.  As you age, your jawbone can thin.  This can actually make your jowls look worse.  We can also fill this bony deficiency with an implant or Radiesse®.  In addition, rhinoplasty, a passion for Dr. Bentkover, clearly modifies the fifth layer and can sometimes make you look younger. So, what do we mean by Facial Rejuvenation.  Some or all of the above.  Whatever you need and whatever you choose. 

Stuart H. Bentkover, MD FACS

December, 2007