Robert Silich MD | New York Plastic Surgery Blog

Q: Does the hair grow back in a brow lift?
The hair does grow back but based on the concept of the brow lift procedure itself, the hairline usually moves farther posteriorly. Most of the time this is the desired result and is aesthetically pleasing and the basis for the procedure. The ideal candidate therefore for a traditional brow lift procedure is usually someone who has either an average or lower than average hairline.

There are also some modifications to the incisions in brow lift surgery that allow for less than ideal candidates to still undergo brow lift surgery. These are direct hairline incisions; eyebrow border incisions and of course endoscopic brow lift surgery.

Q: Is there a risk of nerve damage with a neck-lift?
Nerve damage with a neck-lift is usually very limited. The most commonly injured nerve is a sensory nerve that supplies the area of the earlobe. This nerve is called the ‘great auricular nerve’, which lies along the border of the sternocleidomastoid muscle which helps turn the head from side to side. This is a nerve that is very rarely cut or injured but it does get bruised and can cause some temporary numbness along the earlobe. This can last for a few days or even up to a couple of months. The feeling almost always returns and most people don’t even notice it.

Q: After a face-lift, will someone be able to have a natural-looking smile?
Yes, of course. In fact ultimately, the smile should not change at all. Something that can change the smile would be swelling or bruising around certain nerves of the face. Having said that, the smile can look uneven for the first or even several weeks after surgery, if not longer. The nerves that affect the smile very rarely get injured directly but are so sensitive that even a small amount of indirect swelling or inflammation around the nerves can cause a weakness after surgery

After face-lift surgery, very often people will have a little bit of an uneven smile. They may not even notice it, but the surgeon usually would be able to evaluate this. The inflammation and swelling ultimately subsides and the smile returns to baseline.This period is the time for patience and reassurance from your surgeon and a conservative approach.

Dr. Robert Silich was invited to appear on the Neil Cavuto Show on the Fox Cable News Network channel yesterday to speak about an Argentinean doctor who was recently released from prison for perpetrating a plastic surgery scam on some of Hollywood's elite.

Priscilla Presley and other celebrities had gone to Dr. Daniel Serrano around 2003 and began receiving what he claimed were miracle injections that worked better than Botox. In fact, Serrano was injecting industrial, low-grade silicone similar to what's used to lubricate auto parts in Argentina into her face.

The injections by Serrano (who was not a licensed physician in the U.S.) allegedly caused several complications including facial paralysis and infections in some of the patients he injected.

Dr. Silich had this to say: “Unfortunately it is an all too common scenario. People to do more research looking at a home or buying a computer than they would for looking into a doctor. I wish I could say that this is an exception to the rule, but it's really not, it happens all too frequently and unfortunately it happens with the kind of people that you think it would never happen with."

Q: What material is used to enhance the shape and size of a woman’s breasts during augmentation mammoplasty?
A: Augmentation mammoplasty basically is increasing the size of the breasts by using breast implant devices. It can correct not only small breasts but it can also correct a certain degree of ptosis which is breast sagging. There are 3 levels of ptosis: first, second and third degree. A breast implant alone usually is able to correct very mild first to second degree ptosis without having to do a formal breast lift which has more scarring. The two materials that are used in breast augmentation are saline (salt water) and silicone gel implants. In 1993 silicone implants were taken off the market by the FDA and have actually been further studied since then and now have re-emerged back on the market for general use and augmentation. They have always been used for congenital deformities and for breast cancer reconstruction but they were taken off the market for cosmetic augmentations for a period of about 14 years.

Q: What changes to the diet or lifestyle do you have to make to maintain liposuction appearance after the procedure?
A: The main thing about liposuction is that though you need not be in great shape, you certainly should not be obese before you have liposuction surgery. Liposuction is really a procedure for problems at specific body areas on people who are normally around the right weight but they have certain distributions of fat that are not aesthetically pleasing to them.

The same thing goes for losing too much weight before hand. You shouldn’t go to your plastic surgeon after you have lost a lot of weight and say, “Oh look at these extra love handles I have.”

As far as lifestyle changes go, liposuction usually jumpstarts people into a better exercise and a diet regimen. Diet is very important afterwards. There are some patients who think that they can eat anything now because of the concept of having a finite number of fat cells (once they are gone the fats cells really are gone forever). However if you do overeat, you can develop something called lipodystrophy or lipodystrophic areas. This refers to a condition whereby someone will then gain weight in other areas disproportion to where they had the liposuction performed.

Having said that, there is a current study out which is fascinating. Plastic surgeons from The Netherlands recently showed that women who have had liposuction done in their abdomen and lower extremities are finding a half cup to one cup size increase in their breasts. Nobody really fully understands why. One theory is that there are circulating fat cells during liposuction that stimulate fat stem cells to then propagate and increase fat stem cells in the breast tissue. But so far no one is really sure what the cause is.

Many people will tend to say, “Oh you know my hips look great, my stomach looks great but now the fat went somewhere else. Now the fat is in my arms or underneath my chin.” Then you find out that they have just been eating a lot more and exercising less, and that that is the true cause of the extra fat appearance.

Q: What are the advantages and disadvantages of a chemical peel?
A: The advantages are that it is a quick outpatient procedure with very minimal discomfort afterwards and very minimal post-operative care. The downside is that the results can be subtle and you probably have to have the procedure performed more than once. You must also be very vigilant about not going in the sun afterwards, so a chemical peel is usually not something that we tend to do a lot of during the summertime. It is usually saved more for the winter months.

A quick answer to that is NO. Everybody is born with a finite number of fat cells. This applies also to liposuction and all other methods of removing fat, particularly in the eye. When you gain weight and you have extra fat, what’s really going on is that the existing fat cells that you are born with are just swelling, they are not multiplying. Once you remove that area, they are not going to grow back. With eyelids in particular, a plastic surgeon has to be very conservative with fat removal because you don’t want a patient to have a very sunken, hallowed eye look.

To come back later and remove a little bit of extra skin down the road is fine. But usually you only need to have fat removed from your eyes, just once. There has actually been a movement lately in eyelid surgery to actually put that fat back into the eyelid particularly in the lower eyelid to fill-in some of those “hallows”.

There are three categories or three stages that I use when rejuvenating the neck area. The first category applies to the patient who has simply extra fat. The muscle tone and the skin quality are good and the irregular jaw line contour is due to fat only. These patients benefit from microsuction alone. The incision is about the size of a staple and no skin is removed, only excess fat. The removal and re-sculpting of the area underneath and along the sides of the chin will sharpen and create a more defined jaw line.

The second category is a more advanced stage of neck laxity, which involves not only excess fat but also usually some degree of muscle tone and/or skin laxity. In addition to microsuction these patients usually require a small incision underneath the chin to tighten the loose muscle and possibly remove a small amount of excess sagging skin.

The third category for neck rejuvenation is the most advanced form. These patients usually require all of the above-mentioned procedures but also an incision behind the ears to really get a good lift and correction of a loose neck. That is really a full neck-lift but still without all of the incisions involved in a face lift.

PLASTIC SURGERY PODCAST WITH ROBERT SILICH MD.

EPISODE #2: UPPER AND LOWER EYELIFT SURGERY CASE STUDY


Listen Now / Download MP3 Duration: 3:11



AUDIO TRANSCRIPT:

Hi! This is Dr. Robert Silich and I would like to offer up my comments on this patient of mine who appears on my web site. I have a set of preoperative and postoperative photographs which are mainly respective of her eyelid surgery. She had upper eyelid and lower eyelid surgery.

I will give you an important disclaimer about this photograph which everyone, this web site and other plastic surgery web site, should be aware of. The postoperative photograph obviously has make-up while the preoperative photograph does not. That disclaimer is to let you know that we’re not trying to pull a fast one on anyone or show you any tricks but these are the very subtle things that you need to notice when you’re looking at preoperative and postoperative photographs. Unfortunately, I wasn’t able to have the patient remove the make-up in the postoperative photograph setting but nevertheless I think that the work that we did will become evident.

If you look at the upper eyelids of this lady, on the upper portion of the screen, she has an extra fold of skin which extends really from the outside of the upper eyelid all the way towards the inside of the eyelid towards the nose. That skin is not only looser but it is also discolored which is also normal for extra skin and it also has what is known as crepe changes which is basically the same term that we use for the material crepe and that adjective can be ascribed to skin changes.

So again, very conservatively, what we performed in this lady was an upper lid blepharoplasty which involves removing that extra layer of skin. I also removed a small amount of fat particularly in the inner part of the eyelids on both sides which is the portion closer to the bridge of the nose. If you notice that on the patient’s right upper eyelid there’s a small bulge in there on the inner part of upper eyelid towards the nose which is a fat pocket that’s hanging down. Now, it’s important to not remove all the fat but just to remove enough so that the contour of the eyelid stay nice and uniform from start to finish. If you look at the postoperative photograph on the bottom, that small set of fold is missing on both sides.

On the patient’s lower eyelids, these are much more complicated condition, however, much more common in people about her age. I should mention she is in her late forties at the time of this photograph. On the upper photograph, the lower eyelids appear to be sunken in and they also appear to have dark circles. This problem is very common. What it most likely represents is not only excess fat pockets on the lower eyelids but also an anatomical change in the way the eyelids are attached to the inferior orbital rim. The inferior orbital rim is the medical term for the cheek bone which attaches to the lower portion of the eyelid.

If you notice on the upper photograph, her lower eyelids have almost lengthened vertically. The longer down on the face than they are in the bottom photograph and the reason for that is with gravity and with normal facial movement throughout the course of her forty-somewhat years the tissues underneath the lower eyelids and on top of the cheek muscle itself slowly start to attenuate. Basically what that means is that they weaken and they stretch down. This causes not only a hallowing and a bulging of the fat which now has been exposed because the cheek previously had covered this but it also gives you that classic discoloration which is a shadow that the upper eyelids will cast upon the lower eyelids. What we were able to do in the postoperative photograph is through an incision underneath the last line, the skin and the muscle were dissected off of the cheek bone itself and we draped over this area a fat to re-suspend the lower eyelids. No fat was removed on the lower eyelids at all but merely repositioned to get a smooth contour of this area. You’ll notice in some other web sites and some other plastic surgical literature sometimes this is known as a mid face lift also the medical term for this could be an Arcus Release. Arcus is basically the anatomical position where the lower eyelid cheek attaches to the infraorbital rim which is that eyelid bone. The recovery for the upper eyelid is pretty standard. It’s about 3 to 5 days. For this kind of procedure, however, in the lower eyelids it’s a little bit longer because there’s a fairly more extensive dissection. But again this is all within the range of 7 to 10 days for recovery and postoperative course is pretty normal for upper and lower lid blepharoplasty with no aerobic activity for 2 weeks and extensive icing for the first 24 hours.