Ferzli Facial Plastic Surgery

Products And Services

• Blepharoplasty

  Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken. REASONS FOR BLEPHAROPLASTY Blepharoplasty tightens the eyelid's muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons. FUNCTIONAL BLEPHAROPLASTY If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. COSMETIC BLEPHAROPLASTY Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person's looking younger and more refreshed. It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face. CANDIDATES FOR BLEPHAROPLASTY The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle. People with eye disease, including glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure are not good candidates for blepharoplasty. THE BLEPHAROPLASTY PROCEDURE Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on. If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed. After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal. RECOVERY AFTER BLEPHAROPLASTY After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind. RISKS OF BLEPHAROPLASTY Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

  Link: Blepharoplasty

• Face Lift

  RHYTIDECTOMY Over time, gravity and sun exposure take their toll on the face and neck. Deep creases that run from each side of the nose to the corners of the mouth appear; the jawline slackens; and the neck develops loose folds and fat deposits. Rhytidectomy (facelift) counteracts these signs of aging by tightening muscle, removing fat, and trimming excess skin. Rhytidectomy improves the look of the lower and middle areas of the face, and the neck. It is most effective for correcting the following: Mid-face sagging Deep creases under the eyes Nasolabial folds Jowls Sagging fat Loose skin and fat under the chin and jaw Although rhytidectomy removes or reduces signs of aging, over time, they will gradually reappear. Rhytidectomy does not improve the look of the brow, eyelids and nose, and some parts of the mid-face. A patient who wants to improve those areas might combine rhytidectomy with a brow lift or eyelid surgery, and/or with injectable soft-tissue fillers, facial implants and skin resurfacing. CANDIDATES FOR RHYTIDECTOMY The best candidates for rhytidectomy want to correct one or more of the signs of aging indicated above; have some facial sagging, but still have elasticity in their skin; are generally healthy; do not smoke; and have realistic expectations about what rhytidectomy can do. It is very important that the surgeon ascertains whether the patient is only interested in rhytidectomy because of pressure from someone else. TYPES OF RHYTIDECTOMY Rhytidectomy is typically performed as an outpatient procedure in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about 2 hours. The way a facelift is performed depends on the surgeon, the patient's facial structure, and the extent of correction desired. TRADITIONAL RHYTIDECTOMY A traditional rhytidectomy is a "full" facelift that rejuvenates the face, jowls and neck, and includes sculpting and redistributing of fat; lifting and repositioning of muscle and deeper tissues; and trimming and re-draping of skin. The incision begins at the temples and travels down to the front of the ear, around the earlobe and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin. LIMITED-INCISION RHYTIDECTOMY A limited-incision rhytidectomy improves the area around the eyes and mouth by reducing nasolabial folds and other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip. In both methods, incisions are closed with stitches or tissue glue. Scars are hidden in the hairline and natural contours of the face. RECOVERY FROM RHYTIDECTOMY After rhytidectomy, the surgeon wraps the incisions in bandages, and may insert drainage tubes; if so, they are taken out the next day. If surgical clips are holding some incisions closed, they are removed, along with any stitches, 1 week after the procedure. Post-rhytidectomy, swelling, numbness, bruising and a feeling of tightness or tension in the face and neck may be felt. The face may look uneven or distorted, and facial muscles may feel stiff. Most of these side effects resolve within 3 to 6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy and itchy over time. Many patients return to work by the third week. Camouflage cosmetics can be used to minimize the appearance of bruising. RESULTS OF RHYTIDECTOMY Results of rhytidectomy are not permanent, and some patients choose to undergo another in 5 or 10 years. In some sense, however, effects are permanent; years later, the face continues to look better than if rhytidectomy had not been performed. RISKS ASSOCIATED WITH RHYTIDECTOMY Possible complications of rhytidectomy include bleeding, infection, bruising, swelling or discoloration, allergic reaction to the anesthesia, skin blistering (usually only in smokers), nerve injury, and temporary or permanent loss of sensation in the face.

  Link: Face Lift

• Neck Lift

  A neck lift is a surgical procedure that smooths and tightens the neck's skin, which can sag from aging or weight loss. There are usually two components to a neck lift: cervicoplasty, which removes excess skin, and platysmaplasty, which removes or tightens muscles in the neck. A neck lift can be performed alone or as part of a facelift. A neck lift candidate is in good physical and emotional health, and has realistic expectations about the outcome of surgery. The results of a neck lift can last up to 10 years. NECK LIFT PROCEDURE A neck lift begins with a small, inconspicuous incision directly below the chin (platysmaplasty) and/or in front of the ear lobes, looping behind the ears and ending in the scalp near the back of the neck (cervicoplasty). Sagging skin is trimmed away and lifted during cervicoplasty; loose muscles that cause the "bands" around the neck to be prominent are tightened during platysmaplasty. In some cases, it is necessary to perform only one of the two procedures. Liposuction is sometimes used to remove excess fat; if so, it is performed before the neck lift. Incisions are glued and/or sutured closed. A neck lift usually takes 2 to 4 hours to perform, and the patient is given either general anesthesia or local anesthesia with sedation. Most neck lifts are performed on an outpatient basis. Bandages covering incisions are removed after a few days; sutures are typically removed after 7 to 10 days. RECOVERY FROM A NECK LIFT Swelling and bruising from a neck lift can last up to 10 days. Applying cold compresses and keeping the head elevated for the first 48 hours following surgery minimizes swelling. Keeping the head still, and avoiding turning or twisting it for the first few days post-surgery, is recommended. Medication is prescribed to help alleviate discomfort. Most people return to work and other normal daily activities within 2 weeks, after which bruising and swelling have subsided. More strenuous activities should be avoided for 4 to 6 weeks. RISKS AND COMPLICATIONS OF A NECK LIFTT Although rare, possible risks and complications of a neck lift include the following: Scarring Excessive bleeding Hematoma Tissue death Blood clots Numbness Intense itching Skin discoloration Persistent swelling A more serious complication, also rare, is facial nerve damage that can lead to muscle paralysis.

  Link: Neck Lift

• Rhinoplasty

  Rhinoplasty (nose surgery) is one of the most frequently performed plastic surgery procedures. During rhinoplasty, the nose is reshaped, reduced or augmented to improve its appearance. Rhinoplasty may be performed to correct a birth defect, or repair an injury such as a broken nose. It is also often performed strictly for cosmetic reasons. For a patient with ongoing sinusitis, rhinoplasty is sometimes performed in conjunction with endoscopic sinus surgery; for a patient with a deviated septum, it is often performed along with septoplasty, a procedure that corrects a deviated septum. In such cases, rhinoplasty effectively treats health and breathing problems, in addition to improving the patient's appearance. CANDIDATES FOR RHINOPLASTY Candidates for rhinoplasty have finished their facial growth. Girls should typically be at least 15 or 16 years old; boys should be at least 17 or 18. Patients considering rhinoplasty should be in overall good health and not smoke. It is important that candidates have realistic expectations about what rhinoplasty can do. Although undergoing rhinoplasty may boost self-confidence, it should not be viewed as a cure-all for personality or relationship issues, and should not be the result of social pressure. GOALS OF RHINOPLASTY There are several goals of rhinoplasty; they include facilitating breathing as well as improving appearance. During rhinoplasty, the surgeon may attempt to do one or more of the following: Remove a hump Modify the bridge Reshape the tip Reshape or resize the nostrils Repair an injury Open breathing passages Increase or decrease size Rhinoplasty can involve modifying bone, skin or cartilage, or all three. THE RHINOPLASTY PROCEDURE Rhinoplasty, which takes from 1 to 2 hours, is usually an outpatient procedure performed under IV sedation or general anesthesia. Two techniques are typically used. In closed rhinoplasty, incisions are made within the nostrils. In open rhinoplasty, an incision is made across the columella, the tissue between the nostrils. With both methods, the soft tissues covering the nose are gently lifted, and the bone and cartilage are sculpted to the desired shape. If additional cartilage is needed to augment the nose, it is frequently taken from the patient's nasal septum. If larger sections of tissue are required, cartilage may be surgically removed from the ear or other parts of the body as well. If the patient has a deviated septum, the septum and inner structures of the nose are adjusted to improve breathing. The tissues are then redraped and stitched closed. If necessary, nostrils are reshaped in the final stage of rhinoplasty. RECOVERY FROM RHINOPLASTY Immediately after surgery, the patient's nose and eye area are usually bruised and swollen. Splints and nasal packing remain in the nose for a few days. During this period, the patient may experience some nasal pain or a dull headache, as well as some bleeding and drainage from the nose. Most patients feel like themselves within a few days and are able to return to regular activities in about a week. To increase comfort, and decrease bleeding and swelling, rhinoplasty patients are advised to follow these post-surgical directives: Avoid strenuous activities Take baths instead of showers Avoid blowing the nose Avoid becoming constipated Avoid exaggerated facial expressions Brush the teeth gently Avoid pulling clothing over the head Use sunscreen that has an SPF of 30 or higher Limit dietary sodium Do not use ice packs Although the patient usually looks "normal" a week or two after surgery, minimal swelling may be present for as much as a year. RISKS OF RHINOPLASTY Complications associated with rhinoplasty are rare and, when they occur, usually minor. Surgical risks in general include infection or adverse reaction to anesthesia. In the case of rhinoplasty, specific risks include the following: Recurring nosebleeds Difficulty breathing through the nose Permanent numbness in or around the nose Persistent pain Discoloration of skin on the nose Scarring Perforation of the nasal septum It is possible that a patient is not satisfied with the results of the rhinoplasty. In such a case, a second surgery, called a revision rhinoplasty, may be performed at a later date.

  Link: Rhinoplasty

• Brow Lift

  Also known as a forehead lift, a brow lift is a surgical procedure performed to reduce signs of aging in the forehead area. It aims to remove or minimize deep horizontal creases across the forehead and bridge of the nose, and the frown lines between the eyebrows. It also lifts the eyebrows, making the eyes look more open. COMMON BROW-LIFT TECHNIQUES There are two techniques used for performing brow lifts. The classic lift requires a long incision that runs across the top of the head, at the hair line, and down to the ears. However, for a woman who has a high forehead, a coronal incision, which is made behind the hairline, may be used. The endoscopic lift requires three to five small incisions that are made across the forehead, at the hairline. These shorter incisions mean a shorter recovery time and less scarring than those from a traditional brow lift. Which technique is chosen depends on the thickness, texture and elasticity of the skin, the bone structure of the face, the overall appearance of eyebrows and eyelids, and the position of the eyebrows. THE BROW-LIFT PROCEDURE Brow-lift surgery usually takes about one to two hours to perform, and takes place at a hospital, an office-based surgical suite, or an ambulatory center. Either general anesthesia or intravenous sedation is used. Depending on the surgical technique used, one long incision or a series of small incisions is made. Tissue and muscle underneath the skin are moved or repositioned as necessary. At the end of the procedure, the incision(s) is closed with sutures, screws, adhesives or surgical tape; a drain may be put in to collect excess blood and fluid. Postsurgery, the patient is moved to a recovery area for observation. RECOVERY FROM A BROW LIFT A patient typically returns home on the day of the brow-lift surgery, although an overnight stay may be necessary for some. Swelling may be pronounced for the first day or two after surgery, although most swelling goes away within 2 weeks. To prevent post-operative bleeding, bending and heavy lifting should be avoided for a few days. It can take up to 6 months for swelling to fully subside and scars to fade. RESULTS OF A BROW LIFT Depending on the patient's presurgical appearance and goals, a brow lift's results, which can be seen immediately, can be either subtle or dramatic. Eyes will appear more "open," and creases across the forehead, bridge of the nose, and between the eyes will be much less prominent. RISKS ASSOCIATED WITH A BROW LIFT Prior to scheduling surgery, the patient and surgeon should fully discuss the risks associated with a brow lift. In addition to those associated with any type of surgery, a brow lift's risks include the following: Hair loss around the incision site(s) Facial asymmetry Higher hairline Injury to facial nerves Eye dryness/irritation The chance of complications is minimized by choosing a board-certified plastic surgeon who has experience in performing brow lifts.

  Link: Brow Lift

• BOTOX®

  BOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines. APPLICATIONS FOR BOTOX COSMETIC Although originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, BOTOX Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of BOTOX Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. BOTOX Cosmetic is used to treat the following: Forehead furrows Frown lines Crow's feet Skin bands on the neck According to Allergan, BOTOX Cosmetic has been "extensively researched, with approximately 2500 studies." BOTOX COSMETIC PROCEDURE AND RESULTS Using a very fine needle, BOTOX Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals. SIDE EFFECTS OF BOTOX COSMETIC Injection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following: Pain Infection Inflammation Tenderness Swelling Redness Bleeding Bruising Normal activities may be resumed immediately after receiving injections.

  Link: BOTOX®

• Restylane®

  U.S. Food and Drug Administration (FDA)-approved Restylane® injectable gel is a cosmetic "filler" that contains hyaluronic acid (HA), a natural substance that is found in the body. HA gives volume and elasticity to the skin, but as the body ages, HA levels decrease, resulting in loose skin and wrinkling. When injected, Restylane gel is designed to plump the skin beneath lines and wrinkles, smoothing them out and making them less noticeable. The most common areas for Restylane treatment are the glabellar lines (which run between the eyebrows) and the nasolabial folds (which run from the sides of the nose to the corners of the mouth). Restylane injectable gel is also FDA-approved, for those 21 and older, for enhancing the lips. According to manufacturer Medicis, results can last for up to 6 months, at which point the hyaluronic acid is reabsorbed by the body. BENEFITS OF RESTYLANE INJECTABLE GEL When injected, Restylane gel plumps up glabellar lines and nasolabial folds, making skin appear younger and look smoother. When used for lip enhancement, it makes the lips fuller and gives them more definition. ADVANTAGES OF RESTYLANE INJECTABLE GEL One significant advantage that Restylane injectable gel has over other facial fillers made with hyaluronic acid is that it contains nothing of animal origin. As a result, it does not require a potential user to undergo allergy testing, which can sometimes take weeks. Another advantage is that Restylane injections are performed in-office, usually by a dermatologist, in less than half an hour, and require little-to-no downtime for the patient. SIDE EFFECTS OF RESTYLANE INJECTABLE GEL The most common side effects of Restylane injectable gel are swelling, redness, pain, bruising and tenderness in and around the injection sites. They typically go away within a week. Although considered safe for most patients, Restylane injections carry a risk of infection, bleeding or allergic reaction.

  Link: Restylane®

• JUVÉDERM® XC

  JUVÉDERM® XC injectable gel is a U.S. Food and Drug Administration-approved dermal filler that, according to its manufacturer, Allergan, Inc., is designed to "temporarily treat moderate to severe facial wrinkles and folds such as nasolabial folds" in people older than 21. Unlike the original JUVÉDERM injectable gel, JUVÉDERM XC is infused with lidocaine to make its injection more comfortable. JUVÉDERM XC is a smooth-consistency gel that restores volume to the skin, and smooths away moderate-to-severe facial wrinkles and folds. It is made of hyaluronic acid (HA), a sugar that occurs naturally in the body. In terms of the skin, HA's role is to deliver nutrients and hydration, and act as a cushioning agent. Young, healthy skin contains a lot of HA, but factors that include aging and sun exposure reduce the amount, causing skin to lose structure and volume. JUVÉDERM XC is most effective in improving the appearance of nasolabial folds, the lines that run from the bottom of the nose to the corner of the mouth on both sides of the face. JUVÉDERM XC INJECTABLE GEL PROCEDURE JUVÉDERM XC injections take about 15 minutes to administer in a doctor's office. A fine needle is used for the injection, which is given under the skin in the targeted area to add volume or fill in wrinkles and folds. Because JUVÉDERM XC contains lidocaine to improve comfort, an anesthetic may not be needed. However, a doctor may still elect to use a topical anesthetic on the area to be treated before giving the injection. Afterword, the doctor may gently massage the treated area(s). Once treatment is completed, patients can return, with virtually no downtime, to their regular activities. For the first 24 hours after treatment, to reduce the risk of complications, patients should avoid strenuous exercise, excessive sun or heat exposure, and alcohol consumption. RESULTS OF JUVÉDERM XC INJECTABLE GEL The results of JUVÉDERM XC are visible immediately after injection; any swelling and bruising, to which ice can be applied, should subside during the next few days. Results can last 6 to 9 months, and, in some cases, up to year. However, according to its manufacturer, "Results from injectable dermal filler vary and correction is temporary. Supplemental 'touch up' treatments may be required to achieve and maintain optimal correction of . . . wrinkles and folds." RISKS OF JUVÉDERM XC INJECTABLE GEL Although JUVÉDERM XC is considered safe, there is a risk of side effects. They are usually limited to the injection site, and include the following: Redness Pain or tenderness Firmness Swelling Lumps or bumps Bruising Itching Discoloration Infection For customized treatment, Allergan, Inc., offers two types of JUVÉDERM XC: JUVÉDERM Ultra XC, which is suitable for superficial facial lines and folds, and JUVÉDERM Ultra Plus XC, a stronger formulation that is used for deeper facial folds and lines. JUVÉDERM XC is the first HA filler that is FDA-approved for use on people of color.

  Link: JUVÉDERM® XC