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Facial Aesthetics (Facial Rejuvenation)

How should you look at facial rejuvenation?

Facial rejuvenation is one of the most common applications in aesthetic surgery. Because of the fact that causes of an old looking face varies, making it look younger and fresher requires combined application of multiple methods or surgeries, at the same time or one after another. Aging is a constant process and it cannot be stopped, fighting it also must be constant.

What are the causes and consequences of skin aging?

As a result of changes caused by outer factors such as time, gravity and the sun, face loses its young and rested look and becomes tired, hanging and wrinkled. So basically, an aged face develops loss of volume, wrinkles, hanging and spots. Then if we were to make a face look younger, we have to fight loss of volume, hanging, wrinkle and spots. It will be difficult to reach to an ideal result when one of these factors is missing.

What are the effects of aging on the upper face?

When we look at the upper face, we see that the lines on the forehead got deeper and became permanent as a result of mimics that are repeated in years such as looking surprised and confused. Due to the effect of gravity, the skin and muscles that lift the eyebrows hang downwards. Upper eyelids get loose in years and the skin that has a single layer in youth folds on itself, even falls on the eyelashes and make seeing harder. As a result of weakened connective tissue that holds the fat tissue around the eye socket, fat pads and under-eye bags. Under-eye bags are usually more visible under the lower eyelids but they may be seen on both eyelids.

What are the effects of aging on the mid-face? 

When we look at the mid-face, we see that cheeks and zygomatic bone gets depressed and even hollow as a result of mimic muscles and skin hanging and reduction of the fat pads on the cheeks. Nasolabial sulcus gets deeper, which begins at the both sides of the nose and extends downwards. Fissures develop around the mouth, vertical to the lips.

What are the effects of aging on lower face? 

When we look at lower face and neck area, we can see that the skin is hanging as a result of loosening due to weak platysma muscle and the lovely arc between the jaw and neck is lost, that there is a direct connection between the jaw and neck when looked from sideways.

What is the philosophy in aging and what are the aesthetic interventions proper to the age? 

When we look at babies’faces, we can see that some natural fold are present even in that age, however, this volume of a baby face makes it look beautiful, not bad. Therefore, one of the most important causes of an old age is the loss of tissues of face (fat tissue, muscle and bones) in time due to atrophy. This condition which begins in the ages 30-40, can be postponed by filling methods (fat tissue transfer or filling injections), methods that strengthen the connective tissue which carries the deep tissues and collagen fibers and the young look on face can be preserved until 45-50 without the need for a surgery. In this period, thin wrinkles that develop especially on the forehead, eye contour, between the eyebrows due to mimic activity should be removed via Botulinum toxin-A (Botox-Disport).

Sometimes Botulinum toxin-A applications can be performed for preventive medicine around 30s even when wrinkles have not formed yet.

How is filling injection performed and what is its effects?

Fat tissue injections are applications that can be performed under local or general anesthesia. Person’s own fat is harvested via an injector or a thin cannula. Volume loss is removed by injecting this tissue via another thin cannula. Because of the fact that fat tissue hosts stem cells inside, it provides a rested and fresh image in the area of application. Approximately %50 of the fat tissue volume that is transplanted to another place of the body is permanent in that area.  The level of permanency usually becomes clear in the first three months. Thus, if the acquired volume is not adequate at the end of 3 months, it should be repeated 2-3 times in order to reach the sufficient amount. Permanency of the fat tissue depends on patient’s characteristics and smoking status.

What is filling substance application like? What are its effects?

The most common filling substances that are used in our day are Hyaluronic acid and calcium hydroxyapatite. Their duration of effect varies between 6 months and 1.5 year. They keep water in the area of application and create a volume. Filling substances need to be repeated in certain periods, but an accumulative effect can be acquired after a couple of sessions. For the folds that are located on the lips, eye contour, zygomatic bone and that extend downwards from the nasolabial sulcus, filling substances with different molecular structure are being used. Although there are some permanent filling substances, it is very risky to use them. They may create permanent hardness and masses. Therefore, permanent filling substances are not preferred much by us aesthetic surgeons. If a filling substance will be used, we prefer temporary filling substances.

Who are the candidates for a face-lift operation?

If the symptoms of aging are clear and hanging is present, surgical intervention, namely face-lift operation becomes inevitable. Face lift operations are performed by various methods towards the problem of the patient. These methods are, forehead-lift, mid-face lift, total face lift, neck lift etc. When necessary, endoscope may be used during the operation. If patient needs so, eye-lid aesthetics should be performed during face lift and eye contour should be rejuvenated.

How are the forehead and brow lift operations performed?

Although many different techniques are there for the forehead lift and brow lift operations, usually the cut is made on the scalp and the scar is hidden. Additionally, various lifts are used or only the forehead skin is removed up in order to pull the brows upwards (brow lift). Brow lift operations can be performed via endoscopy in order to reduce the length of the cut. This procedure which is applied via special cameras and tools is called endoscopic brow lift operation. Brow lift operations can also be performed through very small cuts (1-2 mm) without opening the skin by inserting a surgical lift thread. This way, only the brow is lifted up and it is not a wide intervention. However, it is a popular non-surgical brow lift method for those who hesitate to have a surgery. You should decide on your method together with your surgeon.

How is mid-face aesthetic operation performed?

Mid-face lift operation (Facial aesthetics) is performed in order to make the area between the eyes and mouth which includes the cheeks and zygomatic bones look younger. This area hangs due to the gravity and causes an exhausted and old look. Cheeks and zygomatic bones that have a volume in young people becomes flat in the old. The purpose in the mid-face lift is to carry the mimic muscles and skin above to their natural place. This way, the cheeks get plump and the deep wrinkles around the mouth are removed and the exhausted look on the face is relieved. In order to do this procedure, a line between the lower eyelids and eyelashes is cut without leaving scar (lower eyelid aesthetics and removal of under-eye bags can also be performed through the same cut in the same session). Additionally, there may be small cuts that won’t leave scars on the scalp. Mid-face lift operation can also be performed via endoscopy. Non-surgical lift methods can also be applied with this purpose. Although they are not as efficient and permanent as surgery, it provides benefit for those who hesitate to have surgery. Surgical lift threads (Aptos) are inserted to the mid-face through small cuts. It lasts for 1.5-2 years. Mid-face aesthetics with surgery is permanent but aging is an ongoing process, so its effects will show up sooner or later.

How are total face lift aesthetic operations performed?

Face lift operation is performed in order to remove the hanging and wrinkles on the facial and neck skin. It is the widest of all the facial rejuvenation operations. Along with aging, the skin, the muscle and connective tissue gets loose, beaten by the gravity and becomes hanging. The skin is cut on a line between the ear fold and hair in order to hide the future scar. In a classical face lift operation, after the skin is cut, the skin and subcutaneous fat tissue is lifted together and the muscle and connective tissues of the deep are separated. The skin is lifted and freed from the temporal site, cheeks, jaw and neck. The muscle and connective tissue, which are the lifting power that creates the resistance against the gravity can be seen. This tissue is tensed via permanent stitches and the loose formation is removed. Subsequently, the skin is lifted behind and upwards and the excessive amount is marked and removed. Lastly, the skin is sutured and fixated. Additional to all these procedures, liposuction can be applied to the neck in the same session.

What are the additional treatments to the face lift?

A person who decided on facial lift surgery must know that in order to have a successful surgery, additional applications such as fat injection, filling substance, laser or Botulinum toxin-A (botox-disport) may be required after the surgery if the doctor deems it necessary. These techniques which we call non-invasive help the result to be much better, the skin to look younger and fresher.

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