Hairline lowering surgery is great for patients with a large forehead that is unchanged. Anyone who is actively losing hair is NOT a good candidate for hairline lowering surgery. If your hairline is thinning or receding, you should look into possible medical causes for this. Sometimes hormonal or environmental factors can contribute to hair loss. to learn more about harline lowering surgery, also known as forehead reduction surgery please visit our Hairline Lowering Surgery/ Forehead Reduction Surgery page.

The word "facelift" has been used generically to describe a number of procedures that have the goal of improving the appearance of the face. The term "liquid facelift" has been used to describe improving the appearance of the face via fillers or sometimes fat. Same goes for the term "non surgical facelift." SOmetimes the term facelift has been used to describe an overall facial rejuvenation which might include a classic rhytidectomy (technical word for a facelift) as well as a browlift, eyelid surgery, and neck tightening (platysmal plication). A "mini facelift" is not a technical procedure but a coined term that could describe any number of procedures from a non aggressive rhytidectomy to a neck tightening procedure. Needless to say, there is no uniformity in the terminology used for these procedures. What one surgeon might call a facelift, another might call a necklift, and another might call a mini-facelift.

The lack of uniformity in the terminology can lead to confusion when patients try to compare apples to apples and know what different surgeon's plans might be for them.

In my practice a facelift is a rhytidectomy that treats the jowls and neckline. It can sometimes be combined with a platysmal plication (further neck tightening, called a necklift by some) which is done via a small incision under the chin. A facelift doesn not help the brows or eyes--that's a separate procedure. A facelift does not raise the cheeks significantly--that's a cheeklift or midface lift.

Some surgeons call a facelift a necklift, maybe because it sounds more benign and less threatening, or maybe because they want to make sure the patient does not think it will "lift" the entire face--it only treats the jowls and sagging neck. A patient is a good candidate for a facelift if they have significant jowling and sagging of the neck while still having good skin elasticity.

Upper eyelid filler lasts longer than almost anywhere else on the face or body. Routinely I have patients for whom it has lasted for over 3-4 years. When it slowly dissipates it usually does so uniformly. This makes upper eyelid filler a really great value for improving one's appearance. You must remember that there will continue to be aging changes taking place over those few years as well, so to maintain the aesthetic result you might want to top off your upper eyelid filler treatment every so often.

LaViv represents the next generation of skin treatments using your own body's cells. Currently LaViv is only FDA approved for treatment of the nasolabial folds, but the company is trying to get FDA approval for treatment in the rest of the face for an indication for acne scars and fine lines.

The process for LaViv is very time consuming and "high-tech". A skin biopsy is taken from behind the ear and sent over to the company's lab. Fibroblasts are separated and grown in culture, a process that usually takes about 3 months. When your cells have sufficiently grown they can be ordered back from the lab. The cells are injected back into your skin where they will continue to grow, secrete collagen, and stimulate other fibroblasts in yor skin to do the same.

LaViv is the latest breakthrough in skin science and is showing promise. In my practice, I do not think it is the best possible value for nasolabial folds. I do think it could represent a really good treatment option for patients with acne scars and fine lines on the face. Currently there is no really good treatment for fine lines caused by skin thinning. It might also be a good option for patients with very thin under eye skin and fine lines.

The under eye area is extremely vascular and delicate. It is possible to inject filler under the eye while on plavix, but this will certainly increase the probability of a bruise. Since botox is applied very superficially in the skin, there is a much smaller chance of bruising than with restylane under the eyes as that is injected much more deeply.

A Y lift is a trademarked name for placing filler in the face to restore a more youthful facial shape and contour. The concept has been around for years, but the term "Y lift" was trademarked by a dentist in New York a few years ago. Basically filler is placed around the midface, eyes, and chin and jaw area to recreate the shape of the face when it was younger. The theory goes that a youthful face is shaped more like the letter Y and as we age we lose the lateral volume of the upper face which makes our faces seem more droopy. The only thing I find problematic about this is that it promotes a cookie cutter approach to facial fillers and volumization. I believe that for patients who naturally have very high cheek bones a Y lift will only make them appear more gaunt and older looking. A personalized approach is needed for every patient.

Patients need to take the time to do their research. The media loves catchy "new" procedures; it is easy for them to report on and it gets good ratings. Remember that just because something is on television does not make it the "best" thing out there, it just might mean someone has the "best" PR person out there. Sometimes a "new" procedure is just rebranding or trademarking a term for something that has been around for years. Plastic surgery is an investment. Just like with any other investment, the more informed you are about the process, options, and expected results, the smarter you will be and hopefully make the best investment decision.

Eyelid ptosis is when the actual eyelid is sitting lower and if low enough can actually block your field of vision. Eyelid pseudoptosis is when the eyelid position is normal but more of the upper eyelid tarsal plate is showing due to an asymmetry or volume loss in the upper eyelid brow fat pads. Eyelid ptosis and eyelid pseudoptosis are very different in regards to treatment and need to be diagnosed properly and treated accordingly.

There is a non surgical option for the treatment of mild eyelid ptosis. Botox or Dysport can be used in very small amounts on the upper eyelid to help it open up a bit. This can correct the eyelid ptosis for about 3-4 months.

Eyelid pseudoptosis can be corrected by addressing the volume deficit in the upper eyelid and brow. This can be done with fillers or fat injections to restore the lost volume.

The following before and after photos demonstrate patients with very mild ptosis and pseudoptosis combined. Filler was used in her upper eyelids to balance the eyelid show combined with Dysport in the upper eyelid. The first patient has the problem only on the left eye, while the second patient has it affecting both eyes.

Left upper eyelid ptosis and pseudoptosis treated with fillers and Dysport

Bilateral upper eyelid ptosis and pseudoptosis treated with fillers and Dysport

Wrinkles on earlobes slowly develop as we age and our earlobes deflate, just like the rest of your face! In the medical literature an earlobe crease has been correlated with some cardiovascular diseases. The simplest way to treat earlobe wrinkles is to place a small amount of filler in the earlobe. The wrinkles immediately improve. Filler in the earlobes tend to last significantly longer than in most other parts of the face. If it helps make you feel better, probably no one else is noticing your wrinkled earlobes!

Temples are actually one of the best places to put filler since it seems to last an extra long time in this part of the face. There are several filler options in the temples. These include Juvederm, Radiesse, and Sculptra. Each has its own unique advantages and disadvantages. I have seen filler last well over 2 years in this part of the face, but I advise patients that they might have to come about once a year for a slight top off. As for how much filler you might need, well, that depends on how hollow you are. On average patients tend to need at least half a syringe of filler to an entire syringe of filler PER temple. Sometimes more if there is significant hollowing. Usually I can estimate before hand about how much filler it will take.

Fat injections are another way to fill in hollow temples, but this is probably best for patients who need a significant amount of filling of their entire face.

Some surgeons use an incision in front of the hairline in the temple region. This can sometimes leave a noticeable scar especially if your skin color is not very pale white. Sometimes this also distorts the shape of the hairline in the temple region. Even if the scar healed well it could still be noticeable in this region. This same kind of problem can arise after a temporal brow lift if the incision was not placed correctly.

A scar revision is not always the best solution to solve this problem. Because hair bearing scalp might have been excised during the surgery, the shape of the hairline might be distorted. There are several other options that can be used to address this problem.

The first and simplest is especially useful in patients who have a pale scar with darker skin. The color contrast between the scar and normal skin is a big contributor to it being noticeable. Permanent tattoo makeup can be used to place pigment into the scar and reduce the contrast with the skin.

The second option is to use hair grafting to reshape the hairline and to add hair in front of the scar. As the hair grows in the scar will be more hidden inside the hairline.