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Physicians and patients have long recognized that smooth skin and an elegant
neckline are associated with a youthful appearance. In contrast, the aging process
is associated with changes that combine to project a "tired" countenance.
Alterations occur in the density of our facial muscles, facial bones, and fat deposits. Gravity causes sagging of soft
tissues. Fine wrinkles and blemishes result from sun exposure, (accumulated before the harmful effects of ultraviolet
light were appreciated). Still other traits are inherited (e.g., the double chin). Cumulatively, we recognize that our
external appearance reflects all of this "wear and tear", but not our inner vitality. But why shouldn't the face shown to
the world be in harmony with the way we feel? Today, more people are taking better care of themselves by
exercising and eating right. We are more healthy and are living longer. Do we have any options to re-capture that
youthful look? The answer is "Yes, we certainly do."
Facial rejuvenation procedures are unique among surgeries in that the result is one which the community will view
and behold. With respect to appearance, most patients do not desire a "tight, operated look" or a dramatically
different appearance. Rather, the facelift is intended to "freshen" the appearance, by restoring the more pleasing
contours of your face and neck. During your initial office visit, Dr. Wall will then assess the thickness, texture and
elasticity of your skin, the severity of wrinkles and folds, the tone of the facial muscles, the prominence of the cheek
bones, and the shape of the jawline. Photographs will be taken from a number of vantage points to assist in
explaining features unique to your anatomy.
Dr. Wall will review the options available for transforming your appearance. Should you decide upon a surgical
procedure, Dr. Wall will review the aims of the procedure, the goals, and the limitations, of the surgery. For those
patients undergoing a facelift, the incision is hidden in the hairline and along the contour of the ear. It then extends
around the earlobe and back into the hairline. Following surgery, incisions are concealed by your hair or with
make-up. There may also be a tiny incision hidden underneath your chin.
After the skin has been pulled up and back, the excess tissue is removed. In some instances, the deeper muscles
may be re-positioned. A small incision beneath the chin may be used to remove fatty tissue and to smooth the
cord-like structures in the anterior part of the neck (the "turkey gobbler deformity"). After the procedure, people
commonly experience swelling and bruising that lasts for 10-14 days. Most people should allocate two weeks before
returning to social engagements. The last remnants of swelling typically require a month to fully resolve.
Most people return to normal physical activities within two weeks.
Since the healing process is gradual, you should expect to wait at least several weeks for an accurate picture of your
surgical result to develop. Overall, patients are happy with their appearance for many years following the operation.
Friends comment on their refreshed appearance, that they've "lost weight", or that they "never seem to age". Of
course, with the passage of time, everyone continues to age. However, that five to ten year improvement in
appearance will endure. You'll always look better than you would have (had you not undergone the procedure). And,
most importantly, you'll be confident knowing that the face you show to the world looks as great as you feel inside.
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Because well-defined facial features are a mark of physical beauty, enhancing the
chin and cheeks can provide a more elegant and attractive appearance. Facial implants
create remarkable changes by adding balance and definition to underdeveloped
features.
Manufactured from a variety of materials, facial implants are available to augment the cheeks, chin and jaw. They are
placed in a precise pocket located just above the bone, (in order to minimize any chance of shifting over time). The
implants are not visible beneath the skin and the materials are non-toxic. Many materials have been used safely in
reconstructive procedures for several decades. There is an assortment of shapes and sizes available. This variety
allows Dr. Wall to select an implant that is tailored to meet the needs of each individual patient.
During your initial evaluation, photographs will be obtained from a number of vantage points, to assist in explaining
features unique to your anatomy. Dr. Wall will review available options, explain possible risks, and answer your
questions. There will be an opportunity to discuss both your hopes and your concerns for the operation. As with all
aesthetic procedures, communication is the key to ensuring that you will be pleased with your results.
Augmentation surgery is indicated if the chin implant will enhance facial balance and harmony. Typically, chin
implants are recommended for the face that lacks proper proportion. For example, the chin may be too narrow. In
other instances, the chin appears to be "short" when we view a patient's profile. Dr. Wall will take measurements
during the initial consultation and pre-operative visits. Then, he will use your photographs to illustrate how these
numbers correspond to chin features (e.g., "strong" chin). This allows him to determine which implant size is
optimally suited to your face. You will have an opportunity to see and to touch actual implants during your office visit.
Though facial implant surgery may require only local anesthetic, general anesthesia is usually recommended to
optimize your comfort. In most cases, implant surgery is performed on an "out-patient" basis. Occasionally, an
overnight stay may be necessary if more than one procedure is performed. The surgery requires about an hour.
During the procedure, the implant is inserted into a pocket created along the surface of the bone (mandible). Incisions
are made within the mouth, or in a crease located beneath the chin. The chin is bandaged after the surgery to
minimize swelling. If an intra-oral incision is used, dissolving sutures will be employed (they last about 5 to 7 days).
If an external approach is used, very fine stitches are placed in the skin. These stitches are removed after 4 to 5 days.
During the recovery period, you will be instructed to maintain good oral hygiene by brushing your teeth and by using
an antiseptic mouthwash. Some patients find that a soft diet causes less stretching around the incision sites and
minimizes post-operative discomfort. Swelling and bruising may be visible around the chin and neck for about a week.
Cheek bones are one of the most important features of the face. Prominent cheek bones lend a dramatic quality to
the face. Flat cheek bones accentuate the "sagging" that occurs with age, and detract from the appearance of the
eyes. A younger individual may desire a cheek implant in order to add definition to the cheek areas. Other patients
seek to correct the "chipmunk cheeks" (that never seem to go away despite dieting or exercise). Older patients may
wish to have cheek implants to improve the contour of the mid-face or to elevate drooping tissues.
Cheek implant surgery requires approximately an hour. Sometimes, the implants are inserted at the same time as
another cosmetic procedure. In this case, they may be inserted through the common incisions. Alternately, an
incision is made inside your upper lip (about an inch above the gum line). A precise pocket is formed and the implant is placed securely on or below the cheekbone.
After your surgery, the movement of your mouth and lips will be limited for a few days. Swelling, bruising and
tenderness last about a week. The sutures used to close the incision will dissolve in about 10 days.
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Typically, the skin of the face is the first area to show the passage of time. Factors
such as heredity, acne, tobacco use, and sun exposure, combine to produce the
earliest signs of aging, i.e., wrinkles, creases and furrows.
Over the past decade, a number of technologic advances were introduced that provide dramatic improvements in the
appearance of the skin. Of these, the laser has received the most attention. Using this technique, physicians are
able to precisely remove the damaged "outer" surface of the epidermis. In addition, the laser is able to stimulate the
production of collagen and elastin by the "deeper" layers of the skin. These structural elements increase skin tone
and smoothen its appearance. Lastly, by treating the damaged outer layer, Dr. Wall can remove areas of irregular
blotching and pigmentation ("age spots"). Your "new" skin is more supple and more uniform in color.
The laser can address the entire face or just specific areas (e.g., crow's feet). Skin color is not necessarily a barrier
to treatment. However, individuals with particularly dark complexions may not be ideal candidates for the procedure.
(Often, a subtle difference in color is appreciated between the lasered and non-lasered areas.) Skin thickness and
texture are among the other factors that determine whether an individual is an appropriate candidate for laser
resurfacing.
During your initial evaluation, Dr. Wall will assess your skin type, the severity of sun damage, areas of irregular
pigmentation, and the depth of wrinkles and creases. A broad array of options will be discussed, in order to ensure that the intervention selected for you is the most appropriate. For patients considering cosmetic surgery, laser
resurfacing can complement the planned procedure. Thus, the facelift patient may want to improve the fine lines
located around the mouth. Most laser resurfacing is performed on an outpatient basis. However, if combined with
other procedures, a patient may prefer to stay overnight.
The risks of laser resurfacing are few, but include infection and abnormal healing. If you've had allergic reactions in
the past, then skin resurfacing can cause a recurrence of these conditions. If you have a tendency to form thicker
scars (keloids), then this procedure may not be the best option for you. Following the laser resurfacing, you must
avoid sun exposure until the redness of your skin has gone. In fact, it's always best to avoid the harmful effects of
the sun by minimizing exposure and by protecting sensitive areas with sunblock.
For patients with finer wrinkles, a lighter laser setting is used. Most patients can return to work within seven to ten
days. For patients with deep furrows and creases, a higher setting is employed. These individuals may require ten to
fourteen days to heal completely. You will receive detailed instructions about cleansing and moisturizing your skin
from our staff. Camouflage make-up can be used within ten to fourteen days after resurfacing. Most patients have "pinkness" in the treated areas that lasts from four to six weeks. This will fade over time. However, depending upon
how fair your complexion is, you may be more comfortable wearing make-up until all of this pinkness has faded.
Overall, the results of laser resurfacing can be truly impressive. Best of all, changes in the structural elements
continue to occur over the first twelve months. Patients find that their skin tone actually improves for up to a year
after the procedure.
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Facial Implants 
