Face

With age, the position of the eyebrow can drop, leading to hooding of the skin above the upper eyelid. Peripheral vision can be impaired by this excess tissue. There are many methods used to correct a droopy brow. Botulinum toxin (Botox®, Dysport®, or Xeomin®) injected in the muscles that depress the eyebrows can help to naturally and subtly raise the brows. This is temporary and generally lasts around 3 to 4 months. A minimally invasive surgical technique, the endoscopic brow lift, uses between 2 and 5 small incisions just behind the hairline to lift and suspend the eyebrows permanently. In older patients and in men, a direct brow lift, removing skin just above the eyebrows, can lift the brows and the carefully placed scar can be hidden at the top of the eyebrow.

Recovery after brow lift usually takes about 1-2 weeks. After this time, most patients return to work. Swelling and bruising can last anywhere from 2 to 4 weeks depending on individual anatomy and physiology.

When considering facial rejuvenation or facial reshaping surgery, it is important to consider the face as a whole. The lower cheeks contain pockets of fat called buccal fat. Buccal fat can become more prominent with age, weight gain, or due to genetic factors. Buccal fat removal takes out a portion of this fat in order to reshape the face, making it appear more youthful, sculpted, and heart-shaped. It is performed through incisions in the mouth, with no visible external scars. This can be done under local or general anesthesia.

Recovery after buccal fat removal usually takes a few days. Patients can return to work the day after or within the first few days of surgery. Swelling can last up to 1-2 weeks depending on individual anatomy and physiology.

Botox® and other neuromodulators such as Dysport® and Xeomin® can be injected into the upper face and neck to reduce the activity of muscles of facial expression. This can reduce the appearance of dynamic wrinkles, or wrinkles that appear when the face moves. Common areas to inject are the glabella (between the eyes), forehead, periorbital area (crow’s feet), and platysma (the muscle causing vertical neck bands). In addition to immediate wrinkle improvement, these treatments slow new wrinkle formation by reducing or eliminating certain facial movements. Neuromodulators are temporary and their effect generally wears off by 3 to 4 months. Some patients have expressed concern that once they start treatment, they cannot stop. In fact, Botox®, Dysport®, or Xeomin® injections do not need to be continued indefinitely. Even an occasional injection, such as once a year, will provide some anti-aging benefit and help to prevent new wrinkles from forming and deepening.

Most of the fillers done in the office today are made of hyaluronic acid. This is a naturally occurring substance that we have in our bodies. Hyaluronic acid gives tissues elasticity and volume. As we age, we lose hyaluronic acid, and this contributes to the appearance of deep lines and wrinkles. Hyaluronic acid fillers can be used in many areas of the face including the temples, cheek bones, midface, nasolabial folds, lips, chin, and jaw to create a more pleasing facial shape or to restore a more youthful shape. Dr. Irvine uses only hyaluronic acid fillers. These are metabolized by the body and usually last between 6 months and 2 years, depending on the exact filler used. Dr. Irvine uses different fillers in each area of the face, depending on patient anatomy and goals.

Fillers are injected in the office using only topical and/or local anesthesia. There is no down time and patients can return to work immediately with the caveat that no make up can be worn over the injection sites until the following day.

Fat grafting or fat transfer involves removing fat from the abdomen, flanks, inner, or outer thighs, and placing it in the face. As we age our faces lose volume in specific fat compartments in the temples, midface, and lower face. Some of this volume can be restored using temporary hyaluronic acid fillers, but sometimes patients elect to have a more permanent surgical solution by using their own fat to provide a more youthful facial shape. Dr. Irvine does this under general anesthesia or moderate sedation in order to make patients as comfortable as possible. It is often done at the same time as a facelift to improve the overall result. Approximately 40 to 70% of the transplanted fat survives, and after fat grafting, the aging process continues, meaning that the face may continue to lose fat as part of the natural aging process. Therefore many patients may desire a second fat grafting procedure approximately 1 to 2 years after their first one.

Swelling and bruising of the fat injection sites usually lasts 1-2 weeks depending on patient age and the amount of fat injected. After this time patients can return to work.

CO2 fractional laser resurfacing is a powerful tool to tighten loose skin and reduce the appearance of fine lines and wrinkles. Dr. Irvine uses a fractional ablative CO2 laser for her resurfacing procedures. This creates controlled thermal injury to the skin, stimulating the body’s natural collagen production, and filling in deep lines and wrinkles.

CO2 laser resurfacing treats wrinkles which are present at rest and also treats the vertical lines around the mouth and wrinkles in the lower face that cannot be safely addressed with neuromodulators like botox® alone. A laser treatment can be done in the office using topical numbing cream, or it can be done in the operating room under general anesthesia. It is often performed at the time of a facelift to address the fine skin lines that cannot be improved with a facelift alone. Patients may require several treatments to achieve the desired result. It is critical to be on a good skin care regimen before and after a laser treatment and to avoid all sun exposure before and after. During a consultation with Dr. Irvine, she will discuss whether this powerful treatment is right for you and your skin type.

Recovery time varies based on the intensity and depth of the laser and ranges from 1-2 weeks. Slight redness of the face can last for 3-4 months.

Microneedling is a minimally invasive procedure in which tiny needles are placed in the skin to safely stimulate collagen production. Dr. Irvine uses the FDA-cleared RejuvaPen NXT® which uses several tiny (33 gauge) needles to make controlled micro-perforations in the superficial layer of the skin. This stimulates the body’s own healing process to begin, leading to the deposition of collagen. Dr. Irvine also places platelet-rich plasma (PRP) on the skin. The microneedles allow the PRP to penetrate deeper, stimulating further improvement in skin texture and scars. A medication called tranexamic acid can also be used with microneedling to improve the appearance of hyperpigmentation and melasma. The downtime after microneedling is minimal, with redness and swelling lasting approximately 3-4 days.