Put Your Best Face Forward

I have heard advertisements for facelifts that can be performed during my lunch hour. The idea of this really appeals to my “lifestyle”. What’s the deal with these procedures?

Sometimes, advertisements don’t tell the whole story. Over the last several years there has been an explosion in the usage of media by entities that advertise special “lifts” that can be performed quickly, have virtually no recovery period and last for an extended time. As a consumer, it is important to avoid the trap of being “overpromised and underdelivered”.  Most long-lasting facial rejuvenation procedures require not only a suspension of the skin, but a re-anchoring of deeper facial tissues that have sagged or deflated over time. The gold standard of facelift, cheeklift or necklift surgery often requires general anesthetic and time to produce calculated and precise results. Recovery time should not be minimized, as these procedures can produce swelling and bruising for several weeks. Lastly, as a consumer, it is important to be involved in the initial consultation with your board-certified plastic surgeon who will be performing the procedure. This provides you with an excellent opportunity to ask questions, obtain information and understand your surgeon’s strategy for approaching your tailored surgery. If your initial consultation is performed by non-medical personnel or a corporate salesperson, this should be a major red-flag.

I am interested in a facelift, but quite frankly, I have concerns. I often see people shopping or walking around who have obvious scars. Their necks appear very tight, but I often see a very unnatural fold of skin to the sides of the mouth or jowl area that gives an obvious “pulled” look. Why do some facelifts look like this?

There are many approaches to facelifts. Some only concentrate on pulling the skin, while other, more extensive procedures are designed to re-anchor and reposition the deeper layers of the face. This deformity that you are describing is a common hallmark of a facelift that does not address the deeper tissue of the face (known as the SMAS layer). This deeper, muscular layer of the face has loosened at the same pace as the skin and should be resuspended if it is lax. The direction of pull is equally important. The area of the middle cheek (between the outside of the nose and the mouth) has a tendency to pull downward. In Dr. Pacella’s experience, providing a necessary lift in the vertical direction avoids the tendency of this unnatural fold to develop near the mouth.  Regardless of the procedure you choose, your surgeon should not only be adept in treating these areas, but should have the experience necessary to identify how time, swelling and healing will affect the long-term result.

I have broken my nose several times and have major breathing issues. When I exercise, I feel like I can’t get enough air in through my nose. My nose is also shifted to one side and I hate how this looks. Will my insurance cover all these corrections? After all, this is related to a nasal injury, isn’t it?

In general, nasal procedures (such as septoplasty or turbinate reduction) that are performed to improve airflow are reconstructive procedures. Depending on the extent of your impairment, these may often be considered as a covered benefit by your insurance carrier. The benefits of insurance plans vary greatly and each patient is considered on a case-by-case basis. Reconstructive nasal procedures to improve airflow are not often designed to improve the external appearance of the nose. Procedures such as rhinoplasty are often considered cosmetic and do not qualify for coverage under most insurance plans. It is important to understand that procedures done for reconstructive purposes can sometimes destabilize the long-term appearance of your nose if the underlying structure of the nose is affected. For this reason, if you have ever considered a cosmetic procedure for your nose, you may want to consider performing it at the same time as any procedure performed to improve breathing. Special maneuvers can be performed that restructure the natural nasal architecture to both maintain airflow and preserve the cosmetic appearance long term. During your consultation, Dr. Pacella can assist you in determining which reconstructive and/or cosmetic procedures you may be a candidate for.

I have a very busy profession and cannot take the time off for surgery. I have heard that nonsurgical treatments can be effective for wrinkles. How do I know what option is best for me?

Nonsurgical treatments are very effective in rejuvenating the face and require minimal time commitment. While they are not a substitute for surgery, they can often provide very good benefits for specific areas of the face. For example, neuromodulators such as Botox® and Dysport® can be used to prevent wrinkles from forming in the forehead, crow’s feet area or upper nose. They are most effective if the wrinkles are not deep-set and only appear when muscles are moving (known as a “dynamic” wrinkle). If wrinkles are fairly deep and appear even when the muscles are not moving (i.e. a “static” wrinkle), dermal fillers are often needed in addition to Botox® and Dysport®. Dermal fillers such as Restylane®, Juvaderm® and Radiesse® are often used to fill in small lines around the eyes or mouth, the grooves under the eye (known as the “tear-trough”) or the nasolabial folds, or to plump up lips or cheeks that have lost their structure over time. During your consultation, Dr. Pacella will discuss potential options that will fit into your lifestyle. It is important to realize that most nonsurgical treatments are not permanent and may need to be repeated every several months to a year to have the continued, desired effect.

I have been recently diagnosed with skin cancer on my nose. I am concerned about removing the cancer because of potential scarring. What are my options?

While being diagnosed with skin cancer can be frightening, there are options available to remove the cancer and restore the contour of your face and nose with minimal scarring. In conspicuous areas such as the face, cancers can be removed through a specialized technique known as Moh’s micrographic surgery. Utilizing this technique, the cancer is removed in small sections to avoid very large scars or defects. The results of the removal are immediately known, and the defect can be repaired the same day after the cancer is removed. Dr. Pacella specializes in repairing defects of the eyes, face and nose after skin cancer removal. Dr. Pacella works with many dermatologists and skin cancer doctors around San Diego who perform Moh’s surgery and is readily available to provide specialized expertise in repairing the defects created by skin cancer removal. With an exceptional eye for aesthetics, Dr. Pacella designs the repair to hide scars in the natural wrinkle lines of the face. In addition, techniques are not only designed to minimize scarring, but to restore the natural contour. While no surgery can be performed without scarring, their long-term appearance can be minimized by careful planning and designing the reconstruction.


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The questions above are represented for informational purposes only. They do not constitute actual medical advice. Dr. Pacella is pleased to discuss your unique personal circumstances at your consultation.