Facial Cosmetic Surgery Guide - Cleveland Clinic

Facial Cosmetic Surgery Guide

Beautiful You

No one will ever know, unless you want them to.

A natural-looking, rejuvenated appearance is made possible by the skilled and experienced multidisciplinary team at the Cleveland Clinic Cosmetic & Plastic Surgery Center. To help in your decisionmaking process, this guide covers all of our facial cosmetic surgery procedures, introduces you to our renowned surgeons and answers questions you may have.

Cosmetic Artistry. Clinical Excellence.

When you choose Cleveland Clinic Cosmetic & Plastic Surgery Center, you can be confident that our surgeons are board-certified and have been leaders in the field of facial cosmetic and reconstructive surgery. By collaborating in a multidisciplinary setting, they offer you the highest level of care in a wide variety of core cosmetic surgery and medical specialties. Multidisciplinary collaboration ensures that your team consists of specialists in many disciplines who coordinate care to meet your individual needs.

Our physicians, who have significant experience in all areas of aesthetic plastic surgery including facial cosmetic surgery, cosmetic breast surgery, and body contouring procedures, are supported by the long-standing reputation of a world-class medical facility. Every year since 1990, U.S.News & World Report has recognized Cleveland Clinic as one of the top hospitals in America.

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Resources for more information

The Joint Commission

Ohio Department of Health odh.

American Association for Accreditation of Ambulatory Surgery Facilities

Accreditation Association for Ambulatory Health Care

cleveland clinic | Facial Cosmetic Surgery Guide

How to Choose a Surgeon

You've spent a lot of time thinking about your expectations of facial cosmetic surgery and considering various procedures. Below are some tips to help you find a qualified center and surgeon.

1. Look for a center that has a good reputation, that employs board-certified physicians and surgeons in the core cosmetic specialties, and whose surgeons have practicing privileges at nearby hospitals.

2. Be sure that if emergency hospitalization becomes necessary, you can be admitted to a hospital quickly for appropriate care. Most elective cosmetic surgery procedures are done on an outpatient basis, so it is a good idea to call the center and ask about this.

3. Determine whether the center is certified by The Joint Commission, which accredits nearly 16,000 healthcare organizations and programs in the United States ? everything from hospitals to nursing homes to outpatient surgery facilities.

4.Verify that the surgeon who will do the treatment or dermatology procedure is board-certified in one of the core cosmetic surgery specialties, otolaryngology (ear, nose and throat surgery) or ophthalmology. Board certification signifies that a physician has the knowledge, skill and experience required to provide quality patient care in a given specialty. You can verify board certification status using online resources offered by the American Society of Plastic Surgeons, the American Board of Plastic Surgery and the American Academy of Facial Plastic and Reconstructive Surgery.

5. Ask the surgeon for photographs of his or her work. Most plastic surgeons keep a portfolio of "before and after" images. Most feature their best cases, but you can choose the surgeon whose results you like best.

6. Consider the surgeon's experience. How long has he or she been performing this procedure? Is the latest technique being used? Does the surgeon have special training in the use of a technique or new technology? How many of the procedures that you are interested in has he or she performed in a given period? In general, the more experience the surgeon has in performing a certain procedure, the better the results.

7. Make sure that your questions have been answered. Have you been informed of possible risks, side effects and recovery time associated with the surgery? Obtain as much information as you can about the procedure and discuss your expectations with your surgeon.

8. Be sure the center offers thorough preoperative assessment and proactive postoperative follow-up. This should be part of the overall package, regardless of the procedure being performed.

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Facial Cosmetic Surgery Procedures

Board-certified surgeons at the Cleveland Clinic Cosmetic & Plastic Surgery Center offer refined cosmetic nose surgery techniques that can enhance your appearance.

Nose Reshaping (Rhinoplasty)

Cosmetic nose surgery, or rhinoplasty, can improve the appearance and proportion of your nose. Nose surgery also may improve breathing. The procedure can change your nose's profile, overall size, tip, bridge and nostrils.

The best rhinoplasty outcomes are achieved when functional concerns are balanced with aesthetic ones. A narrow nose with poor breathing is not a desirable surgical outcome. When the nose is in proper proportion to other facial features, the patient's facial harmony and self-confidence are enhanced. Achieving this harmony is based on careful examination of the nose in the context of the entire face.

Because cosmetic nose surgery is such a highly individualized procedure, the best results are achieved through a thorough consultation with your cosmetic surgeon. Skin thickness, bone structure, breathing difficulties and ethnic background are important factors to be considered in discussions with your surgeon prior to surgery. Because of the interrelated nature of the nose to the face, many patients with weak chins (lack of chin projection) have a chin augmentation (or genioplasty) in conjunction with rhinoplasty to create a better balance of features.

Your surgeon will examine the structure of your nose, both externally and internally, to evaluate nose function and form and make specific recommendations. The surgeon will take photographs of you and discuss the options available. Using state-of-the-art modern imaging technology, preoperative planning is done with the patient. Computer images are morphed into potential postoperative results, allowing the patient to become an active participant in the decisionmaking process. Based on in-depth communication in this planning phase, your surgeon will explain how the nasal structures, including bone and cartilage, can be sculpted to reshape the nose for the desired results.

Before after

Patient before cosmetic nose surgery (top) and three months after cosmetic nose surgery (bottom).

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Minimally Invasive cheek lift (Percutaneous Mid-Face Lift) A mid-face lift, also called a cheek lift, addresses one of the early signs of aging ? sagging of the cheeks and the surrounding area. One of the newest approaches to this procedure is the minimally invasive percutaneous mid-face lift (PML). Developed by Cleveland Clinic facial aesthetic surgeons, PML can be done with local anesthesia with light sedation. It is an outpatient procedure that takes only about 20-30 minutes to complete and patients are generally fully recovered within a week. And, unlike any other face-lifting procedure, the results are adjustable or reversible, if necessary.

Neck Lift A neck lift offers a smoother and more toned appearance to skin under the chin and neck areas. Newer, less invasive procedures offer shorter operative times, quicker recoveries and can result in significant improvement in the neckline without requiring the extensive surgical dissection of a traditional face lift. The procedure is significantly less expensive than a traditional face lift.

Neck lift surgery can be performed in a variety of ways. Typically, an incision is made in front of and behind the ear. The edge of the sagging neck muscles is identified and pulled up and secured. The resulting excess skin is removed behind the ear hiding the incision. An alternate method popularized by Cleveland Clinic surgeons involves creating an incision under the chin and tightening the underlying muscle without removing skin and without the need for an incision in front of the ear. Procedures are usually performed in half the time of a typical face lift, and patients generally recover within one week to 10 days and usually can return to work after the first week with only minor bruising.

Before

after Patient before face lift (top) and two years after face lift (bottom). 4

face lift (Rhytidectomy) In the early days of cosmetic surgery, face lifts consisted of skin tightening only. Most modern face lift techniques today consist of tightening both the skin and the tissue beneath the skin in the cheek and the neck. There are many techniques. No matter the technique, however, the principle is the same: tightening of the deeper structures allows less tension to be put on the skin, which may lead to a longer term result.

With most face lift procedures, a drainage tube is inserted during surgery. This will be removed a day or two after surgery. All sutures are usually removed within five to 10 days following surgery. Surgeons generally recommend that patients avoid vigorous activity and arrange for post-surgery support from family and friends.

Recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are well concealed in natural skin creases and along the hairline or, if necessary, by makeup until total healing has occurred. Bear in mind that the aging process continues after surgery and that some relaxation of tissues will occur in the first few weeks.

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Eyelid and Brow Lifts

Before

after Patient before cosmetic eyelid surgery (top) and six weeks after cosmetic eyelid surgery (bottom).

Eyelid Surgery (Upper Lid Blepharoplasty) This procedure is aimed at removing excess skin and fat in the upper eyelids. It typically is done under local anesthesia combined with conscious sedation ("twilight sleep") and has one of the most rapid recoveries of any facial plastic surgery procedure. The entire procedure takes approximately 45 minutes to an hour and the pain is minimal in most cases. Some minor swelling and bruising may last a few days, and most patients are completely recovered after a week. These procedures may be combined with brow lifts to achieve the best effect.

Eyelid Surgery (Lower Lid Blepharoplasty) This procedure addresses the puffiness of excess fat and the wrinkling of excess skin in the lower eyelids. For those patients with excess fat and little or no excess skin, the procedure can be performed by making the incision inside the eyelid (transconjunctival), avoiding a scar on the skin. For those patients with excess skin and fat, an incision is made just below the eyelashes, where it can be well hidden.

Your surgeon will use an endoscope (a pencil-like camera device) inserted through a different incision, where the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance.

Brow Lift

Also called a forehead lift, this procedure corrects a low-positioned or sagging brow, smooths furrows across the forehead and between the brows, and helps restore a more youthful appearance

A forehead lift can be done in a number of ways. The conventional "open" method involves making one continuous incision starting at ear level and moving up around the hairline. The incision is usually made well behind the hairline to hide the scar.

Cleveland Clinic Cosmetic & Plastic Surgery Center surgeons offer innovations in forehead lift procedures including the use of smaller incisions and endoscopic technology to both elevate the eyebrows and reduce frown lines.

With the endoscopic lift, instead of making one long incision, your surgeon will make about three to five shorter incisions in the scalp, where an endoscope (pencil-like camera device) is inserted into one of the incisions. This will allow the surgeon to view the tissues and muscles from a screen and perform the procedure in a minimally invasive way.

Before

after

Patient before brow lift (top) and six months after brow lift (bottom).

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