Facial Rejuvenation FAQs
- How does Dr. Lam rejuvenate the area around the eyes?
The area around the eyes is perhaps one of the most important areas to rejuvenate. During a conversation and in normal social encounters, about 99% of the time is concentrated at looking at the other’s eyes. Traditional surgery has been only based upon cutting away tissue. Dr. Lam rarely performs removal of skin or fat alone. Using your old photographs, he can evaluate exactly what you used to look like so that his surgical strategy can match your identity and thereby preserve and enhance your identity rather than alter your appearance so that you no longer recognize yourself.
Accordingly, Dr. Lam uses a combination approach to rejuvenate the periorbital area (the region around the eyes). For the upper eyelid that is hanging, he may remove a little extra skin if the eyelid appears to be drooping over the eyelid. Occasionally, he may perform a browlift if your old photographs show that your brow was higher than today. For the lower eyelid, he almost never makes an incision. There have been too many problems with the eyelid actually pulling downward in an unnatural way. Instead, he uses a technique known as “transconjunctival” in which he makes no skin incision to remove any excess “fat bag” that may be protruding. This technique preserves the shape of the lower eyelid and facilitates both a safe and a rapid recovery.
Part of the process of aging is also hollowing around the eyelids, where the bony rim around the eyes becomes more apparent. Dr. Lam believes that visibility of the bony rim around the eyes leads to a more aged look and camouflage of this area is a vital component to his overall strategy in periorbital rejuvenation. Grafting one’s fat around the eyes can at times truly provide the most natural and remarkable rejuvenation, especially when combined with traditional skin and fat removal techniques.
After a detailed consultation with Dr. Lam, he will be able to evaluate which method or methods would be appropriate in your situation.
- Does Dr. Lam perform facial rejuvenation around the eyes differently for men?
Yes, browlifting and excessive removal of skin from the upper eyelid in most men can alter their appearance in an unfavorable way and even feminize the face unnaturally. He rarely will perform a browlift in a male and will only be very conservative with skin removal from the upper eyelids in men. If you look at the celebrities out there that have a very strong, masculine face, you will notice that almost all of them have a very low brow and a very full and draping upper eyelid contour. For example, Tom Cruise has very narrow eyes but he still appears both youthful and masculine, even in his forties. It is particularly important to review old photographs for men to determine which strategy would be ideal in a particular case. Bringing your old photographs in to Dr. Lam will be very helpful both for you to understand the aging process and for Dr. Lam to help guide you in the best options available for you.
- What is the role of browlifting?
Browlifting can help with the tired expression of one’s eyes. However, Dr. Lam performs far fewer browlifts than he did many years ago. We are all programmed by the media and by other plastic surgeons to take two fingers and to lift our brows up to show how much better we can appear. However, careful review of one’s old photographs can reveal that your brow may never have been that high. Besides reviewing old photographs, you should review the paragons of youthful feminine beauty exemplified in such periodicals as Glamour, Allure, and Vogue. Many times, one will begin to understand that oftentimes young women who are deemed attractive have relatively low but full brows. The aesthetic over the past decade in particular has moved away from an exposed and elevated brow to a more natural configuration. Evaluating the role of browlifting for you will require a consultation with Dr. Lam.
After discussion with you, if Dr. Lam should elect to perform a browlift his technique does not require any long incisions. He uses only tiny incisions behind the hairline (a total of five) that heal very quickly. He does not remove any hair or skin during the procedure. This technique is known as an “endoscopic browlift.”
- What is the recovery for cosmetic eyelid enhancement?
Traditional eyelid procedures require generally very little recovery time. It is recommended that you take off from work for a week in order to permit sufficient time for most of the swelling to dissipate. Bruising usually takes 1 to 2 weeks to completely resolve. Dr. Lam can use his laser to lessen bruising significantly at the end of the first week should you experience some bruising. With lower eyelid procedures, as no skin incision is undertaken, there will not be a need to remove any sutures. For the upper eyelid, sutures are removed at the end of the first week. During that week, you will have to clean the incision with peroxide and dress the incision with an antibiotic ointment, all of which Dr. Lam supplies you on the day of the procedure.
- I have wrinkles around my eyes. Does Dr. Lam remove those wrinkles with his surgery too?
Yes and no. Dr. Lam does not believe that wrinkles should be “cut away”. Wrinkles under and around the eyes are creases in the skin that should be managed with a skin treatment. BOTOX can help prevent these wrinkles from getting worse by reducing their root cause, i.e., wrinkles that appear when you smile, frown, and raise your forehead. With a consistent regimen of BOTOX , lines and wrinkles that are not too deep can soften if not entirely disappear over time. For deeper wrinkles, a skin resurfacing treatment is necessary, e.g., plasma resurfacing, PIXEL treatments, etc. (See “Skin Rejuvenation FAQs” for more details.) The reason that Dr. Lam believes that the skin around the eyes should not be removed to take care of wrinkles is two-fold. First, it can be unsafe in that skin removal in the delicate lower eyelid area can result in the eyelid moving downward in an unnatural way, as explained above as to why Dr. Lam does not perform an incision in the lower eyelid area. Second, wrinkles around the eyes really are not significantly improved with removing skin even though it may appear that way to you when you take two fingers and pull back on the skin. That maneuver has very little bearing on the way that surgery helps one’s wrinkles.
- How does Dr. Lam rejuvenate my cheek area?
There are two principal ways to rejuvenate the cheek area, lift it or fill it. In Dr. Lam’s first textbook, Comprehensive Facial Rejuvenation, he explained his strategy for cheek rejuvenation using what is termed a “midface lift“. However, in the evolution of his strategy, he has found that filling the cheek can provide the most remarkable and natural rejuvenation. He considers the cheek as an extension of the “frame of the eye” where the cheek actually supports and enhances the look of one’s eyes. In order to simulate the look of how filling the cheek can accentuate the beauty of one’s eyes, all you have to do is to take your thumb and lift the cheek up gently and look into a mirror at your eyes, then let go of the cheek. You will immediately see the impact that a slight amount of volume can make. Fat grafting can be the most natural way to achieve this result. Unfortunately, a cheek implant is a poor choice in overall facial rejuvenation of the cheek area for a number of reasons. First, the cheek implant is partially exposed, i.e., can be seen through the skin in an older person, as the soft tissue volume of the face begins to go away. Further, what makes a face look young is the smooth transitions between the lower eyelids and the cheek and the lower face. Fat grafting permits a seamless result in which the hollow lower eyelids are gently blended with the cheek area. A cheek implant, on the other hand, actually worsens the way the lower eyelids look since it renders the hollow under the eyes even more apparent.
- What is Dr. Lam’s facelift technique?
Facelifting is an important component in Dr. Lam’s overall strategy for facial rejuvenation. Facelifting is a term that truly describes lifting of the jawline and neck only. As mentioned, Dr. Lam rarely believes that the cheek and the brow need to be elevated in most cases. The technique that Dr. Lam uses requires only a limited incision that does not extend into the hair-bearing area. Most traditional facelift procedures require an incision that extends up into the sideburn and up through the temple. Besides adding unnecessary recovery time, the problem with this incision is significant hair loss, especially in the person that undergoes another facelift in the future. In fact, Dr. Lam has performed numerous hair transplantations in women who have undergone this style of facelift. His incision also does not pass low on the back of the ear where your incision would be exposed should you wear your hair short or in a ponytail. Instead, his incision hugs the ear and the hairline so that it becomes virtually undetectable and again does not require any removal of hair.
Dr. Lam’s results simply do not look pulled. He lifts and repositions the deeper tissue called the SMAS to achieve your desired rejuvenation without ever tugging or pulling on your skin. He does so in a VERTICAL orientation to match how tissues fall. Instead of pulling back, which can lead to a pulled look, the tissues are repositioned vertically upward so that you 1) have a better neck contour and 2) do not have a pulled look. Also, more invasive facelift procedures that release all the facial ligaments can impart a pulled or windswept look, which Dr. Lam also does not prefer.
Besides the incisions around the ear area, a tiny incision is performed underneath the chin along the skin’s natural crease in order to perform liposuction of the neck as needed and to reunite the hanging bands that develop as the platysma muscle separates, commonly referred to as the “turkey gobbler” deformity or “waddle.” After the muscles are brought back into lignment, the incisions are made around each ear and the deep tissues are elevated so that the neck is lifted up like a corset. For more information about the recovery involved, please see below.
- How about a Contour threadlift, or suture lift?
Threadlifts are off the market as of July 2007 and have proven to be a completely unreliable, inconsistent, and short-lived method of facial rejuvenation. Dr. Lam no longer uses threads of any kind.
- What if I just have liposuction of my neck instead of a face or neck lift?
Although liposuction seems to be an appealing option to tighten the neck tissues, it is not a wise solution in someone 40 years or older. Generally speaking, liposuction of the neck is reserved for someone younger than 40 years old for the following reasons. First, liposuction of the neck in an individual older than 40 years old may produce a worsening in outcome without a concurrent facelift in that the muscle bands (“turkey gobbler”) may be more exposed after a procedure without the benefit of lifting them with a facelift. Since the skin elasticity diminishes after 40 years of age, the tissues may not tighten back without the aid of a simultaneous facelift with your liposuctioning. However, for someone with only mild fullness in the neck younger or older than 40 years, Accent XL may be non-invasive options to help modify this problem without surgery. Discussion with our team at our laser center (972-312-8189) may provide answers to your questions about these methods.
- How does Dr. Lam perform liposuction of the neck?
There are many ways to undertake neck liposuction. The two basic methods are known as “open lipectomy” and “neck liposuction“. Dr. Lam uses both techinques. Open lipectomy involves precisely removing the fat piece by piece in the neck visualizing the area through the tiny incision under the chin. In select cases Dr. Lam also uses what is termed neck liposuction as it uses a machine to suction the fat away. Dr. Lam first releases the tissues adherent to the fat with gentle dissection then suctions the fat out evenly throughout the neck. Dr. Lam believes that some people have significant amount of fat under the platysma muscle, which must be removed to improve neck contour, especially in what many plastic surgeons term a “difficult or heavy neck”. With Dr. Lam’s technique, none of these necks are really difficult at all. By evenly removing fat across the entire expanse (from jawline to jawline) Dr. Lam is able to achieve more uniform results and at the same time promote good scarring that helps the entire neck maintain an elevated position thereafter.
- What is the recovery time for a facelift?
The recovery following a facelift is limited to a week or two after the procedure. Generally speaking, it is advisable to take one week off of work to have the procedure done and to recover from it. Although there will be some swelling in the first 1 to 2 weeks, the recovery is not significantly deforming, as may be witnessed in other plastic surgery offices. You may have a few areas around the ears that appear slightly lumpy and swollen and you may look slightly pulled for the first 1 to 2 weeks. Thereafter, almost all of those issues will be entirely resolved. If you have bruising, Dr. Lam can laser down most of all your bruising at the end of the first week.
You will have a bandage that wraps around your neck and head for the first night, which is then removed the following morning in Dr. Lam’s office. You will not need to be hospitalized, as the facelift is a relatively short procedure (about 2.5 hours) done in Dr. Lam’s on-site surgery center. You will then wear a supportive neck bandage (an ACE wrap that will be supplied by Dr. Lam) for the entire week 24 hours a day as tolerated. After the first week, you can wear this light bandage at night for the following 4 to 6 weeks to minimize swelling and to achieve optimal results in your neck. You will clean your suture lines with peroxide and dress them with an antibiotic ointment, which Dr. Lam will supply to you, for the week following the procedure, which you will then stop thereafter. The sutures around the ears are removed by Dr. Lam at 7 days following the procedure, and the sutures under your chin will remain for 10 days. Generally speaking, you should be socially acceptable within one to two weeks. Most of Dr. Lam’s patients take one week to 10 days off from their work.
- Are there any differences with a male facelift?
Yes, the standard incision around the ears must be modified for the male patient in most cases. If you have a scant beard that does not extend to the ear, then the standard female incision that curves inside the ear can be designed for you. For most men, however, an incision in front of the ear where it dimples a bit is the ideal location. The one limitation is that in the morning, you will be shaving a bit closer to the ear, which requires more attention and perhaps time. An incision can be made where the normal beard distribution ends, but this incision line can be more visible in those that do not wear a beard. If you wear a beard normally, then this incision line is preferable since the beard distribution does not become moved back slightly toward the ear.After the procedure, the same rules apply for you as they do for women. However, you will not be allowed to shave for the first two weeks and thereafter you must use an electric razor for an additional two weeks. Although it may sound unappealing not to shave for the first two weeks, oftentimes the light beard that you grow almost entirely hides bruising and swelling. Dr. Lam has remarked that most men already look good several days after the procedure because of this fact. Also, the richer blood supply to the lower face that men possess owing to their beards can help make the recovery even faster than in women.
- I have heard that once I have a facelift that I must continue to “keep it up”?
A facelift result is permanent minus the natural aging that continues to occur over time. You will always look better than if you never had anything done. Another facelift may be beneficial in the future after several years to maintain a result but you will certainly not look worse in a few years compared to someone who never had a facelift to begin with. You will always look better than if you never had anything done. The best way that Dr. Lam explains the permanence of his result is with a simple imaginary analogy. If you had a sibling who is your identical twin and both of you are subjected to the same external factors (sun, smoking, diet, exercise, stress, etc.), after your facelift (and/or other procedures), you will always look much younger than your twin sibling even though both of you will continue to age.
- Does Dr. Lam have a no-cutting alternative to the traditional facelift?
Yes, Dr. Lam performs what is known as a trampoline lift that is very effective in improving the neck without any incisions or need for suture removal. The recovery is approximately a day minus the possibility of bruising. There is some tightness that can linger a couple of months but the results in the neck are superlative especially considering the short recovery time needed. It is particularly well suited to men who do not want a full facelift. This procedure however does not improve the jowls or the neck line but only the hanging neck itself.
- Does Mederma (onion extract), Strivectin, or Vitamin E oil work to help improve the appearance of my incision?
Dr. Lam does not believe that any of these remedies work to help a scar mature well. In fact, rigorous scientific studies that have involved blinded, prospective, randomized, split scar analysis (in other words, good and controlled scientific research) have indicated that these treatments provide no improvement at all in an incision or scar. In fact, Vitamin E oil has been shown actually to worsen wound healing in some cases. In the past, Dr. Lam used Vitamin E oil to help with wound healing. However, with recent evidence to the contrary, he no longer believes that any of these topical ointments do any good to help with scar healing.
- How important is symmetry in overall beauty?
Although Dr. Lam performs every procedure with the precision of symmetry, he believes that subtle asymmetry is natural and present in almost every person without detracting from overall attractiveness. In fact, it is impossible to make both sides of the body the same through plastic surgery. However, Dr. Lam believes that “harmony” or the proportion between various facial features, like the nose, eyes, cheeks, and chin is really what leads to overall beauty and attractiveness. Accordingly, Dr. Lam always strives to evaluate the entire face as a unit to see how each part of the face can be enhanced to make the overall impact of the face more attractive. Understanding facial balance and proportion requires a keen artistic eye, which Dr. Lam exercises in every case.
- Where does Dr. Lam perform his procedure and what kind of anesthesia/sedation does he use?
All of Dr. Lam’s cosmetic procedures are performed on site in the Lam Facial Plastic Surgery Center, which is fully accredited by the Joint Commission. All procedures are performed on an outpatient basis, i.e., you will not require hospitalization or an overnight stay. Dr. Lam uses only hand-selected board-certified M.D. (doctor) anesthesiologists. Dr. Lam’s surgery center and licensed medical staff are equipped to handle all levels of emergency and have a transfer agreement with the Presbyterian Hospital of Plano situated one block away, where Dr. Lam is on staff.