Our practice philosophy on facial rejuvenation centers on a personalized, patient-oriented approach. Attention to each patient’s individual needs, goals, and aging patterns is fundamental. We approach facial rejuvenation as a whole, maintaining the original and correct anatomical relationships of the facial features. This art of balanced facial rejuvenation that results in a natural appearance involves the interaction and utilization of all the resources Dr. Barone and our staff provide.
Our approach to facial and general rejuvenative programs begins with an analysis of the three components of aging: skin surface, tissue position changes, and volume loss. It should be emphasized that rejuvenative surgery can correct and improve the manifestations of aging, but it does not stop the aging process. Aging is a natural biological function and will continue, influenced by each individual’s genetics along with external factors in the environment such as stress, sun exposure and smoking. Although we cannot stop the aging process, the manifestations of aging caused by these external factors can often be mitigated and rejuvenated, which significantly and positively affects the patient’s health and appearance.
The manifestations of aging and damage to the surface of the skin are important considerations as these are the initial and most visible signs of aging. The majority of these accelerated changes are caused by sun damage which is termed “photoaging.” The result of prolonged sun exposure, particularly on unprotected skin, results in brown spots or “age spots” known as hyperpigmentation, thinning of the skin, collagen loss, visible blood vessels under the surface, and loss of youthful skin tone caused by the degradation of collagen and elastic fibers in the skin. Additionally, prolonged sun exposure to unprotected skin results in precancerous changes (actinic damage, actinic keratosis) and increases the risk of skin cancer.
Although many patients believe that sagging or drooping skin is the most common manifestation of aging, the loss of volume of the deeper layers of the skin and underlying fatty tissue is actually more significant. This loss of tissue volume is particularly noticeable around the mouth and eyes. These areas of the face must be addressed in order to obtain a natural and balanced result without having an “operated” look. Dr. Barone has extensive experience with grafting the patient’s own fat to restore volume to other areas, as well as using many of the FDA-approved injectable tissue fillers.
The term “tissue positional changes" refers to the shift and gravitational descent of not only the skin but also the underlying fat, muscle, and deeper structures of the face and neck. It is important to remember that a young face is not an older face with tight skin. In other words, simply tightening the skin (as is common in traditional facelifting) often looks artificial because it does not address the deeper components of aging and the changes in tissue position. As we age, the deeper ligaments that support the facial structures often become lax, allowing for decent of the fat and deeper structures along with laxity of the facial muscles. This descent or tissue shifting is most naturally corrected by repositioning these deeper tissues back to their original position while respecting the original anatomic relationships of youth.
By careful analysis and respect for these three key components of aging, we can formulate a comprehensive plan for facial rejuvenation that will provide a balanced and natural result. Again, it must be emphasized that although there are many options, techniques and services available, a personalized plan for each patient will be created based on individual goals, preferences, budget, and recovery time.
At Frank Barone, M.D. Plastic Surgery, our goal is to provide patients with surgical and non-surgical procedures that produce natural-looking results that last for years to come. We realize our patients are making an investment in their appearance. We also know the single best way to maintain that investment is to take care of the skin. Making the effort to prepare the skin before surgery can produce better results by helping the skin heal faster and can also help prevent complications such as hyperpigmentation. Continuing to care for the skin post procedure is the insurance policy for long-lasting results.
Our medical staff and aestheticians work with each patient to develop a skin prep regimen that includes specific products and minor procedures that help ready the skin to be treated, beginning with a VISIA®; Complexion Analysis. VISIA is an imaging system that takes a photo of the face and instantly analyzes eight different characteristics of the skin – measuring spots (pigmentation), wrinkles, texture, pores, UV and red spots, porphyrins (acne-causing bacteria), and photodamage. With this information, the aesthetician can provide a more targeted treatment program for each individual, and she also can repeat the VISIA process to track each patient’s progress over time.
Immediately after surgery it is imperative that post-operative instructions given to you by our staff are carefully followed. This will minimize risk of complications and infection and will encourage proper healing. Our medical staff and aestheticians are there for you every step of the way during the healing process and will be able to guide you through any necessary changes in your post-care regimen.
Maintaining Your Results
You’re totally recovered from your procedure and loving the results, so what next? Your aesthetician can help you build a maintenance program that will keep your skin healthy and results looking beautiful for years to come.
Dr. Barone is experienced in all of the following surgical procedures, but he specializes in individualized, total facial rejuvenation – a combination of two or more surgical and/or non-surgical procedures, skin care and nutrition.
The nose is the central, most prominent feature of the face and a major factor in defining balance and harmony among facial features. When the nose is out of proportion with other facial features or the nose does not compliment the face, it can affect self-image and confidence as well as detract from other attractive characteristics of the face.
We realize there are individual or ethnic differences in features of the nose which may compliment other facial features and are therefore desirable, so we emphasize a highly individualized approach to surgery of the nose.
For cosmetic surgery to improve the balance and appearance of the nose we consider:
Rhinoplasty may be done through an internal approach, or through a small incision in the tissue below the nasal tip (columella). This is called an open rhinoplasty, allowing for direct visualization of the nasal cartilage and other structures. In the past, nasal surgery to improve aesthetic appearance was primarily reduction only, with the take down of nasal bridge humps or large nasal tips. This can often result in an unnatural or “operated look” which is not in balance with the other facial features. Therefore, our practice approach involves reduction only when necessary along with augmentation or addition of tissue and reshaping of nasal structures to provide balance and harmony. In many cases, cartilage grafts obtained from the internal nasal septum or other sources are used to rebuild and reshape nasal structures. These combined procedures result in a more natural look and carefully preserve the important functions of the nose.
Rhinoplasty may also be chosen to correct breathing problems as a result of trauma or injury or from congenital malposition of the nasal septum or other structures. Nasal surgery to improve breathing may be done alone or in conjunction with cosmetic surgery of the nose and is considered reconstructive and may be covered by insurance.
Surgical rejuvenation of the eyelids or blepharoplasty is indicated for reducing the aging changes of the eyelid structures. Blepharoplasty is one of the most commonly performed surgical procedures in the United States and has an excellent safety record when performed by an appropriately trained surgeon. Aging changes of the upper and lower eyelids often have a major influence on a patient’s appearance as the eyes are one of the most revealing facial features. A properly done blepharoplasty will result in a more rested and alert appearance and significantly affect the youthfulness of the face.
Eyelid surgery can improve or treat:
Our approach to eyelid surgery is based on achieving a natural or non-operated appearance while restoring the position and contours of youth. An examination of the characteristics of youthful eyelids reveals that fullness or adequate tissue volume is important as is the position of the eyelid skin. Our surgical approach in eyelid surgery is therefore directed towards repositioning the normal fatty tissue of the lids to its previous youthful position and restoring the contours of the skin and support structures rather than simply excising this tissue. This is particularly important in eyelid procedures because excessive removal of skin and fat may result in a hollowed or sallow appearance of the lids and an artificial look.
Eyelid surgery or blepharoplasty may be done alone or in conjunction with other facial surgical procedures depending on each patient’s individual goals and pre-operative assessment.
The brow lift is a procedure to elevate the forehead, lateral eyelid and upper nasal skin and tissue and return them to their youthful position. Depending on the individual aging characteristics of each patient, the brows may be elevated or returned to their original location of youth.
Dr. Barone prefers to perform his brow lifts using the endoscopic approach. Unlike the traditional open brow lift which requires a large incision across the scalp, the endoscopic approach utilizes four small incisions located and hidden in the scalp.
There are several distinct advantages to the endoscopic approach:
The brow lift is really an upper facelift and provides repositioning and support for the entire forehead and even the tissue of the upper eyelids and lateral temporal areas or lateral eyelid skin.
A brow lift:
If you are concerned about the progressive signs of aging in your face and neck, you may consider a facelift to correct these changes. Technically known as a rhytidectomy, a facelift is a surgical procedure that will reposition the facial and neck tissues to improve visible signs of aging.
The areas addressed are:
A facelift is usually part of a comprehensive facial rejuvenation surgical plan that may also include a forehead or brow lift done by endoscopic technique, and eyelid surgery to rejuvenate aging eyes.
Other procedures that may be combined with the facelift in a rejuvenative plan include improvement of the skin surface through facial peeling or a laser therapy and volume replacement utilizing the patient’s own fat cells or FDA-approved injectable volume enhancers such as Restylane® or Juvederm®.
A facelift is a highly individualized procedure and is best suited to the patients who are seeking self improvement and the restoration of a youthful appearance. Because the facelift is a surgical procedure, it is appropriate for patients who are physically healthy and without any active or serious medical problems. It is also important that the facelift patient have realistic goals for the improvement in appearance and not be motivated by other external factors. Smoking is potentially harmful for the facelift patient because of its effect on reducing circulation in the skin and tissues which can effect healing and create other complications.
Cheek or malar lifting is a surgical procedure that improves the appearance of the central face where the tissues at the lower eyelid extending down to the corners of the mouth and the jowl have descended. When done properly, the malar or mid-facelift can restore the youthful contours of the middle facial structures and provide a natural, more youthful appearance. The cheek lift is sometimes performed with other facial procedures such as facelifting or endoscopic brow lift.
Specifically, the cheek lift can treat: