The term “Sub-Muscular Aponeurotic System” refers to the layers under the skin that consist of muscle and collagen (connective tissue). In a modern facelift, these are tightened as well as the skin, to create a firmer and more youthful-looking result. At the same time, liposuction can be used to remove excess fat.

Facelifts work on the cheeks, jawline and neck. An incision called the “S” incision is made on each side. It runs partly inside the hairline and partly in front of the ear.

A facelift takes between 2 and 3 hours to perform and can be done under general anesthesia or local with IV sedation. It can be done in a hospital or a doctor's surgical office.

Recovery is usually rather quick, with not much pain, although a pain medication will be prescribed if needed. The swelling subsides within days and the bruising fades in a few weeks.

The pinkness in the scars fades after a few months, leaving a narrow white line, most of which can be hidden by hair or makeup. Although the results are not permanent, they do last many years and most people don't feel the need for any further work for about 8 to 15 years or so.

As we age, the force of gravity pulls downward on our face and this droop can affect the eyebrows, which in turn affect the upper eyelids, pulling them downward and creating a tired look to the face.

Aging also brings crow's feet at the corners of the eyes and of course, frown wrinkles. And some of us have eyebrows that are positioned low over the eyes, just from our genetics.

The endoscopic brow lift calls for several small incisions in the scalp (3 to 5, depending on what exactly is to be done), each an inch long or less. Through one of these, the cosmetic surgeon will insert an endoscope. Through another of the incisions, he inserts surgical instruments and carefully lifts the forehead skin to a new position. The eyebrows are lifted at the same time, giving the eyes a wider look.

In this type of browlift, no skin is removed. So this is not the procedure of choice for a person with many horizontal brow wrinkles. But the small incisions leave very small scars, which makes it good for men whose hair is too thin to cover scars.

The temporal browlift (also called a lateral lift or lateral brow lift) is a variation of the endoscopic brow lift. In this procedure, the small incisions are located a little further to the sides, nearer the temples, and the new position of the skin and underlying tissues has a slightly more slanted angle. It also lifts the cheeks a little, giving a more youthful line to the cheekbones.

Excess skin is removed, which lifts the outer ends of the eyebrows slightly, but doesn't lift the center ends. Crow's feet are also removed with this method. It can be done at the same time as an endoscopic brow lift and / or a facelift.

The corrugator muscle is the one which squeezes the eyebrows together, forming frown wrinkles as we age. A corrugator excision is often performed along with a browlift and involves modifying or removing part of the corrugator muscle so that frown lines will not re-develop.

This is a method for raising the eyebrows without affecting the hairline or working on frown lines or crow's feet. The incisions are right along the tops of the eyebrows and raise only the eyebrows themselves. The resulting scars are barely visible against the hair of the eyebrows.

A laser is a focused beam of light which can be precisely controlled by the cosmetic surgeon for resurfacing the skin. Lasers are very effective at removing such things as moles, fine wrinkles, spider veins, port wine stains, or mild scarring.

Then the laser power is lowered and the laser used to heat the dermis gently. This stimulates it to produce collagen fibers. (Collagen is a protein that's common in the body, and is produced any time the skin's integrity is damaged.) As the collagen heals the treated area, new skin grows which is softer and less wrinkled.

Laser resurfacing is done with a local anesthetic and if needed, also a sedative. Depending on what other procedures you're having done at the same time, a general anesthetic may be used.

Afterwards, there'll be swelling and discomfort for perhaps a week or so, and there could be some oozing for a couple of weeks. The skin may be pink or red for several months as it regrows and recovers.

You'll need to avoid direct sunlight, and if you have to be outdoors, use a sunblock with an SPF of 25 or more. Also avoid moving your facial muscles as much as possible and use a moisturizer at least twice a day to keep your skin hydrated and supple.

Since cosmetic surgery has become so popular in the last 10 years or so, some doctors have taken short cut training to take advantage of this at a disservice to the general public. You want a properly trained and experienced surgeon, not one who might gain his basic experience on you! Choose a plastic surgeon who's certified by the American Board of Plastic Surgery (ABPS), and one who's a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS).

While you should by all means listen to your friends and acquaintances who may have had cosmetic surgery and want to recommend their doctor to you you should do your homework too, and check the doctor's credentials.

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