Facial Plastic Surgery

Facial Plastic Surgery refers to all procedures that I perform above the clavicles, which includes facelift and neck lift, nose job (rhinoplasty), brow lift, chin implants, fat transfer, liposuction of the face and advanced skin care options.

People often infer from the number of before and after photos on my website that I perform mostly bodywork. But, about half the work I perform is above the clavicles and these patients often prefer not to reveal their faces on my website.
Aging Baby Boomers have led the demand in facial plastic surgery because this is a generation that prides itself on keeping fit and looking good. The changes in the body that occur with age can make one look older and more tired. The proliferation of “selfies” and the popularity of social media are constant reminders of these disappointing changes. The goal of facial plastic surgery is to offer patients options to naturally shape and rejuvenate their appearance.

For the past ten years, there has been an explosion in popularity of non-invasive facial rejuvenation options. Although these services have offered some rejuvenation benefits and reduced recovery times, they have fallen short in the quality of results compared to the gold standard surgical techniques. This cost is quite high. Many patients are seeking services that they only need once and that will offer them true natural rejuvenation. Successful facial plastic surgery means natural-looking results without the stigma of surgery. The overdone, artificial look is the product of inexpert plastic surgery but makes great viewing on the celebrity rounds.

By combining surgery with non-surgical alternatives such as fillers, Botox, chemical peels and lasers, facial plastic surgery outcomes have been revolutionized. Re-suspending loose tissues, plumping hollow areas of the face, and softening deep wrinkles all work synergistically to provide for the most natural and youthful outcome. It’s actually possible to look beautiful without looking artificial or “operated.” Keep them guessing — “Did he/she have plastic surgery?”

Further details of facial procedures are addressed elsewhere on my website. Below, I have broken down the face into specific areas to discuss the typical aging changes and the most common rejuvenation alternatives. Read my blog on recovery from a face and neck lift.

Forehead

Creases of the forehead and between the eyes are the result of muscle activity beneath the skin. Facial expressions — those of happiness, sorrow, and surprise — result from the coordinated use of these muscles. Excessive use causes fine lines that turn into deep creases over the years. As the eyebrows droop with age, the youthful “bright eyed” appearance turns into one of fatigue and sadness. This upper third of the face is best treated with fillers to plump the creases, Botox to weaken the muscles that cause the creases and brow lift to elevate the eyebrows, reduce the muscle stress and soften the creases. The use of Botox and fillers requires regular maintenance while a forehead lift is essentially permanent. Depending on the patient’s anatomy, a forehead lift can be performed with an open incision or endoscopically, with minimal incisions. In experienced hands, these alternatives offer low risk, high reward outcomes.

Eyes

The eyes are the center of human communication and one of the first things anyone will look at. The aging process results in excess skin of the upper and lower eyelids, pockets of fat in the eyelid compartments and the lower eyebrow position. Creases form between the eyes and “crow’s feet” form on the sides of the eyes from squinting. Settling of tissues on the upper cheek can cause furrows; depressions and swelling that detract from the appearance of the eyes.

Rejuvenation alternatives for the eyes vary from the simple to the more complex. The use of makeup alone offers an affordable way to make your eyes more attractive and youthful. Botox and fillers can work wonders around the eyes. Alternatively, a patient’s own fat can be used, albeit with less consistent results. Eyelid surgery (blepharoplasty) and a brow lift are very powerful rejuvenation options.

Given all these options, patients are often confused by what the most suitable treatment is. That is why you need to expose yourself to medical practitioners at various levels of expertise—from your makeup artist up to your plastic surgeon. As a general rule, younger patients benefit from the non-invasive alternatives like fillers and Botox, while older patients benefit from actual procedures that remove excess skin, elevate eyebrows and contour the fat around your eyes.

Nose

The nose is the center of the face and therefore it is hard to hide. A big or crooked nose can take away from the beauty of your face. The most common requests for anyone considering a nose job (rhinoplasty) are to reduce the size of a large nose, to refine a nose that has a round, generous tip or to remove a hump on the bridge of the nose. Breathing is important as well, and in many cases your surgeon may suggest changes to the inside of the nose (septum and turbinates) to enhance your breathing. Read my full article on rhinoplasty.

A secondary rhinoplasty is work done on a previously operated nose. For those who are not satisfied with the results of their original work, there are many things that can be done to improve the outcome. The ultimate goal is to achieve a nose that is smaller and more refined, not overly operated or drastic in change.

Lips

Lips decrease in size as we age. Plumper, fuller lips are youthful and attractive. The best way to enhance the appearance of your lips is to consider fillers, plumpers or soft silicone implant placement. The goal is to make the lips fuller and not to overdo it. Overuse of fillers and overly large or poorly placed lip implants are not attractive. Deep lip lines and creases around the mouth are very undesirable to most, as this is a sure sign of age. These creases can be addressed with fillers, as well as chemical peels, laser treatments, or dermabrasion treatments.

Teeth

I can’t say enough about attractive teeth, because a great smile is worth millions! White and straight is the rule. Never underestimate the benefit of nice choppers; a visit with an experienced and qualified dentist can be worth every penny.

Chin

A weak chin can affect facial balance and symmetry more than most people think. It will also affect the appearance of the neck, as the lack of bony support can result in fullness below the chin and a full neck angle. An appropriately sized and well-placed chin implant is a very powerful procedure. In experienced hands, the incision beneath the chin is well hidden and the result improves the appearance of both the face and the neck.

Cheeks, Nasolabial Folds and Jowl

These areas of the face all begin to collapse with aging. Judicious use of fillers can be used in these areas with success, but it’s important to not overdo it to the point where the face begins to look too full and unnatural. Cheeks are best enhanced with fillers or implants, the nasolabial folds are softened with fillers and the jowls can be treated with fat removal if the skin quality is good. All these areas can be enhanced with a facelift and / or a neck lift procedure. Often, some combination of a lift and fillers work the best.

Facial Skin

Your skin is the foundation for beauty. Healthy, smooth, evenly textured skin is an essential component of facial rejuvenation. Texas sun can take its toll on your skin. Thankfully, chemical peels, lasers, and medical grade skin care products work wonders on sun damaged, wrinkled and blotchy skin. Never underestimate the benefits of radiant, healthy skin when you are considering facial rejuvenation. Fillers, Botox and lifting procedures are only fully realized if the skin is rejuvenated as well.

Neck

The aging neck is a common concern for many patients seeking rejuvenation alternatives. The neck becomes full, the angle of the neck disappears, the jawline is obscured with excess skin folds and neck banding from the underlying lax muscle can show through. Any photograph seen at a profile reveals these changes.

Unlike the face, the neck isn’t an area that responds well to plumpers, Botox, lasers or chemical peels. Subtle improvements can be made, but not true rejuvenation. Genuine benefits can only be accomplished with a neck lift, which often combines skin tightening, fat contouring and muscle tightening. An anterior neck lift is performed though an incision under the chin while a full neck lift often requires incisions beneath the chin and around the ear and in the hairline behind the ears. Impressive results include an improved neck angle, a reduction of jowls, removal of neck bands, an attractive jawline and a tightening of the loose skin.

— Robert Caridi, M.D.
Certified Plastic Surgeon
Founder of Westlake Plastic Surgery, providing plastic surgery in Austin, TX