The Albany Plastic Surgery Blog by Dr. William F. DeLuca




The Skinny on Liposuction

Liposuction is a body contouring procedure that removes fat under the skin to address trouble spots throughout the body.

Traditionally liposuction has been used to tweak areas resistant to exercise such as the love handles, the lower abdomen, the neck, and the buttock. Liposuciton is performed through small access incisions hidden in inconspicuous areas. Because of this, the recovery is relatively quick compared to more invasive surgery, and the restrictions after surgery are few.

Unfortunately, however, liposuction does not have the ability to address any excess skin laxity. The overall success of the procedure depends on the skin retracting back after the fat is removed. The ideal candidates are young patients with good quality, elastic skin. In patients where the skin does not retract, a skin tightening procedure can be performed to address the excess loose skin.

Liposuction treatment areas

An alternative use of liposuction is as a debulking procedure during weight loss to “jump start” the process of slimming down. This procedure results in a modest weight loss and an incremental improvement in contour that helps motivate patients to continue losing weight through dieting and exercise.

Compared to traditional liposuction, debulking liposuction focuses on performing the procedure quickly with large cannulas to remove as much fat as possible in as short a time as possible. This change in focus keeps OR and anesthesia time down and, therefore, significantly reduces cost. There is less attention paid to fine contour refinement and, therefore, patients must accept that there may be contour irregularities that may need further tweaking with contour focused liposuction or surgery in the future.

As with any body contouring surgery, realistic expectations are important. A detailed examination and an in-depth discussion with Dr. David Tauber at DeLuca Plastic Surgery will help delineate the best surgical options.

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

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Do I Really Need A Tummy Tuck? – Post Baby Body Contouring

What Happens to My Belly During Pregnancy?

The pregnant abdomen undergoes many changes as the growing fetus and weight gain associated with pregnancy stretches the abdominal skin and underlying musculature. Delivery of the baby releases this pressure and the skin and muscles are able to start retracting back to their normal size. Often, however, the skin and the muscles often remain stretched – making post-baby physical recovery difficult as new-moms are faced with excess, hanging skin, stretch marks, and a post-baby bulge.

Post Baby Belly Picture

Stretch Marks, Loose, Hanging Skin, and A Post-Baby Bulge After Pregnancy

For these moms, a typical full tummy tuck (full abdominoplasty) is offered to flatten and remove excess skin and stretch marks from both above and below the belly button and tighten the abdominal muscles. The trade off, however, is a scar in the bikini line that extends hip to hip and a scar around the belly button.

Do I really need a full tummy tuck? – Why not just liposuction or the “mini tuck?”

This is the number one question patients ask when they come in looking to get their pre-baby(s) body back. Most often, patients are hoping to only need some liposuction or a mini-tuck to address their concerns.

Liposuction is body-contouring procedure that removes fat from under the skin through small stab incisions using small cannulas. It is used to address trouble spots throughout the body. The overall success of the procedure depends on the skin retracting back after the fat is removed. The ideal candidates are young patients with good quality, elastic skin who are targeting stubborn areas resistant to diet and exercise.

A mini abdominoplasty (or mini-tuck) is a fine-tuning tummy-tuck that removes a small amount of lax skin from below the belly button. It is tailored to a small subset of patients who have no abdominal wall laxity, no excess skin above the belly button, and only a small pouch of excess skin and fat below the belly button.

Mini Tummy Tuck Diagram

Mini Tummy Tuck Surgery

Unfortunately, most women have too much excess skin and laxity in their belly muscles to benefit from liposuction or a mini-tuck alone.

How can I see what surgery may be right for me? – “The Mirror Test.”

An easy way to know if you need a full tummy tuck is to look for the following things while naked and standing in front of the mirror.

  • From the front, do you have stretch marks around your belly button? When you pinch your skin, is it thick and snappy or is it thin and crepey?
  • Front the side do you see skin that hangs, creating an extra fold(s) (perhaps you have to “tuck” this extra skin into your underwear or pants)? When you flex your belly muscles, does your belly still bulge?

If you answer “Yes!” to any of these questions, you will probably need a full tummy tuck.

What is a “FULL” tummy tuck?

The full tummy tuck (full abdominoplasty) operation is performed in an operating room under general anesthesia and begins with elevating a layer of belly skin and fat; separating it from the belly muscles all the way up to the ribs. During this dissection, the belly button is separated from the surround skin and left attached to the belly wall. The skin and fat is pulled down tight and the excess skin and fat is removed. The abdominal muscles are then sutured together to remove the laxity (plication). Finally, the belly button is brought out to the surface through a new hole in the skin (transposition) and the incisions are closed over drains.

Full Tummy Tuck Diagram

Full Tummy Tuck Surgery

How is recovery from a full tummy tuck?

As with any surgery, the pain after a full tummy tuck is usually worse in the 2-3 days immediately after surgery and tends to improve after that. Management of pain is usually through a combination of narcotic and non-narcotic pain medications taken by mouth, oral medications that lessen muscle spasm, and long acting local anesthetics injected during surgery or infused from a small pump. The ability to return to work and everyday activities is variable and depends on many factors including the type of work, the pain tolerance of the patient, and the extent of the procedures. Most patients are ready to return to their lives in 2 weeks.

Pre and Post Mommy Makeover (Tummy Tuck and Breast Lift)

Pre and Post Mommy Makeover (Tummy Tuck and Breast Lift)

What about my breasts?

Deflated, drooping breasts after childbearing and breast-feeding are a common complaint. These patients are offered a combination of a breast lift and / or augmentation with an abdominoplasty – coined a “mommy makeover.” Dr. David Tauber at DeLuca Plastic Surgery tailors all of these operations to each individual patient.

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

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Do I Really Need A Breast Lift? – Breast Surgery After Kids

After having children everyone would like to have their pre-baby breasts back without any scars. The decision to do a breast augmentation by itself versus a breast augmentation with a breast lift, however, is less based on patient preference and more dictated the saginess, the nipple position, and the ratio between the breast volume and the amount of excess skin that is present.

How ptotic are my breasts?

The gold-standard method of assessing the need for a breast lift is the “pencil test.” Standing in front of a mirror, lift the breast and lay a pencil in the fold under the breast and allow the breast to settle over the pencil. Look at the position of the nipple in relation to the pencil.

Pencil Test For Determining Degree of Breast Ptosis

Pencil Test For Breast Ptosis

The lower the nipples and breast are below the pencil and the more excess skin you have, the greater the chance you will need a breast lift and the more of a breast lift you will need. If your nipple and a majority of your breast are at or above the pencil (Normal), you will likely get a great result from a breast augmentation alone. Larger implants can shift this equation slightly for patients that have borderline ptosis (Grade 1).

What is a breast augmentation?

A breast augmentation (insertion of implants) is often performed to replace volume lost from weight loss, breast-feeding, or age or to increase the size of the breast for aesthetic reasons.  It is most appropriate for patients with breasts that don’t sag (normal ptosis).

The implants can be placed over (sub-muscular) or under (sub-glandular) the pectoralis muscle. Advantages to sub-muscular implants include a lower risk of capsular contracture, lower chance of rippling, better coverage in thin women, and perhaps a more natural upper pole contour. Implants placed under the muscle can, however, be influenced by the contraction of the pectoralis muscle – especially in very athletic women.

Implant Position - Above and Below the Muscle

Native Breast, Sub-Glandular Implant, and Sub-Muscular Implant

Implants placed over the muscle, in contrast, are more visible. This results in larger looking augmentation and a sharper transition between the natural breast and the edges of the implant resulting in a more done look. Additionally, in thin women, the folding of the implant in the sub glandular pocket can manifest as rippling of the skin.

There are a variety of implant types, shapes, and styles and the implants are most often inserted through one of two different small incisions. These include 1) an incision around the lower half of the nipple areola (peri-areolar), or 2) an incision in the breast crease between the breast and the chest wall (infra-mammary incision). The choice of incision is based on multiple factors including surgeon preference, patient preference, patient anatomy, and / or type of implant.

Breast Implant Incisions: Periareolar and Inframmammary

Breast Implant Incisions

What is a breast lift?

A breast lift (mastopexy) is powerful procedure that can lift the nipple, remove excess skin, and reshape the breasts to sit higher on the chest in a more youthful position. A breast lift is appropriate for patients with breasts that are adequately sized but saggy (Grade 1 and greater ptosis); but can also be done in combination with an implant to add volume (breast lift – augmentation), to adjust for asymmetry, or to improve unusually shaped breasts (tuberous breasts).

The trade off with a breast lift is a scar on the breast around the nipple with a possible extension down towards the breast crease creating a lollipop or possibly an inverted “T” pattern. The choice of incision is based on multiple factors including patient anatomy, surgeon preference, and patient preference.

Breast Lift Incisions: Peri-Areolar, Lollipop, and Inverted "T"

Breast Lift Incisions: Peri-Areolar, Lollipop, and Inverted “T”

What surgery is right for me?

A detailed examination will help delineate the best surgical treatment. The goal of a breast augmentation or a breast lift is to create an aesthetic breast with the size, shape, and projection that is desired by the patient. The decision the type of surgery and the size, shape, and position of the implants is based on the patient’s anatomy, the type and size of the implant, and patients preferences.

During your consultation, measurements of the breasts are used as a starting point to recommend a surgery and in-office sizing and digital three-dimensional computer simulations are used to help guide your implant choices.

Dr. David Tauber at DeLuca Plastic Surgery tailors the operation to each individual patient.

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

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Hollow Cheeks – Treatment with Implants, Fat Transfer, and Fillers

The aging, hollow face is typified by soft tissue decent and volume loss. These stigmata of growing older are manifest by the development of nasolabial folds, marionette lines, and jowls combined with a sunken mid-face and hollow cheeks.

In recent years, DeLuca Plastic Surgery has looked past skin tightening as the solution for all of these complaints and has recognized the role that volume loss contributes to the appearance of aging, hollow cheeks. This volume loss occurs as the soft tissue (and even bone) of the face resorbs over time as we get older or secondary to weight loss. To combat these changes we utilize a variety of techniques including several types of non-invasive facial fillers, fat transfer, and facial implants.

Projection of the cheeks and mid-face is due to the interaction of the bones of the face and the overlying skin and soft tissue. Facial implants are used to add a more substantial foundation to hollow cheeks by adding projection to the bones of the face in patients that have experienced significant resorption as they age or who have always lacked projection.  Skeletal implants are powerful tools to modify the framework of the face and can produce dramatic results. In our practice, these implants are often combined with soft tissue augmentation, such as fat transfer, to treat hollow cheeks – restoring harmony and symmetry.

Facial Implants Used in Treating The Thinning Face

Types of Facial Implants

Fat transfer is a surgery by which  fat is injected into the face to add volume to hollow cheeks and give the face a lifted, fuller, and more balanced appearance. The procedure takes place in the operating room under general anesthesia or mild sedation and starts with liposuction of the abdomen or thighs to harvest the fat needed for the transfer. This procedure is performed through multiple small “stab” incisions using a fine cannula.

The collected fat is carefully filtered to remove impurities and transferred to syringes. Dr. Tauber then injects the fat into the face using a blunt cannulas into the deep fat compartments of the cheek. Fat grafting is also performed by itself or in combination with a facelift or blepharoplasty.

Stages Of Facial Volume Loss in The Thinning Face

Stages Of Facial Volume Loss

For patients that are looking for non-surgical approaches to fight the volume loss associated with aging, hollow cheeks, recent advances in facial fillers have offered alternatives to the knife.

Fillers are a type of injectable gel used to replace or add volume to the face in an effort to make hollow cheeks look fuller and, thus, younger. Fillers are also used to camouflage wrinkles or depressions. Treatment areas most often include the nasolabial folds (between the nose and the corners of the mouth), the marionette lines (between the mouth and the chin), the cheeks, and the area around the eyes.

Hyaluronic Acid (HA) filler is one type of this gel. The filler adds volume to the face directly and by recruiting water to the tissues. Hyaluronic Acid comes in different formulations.

Thinner formulations such as Belotero are used more superficially (at the surface of the skin) to fill fine lines (such as acne scars and smokers lines around the mouth) and restore volume of tissue with thin skin (such as around the eyes). Moderate thickness fillers such as Juvederm Ultra are used just under the skin to add volume to camouflage larger wrinkles (such as the NLF or marionette lines), plump the lips, and add volume to the lower face. Thicker fillers such as Juvederm Voluma are used to in the deep tissues (often close to the bone) to restore volume to the mid-face and to provide a structural base on which thinner fillers can be layered.

The restoration of volume to aging, hollow cheeks often requires a combination of techniques including facial implants, fat transfer, and fillers. These techniques are often combined with skin removal surgeries such as a facelift or blepharoplasty in a wholistic approach to facial rejuvenation.

Dr. David Tauber and DeLuca Plastic Surgery tailor all of these services to each individual patient.

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

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The Brazilian Butt Lift – Baby Got Back

There has always been a fascination with the posterior of women, however, over the last few years plastics surgeons have seen the demand for the Brazilian Butt Lift to skyrocket. This new found focus has still not eclipsed breast augmentation or liposuction as the procedure of choice, however, the influence of celebrities such as Kim Kardashian and Nicki Manaj have caused demand to surge 58% over the last year.

Brazilian Butt Lift

Dr. David Tauber and DeLuca Plastic Surgery have seen requests for buttock augmentation increase year over year during he same time period. In response to this demand we have recently began offering our patients the world famous Brazilian Butt Lift.

The Brazilian Butt Lift involves fat transfer, or fat grafting, to the buttock from the belly, back, thighs, and other donation sites to improve the size and shape of the buttock.

The operation takes place in the operating room under general anesthesia and starts with liposuction of the abdomen, back, thighs, and other donation sites to harvest the fat needed for the transfer. This procedure is performed through multiple small “stab” incisions using a small cannula. Once the fat is harvested, a second round of liposuction is then performed to harvest fat from the lower back above the buttock, and the outer and the posterior thighs. This improves the lower back contour, improves the shape of the buttock in relationship to the surrounding tissue, and increases the step-off from the back to the buttock – accentuating the buttock.

The collected fat is specially washed and transferred to syringes. Dr. Tauber then injects the fat into the buttock through the same small “stab” incisions hidden in the buttock creases. The injection of fat increases the size of the buttock and is distributed as to give the buttock a lifted, fuller, and more balanced appearance.

After a Brazilian Butt Lift, patients should expect bruising and swelling in the treated areas. This swelling usually worsens at first and then begins to settle out at about a week. The patients wear a compressive garment for 4-6weeks that helps smooth the counter of the treated areas. In addition, the patient should refrain from sitting on the grafted areas to help encourage graft take. Patients are usually able to go back to work within a week from surgery.

The final result of a Brazilian Butt lift is influenced by what shape the patient has to start with, the retraction of the skin after liposuction, the amount of fat grafted, and how much fat survives (50%-70%). Patients may require more than one round of grafting depending on their desired results.

The Brazilian Butt Lift is a powerful procedure for contouring the buttock and it can be done alone or in concert with a breast augmentation or abdominoplasty (tummy tuck) for total body rejuvenation. Dr. David Tauber at DeLuca Plastic Surgery tailors all of these services to each individual patient.

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

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Current Trends in Labiaplasty – The Edge vs. The Wedge

Women seek labiaplasty for many reasons ranging from discomfort with intercourse and pinching in tight clothing to purely cosmetic reasons. According to the American Society for Aesthetic Plastic Surgery there has been a significant increase in the number of these tissue removal and restructuring procedures — an astonishing 48 percent rise in 2014 from 2013. Workout gear is becoming tighter and women are becoming more self conscious about how they look in lycra enhanced tight clothing.

Although there are variations in technique and equipment used, labiaplasty most often involves reducing the size of one or both of the labia minora through one of two basic techniques. Both techniques attempt to preserve the nerves to the skin within the mucosa instead of simply removing it. In addition,  both techniques can be extended to remove some of the excess clitoral hood.

The first technique is a straight-line (trim) excision. It removes the excess tissue in straight line front to back. This technique is more straightforward and has the added benefit of removing the unsightly thickened free border of the labia. There are variations on trim that include the Lazy-S Labiaplasty and the Extended Excision Labiaplasty.

Labiaplasty Incisions

Labiaplasty Incisions

The second most common technique is the wedge excision. It removes a pie-shaped wedge of tissue from the central portion of the labia. The remaining tissue at the front and back is then brought together and closed. This technique preserves the free border, however, it is more complex and requires additional incisions to remove the dog-ear that forms. There are variations to the original wedge resection including the the Z-Plasty Wedge Labiaplasty, the Hockey Stick Wedge Labiaplasty, and the DOVE (Double Opposing V-Plasty with Extended Deepithelizing) Wedge Labiaplasty.

The choice of technique is based on patient preference and is tailored by Dr. David Tauber to each patients needs. A detailed examination will help delineate the best surgical treatment.

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

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Clinical Diagnosis in Plastic Surgery by Dr. David Tauber

DeLuca Plastic Surgery would like to congratulate Dr. David Tauber on the publishing of the book, Clinical Diagnosis in Plastic Surgery.

Clinical Diagnosis in Plastic Surgery by David Tauber, MD

Clinical Diagnosis in Plastic Surgery systematically presents a collection of entities, syndromes, and diseases that are diagnosed and treated by plastic surgeons, hand surgeons, otolaryngologists, oral surgeons, and dermatologists.

The goal is to document an extensive array of signs and visual clues that are critical to the diagnostic process, thereby enhancing the clinician’s ability to identify relevant diagnostic features and make correct diagnoses. Skill in recognizing deformities and disease processes by observation is of vital importance in plastic surgery, which is very much a visual surgical specialty. In drawing together key diagnostic signs, this book will spare readers the onerous task of searching through endless resources, books, and websites.

A helpful appendix details the various classification systems used in the book with the aid of appropriate diagrams. Clinical Diagnosis in Plastic Surgery is intended for students, residents, practicing physicians, and surgeons in all of the affiliated fields of plastic surgery.

See Clinical Diagnosis in Plastic Surgery on Amazon.

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Botox and Facial Fillers – The Fountain of Youth (Without The Knife)

Botox is an injectable used to lessen the movement of specific muscle of the face in an effort to target wrinkles created by the contraction of facial muscle groups. The areas that are treated most often include the forehead, the area between the eyebrows, and the crows feet (on the side of the eyes). The goal is to soften these tell-tale stigmata of aging without leaving the face looking flat and emotionless. This can be a difficult needle to thread. If done correctly, however, Botox can make the face look younger, raise the eyebrows, and make the eyes look more open.

Botox Before and After

Botox Before and After – 7 Days (courtesy Allergan)

Botox is injected using a very fine needle into the affected areas. Most patients experience little discomfort and by the time they return home or to the office any redness or swelling has disappeared. The affect begins to be noticed over the next week and lasts for about 3-6 months until the effect, again, slowly fades out.

In contrast, fillers are another type of injectable used to replace or add volume to the face in an effort to make the face look fuller and, thus, younger. It is also used to camouflage wrinkles or depressions.

The most often treated areas are the nasolabial folds (between the nose and the corners of the mouth), the marionette lines (between the corner of the mouth and the chin), the cheeks, and the area around the eyes.

Hyaluronic Acid (HA) filler is a gel that is injected under the skin. The filler adds volume to the face directly and by recruiting water to the tissues.

Hyalaronic Acid comes in different formulations. Thinner fillers are used more superficially (closer to the surface of the skin) to fill fine lines and restore volume of tissue with thin skin. Thicker fillers are used to in the deep tissues (often close to the bone) to restore volume to the face and to provide a structural base on which thinner fillers can be layered. Depending on the formulation and location of treatment HA may last 6 months to 2 years.

Injectables - Juvederm Before and After

Juvederm Before and After (courtesy Allergan)

There is some discomfort from the injection that is lessened with topical pain relievers, numbing injections, or by mixing the filler with a numbing medication. Swelling and bruising are common, however, Dr. Tauber lessens the occurrence of bruising with the use of his blunt cannula technique.

Both Botox and fillers such as Juvederm are low risk, high impact products that allow for non-surgical rejuvenation of the face. These products can be used alone or concert with more invasive surgical facial rejuvenation such as a facelift or blepharoplasty. Dr. David Tauber and DeLuca Plastic Surgery tailor all of these services to each individual patient.

DeLucaPlastic Surgery Botox new patient price is $10 per-unit (1st session).

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

#plasticsurgery #botox #injectables #juvederm #social

Blepharoplasty with Fat Redraping – Solutions For Aging Eyes

The aging eyes are characterized by the development of wrinkles, fine lines, drooping skin, midface hollowing, and eyelid bags. These changes make patients look tired and angry. The bulging of the lower eyelids occurs as the tissue wall (orbital septum) that holds the fat in the orbit begins to weaken and stretch.Traditional blepharoplasty attempts to address this bulge by removing the fat.

This approach to treating the aging eyes removes the bulge, however, it can produce two unwanted effects. The first is an unmasking of midface hollowing that was masked by the fullness of the bulging lower eyelids. The second occurs as the face continues to age. Over time, the orbital fat begins to loose volume. This produces hollowing around the eyes. If the fat is removed during a blepharoplasty, this hollowing is accelerated. This leaves the patient with a skeletal look that is difficult to correct.

An alternative, novel blepharoplasty procedure replaces fat removal with fat repositioning or fat redraping. During this procedure, the fat that is normally cut out is left intact. The septum is cut and the orbital fat is gently unfurled over the orbital rim and into the tear trough. Redraping the fat in this fashion decreases the risk of hollowing of the orbit and augments the soft tissue of the tear trough – lessening this deformity.

upper+and+lower+eyelid+surgery+with+fat+re-draping+and+facial+implants+for+mid-face+hollowing_4

The procedure is carried out though an incision hidden on the inside of the eyelid requiring no sutures. The surgery can be combined with a skin excision in those patients that require it. Recovery is similar to a traditional blepharoplasty – 1-2 weeks of swelling and bruising.

Blepharoplasty is a powerful procedure for rejuvenation of the eyes. It can be done alone or in concert with a face lift to achieve comprehensive facial rejuvenation. Dr. David Tauber at DeLuca Plastic Surgery tailors all of these services to each individual patient.

More blog posts from Dr. Tauber.

Make an appointment for a free consultation today.

#plasticsurgery #blepharoplasty #social

Deciding On Your Best Option: Mid vs. Mini Facelifts

Facelift before and after photo- Deluca Plastic SurgeryThere are multiple types of facelifts; determining which procedure is right for you can be difficult. We want to help our patients make the right choices concerning their personal appearance, so we’re going to help you select a procedure that will benefit you the most. Specifically, let’s examine the differences between a Mid Facelift and a Mini Lift. These two techniques are somewhat similar, so distinguishing which one is for you will be dependent on factors unique to each individual.

Mid Facelift

Mid facelifts are focused on raising the soft tissues of the cheekbone area. The ideal patient for this technique is usually in their 40s and experiencing the early signs of aging. This middle area of the face flattens, becoming less full and “puffy.” The cheeks sag downwards, creating a hollow appearance underneath the eyelids. The nasolabial folds, commonly called “smile lines,” begin to fold over and droop. For patients without significant sagging of the jowls and neck skin, this procedure is used as an alternative to the traditional full facelift. Incisions are made along the hairline and inside the mouth, allowing us to vertically re-position the fatty cheek tissue. This restores the cheeks to a more risen and youthful look, significantly improving their roundness and appearance. Recovery is also relatively faster than a full procedure.

Mini Lift

Mini facelifts, like the mid lift, focus on the cheekbone area, and are viable alternatives to the traditional full facelift for individuals experiencing symptoms of early aging. Just like its name implies, it can be considered a temporary version of a traditional full lift procedure. The Mini Lift is primarily a much less invasive technique that avoids heavy dissection; incisions are made near the hairline around or behind the ear, where scars will be hidden in the natural folds of the skin. From there, an endoscope and sutures can be used to re-adjust the soft tissues underneath the skin. This procedure would be ideal for younger individuals looking for a way to offset the effects of early aging as they begin to take root.

Deciding For Yourself

Understanding the types of facelifts available will assist you tremendously in making your decision. Be sure to take these details into consideration first: the elasticity of your skin in the neck and jowls, the bagginess of the cheeks or skin under the eyes and the intended length of results you hope to achieve. If these symptoms aren’t severe and you’re still relatively young, a Mini lift might be right for you. Otherwise, a standard lift or mid lift may be appropriate. It’s important for your health and your appearance to understand the options available and which one suits you best.