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




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.

There is No “Right” or “Best” Age for a Facelift

Nice Face The facelift is experiencing a bit of a renaissance it would seem. I have patients of all ages ask about the surgery and whether or not they would be a “good” candidate for the procedure. It’s a good question.

Fifteen years ago, the average age of a patient was about 60 to 65 – today it’s closer to 45 to 50.

Why? Previously, patients were waiting until signs of aging had become extremely visible before opting to ‘turn back the clock’ 10 to 15 years (which is what a well done facelift can do). These days, patients are taking a more proactive approach in reducing the appearance of aging skin – and so are opting for less extensive lifts in their 40s and early 50s. That said, there’s absolutely no “right” or “best” time to undergo a facelift and if anything, having the procedure a little later on makes for an even more dramatic* result (because the face ages at a faster rate the older we get, so the difference between 30 years old and 40 is less than 40 and 50).

Medically known as a rhytidectomy, the procedure addresses the impact that aging, gravity, stress and sun exposure have on human skin. Of course, each of these factors affects different individuals in distinct ways. One only needs to sit among a group of friends to see that no two women (or men) of the same age look alike. This is due to genetics and personal care regimens.

There are a variety of types of facelifts procedures including: full, mini and refresh facelifts. A qualified plastic surgeon will tailor a procedure to the needs of their patient. Facelifts are often combined with other facial surgeries and treatments, like eyelid surgery and Botox, for optimal results.

It is important to keep in mind that the facelift is a surgical procedure. Thus, when it comes to age, the limiting factor may be medical and not aesthetic. Before undergoing a facelift, patients should receive medical clearance from their family physician or cardiologist to ensure you are healthy enough to undergo surgery. Ultimately, the big “if” factor is anesthesia and not the surgery itself. Thus, it is important to select a plastic surgeon that works with an experienced, board certified anesthesiologist and with whom you are comfortable.

As with any form of surgery, be sure to research your plastic surgeon or potential plastic surgeons ahead of time. Not only should you look for their qualifications and board certifications, but also check out the before and after photos on their website to preview their work. By looking at the quality of their work and the type of results that are able to provide, you should be able to get sense of which plastic surgeon is best for you and your end goals.

Ultimately, there is no best age for a facelift patient. Whether you’re 40 or 75, if you’re in good health but looking to improve your appearance, you may be a good candidate for a facelift. Whatever your age, the procedure can help you look better and feel more confident.

 

Traditional Versus Smart Liposuction: Get the Facts

Patients who are looking for body contouring options may have heard of a new option that has appeared in the U.S. over the last several years. SmartLipo is a procedure that has gained a lot of buzz, causing patients to ask if this is a viable, and even better, option for them than liposuction. Many plastic surgeons haven’t been as impressed by this new technology for a number of reasons. If you’re considering a body contouring procedure, learn some of the basic facts about both approaches here. And remember, nothing can replace a one-on-one consultation with an experienced plastic surgeon. When it comes to liposuction, Albany residents deserve to be well informed about long-standing fat removal procedures along with the newest products and services available to them.

liposuction-stomach-abdomen-example-photo-albany-491x327

First, let me tell you more about my stance on fat removal procedures and what improvements this procedure has seen since 1982, when it was first introduced to the public in the United States. The first major improvement to the process was the addition of a specially designed blend of lidocaine and adrenaline. This liquid acts as an expander in the targeted area, which results in less bleeding and practically eliminates the need for patients to donate blood prior to the procedure.

The second significant improvement to the process was adding more power. This simplified the work of the surgeon, making it easier for him or her to get precise results, and improved the experience for patients as well. Because smaller cannulas can now be used, the procedure is much more precise than in its original days.

As far as laser liposuction, much of the plastic surgery community feels it is well-marketed but a minor change. No significant research has been done to demonstrate that the results are better than the heavily tested and proven tumescent method. To the contrary, there are some potential side effects that anyone considering the procedure should know about, specifically the risk for thermal burns. Furthermore, I am hesitant to adopt a technology that not only lacks solid proof of its performance and results, but also could lead to significantly higher costs for my patients.

At the end of the day, my team and I are proud of the work we do using the tumescent method in our office in Albany. Liposuction is a delicate procedure that depends mostly on the expertise of your plastic surgeon, not on his or her use of the trendiest products or approaches. Let me take this opportunity to invite anyone considering liposuction to come visit us for a free cosmetic consultation. We invite you to look at the results of some of our more than 1,000 satisfied clients who have gotten the contours they desired through liposuction with Deluca Plastic Surgery.

Correcting Tuberous Breasts with Surgery

Tubular Breast
Many women tend to be self-conscious about having tuberous breasts; however, an experienced surgeon can perform a dual plane breast augmentation with a periareolar lift to correct this condition.

Tuberous breasts is a condition where the breasts form into a tube-like shape because of constriction at the base of the breasts during development. The breasts also tend to develop farther apart and unevenly than a normal chest. The breasts are often characterized by enlarged areolas and sagging. Although this condition may prevent a woman from breast-feeding, it doesn’t lead to any other pregnancy or fertility related issues.

Women with tuberous breasts may range from type one, which is the mildest to type five, which is the most severe. With type one, only the lower inside of the breast is constricted. In the most severe cases, the entire breast is constricted and can be physically deforming.

While having this condition isn’t necessarily a physical concern for health related reasons, it can be psychologically troubling to women who suffer from this condition. Many women tend to be self-conscious about their breasts, and shy away from intimacy, or are embarrassed to get undressed in front of their partner.

There are also other issues to consider for someone with tuberous & tubular breasts. Many women tend to have trouble finding bras or other undergarments that fit properly. Some women have to specially order their bras in order to support their breasts correctly.

One option for women with this condition is breast augmentation with a lift surgery. For women who are self-conscious or frustrated about the shape of their breasts, a surgeon can correct the size and fill out the shape. The doctor can also debulk the area around the nipple in cases where the areola is large or puffy.

The surgery is particularly challenging; however, a good surgeon with plenty of experience can correct this condition with a dual plane breast augmentation with a lift. It’s important to discuss the surgery and your expectations with your doctor before heading into the operating room, if you are considering this type of surgery. In many cases, surgery can correct this condition restoring the breasts completely.

Rhinoplasty Recovery: What You See Right After Surgery is What You Get

Photo Of Doctor And Patient Discussing Plastic Surgery RecoveryI recently read a blog post by a plastic surgeon in Manhattan who specializes in rhinoplasty. The surgeon made a point that I have seen echoed by quite a few other plastic surgeons on RealSelf.com when answering questions from patients going through rhinoplasty recovery.

The question being posted across multiple online forums is: How different will the nose look 1 year after surgery as compared to 3 months, or 6 months? In other words, “If my nose looks great at 3 months, will it still look good a year from now? Or will it look overly defined and tight as more time passes?”

My opinion is this – there is no definitive answer. Each nose is different and no one can predict how your nose will change over time. However, one thing is glaringly clear to me about rhinoplasty recovery: If the nose doesn’t look good at 3 months, it isn’t going to look good in a year.
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Skin Tightening Q&A: Do “Non-Surgical” Lasers and Ultrasound Work?

Question - Can you offer some insight into all the non-surgical procedures that are inundating the market for skin tightening, for instance, lasers and soundwave technologies? Many are saying they were featured on shows like Dr. Oz to lend credibility to their claims…. I suspect it is just another “too good to be true” story, but your thoughts on the subject would be most welcome. – Debra


Answer - Excellent questions, Debra. Regarding the latest generation of “non-ablative” lasers for skin tightening and sound-wave technologies, the short answer is that, as with most things in life, “there are no shortcuts” and “if it’s too good to be true, it usually is” (for more on the high cost of smartly marketed, less invasive and/or expensive treatments and technologies, please see slides 14-17 from my ‘What to Look For in a Plastic Surgeon‘ presentation.

That said, if a new product, technique or technology is shown to be both safe and superior to the current treatment standard (through peer-reviewed, double blind studies by other plastic surgeons), my approach has always been to assimilate/incorporate it into my practice. Even then, however, I try to never be among the first wave of users. This helps ensure not only the safety of my patients, but also their satisfaction with the results as well.

Case in point, for years, laser liposuction companies and MDs claimed that the machines not only suctioned fat, but were also a method of non-surgical skin tightening. The technology was promoted featured on promoted featured on Oprah, GMA, The Today Show, People Magazine (‘The New Lipo: Has Fat Met Its Match?) and hundreds of other publications. But since its introduction, no studies have confirmed its superiority to traditional tumescent liposuction methods. What has been confirmed, though, is laser liposuction’s potential to burn skin. More on that here.

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Breast Q&A: To Breast Lift or Not to Breast Lift, With or Without Implants?

Perhaps the two most frequently asked questions I receive from women interested in breast enhancement surgery are:

  1. “Do I need a breast lift with or without implants?”
  2. “Can I get an ideal result with just breast implants?”

As with most operations, it’s always best to get things right the first time around. And when it comes to breasts, getting it right doesn’t typically mean looking great for only a few short years before the effects of gravity and time undue all the good work that was done.

So when I advise my mastopexy (breast lift) patients on what their options are for achieving the best and most youthful looking breast possible, I always make sure that they have a crystal clear understanding of what their surgery options are and how each option will look and feel over time (re: 1 year, 5 years, 10 years etc.) rather than just what they can expect to look like during the immediate post-operative period.

9 times out of 10, the best path forward is clear and the patient is in full agreement that the procedure’s pros outweigh any cons that may inherently be involved (e.g. a slightly longer incision in return for a stronger, more longer lasting lift).

Of course, not every breast fits perfectly into one of the the breast types described below, but most do, so hopefully readers will find the following example photos and procedure recommendations helpful and/or informative , especially if they are considering their options for a breast lift with or without implants/augmentation.
 

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Face Q&A: For Sunken Hollow Cheeks, Fillers, Fat Injections or Facelift?

Question – Below my cheekbone a hollow channel is inching towards the center of my face. I had a facelift two years ago and cannot figure out what is causing this. What can be done to correct this?

The facelift was two years ago. On one cheek, just below my cheekbone and along the path of the lift, a hollow channel has been inching toward the center of my face. The doctor has assured me that this was not a thread lift. The hollow is about 1.25″ in width. The skin above it is taut and looks lifeless. The hollow keeps lengthening and it looks awful. What could be happening? And can anything be done to stop it and/or correct it? – via RealSelf


Answer – Given that your facelift was two years ago, there are a couple possible reasons for why your cheeks now appear hollow/sunken based on the details you provided in your question: One possibility is that your surgeon did more ‘pulling’ & ‘tightening’ of your skin and not enough/any fat or tissue reposition. Another possibility is that you’ve experienced some fat re-absorption within the cheek area in the 2 years since your facelift as a result of weight loss, changes in diet, and/or BMI. The good new is that there are a few ways to replace the volume you’ve lost, which I’ll detail below.

 
How an overly tight facelift can cause hollow cheeks

Without before and after photos, it’s difficult/impossible for me to diagnosis what’s causing your cheeks to appear hollow after facelift surgery. That said, hollowing of the cheeks is most likely a result of how the skin was repositioned/draped during your previous facelift surgery. Not only does overly tightened/pulled skin create the ‘joker’ look so many over-done facelift patients have, but also, excessive hollowness in the mid-face region just below the cheek bone.

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Mommy Makeover Q&A: What Will My Mommy Makeover Recovery Time Be?

Question – How long is the down time during a mommy makeover recovery? How much pain will I be in after surgery?

What is recovery like with a mommy makeover? I have scheduled both a breast augmentation with lift and a tummy tuck and am pretty scared. I am worried that the pain will be unbearable.

I know medication will be provided but I do not want to be comatose. I have 2 small children and a wonderful husband that will be taking 100% care of all 3 of us but I also want to be coherent. Will I be alert and will I be in so much pain as to scare my children? I have had 2 c sections and the pain was completely bearable.


Answer – Both procedures, breast augmentation and tummy tuck, come with a certain degree of pain and discomfort; that said, every patient’s pain tolerance is different. Most patients feel “uncomfortable” for the first few days, but after about a week, begin to feel reasonably well. By the 2nd or 3rd week, you should be back to performing most of your normal, day-to-day activities.

Pain level and recovery time are two of the most commonly asked questions of my mommy makeover patients – it’s very important that you make the most of your early-recovery. Ample rest and low-to-no stress is key. Pain during recovery can also be a big part of that trepidation. The best place to start answering this question is to consider the surgical plans behind your personal transformation.

It’s important to know the details of each procedure in order to make the best decisions regarding your own mommy makeover. While each makeover is tailored to the individuals needs and goals of each and every patient, the surgery usually includes a breast enhancement and some body contouring procedures.

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Breast Q&A: What’s the Best Way to Correct Grade 1 Breast Ptosis (Sagging)? Implant, Lift or Both?

Question – What is the best way to correct breast ptosis, high or moderate profile implants, a breast lift or both?

Stage I Breast Ptosis

Breast sagging after pregnancy

I am 36 years old, breastfed 2 kids, and have lost volume in my breasts. I have some sagging but my nipple is still over the fold. I weigh 130 pounds and am very fit and toned.

I am 5″4″ and my breast size is a 34B. Before my kids I was a 34C cup. When I was breastfeeding I was a 34D cup. I would like to be a D cup and wonder what type of procedure would be best to correct my ptosis?


Answer – Since you have a small amount of glandular ptosis (pseudoptosis), you not only want to fill-OUT, but lift-UP a little as well. Therefore, my approach would be a dual plane breast augmentation, which would fill out the inferior/lower pole nicely, give you muscle coverage across the upper two thirds of the breast and a nice, slightly lifted appearance.

More specifically, given your body measurements and photo (which shows pseudoptosis with mild Grade 1 ptosis), I suspect that 450cc moderate plus profile implants are needed to give you both the breast size (D cup) and breast lift you desire.
 

How To Classify/Grade Breast Ptosis

Simply put, grade 1, 2 or 3 glandular ptosis, which refers to how far the areola is sagging below the inframammary fold beneath the breast, the lower attachment point of the breast to the chest wall.

  • Grade 1: Mild Ptosis – The nipple is at the level of the inframammary fold, but most of the breast tissue is below the nipple.
  • Grade 2: Moderate Ptosis – The nipple is located below the inframammary fold and below the majority of the bottom breast tissue.
  • Grade 3: Advanced Ptosis – The nipple is far below the inframammary fold and points towards the floor.
  • Pseudoptosis – The nipple lies above or at the level of the inframammary fold while the majority of the breast has descended below the level of the fold. This is not true ptosis, or sagging.

Diagram of breast ptosis (drooping/sagging) degrees/stages

The degrees/stages of breast ptosis (drooping/sagging)


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