Posts Tagged "Botox"

Brow lift for uneven brow. Is it a good option?

First and foremost, brow lift surgery is primarily designed to rejuvenate the upper third of the face by smoothing out the horizontal creases across the forehead, and the vertical lines between the brows. If needed, it can also reposition the sagging eyebrow or even “reshape” them.

Almost all people have some brow asymmetry, although it is often in mild form. But in extreme cases of lopsidedness, they may seek treatments to achieve a more balanced appearance.

brow lift for uneven brow

Before and after photos of a patient who had brow lift surgery.

Significant or obvious brow asymmetry is caused by several factors such as bone irregularity, facial muscles acting or moving differently, unilateral eyelid ptosis or droop, and nerve damage due to trauma, Bell’s palsy, or other similar conditions.

If the underlying problem is caused by facial muscles [of expressions], Botox injection might be a better option than brow lift. While it is an inexpensive non-surgical alternative, its effects can only last 4-6 months, so it requires regular touch-ups to maintain its results.

With Botox injection as a non-surgical brow lift for uneven brow, the goal is to paralyze the offending muscle that is pulling down the lower brow. This is achieved by injecting this drug into the lateral crow’s feet region and the area near the inner brow, while leaving the other brow untouched.

The idea is to release the lower brow and let it somewhat “float” that it appears close to symmetry with the other one.

However, some patients are more suitable for a unilateral brow lift (with or without Botox injection), which provides longer lasting results than Botox.

Brow lift typically uses a few small incisions behind the hairline to allow the surgeon to adjust and correct the offending muscles and tissue responsible for the sagging appearance of the brows and/or forehead wrinkles, according to Upland Plastic Surgery Institute.

Despite best efforts, there will always be some level of asymmetry after surgery or Botox, although it is generally mild. The reason is that almost all people have asymmetrical facial bone structure (right vs. left) to begin with.

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Nowadays, there are different neck lift options that range from surgical techniques to minimally invasive methods. To achieve natural and longer lasting results, some patients may need a customized “combinations” approach.

A “real” neck lift surgery uses incisions behind the ear, specifically the junction where it meets the head so the scars lie within the natural fold of skin and are virtually undetectable. Occasionally, a third small cut is placed beneath the chin that allows the surgeons to tighten the loose neck muscles.

neck lift options

before-and-after photos of neck lift patient

Many surgeons agree that the results of neck lift last an average of 5-7 years (before a revision or touch-up is warranted), although in reality it varies considerably due to factors such as the skin quality, lifestyle (skincare regimen and use of sunscreen), diet, and weight.

The incision under the chin will also allow the surgeons to remove any excess fat, a procedure more accurately referred to as facial liposuction. As a stand-alone procedure, it could provide good results as long as the patients have a relatively youthful elastic skin that can shrink around the new contour.

However, patients with redundant skin and significant neck laxity are poor candidates for a liposuction-alone procedure.

Aside from proper patient selection, liposuction also entails judicious fat removal. The general rule of thumb, according to renowned Beverly Hills plastic surgeon Dr. Tarick Smaili, is to leave some fatty tissue behind that will prevent the muscle bands from becoming visible beneath the skin.

Simply put, liposuction of the neck is not about removing the optimal amount of fat, but preserving some fat layer in skin to achieve a smooth, youthful appearance.

Instead of surgery, some patients are more suitable for non-invasive procedures such as Botox in which an injectable drug is used to temporarily paralyze muscles that are responsible for the wrinkles and deep facial creases.

However, Botox is only suitable for patients with isolated neckbands who have a relatively good skin tone. Another caveat is that most patients require 3-4 touch-ups every year if they want to keep its rejuvenating effects.

In its own right, Botox can provide impressive results. However, patients with excess fat, redundant skin, and/or markedly thick platysmal bands (they are responsible for the V-shaped tracks that start from the top portion of the neck to its base) will have no or very limited improvement.

The aforementioned neck lift options are typically combined to achieve a more rejuvenated appearance. A highly customized facelift can also deliver a more balanced result to “older” patients who need a more extensive amount of work.

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Blepharoplasty cost varies considerably across geographical location, although most Beverly Hills plastic surgeons charge $2,000-$3,000 in “isolated” upper eyelid surgery under local anesthesia. But if the lower eyelid or under eye-bags is addressed at the same time, most patients can expect to pay twice the amount.

Clinics in posh districts and surgeons who specifically cater to high-profile individuals also charge higher than the average. While a premium price does not always equate to good value, it generally provides high value on privacy—i.e., private first floor entrance and exit.

blepharoplasty cost

Aside from “exclusivity,” patients who need a more extensive amount of work will also have to pay more because they will require general anesthesia.

To achieve maximum longevity and/or a more rejuvenated appearance, some patients will also need their upper blepharoplasty to be performed in conjunction with a brow lift. As of this writing this “combo” procedure, which is almost always performed under general anesthesia, costs around $5,000-$6,000.

Another common adjunct procedure of blepharoplasty is dermal filler injection, which is often used to correct the deep tear trough and “skeletonized” eye socket. It costs around $600-$700 and is typically repeated annually to maintain the “plump up” look of the skin.

Most US doctors who treat the areas around the eyes with fillers often choose Juvederm and Restylane, two brands that consist of hyaluronic acid gel that is naturally found in the skin, so the risk of allergic reaction is very unlikely.

Aside from its compatibility with the human body, hyaluronic acid can be easily dissolved or reversed by an injectable enzyme if the patient is not happy with the results.

Botox injection is also a common complementary procedure of blepharoplasty. When used to treat the appearance of crow’s feet, it costs around $250-$400.

Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, warns that prudent patients should not only focus on the price, nor skimp on their surgery, but rather choose doctors with great qualifications, resulting in more natural results and lower risk of complications.

Dr. Dhir says that board certifications and plastic surgery affiliations must be factored in when looking for a reputable blepharoplasty doctor. A good rule of thumb, he further explains, is to choose a board-certified facial plastic surgeon (ENT), board-certified plastic surgeon (member of the American Board of Plastic Surgery), and/or board-certified ophthalmologist.

Aside from “proper” board certifications, Dr. Dhir highlights the importance of choosing a surgeon who performs blepharoplasty and its adjunct procedures on a regular basis, and has impressive before-and-after photos of his actual patients.

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Plastic surgery alternatives offer some benefits such as no or minimal downtime, lower cost, and fewer side effects, as opposed to “nip and tuck” procedures that require more commitment and longer recovery.

The list below explains some of the possible plastic surgery alternatives; however, most of them cannot replicate the exact effects achieved by the “real thing.”

plastic surgery alternatives

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* Facelift alternatives. Perhaps Botox is one of the most commonly used non-surgical facial rejuvenation procedures. This injectable drug paralyzes the muscles responsible for the sagging appearance or dynamic wrinkles caused by repetitive facial expression.

Dermal filler injection is another good alternative. It works by plumping up the hollowed skin caused by loss of facial fat or soft tissue atrophy or shrinkage.

Other possible facelift alternatives include medical-grade chemical peels, Thermage, and laser skin resurfacing.

However, these aforementioned treatments provide little to no improvement if there is significant tissue laxity or redundant skin, problems that only a “real” facelift can address, as suggested by Los Angeles plastic surgery experts.

Facelift surgery uses incisions within the ear’s contour and/or behind the hairline (so the scars remain hidden), allowing the surgeons to trim any excess skin and tighten the underlying facial muscles. As a result, its effects can last up to 10 years, as opposed to several months in injectable treatments.

* Liposuction alternatives. Non-surgical alternatives often use laser or ultrasonic waves to penetrate the skin and “liquefy” the fats, which the body will gradually flush out, a process that could take several weeks to months.

Meanwhile, liposuction surgery uses a few incisions measuring 1/4 to 1/8 of an inch, which further contract as they heal that after about a year they are difficult, if not impossible, to detect.

Liposuction is ideal for treating a large surface area, while its non-surgical alternatives are only suitable for limited contouring. Simply put, having surgery is the only way to achieve dramatic improvements.

* Tummy tuck alternatives. A combo procedure that involves non surgical laser liposuction and Thermage—which uses radiofrequency that is known to promote new collagen growth, thus leading to a tighter, smoother skin—might provide good results to patients who require minimal correction.

But as with any non-surgical alternative, the combo procedure is only suitable for patients with very little loose skin. Anyone with a redundant skin can only benefit from tummy tuck, which typically uses a hip-to-hip incision within the lower abdomen and just above the pubic area to hide the scar.

Because tummy tuck involves a large flap of skin, it is only reserved for healthy individuals with no healing problems.

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The open brow lift surgery is reserved for patients with a significant amount of sagging skin in their forehead area, thus some plastic surgeons refer to it as the “gold standard.” Nevertheless, some people balk at the length of scar, which usually runs at the center of the scalp or within the hairline from ear to ear.

While open brow lift is known to provide the most dramatic improvement, it is a bad option for men with hair loss problem due the resulting visible scars. Patients with high forehead might also be poor candidate, particularly if the incision is placed at the middle of the scalp because the technique can pull their hair back, resulting in a longer forehead.

Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons specializing in facial rejuvenation procedures, explains some of the minimally invasive alternatives to open brow lift surgery.

  • Botox injection

Botox works by paralyzing temporarily the facial muscles, thus removing or softening the appearance of facial wrinkles, and correcting some of the saggy forehead skin. While the treatment has no or very short downtime, it must be repeated every four to six months to preserve its rejuvenating effects.

  • Volumizers

Sometimes, the aged appearance in the forehead is primarily caused by loss of fat, making volumizers like fat graft and traditional dermal fillers such as Radiesse, Sculptra, and Restylane as good, if not better, alternatives to brow lift surgery.

These injectables are particularly ideal for correcting the gaunt forehead and horizontal creases caused by loss of facial fat.

  • Skin treatments

Chemical-grade peels, Theramage, and laser treatments could address fine lines, dry and leathery skin, pigment problems, and other effects of sun damage. While they can deliver a good amount of improvement for the right candidates, they are often combined with other procedures for a more rejuvenating effect.

  • Endoscopic brow lift

Basically, this is a surgical procedure that involves risks found in any other surgery—e.g., bleeding, swelling, infection, downtime, etc. But unlike the open technique in which one continuous incision is used, the endoscopic approach uses a few tiny skin openings behind the hairline to tighten the deeper facial structure and skin.

With this less invasive brow lift technique, doctors use an articulating fiber-optic camera attached to a monitor, allowing them to see the underlying anatomy of the forehead without resorting to “open” incision techniques.

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