Expert Doctor

Facial Rejuvenation

Sam Lam, MD

Plano, TX

Facial rejuvenation is any surgical or non-surgical cosmetic procedure used to restore a youthful appearance to the face and neck. The depth of the treatment, invasiveness, risks and downtime depends on whether the treatment method is surgical or non-surgical. A better understanding of the aging components of a person, as well as technological advancements, allow doctors to treat facial issues with minimal trauma by using smaller instruments for increased accuracy, minimal discomfort, less bruising and bleeding. Some of the most popular facial rejuvenation techniques include Botox, dermal fillers and fat grafting for volume loss, laser treatments, brow lift, eyelid surgery and a facelift.

Am I a Good Candidate for Facial Rejuvenation?

GOOD CANDIDATES for facial rejuvenation include:

Any patient who is unhappy with fine lines, wrinkles or creases on the face and neck
Patients with sunken regions or hollowed contours such as the cheeks, temples or below the eyes
Any patient with dark spots or pigmentation issues
Patients who are not quite ready for a surgical procedure or those who are not able to have surgery due to other health risks
A patient with loose or sagging skin
A patient who has already had a facial surgery and wants a non-invasive touch-up treatment to maintain the results

The following patients are NOT GOOD CANDIDATES for facial rejuvenation:

Patients with active herpes or open lesions on the face
Patients who smoke since smoking hinders healing
Patients with unrealistic expectations or goals

How is Facial Rejuvenation Performed?

The manner in which facial rejuvenation is performed depends on the type of procedure and the technique used.

Non-Surgical Cosmetic Facial Rejuvenation

Non-invasive and minimally invasive procedures may be performed without anesthesia or with local anesthesia. Some treatments offer local anesthesia with sedation. In general, the surgeon will cleanse and mark the area to be treated before performing the procedure.

Botox and dermal fillers do not require incisions and will be administered by injection only. The doctor injects the Botox into the muscle below the wrinkle. Botox works by minimizing the movement that causes wrinkles and this allows the skin to relax. Dermal fillers are injected under the skin and work by plumping up areas that cause a patient to look gaunt or older. Most dermal fillers are already pre-mixed with lidocaine to help ease the discomfort of the injection. The filler will be gently massaged to ensure an even distribution.

Fat grafting involves the doctor removing fat, via liposuction, from the patient’s own body and transferring it to the lacking area with injections.

During a laser treatment, the device is passed by the treatment area and heat energy targets the various skin layers to promote collagen production, tighten the skin and/or remove damaged skin for new skin growth.

Surgical Cosmetic Facial Rejuvenation

A brow lift, eyelid surgery and facelift all require incisions. The incision lengths and locations vary according to the type of procedure and technique used. The surgeon will make every attempt to place the incisions within the natural creases of the treated area to better conceal them.

A brow lift, AKA a forehead lift, is when tissues are lifted above the eyebrows in order to reverse the effects of gravity, tighten any soft tissue on the forehead and provide a better contour along the eyebrows, forehead and upper eyelids. During an open brow lift, the surgeon makes a long incision across the forehead that follows the hairline or a crease of the forehead. The skin is lifted from the underlying tissues and then the muscles are loosened to remove excess skin and fat. The remaining skin is pulled down and stitched into position. During an endoscopic brow lift, tiny incisions are made on the scalp and then an endoscope is inserted to stretch the forehead tissues so the tissues can be anchored into place.

Eyelid surgery is also known as upper and lower blepharoplasty. Upper blepharoplasty addresses extra skin and fat in the central and nose side of the upper eyelid. The surgeon makes an incision along the natural crease of the upper eyelid. Fat deposits are repositioned or removed through surgical tools, radiofrequency cutting devices or lasers. The muscles and tissue are tightened and excess saggy skin is eliminated. Lower blepharoplasty addresses the skin and muscle below the eye. An incision is made about 1 or 2 mm below the lash line and towards the outer corner of the eye. The flap of skin, or the skin and muscle, are raised so any excess fat can be removed or repositioned. The flap is pulled up, towards the outer cheek, and then sutured into place after the excess skin is trimmed away.

A facelift, AKA a rhytidectomy, reduces the appearance of facial wrinkles and other signs of aging on the face and jaw. The surgeon lifts and tightens the underlying muscles in the face for a more youthful and contoured look. Plus, excess skin and fat is removed that adds to an aged appearance. There are multiple facelift techniques and the one chosen by the doctor depends on the desired results as well as the condition of the facial muscles and the amount of wrinkles and fine lines.

What is the Cost of Facial Rejuvenation?

The cost of facial rejuvenation varies according to the type of procedure performed, the type of anesthesia used, any fees charged by the surgeon or the facility and the geographic location of the office.

Botox costs anywhere between $300 and $1000
Dermal fillers run from $500-$10,000
Fat grafting runs from $800-$3000
Laser treatments can cost anywhere from $4800-$7500
A brow lift is $4000-$12,000 depending on the type of lift performed and the extent of the procedure
Eyelid surgery is $2000-$4000 for an upper blepharoplasty and $2500-$5500 for lower blepharoplasty
A facelift costs anywhere from $6000-$12,000

Recovery and Downtime

The amount of RECOVERY and DOWNTIME varies per treatment:

Botox may cause some bruising from the injection but patients are able to resume work the same day.

Dermal filler patients might see some redness, swelling and bruising at the injection site for a few days to a week. Patients can use ice packs to minimize discomfort and makeup to conceal these side effects. Patients should refrain from intense physical activities for 24 to 48 hours to help minimize swelling and bruising.
Fat grafting procedures may require 7 to 14 days of rest due to the liposuction portion of the procedure. There will be some discomfort in the area where the fat was harvested. Patients are encouraged to walk around the house to help speed healing and minimize the risk of blood clots.
Laser facial rejuvenation patients will have some tenderness, bruising and swelling in the treatment area for 7-14 days. They can return to their normal activities within a week.
Patients can expect to feel some tightness on the forehead and discomfort after a brow lift. Ice packs can be used around the eyes to reduce swelling. It is recommended to sleep with the head and back elevated during the first 5 to 7 days. It is normal for bruising to happen below the lower eyelid for 2 or 3 weeks. Numbness usually lasts for several weeks but most patients can return to work after 7-10 days.
After eyelid surgery, the eyes may be loosely covered with a lubricating ointment and gauze and there may be some discomfort. Bruising, numbness, swelling and irritation at the incision site and dry eyes are common for 2-3 weeks. Patients can return to work 2 days after the procedure. Residual swelling can continue for up to 3 months. Patients should use darkly tinted sunglasses and protect the eyes from the sun while recovering.
The amount of pain and discomfort after a facelift varies depending on the technique. Patients are usually able to get up and move around after a few days but they will have some discomfort and bruising for 10 to 14 days. Some residual swelling may last for several weeks to months. Small drainage tubes may be placed just under the skin to expel excess fluids. The tubes and sutures will be removed during the first post-operative week.
Patients can usually return to normal activities and work after 4-7 days but strenuous activity and physical work should be avoided for 2 weeks or more.

Results

While fillers provide immediate results, the effects of Botox will take a few days to a week since it takes time for the skin to relax. Nevertheless, results will continue to improve over the next few weeks as the skin smooths out and the filler encourages new collagen production. However, these treatments are temporary with Botox lasting 3 to 6 months and fillers lasting anywhere from 6 months to 2 years. Therefore, patients need repeat injections to maintain the results.

Fat grafting is permanent since the filler material is a living tissue and incorporates with the existing tissue.

The results from laser treatments can be seen between 1 and 3 weeks. Less aggressive laser treatments may require several sessions to gain the desired outcome and they can be repeated each year. Aggressive treatments tend to have longer-lasting results and may not need to be repeated for 2 years or longer.

The results of a brow lift will not be immediate due to swelling and bruising. Patients should be able to see some improvements after most of the swelling and bruising has subsided. Improvements continue over the next 6 months. Brow lift results are long lasting and considered permanent. However, gravity will continue to pull down the skin as the patient ages and new wrinkles will eventually form.

The results for upper or lower blepharoplasty gradually appear as swelling and bruising subsides. The results will continue to improve for up to a year after surgery. Eyelid surgery results can last up to 20 years but the natural process of aging will eventually alter the results of blepharoplasty.

Patients may be able to notice some results immediately after a facelift but most of the results are not visible thanks to swelling. It can take up to 6 months for the final outcome to be apparent. Facelift results are generally permanent but, as a person ages, fat volume naturally decreases and gravity pulls the skin down. However, the patient will look 10-15 years younger than their actual age for the rest of their life.

Limitations of Facial Rejuvenation

The limitations of facial rejuvenation include:

The results that a person desires might not be possible if the patient chooses a non-surgical procedure over a surgical treatment
The expense when it comes to repeat sessions, or several injections to meet the desired outcome, might limit patients from undergoing facial rejuvenation
Very thin patients may be limited with the amount of fat they have available for fat grafting
Patients with active herpes, or those prone to acne outbreaks, may be limited from certain treatments until they get the condition under control

Risks of Facial Rejuvenation

The risks of facial rejuvenation include:

Adverse reaction to anesthesia
Bleeding or blood clots
Infection
Numbness, tingling or changes in sensation
Skin necrosis
Scarring
Filler migration if it is injected into a blood vessel
Reabsorption of fat grafts
Asymmetry
Skin burns from the heat of a laser
Damage to underlying structures with surgery
Unhappiness with the results if realistic expectations are not set