Facial Rejuvenation’s 5Rs: Relax, Refill, Resurface, Redrape and Remove

Although the hands of time cannot be completely turned back, facial rejuvenation can slow down or even reverse some of the natural aging processes which produce lines and wrinkles, age spots, broken capillaries, dull skin, and uneven tone and texture. Other flaws include loss of collagen and elastin, resulting in sagging skin, gaunt faces, dark circles and puffiness under the eyes. Open pores and acne scars also appear more visible.

There are 4 things that happen to our face as we age:

  1. Volume loss (mainly fat)
  2. Sagging tissues because of gravity
  3. Facial bones thin out and become lighter
  4. Skin thins, develops fine lines and wrinkles, as well as, brown patches

I think of skin and facial rejuvenation in terms of the 5 Rs:

  1. Relax: refers to using anti-wrinkle injections which so often wrinkles caused by muscle movement.  The facial muscles of expression, if used too much, can result in “frown lines” between the eyes, “worry lines” of the brow or “crow’s feet” beside the eyes.  By relaxing the muscles responsible for these expressions, we are able to interfere with the development or progression of such lines.
  2. Refill: various products, from fillers to one’s own fat, can be used to address facial volume loss. Such techniques are used in the treatment of deeper wrinkles, folds and expression lines that are too deep to be adequately affected by resurfacing.
  3. Resurface: refers to methods that remove the outer layers of the skin to yield a smoother, more even-coloured texture. These techniques are used to treat sun-damaged, weathered, or aged skin. These are useful for dealing with wrinkling of the skin, blotchiness, roughness and loss of lustre e.g. facials, microdermabrasion, chemical peels, and lasers.
  4. Redrape: refers to traditional surgical interventions that improve areas of redundant skin. Overtime and with accumulated sun damage, the skin loses its elasticity and may begin to sag. This is especially true in the lower face and neck although laxity of the brow skin and eyelids is also common. Most treatments for significant sagging of the face require surgical interventions e.g. facelifts, brow lifts, eyelid lift surgery.
  5. Removal: It is not uncommon to develop unwanted bumps, broken blood vessels, brown spots or tags on the skin, especially on the face and neck. All of these can be treated by simple removal techniques. In many cases, liposuction (removal of fat) can tighten the neck adequately without actually removing skin surgically.

Today, in the field of cosmetics, refill is much more appreciated in our approach to facial rejuvenation. Temporary fillers like hyaluronic acid (HAs) are considered the gold standard. Fillers are often combined in different areas of the face to recreate youthful contours, sometimes referred to as a “liquid facelift.” My go-to fillers for correcting hollows under the eyes, cheekbones or lips are HAs or fat. Vertical lip lines are treated with a combination of HAs and anti-wrinkle injections or laser resurfacing.

Fat transfer can be used to replace volume in most areas of the face including the temples (a much-neglected area until recently), cheeks, jawline, nasolabial folds, and marionette lines. It gives reliable, natural-looking results, and even improves the texture of the skin. Fat transfer is an easy, economical, safe, and comfortable means of volume replacement for the face. Fat is harvested from an area of excess fat such as the hip, thigh, or abdomen.

The fat is then processed and placed in small amounts to resculpt the facial contours of the face. Fat transfer is usually done under general anaesthesia. Fat is also an excellent choice for rejuvenating the hands, as it camouflages the appearance of visible tendons and dilated veins.

There are so many choices available for skin and facial rejuvenation. One can create a natural and gradual volume replacement. The “cookie cutter” approach to fillers is out. Discussing the 5 Rs and how the various techniques are used in combination for skin and facial rejuvenation can aide in maximising outcomes.

Question:  What signs of facial aging trouble women the most?  You can leave a comment below.

Eyelid surgery for a more youthful look

Eyelid surgery is an operation that can dramatically improve a patient’s appearance within a relatively short recovery time. Droopy eyelids is one of the major reasons why some people often consider eyelid surgery (blepharoplasty) to get rid of excess eyelid skin for a youthful appearance. In other cases, eyelid surgery helps in improving ones vision by offering a field of view that is less obstructed after the removal of excess skin.

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How is eyelid surgery performed?

Eyelid surgery can be performed on your upper eyelids, lower eyelids or both. The plastic surgeon will carry out pre-operative evaluation on factors such as your facial muscles around the eyes, the symmetry or droopiness of your eyebrows and underlying bone structure. After the evaluation your plastic surgeon will be able to determine the amount of skin and/or fat to get rid of. Some points to consider:

  • your plastic surgeon will make accurate markings to show where the excess tissues will be removed on your lower and upper eyelids.
  • On your upper eyelid, they will make a surgical slit concealed in the natural fold of the upper eyelid.
  • In the lower eyelid, the surgical slit will be concealed below your lower eyelashes. When unwanted fat only is being removed, the slit can be made inside the lower eyelid which is referred to as a transconjunctival incision. Laser resurfacing may at times be used together with this method so as to make the lower eyelid skin tighter.
  • The plastic surgeon will also get rid of excess tissue through these slits.
  • At times, fat may need to be redistributed in the lower lids to completely remove bulges or puffiness. Other changes may be made so as to correct special problems such as muscle laxity.
  • The scars are generally inconspicuous after healing.
  • For patients who have dry eyes, very little amounts of tissue are removed to avoid exposing more of the eye to the air which may worsen the symptoms.

When to consider eyelid surgery

  1. If you have too much skin hanging or covering the upper eyelids natural folds.
  2. If loose skin hangs down from the upper eyelids over the eyelashes.
  3. If the under of your eyes has deep grooves and bulges.
  4. If both your upper and lower eyelids look puffy, making your eyes appear aged and tired.

Many people who consider blepharoplasty also consider facelift, wrinkle smoothers, brow lift and dermal fillers for a complete facial rejuvenation look.

What will my eyelid scars look like?

  1. Upper eyelid surgery: The plastic surgeon will mark the natural lines and creases of the lids and keep the incisions as concealed as possible along the natural folds. Thin sutures will be used in closing up the incisions hence making the scars visibility minimal.
  2. Lower eyelid surgery: In the traditional blepharoplasty, the doctor will make the slit in a hidden side along the lash line and smile creases of the lower lid. In the transconjunctival approach, the doctor amends the eyelid puffiness that results due to excess fat by making a cut inside the lower eyelid. This technique doesn’t need an external slit but it cannot be used in the removal of extra skin.

Recovery

This is one of the fast healing surgeries that I undertake. However, it is important that you adhere to all the postoperative procedures that are given. This will include instructions about iced eye pads, bandages and taking of antibiotics if prescribed. I will also offer detailed instructions about the normal symptoms and any signs of complications. The amount of recovery also varies among people so it’s good to be patient and not rush things.

Risks

Fortunately, eyelid surgery has very minimal complications. Thousands of people undergo successful blepharoplasty and are happy with their transformation. However, all surgical procedures come with some degree of risk. Some of the complications may be watery eyes, infection and bleeding, allergic reactions, sensation changes, asymmetrical scarring and haematoma.

Question: What is the most troublesome thing you find with droopy eyelids? You can leave a comment below.