Plastic surgeon’s “first look” assessment

By Dr. Ronald Finger

Contributor

Many plastic surgeons, including myself, try to determine what best fills a patient’s needs when he or she first sees the patient. When it involves the head and neck area, what feature ages the patient the most?

Most commonly it’s the eye lids or the jowl and/or neck, but everyone is different, and it can by any feature from the bottom of the neck up including the hair. After my “first look” at the patient when entering the room, the patient is asked the reason for their consultation. I may agree or ask if they want my opinion.

For the eye area, the problem may be upper or lower eyelids or both. With upper eyelids, typically there is excess skin, which can be so excessive that the skin rests on the lashes. However, surgery may be indicated in even less severe cases.  These require a procedure called an upper lid blepharoplasty, a minor procedure usually done under local anesthesia. Basically, the skin to be excised (removed) is marked with ink and local anesthetic is injected into the skin very slowly to minimize discomfort. Excess skin is removed, and the skin edges are approximated with fine sutures. Sutures are typically removed on the fifth day after surgery. The results are usually a dramatic improvement.

If the problem is lower eyelids, it is usually “bags,” which are pseudo-hernias of orbital fat resulting in shadows under them, causing a tired and older appearance. There can also be excess skin causing wrinkles.  When the “bags” are the only problem, an incision to remove the fat is made inside the lower eyelid. If there is also excess skin, the incision may be in the skin just under the eyelashes, or the skin can be tightened with a laser or proper chemical peel done with local or general anesthesia, according to the patient’s preference.

There are a variety of procedures for aging necks. There may be excess fat and/or skin, or in those with excess sun damage, fine wrinkles. The treatments vary according to the problem. In patients in their twenties to forties, liposuction may be all that is needed to remove excess fat. If skin is saggy, tightening skin is accomplished with probes that emit intense heat, e.g., Renuvion. The intense heat tightens the skin usually with one treatment, which can be done with liposuction. For severe face and neck sagging, a facelift may still be indicated or a direct excision of the hanging skin with local anesthesia, which has a very short recovery time and is very successful at removing excess skin. For fine wrinkles leaving sun damaged skin, proper lasers may also be indicated.

In younger patients who are concerned with sagging of the jowl area, fillers to the cheek area and/or PDO threads may result in a refreshed look without having to undergo surgery. The VirtueRF microneedling device will both melt the excess fat and tighten the skin.

In conclusion, there are many options for addressing signs of aging without major surgery including fast-recovery laser treatments, fillers, Renuvion for skin tightening, and PDO threads to name a few.  A patient must be properly assessed, and options explained in detail to determine their best option.

E. Ronald Finger, MD, FACS is a board-certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com