Fillers for Facial Wrinkles and Folds

Dr. Godin uses a new generation of filler materials which are safer and longer lasting than collagen. He is a nationally known expert in the use of both Radiesse and Restylane, and has published a scientific article about the combined use of both materials. Juvederm™, a new filler from the makers of BOTOX®, is also used. The fillers vary in where in the face they can most safely be placed and how long they last. The most popular areas for improvement are the folds between the mouth and cheeks and the “lipstick lines” around the mouth. These fillers may also be used to enhance the size or change the shape of the lips. These 30-minute treatments are performed in the office under both topical and local anesthesia for comfort. We consider it an advantage to have an expert in facial plastic surgery performing your nerve blocks so that you tolerate the filler injections well, especially in the lip area.

Dr. Godin is also proficient in using facial fillers such as Radiesse, Restylane, and Juvederm, as well as muscle relaxants such as Botox, to not only reduce wrinkles, but also lift and contour sagging facial features. This revolutionary approach, known as a “liquid facelift,” can be used to treat the entire face or specific areas, and offers long lasting results with little or no down time.

Dr. Godin is a Distinguished Member Physician of the Liquid Facelift Association and has contributed patient examples (with permission) to the association Web site for the education of other doctors. Learn more at www.liquidfacelift.com.

Liposuction

While liposuction is actually a surgical procedure, it is listed in the non-surgical category because of its minimally invasive nature. Small suction instruments are inserted through a very small incision in the skin crease under the chin, in order to remove accumulations of excessive fat. Dr. Godin reserves liposuction for the chin and neck areas only. This precise and minimally invasive procedure can be done by itself in younger patients, or as a part of the facelift procedure in many of our patients who are undergoing facial rejuvenation.

Botox® and Dysport® Treatments

Botox® and Dysport® are FDA-approved, highly refined medications used in very small amounts to smooth deep wrinkles, and relax overactive frown lines. BOTOX® and DYSPORT® treatments improve “crow’s feet” around the eyes, wrinkles across the forehead, and vertical furrows between the eyebrows. Highly purified muscle-relaxing agents, Botox® or Dysport® are injected in small amounts to relax selected facial muscles. After these five-minute treatments, patients often enjoy a more pleasant and relaxed appearance. There is virtually no “down-time,” and the effect of the treatments usually lasts 3-6 months and may be repeated.

Tuck-Up Procedures

Tuck-ups are small-incision procedures that target specific problems such as sagging of the neck, a jowl in the middle of the jawline, or sagging in the temple area near the outside corners of the eyes. Tuck-ups are generally performed for younger patients who have an area that seems to be aging more quickly than the rest of the face, or for patients who have had more extensive procedures such as facelifts and forehead lifts and require a “tune-up” of the original work. They have the advantage of being smaller surgeries so there is generally less swelling, bruising and downtime.

Patients can undergo tuck-ups and sometimes return to work in as little as four or five days. With strategic scheduling, this can lead to only two or three work days missed. Tuck-ups have become popular for our “on the go patients” and are recommended when appropriate. If a larger degree of improvement is needed to achieve the patient’s goals, then a more extensive procedure, such as a facelift or forehead lift is planned.

Forehead and Eyebrow Lift

Sagging of the eyebrows and deep lines in the forehead can give one a tired, even angry appearance. The forehead/eyebrow lift is designed to restore the eyebrows to a higher, more youthful postion, and soften the wrinkles so often seen in the forehead. The surgeon is careful to strive for a natural-looking result which does not make the patient look permanently surprised.

The lift may be performed through an incision at or behind the hairline, depending upon the patient’s specific hair pattern. A recently developed technique involves using much smaller incisions and lighted retractors to perform the procedure, and is applicable to some, but not all patients.

One point that patients sometimes find surprising is that lifting the brow can often dramatically improve the appearance of the upper eyelids and allow the surgeon to perform a more conservative upper eyelid blepharoplasty, while still realizing a beneficial effect.

Blepharoplasty

Blepharoplasty is performed to correct deformities of the eyelids. Like other face and neck areas, the eyelids may develop wrinkles and bulges due to either heredity or aging. Pouches, both at the inner part of the upper lids and in the lower lids, are generally due to forward pressure caused by accumulations of fat above and below the eyes. Such excess fat and excess skin are removed in the eyelid procedure. Upper lid correction is done at the same time as the lower lid surgery. Dr. Godin frequently performs the transconjunctival type of lower eyelid blepharoplasty, in which fat can be removed from behind the eyelid without making an incision in the skin.

The operation takes about one to two hours and may be performed under local anesthesia or light sedation in our office surgical suite. Patients generally experience an early return to routine living.

There is usually little or no pain in the post-operative period. Each operation is followed by varying degrees of swelling and discoloration, which usually subside within 10 days. By this time, too, the thin scars can be camouflaged by make-up. These scars gradually blend in well with the surrounding skin and, after several months, are usually visible only on close scrutiny.

Corrective surgery of aging eyelids is frequently performed in combination with facelift or eyebrow surgery.

Otoplasty

Otoplasty is the procedure used to reposition protruding ears closer to the head. Ear deformity can cause deeper emotional trauma than is generally realized, even by the parents of children who have the condition. Because the physical and psychological improvement following the operation is usually dramatic, it is most rewarding to the patient and gratifying to the doctor. Surgery is usually recommended before school age, approximately six years or younger, to avoid classroom teasing. Surgery for older children, teenagers, and adults may also be performed.Local anesthetic with sedation is usually used in the office operating room for adults and teenagers, while a general anesthetic given in the outpatient surgery center is preferred for youngsters. The procedure lasts approximately one hour per ear, and patients go home the same day, usually with very little post-operative pain.The dressing is removed the day after surgery, and a lighter dressing is placed to help maintain the new position and shape of the ears. Afterwards, a headband is worn, especially while sleeping at night, to help protect the surgical result

Facial Implants / Chin Implants

The array of available synthetic facial implants is continually changing. Dr. Godin is a nationally recognized researcher into the uses and safety of one of the most widely used implant materials: medical-grade Gore-Tex. Synthetic implants are most commonly used to build up the bridge of the nose in rhinoplasty, to improve a receding chin, and to give fullness to the cheekbone or malar area.

Rhinoplasty

Rhinoplasty corrects deformities of the nose. The surgeon reshapes and rearranges bone or cartilage, removing any excess. Most surgery for the nose is performed in the outpatient surgery center, and patients go home the same day. The average patient returns to work about one week later. Actual surgery takes about one to three hours, depending on the specific needs of the patient. Rhinoplasties are usually performed quite simply, because people want to look better. They would like the shape and size of their nose to be in harmony with the rest of their features. Sometimes, people like models and performers are motivated by economic or career considerations. There are also many cases in which breathing difficulty occurs as the nose becomes progressively more disfigured because of aging. Some patients also have deformities inside the nose that impair breathing, cause headaches, or create sinus trouble which cannot be satisfactorily corrected without simultaneously straightening the external nose.Photographs are taken to supplement the “before and after” record of the nose and face. These photos are used in planning the operation, much the same way that an architect plans a house. During the consultation, Dr. Godin will show the patient many before and after photos of actual patients who have undergone rhinoplasty.The objective is not only to improve the shape of the nose, but also the appearance of the entire face. It is important that the patient understands rhinoplasty is done to make the nose blend better with the face and be less conspicuous. The procedure is a refinement of the existing nose, not the creation of a completely new one. All that the surgeon can do is attempt to improve what already exists. As long as the patient understands this and has appropriate expectations, there is an excellent chance that he or she will be satisfied with the result.

Following surgery, a white plastic splint is applied to the nose. Packing inside the nose is almost never used. Soft rubber splints with tubes that allow for breathing are frequently placed inside the nose for several days after the surgery. Upon discharge, patients receive easy-to-follow instructions for home care.

The dressing on the nose is removed at the office about five days later. When dressings are first removed, the nose usually appears somewhat swollen, compared to how the final result will look. Patients who expect to see a perfectly shaped nose right away must be careful not to become disappointed. After three or four days, the nose begins to approximate its eventual shape, and the average acquaintance would probably not notice any swelling.

At the end of one week, the swelling and discoloration around the eyes has disappeared in most cases. Some slight swelling of the nose, which the patient feels more than can be seen, is present, but it steadily diminishes over several weeks.

This swelling is particularly noticeable in the morning and goes down as the day progresses. The thicker the skin, the longer it takes for the nose to attain the final shape. It may be about one year before the last one or two percent of swelling is gone. This does not usually bother the patient nor detract from the improved appearance. A small amount of swelling can persist for several months, and all patients are told that they will not see their “final nose” until one year from the surgery. While this is true, the changes in the last few months are usually quite subtle.

If surgery is done on the septum (the partition in the middle of the nose), soft rubber splints may be placed in the nose for a period of approximately one week to encourage proper healing. These splints have tubes built into them so the patient can breathe through the nose, and are not usually visible to others.

After all dressings are removed, patients visit the office several times during a two-month period so the doctor can monitor progress. During this time, patients must be careful not to injure the nose and to protect it from prolonged exposure to direct sunlight. To avoid strain, it is not advisable to lift heavy objects for at least two weeks after the operation.

Pain is unusual in the the post-operative course, but pain relief medication is prescribed in case it occurs.

Finally, Dr. Godin has a great deal of experience with very challenging revision rhinoplasty cases. These surgeries are performed for patients who have had previous nasal surgery, often by other physicians, and desire additional improvements in appearance, breathing, or both. Since rhinoplasty is the most demanding of all procedures in plastic surgery, it is vital for patients who want to improve their noses to seek out a rhinoplasty surgeon with extensive experience. Dr. Godin’s enthusiasm for the art of rhinoplasty has led him to publish his new book, Rhinoplasty: Cases and Techniques, a must read for all practicing plastic surgeons and facial plastic surgeons as well as residents and fellows in training. Rhinoplasty: Cases and Techniques is available from Thieme Medical Publishers, Inc., New York. If you would like a personalized consultation with Dr. Godin to discuss changes that can be made to your nose, please contact us.

The Micro-Mini Lift

The smaller incisions of a Micro-Mini Lift® make it a minimally invasive facelift

Through years of work, I have developed a modification of the facelift, which I call the Micro-Mini Lift®. This is most appropriate for patients with a small amount of excess skin in the jaw line and/or minor looseness of the neck. The incisions are small and recovery time is usually a week or less. I perform this lift mainly for patients in their forties and early fifties who are beginning to see some loosening of the tissues but are not ready for a larger lift. I believe it is crucial to do the right procedure at the right time for my patients and so the Micro-Mini Lift® is a great addition to my face and neck lift line up.

A Conversation with Dr. Michael Godin about the Micro-Mini Lift® minimally invasive facelift

Q: What is the Micro-Mini Lift®?
A: A small-incision procedure to firm the jawline and improve drooping in the neck.

Q: Who can benefit from it?
A: Patients with early jowling and looseness in the neck. Generally, they are in their 40’s or early 50’s.

Q: Why is it called the Micro-Mini Lift®?
A: Because the incisions are smaller than a standard facelift or even a facial or neck tuck-up, it is a mini-lift. “Micro” describes the surgeon’s mindset – an almost microscopic attention to detail.

Q: Can the Micro-Mini Lift® be customized?
A: Yes, it is individualized in every case. For example, the deeper layer (SMAS) may simply be tightened or partially removed and repositioned, depending on tissue looseness and thickness.

Q: If I have a Micro-Mini Lift® now, can I have a more traditional lift when I’m older?
A: Yes, this procedure complements having a more extensive lift later in life. In fact, by creating a firm layer of healing, it can be used to enhance future results.