See article: Neck rejuvenation (Cosmeticbeautymagazine.com)
See also: Adjuncts to facial rejuvenation
See article: Six ways to tell if you need a facelift
See also: Short scar facelift

Definition: Rejuvenation of the lower face from the
temples to the lower neck.

Age: From 30 years old and up.

Surgical technique: The extra skin is removed. Fat is suctioned from the jowls and under the chin. The muscles in the face and neck are tightened. The cheek fat is elevated to a youthful level recreating the cheek highlights. The incisions are placed inside and behind the ear so that you can wear your hair back. The sideburn is left in its youthful position. Philosophy: Think of cosmetic surgery as maintenance surgery. Stay fresh and young looking with regular procedures.

Waiting until you are 65 and going in for the "works" expecting to come out looking
natural is unrealistic. But if you already had a facelift at 45 or 50, then you will look
good after a second facelift at 65.  Those who ignore this advice may need a mini-
facelift 18 months after surgery to tighten the skin again.

Surgical time and recovery: Surgery takes about 2-3 hours. Stitches are out
after 9 days. The patient can go back to work at 10-14 days.

Related procedures: The most frequent related procedures are blepharoplasty
and browlift. A chin implant corrects a receding chin. Alloderm lip implants restore
a thin aging lip and a nasal tip-plasty will elevate the end of the nose to a youthful
level and reduce a bulbous tip.

Facial aging involves loss of cheek and chin projection due to descent of the fat
pads over the cheek and chin regions. In addition, in the chin area, the sagging of
skin in the neck and often a pre-existing obtuse angle between the neck and jaw
line, contribute to the loss of definition. Using implants in facial rejuvenation can
help.

For the last 15 years I have used solid silicone implants. They are stable and
imperceptible when placed immediately next to the bone. They can also be easily
removed or replaced.

Cheek implants can augment the effects of a facelift and can be used either to
elevate the cheek bones alone using a standard malar implant, or they can be used
to augment the cheeks as well as filling in any hollowness in the dimple area. An
extended implant is used in this case. Occasionally only the dimple area is treated
using a "submalar implant".

Chin implants are especially helpful in the case of facelift patients with loss of neck
definition or a flat contour to the front of the chin.

One of the signs of ageing is an enlargement of the nasal tip cartilages and a drop
of the tip giving a hooked appearance. As the tip descends, the bridge of the nose
appears more pronounced. Minor refinements of the nose can make a big difference.
The tip cartilages can be reduced and the tip is elevated. The bridge of the nose is
shaved without breaking the nasal bones. The effect is subtle but overall a definite
boost to the facial improvement.

These procedures can be performed at the same time as face-lift.

1) Cheek Implants

Can be performed at the same time as a facelift or as a separate procedure. An
incision is made inside the mouth just above the incisor tooth. A pocket is made
along the bone and over the cheek area. An implant is placed in the pocket and
sometimes secured with a stitch that comes through the skin or an internal stitch.
The incision is closed with absorbable stitches.

After surgery the swelling increase for 2-3 days and then recedes. Most swelling is
gone after 7-10 days but the appearance will continue to change for up to 12
months as the tissue reshapes around the implant.

2) Chin Implants

Usually performed at the same time as a facelift or as a separate procedure. A
small incision is made under the chin. A pocket is made along the bone. An implant
is placed in the pocket and secured with an internal stitch. The incision is closed
with stitches which are removed 5 days later.

After surgery the swelling increase for 2-3 days and then recedes. Most swelling is
gone after 7-10 days but the appearance will continue to change for up to 12 months
as the tissue reshapes around the implant.

Nasal rejuvenation surgery

Usually performed at the same time as a facelift or as a separate procedure.
Incisions are made inside the nose and the tip cartilages are visualised and reduced
so as to give a more defined tip.

Sometimes an "open" approach is used which means that an additional incision is
made in the skin between the nostrils on the under-surface of the nose. This allows
more control of the final shape of the nasal tip. The nostrils can be narrowed by
excising a wedge of the nostril rim in the crease at the side of the nose leaving a
scar which is usually barely visible. The cartilage and bone of the bridge of the nose
is shaved either through the internal incisions alone or through the open approach.
The incision is closed with stitches which are removed 5 days later. A simple tape
dressing is applied and left in place for 2-5 days.

After surgery the swelling increase for 2-3 days and then recedes. Most swelling is
gone after 14 days but the appearance will continue to change for at least 12
months. Nasal tips in particular will remain swollen for several months and may take
6-12 months to see the optimal result.

In the USA: 605 West Avenue Norwalk, CT USA 06850 Ph: (203) 838-8844 Fax:(203) 853-1862 Efax:(203) 286-1046 Email Prof. Kirwan Also in the USA at: 800 Fifth Avenue, Suite 202 (corner of 61st St.) New York, NY 10065 Ph: (212) 838 8844 Fax:(203) 853-1862 Efax:(203) 286-1046 Email Prof. Kirwan In the UK: 56 Harley Street London W1G 9QA Tel :  +44 (0) 20 7637 4455  (after 2:00 p.m. GMT from UK) Fax: +1 203 853-1862 Efax: +44 (0) 20 7504 8143 Email Prof. Kirwan