Welcome to our October email update.


Most patients state that in choosing to have a facelift, they just want to turn the clock back. “I don’t want to look different; I just want to look younger.” This is certainly a reasonable request but there are times when a little extra change is worthwhile. Some of the little additions can make the difference between a very satisfactory result and one that is outstanding. I thought we might discuss some of these options. Remember, these are just possibilities. Ultimately the choice of what goes into your particular procedure should be based on the changes that you, yourself, want to accomplish. These are suggestions for consideration only. If you are interested, learn more about the procedure and discuss them during your consultation.



One of my favorite procedures is malar augmentation, or cheekbone implants. We don’t do quite as many of these as we used to several years ago. Remember when Bo Derek and Linda Evans were so popular? It seemed like everyone wanted the exaggerated high cheekbone look. Well, cheekbone implants don’t have to look artificial. In fact, the results are much more flattering when the operation is done in a conservative manner. The truth of the matter is that, as we age, there is a gradual loss of bone and this may result in a flattening of the prominence of the Insular, or cheekbone eminence. A small implant can restore that loss or, of desired, add a little extra.

The procedure is accomplished by making a very small incision just above the canine tooth. The incision is really only about a half an inch long – just long enough to allow insertion of the implant. The tissue is lifted off of the bone, carefully creating a pocket that is just the right size for the selected implant.

The implant will almost always stay in place by itself, but in rare cases a tiny titanium screw may be used to anchor it to the bone. The screw is about the size of one of the tiny screws on an eyeglass frame. The incision is closed with one or two absorbable sutures. While the procedure may increase the post operative swelling and discomfort for a few days, the results can certainly be very gratifying.



Buccal, or cheek fat extraction can be a valuable addition in patients with undesirably chubby cheeks. It is often combined with a small amount of facial liposuction. The buccal fat is actually the deeper facial fat that seems to lubricate the muscles used in chewing. Partial removal of the fat can help to reduce the chubby cheek look without any detrimental functional effect. This surgery is also carried out through a small incision made inside the mouth. The fat is gently teased out. No risk of interfering with chewing – plenty of fat is left in place! Not surprisingly, buccal fat extraction is very often combined with cheek bone implants. The two procedures are often synergistic. Removing the buccal fat adds a bit of hollowing to the cheek which can add to the illusion of high cheekbones.



Chin implant insertion is certainly the most common adjunct to a face lift. Many patients notice a gradual loss of the prominence of the chin as they age. Of course a lot of us are born with the propensity of a receding chin. The restoration or augmentation of a receding chin can result in a dramatic improvement in appearance. This is especially true on the profile view. How many of us hate to have a side view photo taken just because we don’t like the look of our receding chin?

Chin implants, like most modern surgical implants, are made of silicone rubber. Silicone is the most inert material used for surgical implants. They have proven to be very safe, having been utilized as an implant material for close to half a century. But modern implants are not the same as those used years ago. When I first started using chin implants in the sixties, the devices were shaped like a button that fit over the very front of the chin. This often produced a somewhat unnatural look. Modern implants are much more proportional. They have long tapered edges and are anatomically correct in that they realistically follow the correct contour of the chin. Of course they come in a variety of sizes and can further be refined individually in the operating room for each specific patient.

The implant is placed through a very small incision under the chin. Many patients already have a small scar in this area from a childhood fall, and so the resulting scar is hardly noticeable.



Our last vignette in our discussion of adjuncts to facial rejuvenation is nose shaping. Here’s another example of an operation that can be carried out to restore a more youthful appearance or to change features that a patient finds undesirable. Many of us notice that the nose appears to droop as we age. No, this is not our imagination; there really is a tendency for the nose to sag with age. There are muscles and ligaments in the nose, too. Just like the rest of our body. These begin to weaken when we get older. Surgery can correct this sag and restore a more youthful shape to the nose.

Here is another example of how modern surgical techniques have enhanced an already fine operation. Through the use of lasers, and other techniques that avoid the need to fracture bones, recovery is now much faster. Also, there is no longer the need for packing in the nose. All in all, a much easier recovery than in past years. Not only that, but the results of surgery are more natural and stable.



These are just a few of the common adjuncts to a face lift. There are lots of others like Botox, fillers such as Collagen and Restylane, not to mention the various modalities of resurfacing. But enough for this month – we’ll save the rest for later. Please do let us know what you would like do see in the newsletter. Your input is always appreciated.


Howard A. Tobin, M.D., F. A. C. S.

For general information: askdena@newlook.org or n41gt@newlook.org