Face

Mid-face Lift

This procedure is helpful for patients who are experiencing typical aging changes in the cheeks, including laxity of the skin of the cheeks, deepening of the nasolabial folds (alongside the upper lip), and marionette folds (alongside the lower lip), and prominence of the jowls.

Many patients choose to undergo rejuvenation of the neck in conjunction with a mid-face lift. This combination of mid-face and neck surgery constitutes a facelift.

Dr. Casso consults with his patient and tries to ascertain what concerns the patient about his or her appearance, and recommends surgery which helps to address those concerns. Proposed incision lines are discussed.

Mid-face surgery involves incisions which are hidden along creases just in front of the ear, and along the edge of the cartilage which partially covers the ear canal (tragus). Incisions then extend upward into the scalp, or in some patients, along the hairline in front of the sideburn and temporal hair.

The advantage of an incision within the temporal scalp is that scars are covered by hair. The disadvantage relates to the fact that when the mid-face is lifted and tissues are shifted upwards, the sideburn hair is shifted upward with this technique. For most patients, this is not a problem. For women whose sideburns are short, however, shifting them upwards may result in a bare area which can be exposed if the hair is pulled back behind the ear. In these patients, Dr. Casso recommends an incision along the sideburn and temporal hairline. This wound is very carefully closed and the scarring is usually nearly invisible.

While this procedure is sometimes performed under local anesthesia in outpatient facilities, Dr. Casso recommends general anesthesia at Houston Methodist St. John Hospital, which provides the patient with a comfortable surgical experience, and close, expert nursing attention, treatment of postoperative nausea, if present, and immediate medical attention in the event of any unforeseen emergency. The option for surgery in a full-service, state-of-the-art facility such as Houston Methodist St. John provides patients with a measure of safety and security which is unmatched.

In this procedure, Dr. Casso makes incisions as discussed with the patient. The skin and subcutaneous tissues of the face are undermined by releasing their attachments to underlying tissues. The deeper layers are similarly detached and repositioned in a vertical orientation, thus lifting the cheek and jowls, and smoothing the nasolabial and marionette folds. This deep plane mid-face lift allows for more complete and long lasting facial rejuvenation than older, skin-only face lifts, which tended to result in early failure and unnatural tension lines, due to the tendency of skin to stretch and give.

While the improvement in appearance is often dramatic, Dr. Casso strives, above all, to insure a natural, un-operated appearance, with nearly undetectable scarring.

Many procedures are promoted for facial rejuvenation, often promising quick recovery, limited invasiveness, local anesthesia, and early return to normal activities. Unfortunately, significant, lasting improvement requires certain surgical maneuvers, which, of necessity, result in some degree of bruising and swelling, which, for most all patients, is a small price to pay for the substantial and lasting improvement which they may enjoy for years to come.

Postoperative pain is generally moderate, and well controlled with oral pain medication.

Most patients choose to go home in the afternoon after surgery, although an overnight hospital stay is certainly an option.

The patient is seen the day after surgery, after which daily showers and shampooing are resumed. Sutures are removed within 10 days, and bruising and swelling will decrease to acceptable levels in 14 to 21 days. Most swelling resolves in four to six weeks, but continued improvement is apparent for several months.

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