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Facial Surgery FAQ

Dr. Murphy presents, “Questions and Answers About Facial Cosmetic Surgery.”

Hi, I’m Doctor Terry Murphy. I am a board-certified plastic surgeon, I’m Chief of Plastic Surgery at Swedish Medical Center, and I want to talk about facial cosmetic surgery. Facial cosmetic surgery is a wonderful diverse field in plastic surgery.

Each patient who comes in who is thinking about having facial cosmetic surgery has certain things they have seen which have changed over time they want to address.

My job as a plastic surgeon is to approach each area of the face based upon what has led to the issues that they’re seeing, what has caused the facial aging, and then develop a plan of treatment to reverse those findings.

I approach the field of facial plastic surgery from the point of view that there are three or four things which have potentially contributed to the appearance of facial aging. It’s important to evaluate the quality of the patient’s skin and things in the past, has there been insults such as smoking, sun exposure, things which have caused the skin to look older with fine lines and wrinkles, are there pigmentary changes, is there loss of elasticity. These are all important things to think about.

I think that the loss of volume is an issue which is perhaps not adequately assessed by a number of physicians as they’re operating on patients for facial rejuvenation. It’s been well shown that over time the fat in the face shrinks up some, the sub-cutaneous tissues will shrink up, collagen will go away, it’s important in many patients who are having facial cosmetic surgery that the subcutaneous volume is reestablished during the procedure.

The third part of the assessment of patients who are requesting facial plastic surgery looks at what gravity may have done. Is there laxity of the tissues, have some of the more important tissues perhaps like the maylar fat pad which lives through here, has that come down over time? Is there jowl formation, loose skin in the neck?

This is added to effects of the skin, loss of volume, to give a full assessment of the facial plastic surgery patient to come up with the appropriate plan.

Once the assessment is completed, we move on to the planned surgery. The consultation involves discussion of which procedures may be done, including elevation of tissues which have become lax.

I typically perform either a cheek lift or a neck lift, or a combination of the two would be a facelift, as I’m performing this procedure I’m operating on the deep layers which have become lax, more on a vertical component, and they’re elevated into position, and the overlying skin is re-draped and tightened over the deep structures.

In combinations of that, we commonly add volume to the areas which have lost volume over time, such as around the perioral area, there can be loss of volume in the lips, loss of volume in some of the folds, in these areas, and frequently a hollow area underneath the eyes. The quality of the skin is then addressed, typically I use the ervian laser which resurfaces skin. It will smooth fine lines around the mouth, around the eye, it can decrease pigmentary issues, skin irregularities safely and effectively.

Commonly while discussing options to improve the lower facial appearance of the cheek and the jowl and the neck, we’ll have a look at the patient’s upper facial features.

We look at the quality and location of the brow tissue, frequently the brow can come down some, cause some hooding, so it’s not uncommon we perform brow lifts. Also, rejuvenation of the eyelids is important.

Sometimes people have excess skin inside of the upper eyelids, wrinkles, both medially and laterally, have to be improved by releasing potentially muscles in this area and also improve in the quality of the lower eyelid.

Evaluation of the structures of the lower eyelid is a very important and sometimes difficult part of establishing facial rejuvenation. There are many structures involved, there can be prominence of fat in the lower eyelid, there can be lack of fat, there can be laxity of skin, and laxity of the supporting structures below our eyelid.

Careful assessment of these structures of the lower lid will lead to the ultimate plan. Sometimes we remove excess fat, sometimes we even add fat to the area. And then frequently we’ll do a procedure to either smooth the skin or tighten it to give the most youthful appearance.

I think you could consider my approach to facial rejuvenation in sort of a holistic or all-encompassing context. As I mentioned it’s important to think of the three factors which have led to facial aging. Make sure you’re addressing those with each patient appropriately to give them their best final result.

Thank you, Dr. Murphy, for all the excellent care and patience you have given me through two bouts of breast cancer. You have helped me survive and thrive. Thank you to all the wonderful nurses in your office, too. They are always kind, professional and knowledgeable.CB