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Question:

The number of different facelift techniques out there is confusing.  I would really like to get a facelift but I do not even know where to begin.  Can you describe what some of the more common and more effective techniques are and what they can improve?

Answer:

In my opinion, a  well-designed facelift is an absolutely superb procedure.  The incisions are hidden very nicely along  the tragal edge of the ear and post-auricular into the hair.  It lifts up the skin beautifully and it  tightens the underlying SMAS or supporting structures very nicely. In the hands  of an experienced facelift surgeon, a good facelift can be done in about two  hours and it can be done even under local anesthesia or certainly IV sedation  to make you comfortable.  The risks are  minimal and the results are absolutely excellent.  A good facelift will take many years off of  you without looking like any surgery was done.

Question:

I am 43 years old. Many years ago an older friend told me you should get your first facelift when you are 50 years old to maintain your looks for later in life. Is this true or is there a rule of thumb as to when you should have a facelift?

Answer:

A facelift is an excellent procedure and in our office, as the years have gone on in my 25 years of practice, we seem to be doing facelifts on younger and younger patients all the time. Most of that has to do with the awareness of people who choose to have their facelifts at an earlier age. A facelift is certainly an appropriate procedure and can be done as long as there is need for it. If you are 43 years old and you have significant jowls or some drooping that you do not like and your neck is beginning to show some problems, you can certainly begin to have a facelift at that age. You are never burning any bridges because if the facelift is done right it can be repeated one, two or even three times if needed over the years.

The nice thing about doing a facelift at an early age is that the amount of work done is usually minimal to get an excellent result and at a time in your life when you are very busy and outgoing, you are also looking your best. Again, it is certainly not too young to do a facelift at 43 years old just as long as there is actually something that can be improved by the surgery itself and it has no affect on whether you get one later in life because you can still do excellent work ten years down the line if you should require more work done at that point.

Question:

I am 57 years old and looking to improve same aging signs in my face. I am not entirely sure what I need, whether I need a full blown facelift or injectable fillers will do or maybe I would better benefit from a brow lift or eyelid lift. I think that I really need a consultation with a doctor. Which of your doctors perform facial surgeries and what are their qualifications?

Answer:

First of all, you are correct that the best way to figure out which procedure would be best for you would be through a live consultation. We do have facial plastic surgeons currently in New York City; Aventura, Florida; Los Angeles; and Miami. We also intend to expand over the coming years so please keep checking at www.plasticsurgeryoftheface.com for other locations, which are opening regularly throughout the nation as far as where we are located to perform these procedures.

Many of our patients come in from out of state or country and often times a live consultation is not possible considering the time and expense of flying across state lines or across country to meet with one of our doctors. A second option beyond a live consultation would be a webcam consultation. If you own a webcam or if you simply stop by a local electronics store for probably $25 to $100 you can purchase a simple webcam that plugs into your computer and works very simply. You can also schedule a live webcam consultation with one of our doctors from anywhere in the world where you can essentially meet the doctor without physically being there. Third, and as a last resort, if there is no possible way to have a webcam consultation or a physical live consultation, you may also submit photographs to us through our website and one of our doctors can review those photographs for you and make a recommendation.

As far as what type of procedure you might need, the important thing is really to look at the areas of the face. If you feel that something is needed below the cheeks or below the ears, it is likely that a mid facelift or injectable fillers would make the most sense. If you feel that your signs of aging are mostly in the eye or forehead area, than fillers, brow lifts or eye procedures would make more sense. As far as which procedures, it is agreed that a consultation be advised. Photograph review or live webcam meeting would also work. As far as which doctors perform these procedures, they include the following:

As of this moment, Dr. Jeffrey Epstein performs these procedures. He is a former President of the Florida Society for Facial Plastic Surgery, a clinical instructor at the University of Miami Medical School and he has been performing these procedures for over 18 years. He has performed over 10,000 total cosmetic surgery procedures.

Posted by Jon Hoffenberg, Executive Vice President FHRPS

Question:

How is a temporal brow lift different from a traditional brow lift?  Is it true that it can be performed in a doctor's office?

Answer:

A temporal brow lift  is something that is usually done with small incisions in the temporal area and  the temporal hair.  It hides very nicely  and it works beautifully to get rid of brow ptosis or sagging in the lateral  aspect of the eyebrows. The big advantage of a temporal brow lift is most  people primarily have problems with sagging of their eyebrows on the lateral  aspects and do not want a big incision or a major operation just to correct  that problem.  Also, since it is hidden  in the hair, the operation hides very nicely. Again, the big difference is  that, unlike a traditional brow lift, it does not involve an incision across  the whole scalp and can certainly be done in a doctor's office in about 35 or  40 minutes under local anesthesia.

Question:

I would like to get a facelift and chin augmentation. Where do your surgeons perform their procedures? Do you have an operating room in your office or are they performed in a hospital or outpatient surgery center?

Answer:

For our patients who are having facelifts or chin augmentation procedures, as well as other facial plastic surgery procedures, the great majority are performed in our offices. Several of our doctors have certified operating rooms. For example, Dr. Epstein has an AAA HC certified operating room for performing surgeries. If necessary or desired, all of our doctors are willing to perform the procedure at the local hospital or outpatient surgery center. However, most doctors prefer to perform these procedures in the office for the following reasons. First, this is where the great majority are performed so each doctor is used to performing their procedures in their own offices. Second, because of our high levels of certification, the environments are sterile and incredibly clean. Third, and perhaps most importantly, hospitals are often time places where people go when they are feeling ill, which means it is a fairly simple place to go and catch some sort of illness or virus, often times very resistant viruses. Because of that, most patients prefer to have the procedure in our offices because our offices are filled generally with very healthy people which means that there is less chance of any sort of infection or virus being picked up by a patient. For that reason, Dr. Epstein, as well as most Foundation doctors, prefer to perform basic procedures in their offices versus at the hospital. In rare cases for very involved IV sedation cases or where insurance is involved, often times they will be performed at the hospital or outpatient surgery center.

Posted by Jon Hoffenberg, Executive Vice President FHRPS

Question:

Ever since my  blepharoplasty my lower right eyelid has been numb.  It has now been two and a half months.  I am getting worried that this should have  cleared up by now.  Is this something to  be worried about and when will the numbness finally clear up?

Answer:

I would say that at  two and half months, if you still have numbness under your lower eyelid, that  is definitely of some concern.  When I do  a blepharoplasty, I rarely have any numbness underneath the eyelid and  certainly if I saw something there after about two weeks I would have some  concern about that. It still may clear up and I am not sure there is anything  specific that can be done for it even if it does not want to clear up, but I  would say at two and a half months there is definitely some concern that it may  be permanent.

Question:

I had my nose job about five weeks ago and the swelling seems to be coming and going on a daily basis. In the morning the swelling is really extreme but then it sort of fades as the day goes on and it is significantly less by the end of the day. I knew to expect swelling but I did not expect this. Is it normal or should I be concerned?

Answer:

The type of swelling that you are describing is very normal after a nose job. Five weeks is not very long and we see swelling to some degree for two to three months after a nose job. Also, there will be some residual swelling possibly for up to a year.  The kind of swelling you are explaining, which is more noticeable in the morning and disappears by the end of the day, is significant for the fact that when you lay down flat your head has more fluid in it and there is obviously more swelling in the nose. As you spend most of the day standing up or sitting and gravity can take hold, it removes much of the swelling that is in the face and the nose. This is very common in anyone who has surgery on their face, whether it be a nose job or a facelift. If you do not have redness or tenderness or any evidence of an infection, I would say your swelling at this point sounds very normal to me and with a little patience should disappear nicely.

Question:

I am interested in getting a brow lift and was just wondering how you deal with payment for the procedures. Do you require everything to be paid up front or can you pay in installments?

Answer:

Dr. Epstein does specialize in brow lift procedures as well as, essentially, all facial plastic surgery procedures. As far as payment options for the procedure, all of our patients can either (a) pay with cash, (b) pay with credit cards which includes Visa, Master Card, American Express or Discover, or (c) they can use one of two payment options through outside finance companies. Those two companies are www.chasehealthadvance.com which offers a 12-month, 0% interest plan and www.carecredit.com which offers 2 years, 3 years, 4 years or 5 years with interest. Both are good options and there are certain requirements that need to be met. For example, the patient must have an American Social Security Number, must be able to provide other details, personal information, and must have acceptable credit scores to be approved for these payments plans.

Those are all of the options that are available to our patients to help pay for the brow lift and other procedures. These payment plans, of course, are subject to change over time but at all times Dr. Epstein's office does offer different payment options for his patients.

Posted by Jon Hoffenberg, Executive Vice President FHRPS

Question:

I am 51 years old and had a facelift almost a year ago. I am not happy with the results. It looks like I am surprised all the time. It is too early to see the final results of the surgery. Can you repair this type of problem using a corrective surgery procedure?

Answer:

A facelift that is a year old should be looking perfectly normal by now. I like my facelift patients within three to four weeks to have a natural look to them. If it has been a year and you still have a surprised look, I would say that you definitely have a problem and you are looking at your final results. The facelift will loosen up but it will loosen up over years as happens with natural aging that goes on after a facelift. If you are not happy with how you look, my suggestion is to consult the surgeon to see about corrective surgery. A good many times a bad facelift can be corrected and you can look much more natural and not have to sit biting your nails waiting for it to loosen up on its own.

 

Hi!  I am Dr. Epstein.  I am with a patient today who is around 10 weeks status post rhinoplasty of African American ethnicity.  That is the only identifying characteristic I am giving so she can stay anonymous.

Her main complaint was that she wanted to preserve her ethnic features which we all agree is important but at the same time she was concerned about the width of her nostrils that especially extenuated when she smiled.  You can see how wide her nasal tip appears on smiling.  She has a pretty smile but this really became the focus, that very wide nostril area.  You can see from another before view.

What I did for her was a combination of refining the tip, narrowing the nostrils.  You can see her here and you can see how nicely she has healed and the greater symmetry.  She is still a little bit off but there is just a limit to the amount of symmetry that I can create. 

You can see if we look down at the bottom view she had an external approach.  You cannot even find the incisions, barely if at all perceptible.  I also made incisions inside the nostrils to go ahead and deal with the nostril narrowing.  You can see I was able to bring it in quite nicely.

Smile for me.  You see when she smiles now she still has some widening but at the same time she goes ahead and it is a more refined look.

She is around 10 weeks post operative.  We may want to do a little touch up at some point just to bring in one of the nostrils to create a little more symmetry but that was the challenge that she did have this asymmetry.

She is happy and she was nice enough to sit for the video.

Thank you.

 

Posted by Jeffrey Epstein, MD, FACS



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