The Modern Browlift by Paul Howard, MD

There are a number of techniques to smooth the forehead and elevate the brow.  Practitioners always tout the technique they use as being the “best” but more likely the procedure some view as “the best” is primarily the operation they are more comfortable with.  Surgeon’s comfort should not triumph patient results for browlift or any procedure where the results of the two procedures are different.

The antiquated browlift requires an incision in the forehead skin – the so-called “direct browlift.”  In an attempt to hide the scar and elevate the brow without the hairline, surgeons flocked to the pre-hairline incision and many claim the very long incision is easy to camouflage and causes no problems.  Common sense belies these claims and most surgeons have abandoned this procedure due to the scarring involved.

The last 10 years has seen the development of endoscopic techniques which minimize the scars by placing the two short incisions behind the hairline while allowing access to the three glabella muscles and the forehead muscles from beneath the skin.  Elevating the brow must be accompanied by some sort of fixation to hold the forehead skin and brow in the raised position for at least 2 weeks. The brow elevation may relapse to its pre-operative position without fixation while the muscle surgery used to decrease glabellar rhytids (wrinkles) and sometimes forehead wrinkles is not fixation dependent.  These rhytids are improved by effectively weakening the forehead and glabellar muscles that cause wrinkles.

Over the last 8 years or so we have developed a unique and quite elegant way to fix the brow and forehead in the raised position with bio-absorbable screws that dissolve after the golden 2 week period of required fixation.  The polymer chosen must be strong enough to withstand screw placement in bone, must maintain its bio-mechanical properties for at least 2 weeks and must eventually be cleared from the body.  The material chosen is a co-polymer of polylactic acid.

The “Modern Browlift” is a well researched procedure with at least 8 years of documented results, short incisions, no hair loss, no prolonged numbness in the scalp and minimal to no elevation of the hairline.

Read more about brow lift and view brow lift before and after photos.

Call today to schedule your consultation 205-877-PAUL

The Perfect Facial Filler by Dr. Paul Howard

Botox and Restylane have become the mantra for those seeking facial rejuvenation without the inconvenience of having a “surgical procedure.”  While these off-the-shelf products are enticing, they are expensive, temporary, and can be painful to inject, especially in the lips.  For more Plastic Surgeons, these artificial fillers (Restylane, Juvederm, Strattice) are appropriate only for temporary improvements where there are time constraints and the need to be in public within a couple of days.  Searching for the perfect facial filler had been elusive until recently.  The emergence of fat from your own body (autogenous) has paralleled the refinements in fat harvesting and injection techniques that have elevated the “take” of fat injections to the 80-90% range.  Coupled with improvements in local anesthesia and anesthetic agents make the overall experience with the new fat injection techniques less painful and more likely to give a permanent, elegant improvement in facial contours and rhytids (wrinkles).  Many non-surgical practitioners complain of the donor site for obtaining the fat.  While we must respect the donor site, offering the patient an improvement in body contour by harvesting fat for injection offers the patient the benefits of a liposuction (method of harvesting fat) procedure and cosmetic improvement of the donor site as well as the areas of the face injected with fat.

What does the future hold for facial fillers?  Ongoing research using stem cell and growth factor technology may lead to even further improvements in fat injection techniques while artificial filler research tries to make their artificial substances last longer and the cost with longer lasting substances is naturally higher and will continue to increase over time.

Fat injection techniques have proven to be a vast improvement over foreign-body injections for facial rejuvenation.  Fat is permanent, soft, cannot be rejected by the body, natural, and requires only small (3-4mm) stab wounds for injection.  The patient can request which body area is preferred as a liposuction donor site obtaining body contour improvement at no additional charge.  The well informed patient will usually choose the elegance of fat injection over the expediency of foreign material injected in the face.

As an extension of fat technology, we have begun fat injections in the back of hands for hand rejuvenation.  The injected fat decreases the appearance of prominent veins, knuckles, and tendons that become more pronounced as we age.  No one should let their hand reveal their age when we have the procedures to reduce the signs of the aging hand.

Read more about top fat grafting surgeon Dr. Paul Howard and view fat injection before and after photos.

The MidFace Lift

Facial aging is complicated by genetics, environment, sun damage, smoking, and drinking.   There is not a single procedure that works for everyone, therefore it is important that individualized evaluation leads to an operation which is specific for that person.  The uniqueness of all faces as well as the patient’s desires may lead to a slightly different surgical approach for each individual.  Another way to say this is that the one-size-fits-all facelift has become antiquated.  To facilitate individualized care we prefer to look at each part of the face separately leading to a unique surgical treatment plan.

We divide the face into its component parts; forehead, eyes, midface, and neck with primary emphasis on the midface.  Midface aging is characterized by sagging of the facial soft tissues causing a deepening of the nasolabial folds, dark circles beneath the eyes, and the development of marionette lines from the corner of the mouth to the jaw line.  The jaw line becomes less defined as the sagging facial soft tissues drop below the mandible causing jaw line “bubble.”  In addition to the sagging soft tissues aging always involves a loss of volume and a loss skin elasticity.  It is the surgeon’s charge to address individual manifestations of aging for each component part of the face.  Elevating the soft tissues must be done and requires a specific vector or direction of elevation which may be unique for each face.  This maneuver defines the jaw line, improves the deep nasolabial folds, addresses the marionette lines, and elevates the lower eyelid skin.  This procedure is always required and must be performed accurately with minimal incisions.  Elevation of the cheek tissues is so important that it must be done under direct vision with the results being technique dependent.  The incisions are much less obvious than the old facelift scars.  While elevating the cheek and malar tissues some augmentation of the malar prominence (cheek bones) is achieved.  The need for additional volume can be affected by adding autogolous fat to the procedure.  As a rule of thumb, we rarely, if ever, remove fat from the midface but frequently add fat back to replace the soft tissues we lose over time.

The next issue to be addressed is the blending of the cheek elevation with the lower eyelids.  These procedures are typically done together; that is lower blepharoplasty and facelift.  The elegance and effectiveness of the mid-face lift sets up the rejuvenation of the remaining parts of the face.

Read more about Dr. Paul Howard’s Howard Lift Facelifts