Facial Surgery – Overview

Facial surgery is a highly customized procedure to suit each patient's goals and needs. Dr. Kirn offers the full spectrum of facial rejuvenation procedures, surgical and non-surgical, to help you achieve your desired outcome. Dr. Kirn believes strongly in minimally invasive surgery where those techniques are suitable for the patient. To determine what's right for you, a consultation is required. Alternatively, you may choose a complimentary computer imaging session with nurse Coral Heater to start the process and review the options. The information below is basic, so there may be additional options identified during a consultation.

Many Non-Surgical Options are also available for facial treatment and are covered in the Non-Surgical Procedures [hyperlink] section.

Blepharoplasty (Eyelids)

Blepharoplasty of the upper and / or lower eyelids may be performed independently or in combination with other facial surgery. The goal of blepharoplasty is to remove excess skin and fat from the eyelids and restore a youthful appearance. Many patients receive comments after blepharoplasty that they look rested or like they have had a good night's sleep. Blepharoplasty is not intended to change the shape of the eye or make the patient look different or unnatural.

The upper blepharoplasty places an incision in the crease of the upper eyelid. The lower lids are addressed either through an incision just below the eyelashes or inside of the lid. The below the lash incision is used most frequently because it allows removal of both skin and fat from the lower lid.

More and more, Dr. Kirn is combining fat grafting with blepharoplasty, just as with other facial surgery. For the eyelids, fat is most commonly placed along the "tear trough crease" extending downward from the lower lid as well as along the junction line between the lower lid and cheek to smooth out this transition.

After surgery, the patient uses ice on the eyes to avoid as much swelling and bruising as possible. Typically, the sutures are removed 3 to 5 days after surgery and the patient is allowed to resume use of makeup then. Blepharoplasty is usually performed at the Lexington Surgery Center as an outpatient. Either general anesthesia or sedation may be used.

Brow Lift

Dr. Kirn prefers the endoscopic brow lift technique so that a large incision is not necessary and sensation to the scalp and forehead is preserved. This operation utilizes 3 small (about one inch) incisions just behind the hairline. Using the endoscope, the muscles which create wrinkles in the glabella (the region between the eyebrows) are weakened. The brow is suspended at a higher level.

Many patients will describe the effect of the endoscopic procedure as having "opened their eyes." Brow lift is not intended to create a surprised or quizzical look. Brow lift is commonly combined with eyelid surgery, but may also be performed as a stand-alone procedure. It is performed using general anesthesia and is an outpatient procedure.

Some patients do not have descent of the brow, but are concerned only about wrinkles in the forehead or glabella. For those patients, release of the corrugator muscle through an eyelid incision (transblepharoplasty browlift) or simply the use of Botox® or Dysport® may be a desirable option.

Facelift

The goal of all facial procedures is to make you look younger. Although patients sometimes desire, and benefit from, procedures which make them look different (such as changing the shape of the nose), this is not a typical purpose of facial rejuvenation. Our goal is to achieve a natural look. As the technology has evolved, the importance of volume replacement has been recognized and that is the reason Dr. Kirn has performed fat grafting as a component of most facelift procedures for many years.

Facelift involves incisions located along the hairline in the temples, around and behind the ear, and possible along the hairline behind the ear. This allows removal of excess skin along with contouring of the subcutaneous fat and tightening of the muscles. Dr. Kirn prefers to run the incision behind the tragus, the cartilage projection at the front of the ear, to better camouflage the scar. Most commonly, the face and neck are addressed simultaneously; however there are times when these operations are performed separately.

Fat grafting is almost always used in conjunction with facelift to replace volume loss in the face. Fat is typically placed in the smile lines around the mouth, and the upper portions of the cheeks, to restore a youthful fullness. If the lips have lost volume over time, fat grafting is used to replace lost volume.

Most facelift procedures are performed using general anesthesia (patient completely asleep), in an outpatient setting at the Lexington Surgery Center. In nearly all of Dr. Kirn's facelift operations, the fibrin sealant, Artiss, is used to avoid the need for drains and limit the need of a chin strap or facial garment. In addition, Artiss helps decrease bruising and the risk of hematoma. Most patients do not find the facelift operation very uncomfortable, but it is important to allow for a sufficient recovery time before appearing in public. Typically, most patients will be presentable for the public within two weeks after surgery, although there can be significant individual differences.

Mini-Facelift

Several "minimal incision" facelift procedures have garnered media attention recently. Although each of these may represent a minor variation, the goal of all is to keep the incisions as short and as concealed as possible. Some of these only involve removal of excess skin and thus, will not provide a lasting benefit to the patient. The short scar / mini-lift Dr. Kirn prefers is the MACS lift procedure which was originally developed in Belgium. The scar for this procedure extends from the base of the temporal hairline (sideburn) at the top of the ear down to the bottom of the earlobe. The MACS lift uses strong sutures placed in the muscle layer of the face to provide lasting support to the cheeks. Dr. Kirn has been using this procedure routinely since 2006 and the duration of the result has been excellent thus far.

The MACS lift does not directly address the neck. However, some improvement in neck contour usually results. In selected cases, liposuction of the neck can be combined to further enhance neck contour. As with classic facelifts, fat grafting is almost always combined with the MACS lift operation.

In addition to the MACS lift, Dr. Kirn also offers another minimally invasive procedure, the subperiosteal midface lift. This procedure is designed to restore fullness to the upper portion of the cheek and smooth the transition from the lower lid to the cheek. Incisions for this procedure are located inside of the mouth and in the temples.

Almost always, fat grafting is combined with MACS Lift to improve facial contours. Similarly, eyelid surgery, brow lift, or other procedures frequently accompany the MACS Lift.

MACS lifts may be performed under sedation or general anesthesia (patient completely asleep). The MACS lift is an outpatient procedure performed at the Lexington Surgery Center.

Facial Fat Grafting

Many patients experience a loss of youthful facial fullness with time. A very desirable means to correct loss of volume is with Autologous Fat Grafting. Fat is harvested from any available body area, processed, and then re-injected into the volume deficient areas. Most commonly, lines around the mouth, smile lines, and the upper cheek area are treated. The lips also tend to lose volume over time and fat grafting provides an excellent method of restoring fullness to the lips as well.

Fat grafting may also be used for treatment of contour irregularities and depressed scars. Certain types of acne scars may be treated with fat grafting. Fat grafting may be used in other body areas as well.

Fat grafting has numerous advantages. Fat is your own body substance so you cannot be allergic to it. It has a very smooth and natural appearance and can be used in almost any body area. Grafted fat has a great longevity and can last years, if not indefinitely. Note however, that the aging process will continue. If facial volume loss is occurring before fat grafting, it will continue afterward. Thus, some patients benefit from fat injections performed periodically over time. Fat grafting also has some disadvantages. Since it is a natural filler, it does not always behave as predictably as a manufactured filler. When fat is transferred, a portion of the fat will survive in the new location and a portion will dissolve away. There can be considerable differences from patient to patient in the percentage of fat which survives and the percentage which dissolves away. Thus, multiple treatments may be necessary to achieve the desired contour.

Fat grafting is commonly performed in the operating room during other facial surgery. It may also be performed under local anesthesia in Dr. Kirn's office procedure room.

Neck Lift

Most commonly, the neck is lifted along with the face. However there are some patients who will benefit from an isolated neck lift procedure. Candidates for isolated neck lift have a well-defined jaw line without significant jowl formation. Neck lifts involve an incision located under the chin and usually small incisions at the earlobes or behind the ears. The neck lift operation tightens up the neck muscle, removes excess fat in the neck, and removes excess skin. Recovery is similar to facelift and involves the use of a chin support garment for several days after surgery. It is an outpatient operation, and is usually performed under general anesthesia at Lexington Surgery Center.

Rhinoplasty (Nose Surgery)

Cosmetic surgery of the nose (rhinoplasty) truly represents a blending of the art and science of Plastic Surgery. Rhinoplasty may be performed to improve the appearance of the nose, to restore the shape of the nose after injury, to improve breathing, or for a combination of these reasons. No two noses are the same, so it is very important for patients to consider exactly what they are interested in changing. Computer imaging is especially helpful during rhinoplasty consultation.

Rhinoplasty may be performed either through an incision across the columella (the division between the nostrils) or entirely through internal incisions. The needs and goals of surgery determine which incision is appropriate. Additionally, the nasal septum may be addressed simultaneously to improve breathing in patients with a deviated septum.

Rhinoplasty is an outpatient procedure performed using general anesthesia at Lexington Surgery Center. Not only does the use of general anesthesia provide the ultimate in patient comfort, but it also has a safety advantage by ensuring a secure airway during the procedure. Following surgery, most patients have a nasal splint which is a plastic guard on the bridge of their nose. Dr. Kirn almost never uses nasal packing. The splint usually stays on for 5 to 7 days after the procedure. Most patients will look presentable to the public within 1 to 2 weeks after surgery.

Chin Implant

Dr. Kirn enhances the contour of the chin either with a chin implant or with fat grafting. The porous polyethylene implants (Medpor ®) are solid, yet they allow the body's own tissue to grow into them. They are affixed to the bone to ensure that they do not move. Because they are solid, they look and feel like bone. Although they come in standard sizes, they are custom fitted to the patient during the surgery. An incision underneath the chin is necessary. Fat grafting avoids the need of an incision, but the degree of enhancement which can be achieved with fat grafting is less than with a chin implant in most cases.

Chin implants may be placed as a stand-alone surgical procedure or they may be combined with other facial surgeries, particularly nose surgery and face/neck lift. Chin implant placement is an outpatient procedure and is usually performed using general anesthesia. Chin augmentation by fat grafting may be performed in the office using local anesthesia.

Surgical Facility

Dr. Kirn performs most facial procedures at the SCA Lexington Surgery Center, which is an accredited outpatient surgery center. Our goal is to provide the best surgical outcome in a setting that insures maximum patient safety and comfort.

Anesthesia for Facial Surgery

Dr. Kirn works only with board-certified Anesthesiologists. Either general anesthesia (i.e., the patient is completely asleep) or a deep sedation is used for most facial procedures. All patients receiving anesthesia require someone to assist them in the early postoperative period.

Recovery from Facial Surgery

Some degree of swelling and visible bruising accompanies most facial procedures. The degree to which these occur determines the length of the recovery interval. Most patients feel better before they look better. Camouflage cosmetics can be very helpful in the recovery interval and patients are encouraged to utilize them at the appropriate time. We have an in-house expert, Marsha Clubb, in the Aesthetic Skin Care Center who can assist you with camouflage makeup as needed. For most facial procedures, use of an is pack is recommended minimize swelling for a day or two postoperatively.

Computer Imaging

Computer imaging is a part of all of our facial consultations. This advanced technology allows the patient and surgeon to develop a mutually agreeable surgical plan. It also gives the patient an impression of what can and cannot be achieved by the procedure. Imaging sessions are offered separate from surgeon consultations as a complimentary service with our experienced nurse.

More Information

Both the ASPS (American Society of Plastic Surgeons) web site and the ASAPS (American Society for Aesthetic Plastic Surgery) sites have more information about facial procedures. Ultimately, an imaging session or consultation with Dr. Kirn will provide the best information which can be directed to your specific needs. You may contact us by phone or e-mail to schedule an appointment.