FACES FIFTH AVENUE

SPECIALIZED IN AESTHETIC & RECONSTRUCTIVE SURGERY OF THE FACE

With a particular focus on the eyelids, orbit and nasolacrimal system.

Lower Lid Fullness

A common concern among patients is the appearance of bags under the eyes that make them appear tired, drawn and older than they wish. Lower eyelid bags occur in different people for different reasons; genetics, bone structure, loss of facial volume with aging, gravity, allergies and protrusion of the fat within the eye socket are just a few of the causes. Depending upon the severity of the bags, there are many non-surgical options that may help reduce the appearance of the excess tissue. Skin treatments such as chemical peels, skin resurfacing treatments such as Fraxel® or skin tightening treatments such as Thermage® may be all that is needed to correct the bags. In some cases the bags may often be masked by hyaluronic acid (HA) fillers such as Restylane® or Juvéderm® where a small amount of the material is gently injected into the area around the bag to mask the puffy area created by the excess tissue. In severe cases the bags can only be completely corrected via a lower eyelid blepharoplasty (also known as lower eyelid surgery).

Depending on the patient different techniques are used to achieve the desired surgical result like in younger patients with minimal excess skin present, a transconjunctival lower lid blepharoplasty may be performed. This procedure involves making an incision inside the eyelid to minimize any appearance of a scar. In older patients or those with more excess skin, a transcutaneous lower lid blepharoplasty may be performed. This procedure involves making a small incision 1 to 2mm below the eyelash line on the lower eyelid, removing the excess skin and repositioning the lower lid fat or removing it completely.

Upper Lid Fullness

One of the primary concerns that patients often desire to improve, is the drooping of the upper eye area. This droop is often a result of the loss of skin elasticity and its diminished ability to “snap back” over time. In addition, there may be excessive fat pockets present, resulting in a “heavy” appearance of the upper lids. For patients with a larger amount of excess skin and tissue, an upper eyelid blepharoplasty (also known as an eye lift) may be an appropriate solution. A blepharoplasty is an outpatient surgical procedure that consists of making an incision in the crease of the eyelid, removing the excess skin and repositioning (or resculpting) the fat to a more appropriate location. The results of the surgery are a more open, vibrant and well-rested appearance of the eyes.

Droopy Brow

Often a heavy and droopy brow area can cause hooding of the upper eyelids resulting in a sad or tired appearance. Depending upon the severity of the droop, there are effective non-surgical and surgical techniques that may help to restore the brows and forehead to a more youthful position offering a brighter and refreshed eye and forehead area.

Non-surgical Treatments for Droopy Brows are , botulinum toxins such as Botox® Cosmetic or Dysport® which can be injected into specific muscles that are responsible for raising the eyebrows to help open up the eye area and provide a well-rested, natural result lasting 3-5 months. If a mild brow droop occurs at the outside edge of the eye area, then in addition to botulinum toxin, dermal fillers lasting 6-12 months such as Juvéderm®, Restylane® or Radiesse® may be injected to lift the tip of the brow and open up the eye area.

Surgical Treatments for Droopy Brows: If a brow droop is moderate to severe, then a brow lift (also called a forehead lift) is often the best option for surgical correction. In addition to raising the eyebrows for a more alert and youthful eye area, a brow lift also helps to smooth creases that develop across the forehead and soften frown lines that often appear high across the bridge of the nose and in between the brows (the 11's).

Depending upon each patient's specific anatomy and the severity of the brow droop, there are several surgical techniques that may be employed to achieve the desired result.

Endoscopic Brow Lift: The surgeon uses a small camera to perform the surgery with smaller incisions behind the hairline than with traditional brow lift techniques.

TransBleph Lift: For those patients with thinning of the hairline or patients who could benefit from both upper eyelid surgery (blepharoplasty) and a brow lift simultaneously, a TransBleph procedure may be an appropriate option.

Temporal Brow Lift: If the central portion of the brow area is well positioned but the outer edges of the brow droops, then a temporal brow lift may be an appropriate surgical option.

Direct Brow Lift: For those with a very heavy brow who do not mind their forehead furrows. A direct brow lift procedure entails making incisions above the brow line in the forehead within the natural crease in the forehead or above the eyebrow so that any remaining scars are hidden after the healing process is complete. A direct brow lift may also be appropriate for facial nerve palsy patients with asymmetric forehead furrows and brow

Hollow Eyes

Hollow Eyes/Dark Circles (also referred to as tired or sunken eyes)

Many people complain that their lower eye area is hollow or they have dark circles under their eyes, thus making them look tired and older than they feel. This is a common concern that often presents in combination with other challenges around the eyes. There could be several issues at hand in this situation that warrants a consultation with a physician for treatment options. In some patients, the positioning of the brow bone may cast a shadow under the eyes. In this case, hyaluronic acid dermal fillers such as Restylane® or Juvéderm® may be used to augment the orbital rim below the eyes to create more balance between the brow and the lower eye area. Also, surgical implants may be an option if more volume is needed than a filler can provide.

In some cases, patients have "bags" or pockets of fatty tissue under their eyes that cast a shadow in the lower eye area. If the bags are mild to moderate, dermal fillers may be used to hide the bag and remove the shadow. Also, other non-surgical treatments such as chemical peels, skin resurfacing treatments such as Fraxel® or skin tightening treatments such as Thermage® may help. In some patients, a lower eyelid blepharoplasty may be the appropriate solution.

Deep Laugh Lines & Marionette Lines

While Botox and Dysport are effective choices to relax muscles and soften lines and wrinkles caused by muscle movements, dermal fillers offer complimentary effects in deeper lines and/or to help reshape and contour the face. Depending upon the needs of the patient, there are several choices in dermal fillers.

Hyaluronic acid (HA) is a naturally occurring and abundant substance in our skin that draws in water to help hydrate the skin. Age, sun exposure and other factors cause the amount of HA in our skin to diminish over time, contributing to a loss of volume and the appearance of wrinkles and folds. HA fillers are composed mainly of hyaluronic acid; thus, they help restore lost volume in the face and minimize lines and wrinkles. Some different types are: Juvederm, Restylane and Perlane.

For more significant volume loss Radiesse may be an appropriate option. Radiesse is different from HA fillers in that it contains calcium hydroxylapetite microspheres that, when implanted, help stimulate natural collagen growth.

Sculptra Aesthetic is a different type of facial injectable in that it works to replace lost collagen, over a series of injection sessions. Sculptra Aesthetic is made from poly-L-lactic acid particles, a biocompatible, biodegradable synthetic material that has been used by physicians for decades. When injected into the deep dermis, collagen fibroblasts form around the particles to gradually replace lost collagen in the skin. It works to correct shallow to deep facial wrinkles and folds as well as volumize hollow areas of the face such as cheeks and temples.

Sagging Face/Neck/Jowls

Often as people get older the cheeks, eyelids, lower face and neck begin to sag and lose volume. Loss of volume in the cheek area causes the folds / lines seen around the nose to the corner of the mouth (called the nasolabial folds) to deepen and as everything sags down so does the lower eyelids, jowls and neck. One non-surgical technique though very dependant on the skin laxity is Thermage.

During a Thermage® procedure, radiofrequency heat penetrates deep into the skin to create tiny wounds. In response, the skin acts to repair those wounds, which leads to the remodeling of collagen and elastin, resulting in tighter, more youthful appearing skin. Because the laser penetrates the skin with a surfacing cooling technique, it leaves much of the skin intact, leading to faster healing times than more traditional ablative treatments like CO2 laser treatments. It usually takes from 20-90mins depending on the size of the treatment area and requires no downtime.

Droopy Lower Lid

Often known as Ectropion. This is a condition where the lower eyelid turns outwards. Most patients usually complain of dry, painful eyes, redness and excessive tearing often with the tears streaming down the face.

It can be caused by skin laxity which occurs as we advance in years or it could be due to more mechanical restrictions, such as a previous lower lid blepahroplasty being performed incorrectly or facial palsies. There are 2 different surgical procedures available to treat this condition, one is to tighten the muscle that holds the eyelid into position or if there is scarring present then a skin graft material maybe needed.

Midface Hallowness

Often known as Ectropion. This is a condition where the lower eyelid turns outwards. Many patients complain of dryness, discomfort, redness and excessive tearing often with the tears streaming down the face.

It can be caused by tissue laxity which occurs as we advance in years or it could be due to more mechanical restrictions, such as a previous eyelid surgery or facial nerve palsies. There are several surgical procedures available to treat this condition and restore normal appearance and function to the eyelids.

Face/Neck Laxity

Often as people get older the cheeks, eyelids, lower face and neck begin to sag and lose volume. Loss of volume in the cheek area causes the folds / lines seen around the nose to the corner of the mouth (called the nasolabial folds) to deepen and as everything sags down so does the lower eyelids, jawls and neck. One non-surgical technique though very dependant on the skin laxity is Thermage.

During a Thermage® procedure, radiofrequency heat penetrates deep into the skin to create tiny wounds. In response, the skin acts to repair those wounds, which leads to the remodeling of collagen and elastin, resulting in tighter, more youthful appearing skin. Because the laser penetrates the skin with a surfacing cooling technique, it leaves much of the skin intact, leading to faster healing times than more traditional ablative treatments like CO2 laser treatments. It usually takes from 20-90mins depending on the size of the treatment area and requires no downtime.

Photo Damage

Over the course of many years, unprotected exposure to sunlight can alter the appearance and consistency of the skin. Furthermore, it may lead to malignancies in the skin that may go undetected for many years.

After careful evaluation, it is generally possible to reverse many of the cosmetic effects produced on the skin with a combination of topical treatments as well as interventions using chemical peels, Intense Photo Light (IPL) and/or various lasers.

Red Spots Rosacea

Rosacea is a common facial inflammatory condition affecting an estimated 14 million people. The condition is characterized by patches of redness and sometimes pustules, visible vessels and papules on the face. While the cause is not well understood, a number of treatments are available including oral and topical therapy as well as the application of lasers and intense photolight (IPL).

If you suffer from this condition, a careful evaluation can provide you with excellent andlong-lasting solutions.

Excess Hair

Excess hair in undesirable places can be caused by a variety of conditions or simple heredity. In most cases, this condition can be managed by the use of advanced technology such as Palomar's IPL (Intense photo light) system. In most cases, the area of concern can be treated in several office sessions. The results are generally long-lasting and largely superior to home remedies or technologies used by many med spas.




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1034 Fifth Avenue
New York, NY 10028