Cosmetic Surgery Procedures Overview

Cosmetic oral surgery procedures are used to repair physical malformations resulting from disease, injury, burns, birth defects or aging. They may also serve to restore normal function and improve individual appearance.

Because of their surgical and dental background, oral and maxillofacial surgeons are uniquely qualified in the treatment of the face, mouth, teeth and jaws.

Extensive education and training in surgical procedures involving both the soft tissue (skin and muscle) and hard tissue (bone and cartilage) of the maxillofacial area make oral surgeons finely attuned to the importance of harmony between facial appearance and function.

Individuals elect to pursue cosmetic surgery for a variety of reasons. For some, the decision is prompted by the need to repair damage caused by accidents or birth defects. In many instances, however, individuals choose cosmetic surgery to improve their personal appearance.

This outlines some of the procedures available to you. In many cases, procedures complement one another and it is common for two or more procedures to be performed in a single operation. Post-surgery discomfort associated with these procedures can range from minimal to moderate and is usually controlled with oral medications. Incisions are typically made within natural folds or creases of the face, making scars inconspicuous. Scars should also fade significantly over time.

Before any procedure is performed, your surgeon will request a thorough medical history to evaluate your overall general health. A careful physical examination will also be conducted. You will discuss the procedure to be performed, the anticipated results, expected changes in your appearance, the type of anesthesia to be used, and possible risks and complications.
    
Cosmetic maxillofacial surgery may be performed on an outpatient basis in your oral and maxillofacial surgeon's office, surgical facility or surgery center, or on an inpatient basis in the hospital, depending upon your surgeon's and your preference. Surgery may be performed under general anesthesia, dental IV sedation or local anesthesia.

While a majority of patients report enhanced self-confidence and self-esteem after their surgeries, it is important to understand that the goal of surgery is to improve appearance. Cosmetic maxillofacial surgery will refine and enhance features that already exist. It will not give you a new face or a new life. How much or how little change is realized depends on the individual and the extent of surgery. Your age, health, skin texture, bone structure and healing capacity are all factors that can affect the results of your surgery.
    
Your expectations and attitude will also play a major role in your recovery. It is important that you discuss the procedure thoroughly with your surgeon and proceed with realistic expectations.
    
Cosmetic maxillofacial surgery will require patience on your part. The final result of your surgery may not be immediately apparent. Each procedure outlined entails a reasonable recovery period during which you may experience some swelling, bruising and discomfort which are part of the normal healing process.
    
Cosmetic maxillofacial surgical procedures are relatively common, but as with any surgery, cosmetic surgery entails a measure of risk. You should discuss with your surgeon the possible risks and complications of the procedure under consideration.
    
Costs vary depending on the geographic area and the complexity of the procedure to be performed. Cosmetic maxillofacial surgery is often considered "elective" rather than medically necessary and as such, it is normally not covered by insurance. Because insurance companies and policies vary, you should check with your agent to determine if your surgery is covered.

Facelift (Rhytidectomy) -- The natural aging process, genetic influences, exposure to sun and other factors cause the skin to wrinkle and sag as it fits the body more loosely.  Skin folds become more prominent, especially around the chin, jaw line and neck. A rhytidectomy, or facelift, can give you a more youthful appearance by tightening facial skin and muscles and removing excess skin.
    
When a facelift is performed, connective tissue and sagging muscles are tightened. In some cases, fat deposits are reduced from beneath the chin and neck, allowing the skin to reposition in a more ideal manner.

Nasal Reconstruction (Rhinoplasty)--Those displeased with the size or shape of their nose can improve their appearance through nasal reconstruction, or rhinoplasty. Rhinoplasty is one of the most commonly performed cosmetic procedures today.
    
During rhinoplasty, corrections are made by removing, rearranging or reshaping bone or cartilage. The procedure can straighten crooked noses, narrow or widen noses or remove humps. Rhinoplasty is usually not performed until a person has reached their mid-teens, when growth is nearly complete.

Cosmetic Surgery of the Eyes (Blepharoplasty, Forehead/Brow Lift) -- Blepharoplasty can correct sagging eyelids, pouches beneath the eyes and excess folds around the eyes. Brow and forehead lifts raise eyebrows and reduce ridges and furrows on the forehead, creating a smoother, younger appearance.
    
A blepharoplasty may be performed on either the upper or lower eyelids, or both during the same operation. Excess fat, muscle and skin are removed to eliminate sagging eyelids. Incisions are made in the natural skin creases around the eyelids, making scars inconspicuous.
    
A forehead and brow lift is often done in conjunction with blepharoplasty to improve brow positioning and reduce forehead wrinkles. During a forehead and brow lift, an incision is made across the top of the head behind the hairline. The forehead and brows are elevated and excess skin is removed from behind the hairline to hide the resulting scar.

Chin Surgery (Mentoplasty) -- Mentoplasty can increase or reduce the size of the chin. The best candidate for chin surgery is the individual with a receding or protruding chin and a normal dental bite.  For those with bad bites or malocclusion, jaw surgery, in conjunction with mentoplasty, may be necessary.
    
There are two basic procedures used in mentoplasty. One involves moving the chin bone forward or backward. The other involves the use of artificial chin prosthesis to add size to a receding chin. To move the bone forward or backward, the surgeon cuts through the chin bone. The lower portion of the bone is then moved forward or backward and wired or fixed to keep it securely in position.
    
A chin prosthesis can also be used to create a more prominent jaw. Using this technique, a prosthesis, similar in consistency to the natural chin and sized to fit the patient, is placed in front of the bone to increase the chin's prominence.

Cheek Implant (Malar Augmentation) -- Malar augmentation can give definition to a face that has flat contour because of underdeveloped cheekbones. The best candidate is the individual with a long narrow face or very round face and flat cheeks. This surgery can help to create the appearance of higher, more prominent cheekbones.
    
During the procedure an incision is made either inside the mouth or immediately below the lower eyelids. Most frequently, using the internal approach, the surgeon makes an incision between the upper gums and the cheek. The surgeon then elevates the soft tissue, creating a small pocket over the cheekbone. A prosthesis, similar in consistency to the natural cheekbone and usually triangular in shape, is then inserted and placed over the cheekbone.

Facial Liposuction -- Even people who are not overweight may be plagued by a double chin, saggy jowls or a very round face. Fat deposits in these locations may be hereditary or due to the natural aging process. These areas are often resistant to exercise and weight loss. Facial liposuction can benefit those who want to remove unsightly fat deposits from localized areas of the face. Individuals who are in good physical condition with good skin elasticity are the best candidates for this surgery.
    
The surgeon makes small incisions along the jaw line, in the cheeks or below the chin, depending upon which fat deposits are to be removed. A tube attached to a high pressure suction device is inserted deep in the fat. The surgeon moves the tube back and forth to loosen excess fat from surrounding tissue and then "vacuums" the loose fat from the face with the suction device.

Treatment of Facial Wrinkling (Chemical Peel) -- A chemical peel is a procedure for treating skin that is wrinkled, scarred or otherwise damaged and is used for both cosmetic and therapeutic purposes. The procedure is helpful for wrinkles, light acne scarring, and irregular pigmentation such as freckles and age spots. Pre-cancerous conditions such as keratoses (thick, rough, reddish growths) also respond well to chemical peel.
    
There are several types of chemical peels: a light peel to remove superficial wrinkles, a medium depth peel and a deep peel for more severe conditions. After thoroughly cleansing the skin, the surgeon uses a small applicator to apply the chemical solution to an area of the face. Excess solution is removed and the surgeon repeats the procedure on other areas.
    
The amount of improvement varies and depends upon the initial condition of the patient's skin. Significant improvement of damaged skin has been achieved, which can produce dramatic results.

Treatment of Facial Scarring (Dermabrasion) -- Dermabrasion is a surgical procedure in which skin that has been scarred from trauma, acne, pox, or other causes, is "sanded" with a rotary abrasive instrument. This "sanding" evens out the skin to give it a smoother texture. Dermabrasion may also be used to treat tattoos, age (liver) spots, wrinkles and certain skin lesions

Remember, the decision to have cosmetic maxillofacial surgery is not one to be taken lightly. If you are interested in learning more about these procedures and determining if you are a candidate for cosmetic surgery, please consult a board certified plastic surgeon.