I Hate my Cheek Implants. What are my Options?
Even if there is nothing wrong with the implants―they haven’t drifted, caused complications, or caused pain―if you are unhappy with your appearance, that is reason enough to seek an adjustment. A surgeon who doesn’t listen to your concerns about your appearance can be incredibly frustrating. If your original surgeon isn’t listening to your concerns, it’s time to find a doctor who will!
Removing old implants
Since the 1990s, implants have evolved to a more anatomic shape. Most implant-related issues are the result of oversized implants or implants that have settled in less than ideal fashion. Ill-fitting implants may require surgical removal, replacement, or both. Implant placement can be associated with motor nerve damage to the muscles of facial expression or can compromise the appearance of the lower eyelid. Sometimes post-surgical changes associated eyelid surgery may need to be revised at the same time the cheek implant is removed. As many of these situations have unique characteristics, Dr. Steinsapir prefers hand-carving a custom ePTFE implant to replace the old implant.
Revising the Submalar Implant
A submalar implant, which sits low on the cheek is a newer type of cheek implant. While this submalar volume positioned at a low level may have appeared complementary at the time of the surgery, some find that this implant begins to look objectionable as the face ages. Occasionally this problem is made worse because the original surgeon chose the wrong size of implant, or because the implant may not have settled correctly after surgery. In these circumstances, the best approach is to remove the original implant, and then replace the volume deficiency with a hand-carved custom orbital rim implant in conjunction with a vertical midface lift.
Other methods have also been described to address midface deficits. Cheek implants represent a classic approach to midface deficiencies. The implant is notched to accommodate the inferior orbital neurovascular bundle. More recently, a porous polyethylene implant has been introduced on the market to accomplish the same augmentation. However, these techniques provided only a modest improvement in the nasojugal groove and importantly it removes volume from the lower eyelid.
Choosing a physician
Because your current surgeon is not addressing your discontent to your satisfaction, it may be best for you to find a new surgeon to perform the adjustments to your cheek implants. When looking for a physician, make sure to choose someone who listens to your concerns and someone who is willing to work with you to find a solution that works with your face, your situation, and helps you to find a satisfactory conclusion.
About Dr. Steinsapir
Dr. Steinsapir is a much sought after oculofacial cosmetic surgeon. He is an innovator in minimally invasive cosmetic procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge facial surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Beverly Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care Please contact us today to learn more about how Dr. Steinsapir can help you attain your aesthetic goals.
What should I expect with my facelift surgery?
Facelift surgery is the most powerful of facial cosmetic surgeries you can undergo. Although we say it in practically every blog entry, in this instance it is more true than ever; choose a doctor who is experienced, up-to-date on the latest techniques, and skilled at performing facelifts. The procedure for facelift has changed significantly in recent years. What is clear is that there is not added benefit for the higher risk, deep plane facelift.
When it comes to choosing the best facelift for you, there is no right answer as to which method is the most effective, natural looking, or successful. A customized treatment plan, established by you and your doctor and based on your features and desires will significantly influence the outcome of your procedure. A facelift will always be a procedure of intelligent choices.
Where is surgery commonly performed and what type of anesthesia?
Typically facelift surgery is an outpatient procedure, but overnight stays may be recommended after deep sedation or general anesthesia. For certain individuals, your doctor can perform your facelift in the office, while you are awake and under local anesthesia. But for most, general anesthesia or deep sedation is the best choice. For cases requiring deep sedation and general anesthesia, Dr. Steinsapir performs surgery at the UCLA Ronald Reagan Medical Center and usually recommends an overnight stay at the surgery center.
Recovery and physical restrictions
A facelift takes approximately four hours. Usually there is minimal discomfort afterward; managed with either over-the-counter or prescription pain medications. You may experience moderate swelling around the eyelids and other areas of the face, but this is normal and is not cause for concern. Most find taking 7-10 days off from work about right. This time frame can depend on the precise nature of you work.
Common complications after surgery
Facelift surgeries performed by a skilled and experienced surgeon rarely have complications. The deep plane facelift mobilizes the tissue under the facial muscles and can injure these motor nerves causing facial weakness. The incidence is small but not zero. The risk amounts to only a very small percentage of individuals who receive this treatment experiencing this complication, but there is just no reason to risk this nerve damage when other methods of facelifts are available. In fact, there is essentially no cosmetic benefit to the deep plane facelift compared to other lifting methods. Other complications can include significant bruising and very rarely infection.
The time frame before full recovery
Recovery periods for facelift procedures vary greatly depending on the type of facelift surgery your physician and you decide on. Typically however, you can expect to return to work after 6 to 10 days. After 2-3 weeks, others are unlikely to detect that you just had surgery. Facelifts are not considered fully healed until about 6 months after. Once you have recovered fully, the results of surgery are very long term.
About Dr. Steinsapir
Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked at the top with a handful of medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center. Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns. Contact us today to schedule a personal consultation with Dr. Steinsapir.
Facial Sculpting with Microcurrent
Microcurrent facial sculpting is a rising trend, but buyer beware the cosmetic surgery fads. Like lasers, the term “microcurrent” sounds sexy and high-tech. But the reality of microcurrents is that they are a lot of hype and very little science. The use of microcurrent devices is essentially unregulated. FDA clearance of these devices is very simple for the manufacturers because the amount of current used is so small. The marketing for microcurrents would have you believe that by stimulating your facial muscles, your face becomes more toned and appears lifted and more youthful. There is no evidence that this is true.
The Truth About Microcurrents
Quacks have been touting the value of electrical current for healing for about as long as man has controlled electricity. Obviously, high voltage, high amperage devices are dangerous. What we are talking about here is very low levels of electrical current. Remember the adage that every good lie begins with a grain of truth. It is easy to understand that if you lift weights consistently enough, the muscles become toned. Proponents of microcurrent devices make the argument that the electricity of these devices will stimulate and tone the facial muscles and this will tone and improve the face, getting rid of wrinkles at the same time. Sounds great. The only problem is that there is not a single scientific study that supports this idea. We call this “phony science.” Microcurrents cannot, and will not lift and reposition the facial tissues. Even the claims of mild improvement are unproven. The harm here is that you are wasting your time and money and being deceived in the process.
Why all the Hype?
The hype surrounding microcurrent facial sculpting machines with unrealistic before and after pictures are equally misleading. Typically these before and after pictures show a loose neck and jowls next to a youthful and sculpted jawline and neck. These pictures could show the same person, but it is unlikely the differences were the result of microcurrent facial sculpting. The smooth, wrinkle-free neck is most likely the result of a little Photoshop magic and lighting, not microcurrent. These treatments offer empty promises. The treatment does not compare to a facelift or nonsurgical facial fillers.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Stem Cell Facelift vs. Fat Transfers
It is said that every good lie contains a grain of truth. The truth about so-called Stem Cell Facelifts is that fat harvested from your body does contain small numbers of adult stem cells. Taking that fat and transferring it to your face as a fat transfer does place these adult stem cells into the face. However, the promise of the name: Stem Cell Facelift is a lie. The implication is that these stem cells in some way rejuvenate the face. Like fad dieting and get rich quick schemes, the public can’t get enough of this type of hype. You would think at some point people would have learned that if it sounds too good to be true it probably is. You would be wrong. Enterprising cosmetic surgeons have learned this lesson as well. So we are bombarded with new procedures with enticing names that seem so scientific. It would be great if the Stem Cell Facelift was based on science rather than science fiction. Do so-called Stem Cell Facelifts provide facial rejuvenation? Yes, but not because of the adult stem cells in the fat. This is just a new way for cosmetic surgeons to insult your intelligence.
The Real Benefits of fat grafting
The reality is, there is no evidence to suggest that stem cells present in adult fat placed in the face have any impact or role in the effects of volumizing the face with grafted fat. Fat grafting procedures work because about 60 to 70 percent of the transferred fat survives, creating long-lasting volume and this helps improve the appearance of the face because loss of volume over time is an important factor in making one look older as we age.
Fat grafting is a biologically safe procedure because the fat transferred is from your body. It is precisely delivered through a tiny poke in the skin that heals without scarring and the procedure can be done under local anesthesia. The fat transfer in a “stem cell facelift” may be combined with other procedures like a traditional facelift or midface lift. It is more accurate to refer to a “stem cell facelift” as “facial volumizing with grafted fat.”
Fact and fiction
It is true that the stem cells in your body fat can be separated from the fat and, in a test tube at a research lab, be stimulated to develop into other cell types. There is a lot of impressive research being done in this area so we can learn more about important potential medical uses of stem cells. But there is no evidence to support the idea that the stem cells in the grafted fat are stimulated this way when transplanted from one part of your body to another
Finding a doctor who relies on science
The biggest concern with the “stem cell facelift” is not that it’s a bad or unsafe procedure, but rather that the term “stem cell” is a deceptive name that promises something that it does not deliver. When seeking treatment, make sure that your potential cosmetic surgeon relies on science, experience, and skill rather than catchy marketing phrases. Your doctor should be a specialist in facial cosmetic procedures and completely honest about what a treatment does and does not do. Relying on the honest application of skills, proven methods, and experience will help you achieve your goals. Deceptive marketing practices violate the principles that make a good working relationship between the surgeon and the patients, which must be based on well-placed trust and honesty.
About Dr. Steinsapir
Dr. Steinsapir is an expert cosmetic plastic surgeon who has skillfully handled face lift and fat grafting procedures in Los Angeles and Beverly Hills for over 20 years. He is a board certified ophthalmologist surgeon and fellowship trained in oculofacial surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert cosmetic surgery provider.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Complications after surgery
Complications following a midface lift and eyelid surgery are especially disconcerting because they can affect the basic functions of your eyes. Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason to be concerned. But sometimes, inexperienced surgeons panic in these situations (even long-in-practice, but inexperienced surgeons) and respond with a shoot-from-the-hip, fix-it mentality, and may push you to undergo corrective surgery immediately. Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may feel pressured to have a corrective surgery. There are certainly times where immediate work is appropriate. Before you agree to such a fix, ask yourself if you are still comfortable trusting your surgeon. In his book Blink, Malcom Gladwell describes the process of “thin slicing;” the way our intuition rapidly assesses a situation. That intuition is ignored at our peril. If the hair on the back of your neck is standing up because your surgeon wants to hustle you back to surgery, ask yourself: are you comfortable with what is being proposed? If you are not comfortable, your best course of action is the natural one―dig in your heals. There are occasional situations that are medical emergencies. However, these are truly rare. There is almost always time for a second opinion.
Undergo a consultation
Before taking any action to correct your complications, carefully weigh your confidence in your current surgeon. There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see, and fully understand the physical complications. Occasionally, the description of what is going on and the actual physical complications are not the same. Fixing complications is specialized business. Even if your surgeon does a lot of primary cosmetic surgery, he or she may be relatively unsophisticated when it comes to repairing surgical complications, especially when this work affects the function of the eyelids.
If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings. Do not blindly follow the recommendations your original surgeon or any surgeon whose recommendations do not make sense to you. Don’t commit to a second surgery unless you have a clear understanding of the following:
- What is going on and why these complications are occurring,
- What type of surgery your doctor has planned,
- Why a surgical solution is necessary,
- The risks of a second surgery, and
- The probability of success or failure.
The risks of midface and lower eyelid surgery and corrective surgery
Lower eyelid surgery and midface surgery have significant risks associated with them. Your surgeon may not fully understand these risks. If you’re experiencing complications it does not mean that your surgeon did something that another surgeon might have done in a similar circumstance. However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.
The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate. Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium. Some of the core papers describe anatomic hypotheses rather than proven anatomic fact. Unfortunately, a hypothesis is a scientific guess―it does not make an established anatomic fact. Lower eyelid surgery through the lower eyelid skin is one example of this. Surgery damages the motor nerves that help support the lower eyelid margin leading to complications that can surprise the unsuspecting surgeon. Naturally, they are not going to say that they are surprised but be assured they would not perform surgery this way if they thought it would cause a problem.
So why do doctors still perform this kind of surgery despite the risks? Despite the inaccurate papers it is possible to dissect in this plane in some cases without significantly altering the nerve supply to the orbicularis oculi muscle. Motor nerve damage to the orbicularis oculi muscle near the upper and lower eyelid margin affects the blink and weakens eye closed. Without this critical blink function, tears do not move across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.
The remedy for midface and lower eyelid surgery complications
To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal. By preserving as much of the lower eyelid function and not cutting out additional tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal. While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cometic eyelid surgery. Be skeptical of solutions that must be done “urgently” or don’t make sense. While very few of these complications mend themselves, with time it may improve so less work than originally thought may be necessary.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Should I get a Deep Plane Facelift?
There are so many different types of facelifts that you may be confused as to which might be the most appropriate treatment for your particular needs. A great facelift is not characterized by type, but by customization. The best way to get disappointing results is by looking for a cookie-cutter procedure. A skilled surgeon can produce amazing results with almost any method if he or she customizes the procedure to your individual circumstances.
The Risks of Deep Plane Facelifts
The deep plane facelift carries with it a risk of facial nerve injury even in the best of hands. This is because the nerves are exposed during the process of dissection. It is not possible to have a great facelift result if part of your face does not move correctly after surgery due to a facial nerve injury. This small risk might be justifiable if the deep plane facelift led to a much better result or a more long lasting procedure. The reality is, after six months it is impossible for experts to tell what technique was used in a particular facelift. So it makes no sense to perform high-risk maneuvers under the facial flaps.
Most any type of facelift can procure excellent results if customized by an experienced facial cosmetic surgeon. The deep plane facelift can be as effective as other methods, but it’s a riskier procedure and the benefits usually aren’t worth the risk when there are other options available. With the deep plane facelift, there is an increased chance of injury to a facial nerve that can even happen in the best of hands. The chance of these facelift complications are small but if it happens to you, the damages could be irreparable; some of your facial muscles will cease to work properly. Since properly functioning facial muscles are essential to your appearance, your results will not be good. Since there is no clear advantage to the deep plane facelift, why take the risk, even if it’s small? If you are set on receiving this method, you will probably find someone who will perform it for you if you knock on enough doors and have enough money, but may end up regretting your inflexibility.
About Dr. Steinsapir
Dr. Steinsapir is a board certified ophthalmologist (eye surgeon) and fellowship trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of BOTOX, which can be a vital part of your evidence-based treatment plan
Can I exercise my facial muscle for an improved tone?
Exercise and diet are essential for a healthy lifestyle, but it’s important to recognize their limitations. Not every condition can be cured by exercise, vitamin supplements or fad diets, especially when the problem is not a result of poor nutrition or inactivity. We absolutely encourage you to exercise moderately and eat well, but we admit to being skeptical of the arising claim that exercising facial muscles can restore youth and beauty to one’s face. This is an unproven method, and when one considers that they are likely still using their facial muscles just as much as they were ten years ago, it becomes apparent that their aging looks are unlikely due to facial inactivity.
It’s appealing to believe that we can resolve all of our concerns through exercise, and while research shows that exercise does benefit our health in many ways, it also shows that further medical treatment is required for many conditions. Just as someone with presbyopia cannot exercise to regain the ability to focus for reading vision, it’s not likely that you’ll be able to reverse the effects of age, time, gravity, and stress by wiggling your face or by having electrical currents stimulate your facial muscle to contract.
There are many types of facial cosmetic surgery and other treatment that can help you obtain the result you need if your doctor determines that you are a suitable candidate. These range from minimally invasive treatments with little-to-no downtime like BOTOX and undereye Restylane to surgeries like the facelift and plastic eyelid surgery including eyelid reconstruction, which give dramatic yet natural results to individuals with far-reaching concerns. While it is impossible to know which treatment, if any, is most suitable for you before a private consultation with the best facial cosmetic surgeon for you, you can be confident that there are a wide range of treatments that an expert can custom-tailor to meet your needs.
As a specialist in facial cosmetic treatments, Dr. Steinsapir has treated many individuals who first explored a variety of “natural solutions” for their aesthetic facial concerns. Frustrated when they saw no results, they eventually consulted with Dr. Steinsapir and opted for proven treatment methods that provide dramatic yet natural results. This human tendency to pursue unproven treatments is not a fault; it is normal to want to independently resolve a problem using the least invasive and most economical method possible.
Dr. Steinsapir is focused on your personal goals and comfort level. Dr. Steinsapir always asks you questions about your specific goals, individual situation, and preferences so that he can plan a solution that is aligned what you want, so you can feel comfortable knowing that you are ultimately in control of your treatment plan. Dr. Steinsapir very much believes in using the least invasive method for accomplishing a particular goal; for example, he does not recommend a forehead lift when a BOTOX treatment for wrinkles will will meet your goals – and he is a leader in his field of minimally invasive solutions.
If you are seeking a proven treatment with an experienced facial plastic surgeon with extensive training in oculofacial plastic surgery, we invite you to a personal consultation with Dr. Steinsapir today. Dr. Steinsapir is honest, friendly, and can talk to you about customized treatments that give you the results you seek by addressing your specific needs and unique facial features. Please call us today to schedule a time when you can speak with Dr. Steinsapir.
About Dr. Steinsapir
Dr. Steinsapir is a board certified cosmetic surgeon and oculoplastic surgeon in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves patients at UCLA, where he is an assistant
clinical professor. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of facial cosmetic surgery and eyelid reconstruction, which can be a vital part of your evidence-based treatment plan.
