• Forehead Lift is there to improve the tired look from low eyebrows and diminishes the frown lines. With aging the eyebrow is lowering and it gives the eyes the look of tiredness. The best way to evaluate if you would be a candidate for a brow-lift is to stand in front of an mirror and to relax your forehead. The relaxed forehead is important for the evaluation of the eyebrow position. Normally the lateral brow is higher and the eyebrow should be above the bony part of your eyeball. Some people are having tension headaches, which can be related to the constant frowning of your forehead to keep your brows up. The incision is disguised in the scalp or along the hairline.

• Facelift (Rhytidectomy) tightens the loose skin of the face. It does not change the eyes or the forehead and has some effect on the neck. The droop of the cheeks and the jowling are a good indication for the facelift surgery. The method is to undermine the skin and to remove the excess. At the same time the underlying muscle is tightened. The incision is concealed behind the ear or in the scalp for most of its length. To decrease the fold between the nose, lip and cheek (nasolabial fold) which is only minimal touched by a facelift, we usually augment this area with fat or other augmentation materials. Often the facelift has an extension into the neck (neck lift).

• Eyelid Surgery (Blepharoplasty) removes the loose skin and bagginess from around the eyes and gives them a fresher appearance. The excess skin is marked and excised. At the same time the small pouches of herniated fat are removed. The incision in the upper eyelid is usually not noticeable, and the incision for the lower eyelid is in the inside of the lid and not visible (transconjunctival). Blepharoplasty does not remove the fine crepiness or the crowfeet from your eyelid skin. For the fine lines we are using the laser or the chemical peel.

  

• Nose Surgery (Rhinoplasty)
  We may be born with a nose that seems to large or to disproportionate for the rest of our face or we were involved in an accident which caused a deformity of our nose. In either case the nose surgery can change the appearance of the nose. The hump can be removed, the size be reduced, the tip position be changed. The best is to have you evaluate your nose from the side and front view and notice things you like or dislike on your nose. Please also discuss your concerns with friends to see if they feel the same way. The incisions for the nose surgery are usually made inside the nose and only a small incision on the outside of the nose is occasionally used, but is really visible.

  

• Neck Lift tightens the skin of the neck and gives a smoother and more defined line around your jaw line. The method is to undermine the skin and remove the excess. At the same time the underlying muscle is tightened. The incisions are concealed behind the ear or in the scalp and under the chin for the most of its length. In men with heavy necks this surgery has to be often redone in one year.

• Skin Resurfacing
  There is often confusion about the difference between these operations. They all do basically the same thing, by removing the surface layers and restructuring the deep layers of the skin they improve the appearance and get rid of many fine line and imperfections.

  • Laser: many different lasers are available for the treatment of different conditions. The best laser for the resurfacing of the skin with the best long term follow-up is the CO2 laser. It is now used for the last 3 years and showed good success in the treatment of wrinkles. It has a few limitations in the use of patient with dark pigmented skin. These patient are not good candidates because they develop areas of severe pigment changes. The other problem is the prolonged healing time with redness of the skin for up to 6 months. The pre-op and post-op treatment is also very extended with different medications. We usually start you on Retin-A, a bleaching creme and glycolic washes 2 months before the surgery and continue with them. The ERBYIUM laser was introduced 1997 and has the potential to widen the spectrum of patients which can be treated with the laser. The studies showed no problems with the pigmentation in darker skinned patient and the healing period is markedly reduced with this new laser. The ERBYIUM laser seems to work for fine lines and wrinkles in the midage patients of all races. The future will tell us, if this laser is as good as promised.
  • Chemical Peel: we using 3 different peels in our practice: phenol,
    TCA  (trichloracetic acid) and glycolic. Each of the different solutions has its place in the treatment of fine wrinkles.
    The skin care program is the same as for the laser patients.
  • Dermabrasion: is mainly used for the treatment of acne patient and for the revisions of scars. It is a sanding down of the skin surface. Pigment changes can also be seen with this treatment.

• Augmentation of Lips and facial Folds is often indicated when the aging involves the lips and the folds around the nose and lips. Resurfacing techniques can only give small improvements
  and the facelift and neck lift are only of limited use. Special surgeries are performed in the direct area around the lips and the facial folds. These surgeries are usually causing scars and have only limited use. During the last years different techniques with different materials were developed. Most of the materials have risks and disadvantages and their indication has to be carefully weighted.

  • FAT is always available and can be harvest from your tummy or the lateral thigh area. The
    fat is then washed and injected in the facial areas. The fat is your own and causes virtually
    no problems. The only disadvantage of fat injection is their unpredictable character. In some patient it works great and shows permanent results after 2-3 injections, in other patient it
    does not seem to work.
  • Collagen is derived from cattles and can be easily injected after a skin test was performed. The use of collagen is easy, but we know that it only works for 2-3 months and we have to reinject these areas afterwards.
  • Goretex is known to you from your clothing materials. Goretex is well tolerated by the body and has a lot of medical indications. The Goretex is placed in the desired area and stays
    there forever or until it is removed. The Goretex material is foreign and therefore not liked by some patients, it can also feel unnatural and stiff in some areas of the face.
  • Alloderm is derived from the skin of a cadaver. The material is tested for all diseases and is sterilized. The material can be placed in the lips and folds. It feels usually natural but we are not able to say if this material is permanent. The first studies showed the material to be relatively lasting but the last word is not said about this material

• Botox has been used for the last 2 years in facial cosmetic surgery. The Botox is an solution which paralyses a small area in the muscle injected. The Botox is used for Crowfeet, Frown lines and for mild cases of brow ptosis. By paralysing the muscle the frown lines and the crowfeeets
  are decreasing. The material is injected in the desired area and has very little side effects. Our longterm studies showed the Botox to be effective for around 6 months before the area has to be reinjected.

• Liposuction (Fat removal) is the removal of fat from the neck and the cheek area. Utilizing a small stab incision behind the ear and under the chin, the fat is suctioned thru small canulas.
  The best results are seen with younger patient with elastic skin . This procedure is relatively atraumatic and can help in giving a more defined chin and neck/jaw line.

• Facial Implants (chin,cheek) are used in patient with aging changes and in younger patients with facial disharmonies. With the aging the underlying fat and bone is also decreasing, causing less projection of the face. The facial implants are made of solid silicone blocks and are well tolerated by the body. Placing a implant can help improve the result of the face and neck lift. The chin implant is often used in combination with nose surgery to give the face the right harmony.

For more information schedule your free consultation with Dr. Wittenberg to discuss this procedure in full. Our experienced and professional office staff members are here to help you with all your questions. Call our offices at (831) 636-9808.