Thank you for asking, this is an important question. Assuming you are a candidate for both eyelid (blepharoplasty) and neck rejuvenation procedures, you would first need to decide if you would indeed like to have both improved. That can only happen after you’ve had a thorough consultation with a qualified plastic surgeon.

Should you then decide that you’d like both your eyes and neck done, my advice would be to do them together at the same sitting for a couple of reasons:

Recovery Time

The first reason is time spent recovering. If you do just the eyes, you’ll be uncomfortable and bruised for up to two weeks. Likewise, when you have your neck done. If you combine these procedures, the total recovery time will still be about two weeks (instead of losing two weeks twice).

Less Cost, More Uniform Improvement

Aside from time considerations, you will save money by going into a surgery center only once versus twice. Probably the best reason of all to do it in one sitting is that you will be able to enjoy a uniform improvement over your entire face as soon as you have healed. This would be akin to enjoying a house that has been totally cleaned, rather than only half done.

The best way to describe this further is through photographs. Take a look at the accompanying pictures below of a 52-year-old female who chose to have her eyes, face, neck, and brows lifted, and to have a small chin implant inserted—all in a single procedure that took less than four hours!

52-year-old female patient of Dr. Bunkis before and after a brow lift, upper and lower lid blepharoplasty, facelift and chin augmentation.

Side view of the same 52-year-old female patient before and after a brow lift, upper and lower lid blepharoplasty, facelift and chin augmentation.

One of the best ways to envision how you would look following such procedures is through the use of computer imaging.  If you would like to set up a complimentary computer imaging session, please feel free to contact Orange County Plastic Surgery at 949-888-9700.

The Evolution of Cosmetic Surgery

Boosted by baby boomers doing all they can to maintain their youth, cosmetic surgery is growing in popularity at a rapid pace. Statistics report that over the past five years, cosmetic surgery procedures have grown by almost 300%.

Desired concepts of beauty are constantly changing, due in part to new technology and expert techniques. According to plastic surgeon, Juris Bunkis, M.D., F.A.C.S. of Orange County Plastic Surgery in Rancho Santa Margarita and Dublin, California, the tight, pulled “wind tunnel” look was the signature of a 1970s-era facelift. There was also the scooped nose with a pinched nasal tip, and unnaturally round, hard breasts after breast augmentation surgery.

Such obvious signs of surgery are no longer desirable by most people, and increasingly shunned by patients who wish to turn back the clock in a more natural way, without such tell-tale signs of surgery.

“Facial surgery is not about looking 30 at age 75! No amount of skin and muscle tightening can achieve such an unrealistic goal,” stated Dr. Bunkis. “It’s about looking the best you can, at any age.”

Other factors play a role in relaying a patient’s age such as the quality of the skin, sparkling eyes and the sound of a voice. The goal of facial rejuvenation today is to create as youthful a result as possible while maintaining a balanced and natural, un-operated look.

New Approaches To Facial Surgery

Dr. Bunkis explained that the newer approaches to facial surgery are primarily aimed at the mid facial region. The relatively new midface lift specifically addresses the central facial hollowness that naturally occurs as many people age. By suspending tissue back to its original place, the aging face can then be sculpted tension free to recreate the soft and graceful curves of youth.

“It is absolutely necessary to achieve this balance to arrive at a pleasing surgical result, explained Dr. Bunkis. “My techniques have changed over the last twenty years, and the concept of a pleasing result continues to evolve.”

Compared to the mid 1970’s, when Dr. Bunkis began doing surgery, techniques today utilize shorter and less visible facelift incisions and a greater emphasis has been placed on midface lifts and other techniques which elevate the fallen tissues in a more natural way. Today’s techniques do not raise the sideburn, distort the hairline behind the ears, or leave patients with a horizontal, pulled back look that was so common in years past.

Understanding the Aging Process

A key factor in plastic surgery advances has been a better understanding by plastic surgeons of the nature of the aging process, and the development of techniques that address aging skin tissue. Nevertheless, technical advances still cannot guarantee a perfect result. Patients must start by choosing the right surgeon—one who not only understands their concerns, but one who also has the ability to focus on what the surgery will achieve, as well as the artistic talent to achieve the desired result. With his years of experience and artistic touch, Dr Bunkis brings to his patients a knowledge and expertise in aesthetic surgery that makes him a leader in his field.

Dr. Bunkis’ main objective is to achieve a natural look for each patient, and to allow each patient to look as good as they can for their given age. He evaluates each patient’s concerns, decides how best he can help them, and offers a solution to their problems. This frequently requires a discussion of areas or procedures that the patient may not have previously considered.

“For example, if someone comes in with a complaint about a droopy neck, but does not mention their severely sun damaged skin, I feel it my duty to discuss laser skin resurfacing for completeness sake”, said Dr. Bunkis. He believes that a layperson may not realize that tightening droopy muscles and skin will not affect the skin’s quality. Such a person may wake up after a face lift with a gorgeous jaw line and face contours, but be disappointed because the skin is still blotchy and sun damaged. Not approaching the face as a whole may create an unnatural result and deprive the patient of full benefit of the doctor’s talents.

The ideal facial rejuvenation procedure leaves the patient with a jaw line that matches the rest of the face including eyes, forehead and skin texture. This process, Dr. Bunkis explains, begins with a through consultation.

Facial Rejuvenation Consultation

So what are the consultations like and what suggestions may be made? This depends on each patient’s concerns, desires, and present condition. Dr. Bunkis begins each facial consultation with an explanation of the aging process and discusses generalized skin care, as well as general anti-aging treatments, which may be applicable.

Normal facial aging is a two-prong process. The first prong is genetically determined, such as the formation of the jowls, drooping of the neck or brows, bagginess of the eyes, the degree of chin prominence, or the size of the nose. These features are not under the patient’s control and cannot be changed without surgery. The second prong of the aging process includes skin texture and the general health of our skin, as well as the amount of fat in our necks, and the impact of sun exposure, obesity, smoking and excessive use of alcohol. This latter group is obviously under a patient’s control. Dr. Bunkis attempts to help each patient develop a healthier lifestyle and, along with his aesthetician, discuss sun protection and long-term skin care options.

Different Facelift Approaches

Dr. Bunkis gave examples of different approaches that might be offered to patients of various ages with various degrees of aging: “For a patient in her thirties with a slight neck fullness, a lipo-sculpting procedure may be all that is required to give her a youthful jaw line, as the skin will usually have sufficient elasticity to snap into place. This same approach would not be appropriate for a patient in her forties, as skin and muscle laxity would be expected to persist if the issue is not addressed.

“For such a patient, however, a traditional facelift may not be required yet. Quite possibly an excellent result could be expected by combining the liposuction with a short incision under the chin to tighten the neck muscles. Or we may add to this a midface lift, which can be achieved with a small stab wound in the fold between the cheek and the upper lid and a short incision behind the sideburn—avoiding incisions around the ears. In an older patient, not only would a full facelift be indicated, but also brow lifts, lip enhancements, or skin resurfacing may be added to achieve the optimal result.”

Setting Expectations

Whatever approach is suggested, Dr. Bunkis explains the expected outcome to each patient thoroughly. “I can do this by placing the patient in front of a mirror and lifting their skin, or by using computer imaging. During the consultation, I always relay my philosophy and give each patient a realistic idea of what they can expect to achieve with surgery. This is an art form and the patient deserves to know my vision before we embark on the surgical voyage,” concludes Dr. Bunkis.

Dr. Bunkis practices in South Orange County and in the San Francisco East Bay. A Board Certified Plastic Surgeon specializing in cosmetic surgery of the face and body, Dr. Bunkis has years of unsurpassed surgical expertise. Below are examples of actual patients of Dr. Bunkis that illustrate the various options for facial rejuvenation.

A 35-year-old anesthesiologist patient with a full neck, before and after neck liposculpture, chin implant and rhinoplasty. This same neck contour and sagging could not be corrected as effectively with an isolated liposuction procedure in someone a decade or two older because of the loss of skin elasticity and muscle laxity.

A 48-year-old, weathered female patient who looked significantly older than her stated age, before and two years after (at age 50) following a full-face CO2 laser resurfacing, endoscopic brow lift, facelift, upper and lower eyelid procedures. The neck was liposuctioned as a part of the facelift, but a neck liposuction alone would only have left her with a thinner but saggier neck and not addressed the unusual laxity and sun damage she had.

Dr. Bunkis can be reached by calling (949) 888-9700 or you can write to him at bunkis@ocps.com.

— Janet d M., Coto de Caza, CA

A: Mid-facelifts are relatively new, but we have been doing them for 10–15 years. Both types of facelift procedures are designed to turn back the hands of time, but each addresses different aspects of the aging process. A standard facelift is still the ideal procedure to tighten a loose neck and to help with jowls.

You are correct in saying that the mid-facelifts are relatively new procedures, but they address an age-old problem: drooping and hollowing of the cheek areas below the lower eyelids, which creates a so-called “tear trough” deformity. These mid-facelifts can be done as an isolated procedure to freshen a face in the late 30s or 40s that is showing the earliest signs of aging, or combined with a traditional facelift in an older person, or as an isolated procedure in an older patient who has had a traditional facelift but the mid-face was not addressed.

One of the beauties of a mid-facelift is that it can be done through short incisions that are hidden behind the hair line and through a tiny stab wound in the fold between the cheek and the upper lip, just large enough to let us insert a few very long needles, which heals without a visible scar. The mid-facelift will not alter your jowls or neck laxity, so if these are an issue, a traditional face and neck lift will also have to be performed to achieve optimal rejuvenation.

Facial rejuvenation is at the top of the list of the most common aesthetic surgical procedures performed here at Orange County Plastic Surgery. Most people feel physically and mentally vigorous and energetic long after their appearance has begun to deteriorate due to aging. A face, neck, brow or mid-facelift procedure is designed to provide you with a rejuvenated appearance. The degree of improvement achieved depends on the severity of the initial deformity, the age of the patient, tissue elasticity and the recommended procedure.

Here are a few patients that show the benefits of the mid-face and traditional facelifts:

(Actual patient of Dr. Bunkis) 47-year-old female before and after mid-face thread-lift with lower-lid blepharoplasty, without the need for a traditional face or neck lift.

(Actual patient of Dr. Bunkis) Similarly aged, 47-year-old female with neck laxity and jowls, but not much in the way of mid-face laxity, before and after an endoscopic brow lift and facelift. No need for a mid-face here. Conversely, a mid-facelift would not have addressed the things that bothered her most: jowls and neck laxity.

(Actual patient of Dr. Bunkis) 54-year-old female a year after a traditional facelift done elsewhere, neck still quite tight, but complaining of mid-face and lower eyelid laxity. To address her concerns, a mid-face thread lift was performed by Dr. Bunkis to lift the drooping cheek tissues next to the nasolabial fold, thus removing the oblique trough that forms across the cheek as people age, and giving her a nice and youthful cheek. This procedure also elevates the junction between the eyelid and cheek, allowing us to shorten the eyelid, adding to a more youthful look. The “after” photos, six years later at age 62, show that the improvement has been well maintained.

It is important to seek a surgeon who is well-versed in all of the options, so that a customized plan can be developed for your concerns.

Please feel free to call Dr. Bunkis at Orange County Plastic Surgery (949-888-9700) for a complimentary consultation so that we can lay out all your options for you.

It would be difficult for me to tell you specifics without seeing you in person, but I can give you some generalities about such procedures, which we call upper and lower eyelid blepharoplasties.

What is Blepharoplasty?

A blepharoplasty procedure is designed to remove excess skin or bagginess around the eyes to give the eyes a more youthful appearance.  As people age some develop lower eye lid “bags” or “dark circles” and excess upper lid skin which drapes down over the lashes.  These signs of aging can be reversed by a plastic surgeon by removing excess skin or repositioning the lower lid fat.  Wrinkles around the eyes which are etched into the skin cannot be removed by a blepharoplasty procedure alone, without the addition of a skin wrinkle treatment such as a laser resurfacing or a chemical peel.  Likewise, a brow lift is frequently recommended to complete the rejuvenation of the eye area.  Frequently such rejuvenation procedures are combined with tightening of the neck skin or elevation of the brows to give the face a more youthful harmony.

Your goal as a patient is to make sure that all of your questions are answered and that you fully understand the procedure and it’s consequences before you decide to go ahead with such surgery.  Your surgeon should explain the procedure to you, give you detailed hand outs about the procedure, show you photographic examples of his/her work, and preferably either show you a staff member who has had the procedure or have a patient who has had a similar procedure contact you so you can get a patient’s insight into having the procedure done.  Do some research online.  Visit your surgeon as many times as necessary to have all your questions answered.

Understand the alternatives as well.  For example, if a patient has a low eyebrow, just removing excess upper eyelid skin will not change the distance from the eyelashes to the eyebrows and a brow lift may be recommended to give a more open eye look.  Sometimes a laser resurfacing will be desired to remove excess wrinkles.

You should visit your surgeon as many times as you wish to have all of your concerns addressed.  At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed and that you accept the risks by signing the informed consent forms.

The operation is performed using local anesthetics with intravenous sedation, or under a light general anesthetic, to make you comfortable throughout the procedure. The anesthesiologist will administer the medications and monitor you to ensure your safety and comfort.

For an upper lid blepahroplasty, the incisions are placed in the normal skin folds of the upper lids.  For lower lid procedures, the incisions are placed just beneath the eyelashes or, if fat has to be addressed but there is no skin excess, a hidden incision can be used just inside the lower eyelid.  Excess skin is removed and the bulges caused by hereditary fat pockets are corrected by repositioning the fat or removing the excess.  The incisions are closed with very fine sutures that will be removed approximately five days later.  Within weeks, the incision will be very difficult to see.  The approximate operating time for upper and lower eyelid blepharoplasties is two hours.

After Blepharoplasty Surgery

There is very little pain associated with a blepharoplasty and most patients do not require pain medication.  What will limit your activities in the immediate post operative period is the presence of significant bruising and swelling.   Our post operative instructions ask the patient to avoid much in the way of physical activity for the first two days, to sit and rest with your head elevated, and to apply ice packs to your eyes continuously except when getting up to eat or go to the bathroom.  Ice does not help after the first 48 hours and the patient is free to do whatever they are comfortable doing.  For example, most patients can walk as many miles as they wish, but in the first week, running would be uncomfortable.  By the end of the first or second week, all bruising should be gone and the patient should have resumed normal activity.

As the years go, the skin will continue to thin and wrinkle but the fatty excesses that were removed do not grow back.  We expect your eyes to look better than they would have without the procedure for the rest of your life.

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Please feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site to learn more about our practice and eyelid surgery in particular.  Here are a few before and after photos to give you an example of what can be achieved with such surgery.

(Actual patient of Dr. Bunkis)  51 year old female before and two years after a lower eyelid blepharoplasty.

(Actual patient of Dr. Bunkis)  71 year old before and after an upper eyelid blepaharoplasty.

A:   All surgery leaves some kind of scar but the newer midface lifts do not leave visible scars.  Such procedures are done either through tiny stab wounds in the nasolabial fold (the fold between the upper lip and cheek) or through incisions inside the mouth, as well as a tiny scar behind the sideburn area.  While the incisions are “minor”, the procedure itself is not “minor” and is done in an operating room, just as a standard face lift would be.

Through these incisions, the flesh is freed from the bone and suspended upward with heavy sutures.  But first let’s discuss what these procedures are good for.  As people age, they develop a depression from the lower lid, downward obliquely across the cheek, the so called “tear trough”.  The midface technique is designed to eliminate or minimize this tear trough, and to restore a youthful roundness to the cheeks.  As healing occurs, these “midface” structures heal to the bone at a slightly higher level, thus improving the appearance of the cheeks and the lower eyelid region.  This is an appropriate procedure for a younger patient without neck laxity or jowls, who is noticing the earlier signs of aging such as a flattening of the midface area and development of tear troughs.  It is also a great procedure for an older patient who has already had a traditional facelift, without a midface lift – yes, some surgeons still do a traditional lift without addressing the midface area!

In our practice, with the exception of some patients with a very round face to begin with, we include a midface lift with almost every traditional face lift to give the patient total rejuvenations.  The midface procedure by itself does not address neck laxity or significant jowls, and a more extensive procedure with a traditional lift will be recommended if this area is a concern.  The modern midface lifts are frequently combined with eyelid surgery, neck liposuction, a full facelift or other aesthetic procedures.  Your best bet would be to visit with a qualified plastic surgeon for an evaluation and to outline your various options.   But I can give you some idea of various possibilities with the following examples:

(Actual patient of Dr. Bunkis)  40 year old female, before and after a mid-face thread lift, lower lid blepharoplasty and secondary rhinoplasty.   Notice the rejuvenated appearance of the cheeks, below the eyelids, as a result of the midface lift.   She was an ideal candidate for a midface lift without a traditional face lift as, at her early age, she did not have any jowls or neck laxity.

(Actual patient of Dr. Bunkis)  54 year old female a year after a traditional face lift done elsewhere, neck still quite tight, but complaining of midface and lower eyelid laxity.  To address her concerns, a midface thread lift was performed by Dr. Bunkis to lift the drooping cheek tissues next to the nasolabial fold, thus removing the oblique trough that forms across the cheek as people age, and giving her a nice and youthful cheek.  This procedure also elevates the junction between the eyelid and cheek, allowing us to shorten the eyelid, adding to a more youthful look.  The after photos, six years later at age 62, show that the improvement has been well maintained.

(Actual patient of Dr. Bunkis)  54 year old before and after a traditional facelift along with a midface lift and tear trough microfat grafting to address the flattening and sagging of the midface area, along with upper and lower eyelid blepaharoplasties.

I have operated on patients in their late 30’s who were good candidates for a facelift, but those instances have been few and far between, and usually with extenuating circumstances such as severely stretched skin from obesity and subsequent weight loss. You are correct in feeling that younger patients with early signs of aging usually are not candidates for a full face lift. Such patients can frequently be helped quite considerably with one of the newer minimal incision techniques including neck liposculpting, tightening the neck muscles through small incisions just beneath the chin and perhaps the ear, endoscopic forehead lifts, or some of the modern midface lifts that are performed through hidden incision inside the mouth and behind the hairline.

Perhaps a series of one of the nonablative laser treatments or intense pulse light (“IPL”) treatments will remove surface blemishes and tighten the skin sufficiently to buy you some time. A lot of the decision making depends on your expectations as well and the degree of laxity you have. But to tell you the truth, as I stated earlier, I could not begin to tell you what your best option would be without evaluating you in person. Please call us at (949) 888-9700 and ask the staff to arrange a complimentary consultation for you and I will be happy to give you my best opinion as to your options. I see patients at the Waves Beyond Skin Care Spa in San Clemente on a regular basis and could see you there if it’s more convenient for you. But first, I will show you examples of three younger patients who received minor procedures that bought them some time before they were ready for a full facelift.

42 year old female with early signs of cheek hollowing and deepening of nasolabial folds (the fold between the lips and cheeks), before and after injections with Sculptra Aesthetic®, a long lasting filler.   By the time this filler wears off and her neck droops more, she will be ready for a full face lift.

Actual patient of Dr. Bunkis – 35 year old female with some upper eyelid hooding, a minor neck adiposity, and early facial laxity, before and after a one hour procedure in which I did her upper eyelids and liposuctioned her neck and jaw line.

Actual patient of Dr. Bunkis – 44 year old female with more than average sun damage, before and after a full-face phenol peel.

A:  You really should go and have another talk with your plastic surgeons – if one recommended a brow lift, he should have explained why he did so. Rarely would we suggest a procedure about a body part not brought to our attention by a complaint originated by a patient. For example, we would never comment about very large or small breasts if a patient came in to discuss an abdominoplasty (i.e. “tummy tuck”). The two exceptions I can think of relate to chin implants and brow lifts, but in such a situation, I sure would hope that the patient left the consultation with an understanding of why we are recommending the brow lift or chin implant procedures!

Patients with weak chins who come in complaining of a large nose or a droopy neck cannot get a great profile without addressing the weak chin because the chin, nose and neck all contribute to the profile. Likewise, if a patient complains of heavy upper eye lids, we have to analyze the balance between the eyelid and brow position. Our duty is to lay out the options for a patient and each person has to choose the procedure(s) that will give them their desired results. In a pure upper eye lid blepharoplasty, the thin skin excess of the lids is removed but the distance from the lashes to the brows is not changed. In patients with low brows, removing the thin, excess upper lid skin may not be appreciated unless the thicker tissues just below the brows are raised as well. This is not to say that every low brow must be raised when doing an upper lid procedure, but the patient has to understand that only the thin, upper lid skin excess will be removed, that the thicker brow hooding will be unchanged, and that the distance between the brows and lashes does not change with an isolated blepharoplasty. If a patient desires a more open – eyed look, this will only be accomplished if a brow lift is added to the eye lid procedure. Not only will the eye area look more open following a brow lift, but during a brow lift, the frown lines between the brows will be minimized because we can remove some of the muscles that cause these frown lines, called the corrugator and procerus muscles. And finally, occasionally I’ll see a patient with hooding caused by low brows who thinks they would like an upper eyelid blepharoplasty, but when I gently elevate the brows, I can see that this patient does not have an excess of thin, upper lid skin, just low malpositioning of the brows and I will recommend to this patient that a brow lift be performed without a lid procedure per say.

A brow lift is a minimally invasive procedure. In the endoscopic brow lift, a few half inch incisions are made behind the hair line, allowing the instruments to be inserted. The tissues are freed from the bone, the muscles sculpted, and the brows raised a few millimeters. The brows are fixed in their new position with a variety of devices. The incisions are rarely perceptible after healing has taken place. Occasionally, a brow lift will be performed as an isolated procedure, but more commonly it will be combined with a minimally invasive midface or thread lift, an eyelid procedure or a standard face lift. If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options.

Please feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to see further examples of similar patients.

See pictures below of some of Dr. Bunkis’s actual patients:

Below: Pre & Post Upper Lid Blepharoplasty

49 year old male before and after an upper (and lower) lid blepharoplasty without a brow lift.
(Note that the distance between the lashes and brows is unchanged. The main benefit of the procedure was to remove the heavy eyelid skin from his lash lines.)

54 year old female before and after an upper lid blepharoplasty (with face lift, chin implant, rhinoplasty) and a brow lift.
(Note that not only has the excess upper lid skin been removed, the frown lines removed but also that the lash line to brow distance has been increased.)

Above: Pre & Post Brow Lift (and Facelift, no upper lid blepharoplasty!)

47 year old female before and after an endoscopic brow lift and facelift.
In spite of her hooded upper lid appearance before surgery, raising her low brows showed that she did not have any excess eyelid skin.

A:  I can begin by telling you that both are correct, at least in part, and I am certain that both doctors are giving you advice based on their view points, training and expertise. The problem is that most dermatologists do laser resurfacing and not surgical procedures – they tend to recommend procedures they know how to do, regardless of what is best for the patient. And likewise, many surgeons do not do resurfacing procedures and may suggest a surgical procedure without considering the resurfacing option.

Without being able to see you in person, I will have to answer this question in the most general terms. I will begin by telling you a few words about aging and what we can do about it. Two events happen simultaneously as we age. Surface changes occur from excessive sun damage. You can use sun blocks, hats and sun glasses to minimize sun damage as you get older.  A laser treatment will remove these superficial signs of aging, but will not affect the dropping and skin laxity, particularly in the jowl and neck regions, that also occur with time. These latter changes are the result of heredity and will not be altered by sun blocks or helped with a resurfacing procedure. In order to alter neck and jowl sagging, plastic surgeons pick these layers back up and tighten them as part of any traditional or midface lift procedure. Frequently, brows will be elevated back to where they once were, or baggy eyelids will be addressed at the same operation so as to restore a sense of balance to the final result – for example, very baggy eyelids would detract from an otherwise well done face lift which gave a patient a youthful neck. But such surgery will not alter sun damage or the quality of your skin.

Another very important factor is a patient’s expectations – these have to be met! Some patients want nothing but a total improvement, others are willing to settle for less improvement because they are not bothered by certain features or because they are trying to save money.

Your best bet is to find an aesthetic surgeon well versed in both the traditional surgical procedures as well as the various resurfacing procedures (chemical peels, laser resurfacing and dermabrasion) so that you can be presented with all the options and then you can decide which is the best option for you.

The best way to illustrate the various options is with a few before and after photographs of actual patients treated by Dr. Bunkis:

First we have this 58 year old female with slight facial laxity and marked sun damage.  She would still have looked quite weathered had we performed just a traditional lift.  Likewise, a laser resurfacing would have improved her facial texture but she would still have had a lax neck and jowls.  I think you will all agree that she benefited most from a facelift and full face resurfacing, all performed at the same sitting.

Our second patient is a 44 year old former ski instructor, with extensive sun damage but not enough skin laxity (i.e. does not have significant neck laxity or jowls) to warrant any type of surgical lift.   She was treated solely with a minimally invasive, skin resurfacing procedure, without any surgical incisions, to remove her fine lines and brows spots.

(Actual patients of Dr. Bunkis, your results may vary)

Dr. Bunkis answers your questions in this column weekly but to give the best answer to the question below, Dr. Bunkis asked his skin care team,  our nurse Tracey Prescott, R.N. and our medical aesthetician, Anne Floerchinger, to provide the following response:

A: Great question!!! You will know when you are saggy enough to warrant surgery, but in the meantime, there are many non-surgical treatments that can improve the quality of your skin.

Most of us do not appreciate fine facial wrinkles, hyperpigmentation and tactile roughness. Now you can have smoother, less pigmented skin with the newest FDA approved Tretinoin cream, Refissa®.   It is emollient based and does not dry out your skin. This product has become the gold standard medical treatment for photo-damaged skin. It works by stimulating cell turn over and causing the sun damaged outer layers to slough off. Refissa® is the first important step to healthier skin. Always remember sun protection year round!

The next step, now that your skin is healthier, may be one of the many peels we offer. Here at Orange County Plastic Surgery we have many peels to choose from. For the purposes of this article we will focus on the Microlaser peel.  Microlaser peel, the “week-end” skin peel, treats skin conditions more aggressively than the Refissa® is capable of doing. The Microlaser peel is performed with Sciton’s Erbium laser which uses a computer guided scanner to ensure maximum precision treatment uniformly. You will see improvements in just a few days!

What exactly does the Microlaser peel treat?

It is a minimal to full epidermis laser peel that precisely removes the outer most layers of the skin. The procedure is individually tailored to the nature of the problem to be corrected: wrinkles, scars, keratoses, pigmentation problems, overall sun damage.

How often does a Microlaser peel need to be done?

As mentioned above, year round sun protection is a key to healthy skin.  The results of any treatment, not just the Microlaser peel, will last longer and be more efficacious if you avoid future sun damage.    One Microlaser peel procedure will usually be sufficient for a few months but subsequent treatments may be required. As mentioned earlier treatments are customized to each person. During your consultation we can determine what will be best for you.

What can I expect from the treatment?

Smoother, healthier, more vibrant skin. A blended complexion with a lessening of fine lines.

Is the treatment painful?

When you come in to the office, a topical triple anesthetic cream will be applied. This application will make the procedure quite tolerable.    Afterwards you will have a surface Oxygen treatment (Oxymist®) created especially for our patients at Orange County Plastic Surgery.

What is my aftercare? Do I need to wear any bandages or dressings?

No.  Microlaser peel is not like a CO2 laser and requires nothing more than a protective ointment like Aquafor or vaseline. This is used as a barrier while you grow new epithelium (baby cells, new skin). You will also come back in to our office for oxygen treatments for the next two days.

Mention this article when calling our office and receive a complimentary consultation and 25% off your Microlaser peel or 20% off your Refissa®!

As you can see, there are options to a scalpel and needle when making your skin look better! You are in good hands at OCPS and we look forward to seeing you so we can customize a skin care program for you!

-Trace Prescott, R.N. and Anne Floerchinger

Orange County Plastic Surgery Skin Team

Face Lifts For Aging Skin

I’ll first address aging in general and then go over a few things we can do to counter these natural phenomenon. As we age, the skin itself looses elasticity and collagen fibers. A number of structures under the skin loosen as well and droop downward, pulling the overlying skin with them. These effects are most commonly seen as brow drooping, lid laxity, a descent of the middle part of the face with jowl formation, and neck laxity. These deeper effects are all hereditary in nature and cannot be significantly altered by things we do nonsurgically. The traditional way to address these areas is with lifting the drooping muscles and underlying tissues back to where they used to be when we were younger. But utilizing newer techniques such as midface lifts and some of the so called thread lifts, we can reposition these tissues to a more pleasing position in a brief procedure, under minimal anesthesia, and with minimal down time – what the patient has to understand is that the results will not be as dramatic nor last as long compared to a standard lift. Totally nonsurgical ways to improve these deeper structures include injections of Botox® to weaken underlying muscles which are causing wrinkles, particularly for the vertical lines between the brows and around the eyes to address crow’s feet, and the injection of various fillers to fill lines, the hollows under the lower eyelid bags, to fill indentations along the top of the nose (the so called non surgical rhinoplasty)or to enhance lips. The number of fillers available to us is vast, ranging from the gold standard, the hyaluronic acids like Juvederm®, Restylane®, Pearlane® and Hydrelle®, the longer lasting but more costly Artefill® or Sculptra Aesthetic®, or your own fat in the form on microfat grafts. The microfat grafts can also be utilized to plump up the tops of the hands to replace subcutaneous tissue that is lost in the normal aging process. Each filler has its pros and cons and these will all be reviewed with you when you come in for a consultation.

Face Lifts From Sun Damage

The more superficial signs of aging, such as the sun damage that occurs from excessive exposure, can be improved by topical treatments ranging from the variety of peels, creams and facials provided by our aestheticians to the micropeel laser, IPL and dermabrasion procedures performed by our laser nurse, to the deeper peels and laser treatments that I do as a surgeon to address the more severe lines and surface sun damage. These procedures all improve your surface texture (removing brown spots and superficial wrinkles), and the deeper procedures I do will also tighten the skin and remove even the deeper wrinkles, but the deeper the treatment, the longer the healing process will be! It is very helpful to have a consultation with one of our medical aestheticians and to draw up a custom game plan for your skin – a long term skin care program will improve the quality of your skin and slow down the aging process! Of course, the best thing you can do for your skin is to avoid excessive sun damage and to use sun block regularly – and we certainly have some very good sun blocks to offer you.

Many Types of Face Lift Procedures

In summary, we have a plethora of “Quick and Easy Fix” procedures and products to offer our patients, and each is recommended after a thorough consultation which includes an evaluation of your skin and a determination of your expectations. We at Orange County Plastic Surgery would be glad to see you for an evaluation of your skin and would like to help you come up with an appropriate plan to minimize your signs of aging! Sometimes a very pleasing change over can be achieved with a relatively simple and minimally invasive procedure! One of the best ways to envision how you would look following such procedures is through the use of computer imaging. If you would like to set up a complimentary consultation with Dr. Bunkis, our nurse, Tracey Prescott, or one of our medical aestheticians, Anne Floerchinger or Janet St. Pierre, please feel free to contact Orange County Plastic Surgery at 949-888-9700.

47 year old female, before and six months after, a 10 minute microfat grafting procedure in which fat was transferred from the abdominal wall to reinflate the lips, cheeks, nasolabial folds and Marionette lines.