Facial plastic surgery can achieve amazing results. It can help you reverse the aging process, making your face look years younger. It can also help you correct elements of your appearance that have bothered you for your whole life. To help his patients rejuvenate their faces, Dr. Kurtis Martin offers procedures such as facelift, brow lift, blepharoplasty, and BOTOX® Cosmetic for Cincinnati area residents who want to turn back the years. Dr. Martin offers the following facial plastic surgery procedures:

Permanent Cosmetics
BOTOX® Cosmetic
Rhinoplasty
Facelift
Chemical Peels
Lip Augmentation
Lip Lift (Nostril Sill Lift)
Brow Lift
Chin Implant
Neck Lift
Blepharoplasty
Soft Tissue Augmentation
Artefill
Cosmetic Ear Procedures
Scar Revision

This is intradermal pigmentation which is a revolutionary method of applying micro insertions of natural pigments into the dermal layer of the skin. This technique is used in a variety of cosmetic enhancements.

Summer Special: Save $100 off any procedure if scheduled May through September.

Eyeliner upper or lower	$350
Eyeliner upper and lower	$600
Eyeliner (Mucosal)	$650
Designer Eyeliner (use of more than one color)	$650
Lip Liner	$450
Full Lip Color	$600
Eyebrows (full)	$500
Eyebrows (Stokes)	$500
Beautymark	$100
Blush (cheek contouring)	$500

Prices subject to change without notice.

All procdedures are performed by Amanda Ritter, our Licensed and Certified Specialist. Call Dr. Kurtis Martin's office today at 513-469-0300 and schedule your consultation.

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"A five minute non-surgical procedure with no down time and miraculous results" is how Dr. Martin describes Botox cosmetic. Used since the 1980's for ophthalmologic conditions and approved by the FDA in 2002 for wrinkle reduction, Botox cosmetic (a purified form of botulinum toxin) is used to reduce or eliminate frown lines, crow’s feet, forehead wrinkles, and perioral wrinkles. Using advanced injection techniques, Dr. Martin can also create a non surgical brow lift as well as elevate the corners of the mouth. Others uses include minimizing the platysmal neck bands, reduction of migraine headaches, and eliminating hyperhydrosis (excessive sweating).

Botox works by weakening the injected muscle allowing dynamic wrinkles to soften or disappear. Results typically last three to four months although individual results can vary. With continued use of Botox, patients may actually see longer lasting results. Botox injections can be repeated as often as necessary with no known adverse effects. A common myth is that discontinuation of Botox treatments will make the wrinkle look worse. This is simply not true. Complications are rare but can include redness at the injection site, bruising, or a droopy eyelid. A droopy eyelid can be treated successfully with eye drops prescribed by Dr. Martin.

Dr. Martin has been performing Botox treatments for nearly 8 years and has one of the busiest Botox practices in the Cincinnati and Dayton areas. You may schedule your appointment and receive your Botox treatment the very same day. Following your Botox treatment, results may become evident in 24-48 hours but require 1-2 weeks for maximal improvement. No follow up appointment is necessary. Pricing averages $275-$300 per area but can vary depending on the number of areas treated.

If you are considering Botox cosmetic, remember to choose a plastic surgeon with the knowledge and experience necessary to achieve the look you desire. For more information on Botox cosmetic please visit the national website at www.botox.com.

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Rhinoplasty (nosejob) is one of the least understood and most technically difficult operations in plastic surgery. Everyone can spot a patient who has had a poorly performed rhinoplasty. Fortunaetly for patients, recent changes in philiosphy and advancement of techniques have led to more natural results. Many books and articles have been written about rhinoplasty and below is a discussion of some of the more common errors seen in cosmetic rhinoplasty.

A prominent dorsum is one of the most common complaints in patients seeking rhinoplasty. In the past, it was acceptable to over resect the dorsum of the nose resulting in a scooped out look (ski jump). This was created by removing too much bone and cartilage and by not correcting the tip adequately. In the modern era of rhinoplasty, we now strive for a more natural look with a conservative resection leaving the dorsum nearly straight. Another common complaint in patients is a wide nasal tip. In the past, correction lead to a nasal tip which was over resected (again). How many people have you seen with extremely small, balled up nasal tips? Again, this was the norm in the 1970’s but now is frowned upon. Staying with the same theme (removing less), cartilage removal and septal excision are now more conservative resulting in a natural, less surgical looking nasal tip.

It is very important to obtain a successful surgery the first time as secondary rhinoplasty (redo operations) can be very difficult. With each surgery the amount of scarring increases, as does the possibility of complications such as nasal skin necrosis or deformity of cartilage. Accordingly, some surgeons will not do a secondary rhinoplasty and will refer patients to surgeons who specialize in this type of surgery.

In performing rhinoplasty, a thorough preoperative evaluation and well thought out plan followed by precise surgical technique ensure a successful result. The first order of business is to inject the nose with local anesthetic with epinephrine to diminish bleeding. Sometimes local anesthetic is placed into or on the nasal septum if septal surgery will be necessary. Incisions are made on the outside of the nose (columella) and also on the inside of the nostrils. The skin is then dissected away from the underlying structures allowing excellent visualization of the deformities. First the prominent dorsum is rasped down (sometimes excised) to the appropriate level. This includes removal of bone and cartilage. Later the nasal bones are fractured and very carefully pressed together to narrow the nose and to eliminate the “open book” deformity. Now the tip is freed up and the lower lateral cartilages are trimmed to narrow the nasal tip. This is where the surgeon should leave an adequate amount of tip cartilage (5-6 mm) to establish a natural look. Over resection here will lead to a small, balled up tip with an unatural look. The remaining cartilages are sutured with multiple sutures to achieve tip projection and to also narrow the tip. Under resection of the septal tip here can lead to a parrot beak deformity (supra tip deformity). Attention is then turned to the nostrils. Wide nostrils are reduced by removing very small amounts of skin at the base of the nostril (alar base reduction). The entire nose is then evaluated for final revisions followed by suturing of all incisions. Intra nasal packing is usually not necessary. Healing is relatively quick but swelling of the tip may take 6-12 months to resolve. Bruising is also a concern when the nasal bones are broken and may resolve in 1-3 weeks.

When contemplating a rhinoplasty, it is helpful to undergo advanced computer imaging so that you and your surgeon can agree on an expected result. If you are considering cosmetic rhinoplasty, ask your surgeon about their experience and view before/after pictures of their work.

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Which facelift is right for you? The “mini facelift? How about the MACS Facelift? Maybe the endoscopic assisted biplanar facelift. Or my favorite “The exclusive Kurtis W. Martin lift”. You get the picture. Choosing the right procedure for the best result can be very difficult. The problem is keeping up with all the technology and separating the facts from the hype. The most important factor when considering a facelift is to choose a surgeon who can achieve consistent, predictable results with minimal complications. During your consultation with your surgeon look at before/after pictures of facelift patients and see if you like what you see. You must understand that not all surgeons perform all the techniques available. Most surgeons choose a limited number of techniques which produce excellent results with limited complications. Let’s look at an example. Surgeon A performs many facelifts a year and uses very quick, simple techniques that are well received and have minimal recovery. His patients are very satisfied. Surgeon B performs very long procedures using the latest and most invasive techniques available. His patients take longer to recover but are also very happy. Which surgeon is performing the “best” facelift? The answer is both surgeons are able to achieve consistent, high quality results using different approaches. So don’t base your opinion of a surgeon on which procedures he performs. Let’s look at some of the common questions regarding facelift surgery.

1. When should I have a facelift? You should consider facelift surgery when you want improvement in your facial situation. You are never too young (well maybe) nor too old to have a facelift. The aging process of the face is determined by genetic factors as well as environmental factors. You have no control over genetics but you can control environmental factors (smoking, sun exposure, skin care regimen, etc.) Younger patients will usually require less invasive procedures for facial rejuvenation. Some evidence exists that having a facelift at a younger age will result in a longer lasting facelift.

2. Am I too old for a facelift? As stated above, you are never too old for a facelift as long as you are healthy. My oldest facelift patient is 85 years old.

3. Will I look “pulled” or “windblown” after my facelift? Absolutely not! Most people want to look like themselves only younger. Few people want a windblown look. A tight, pulled look is very unnatural. Some people believe the tighter the pull the longer the facelift will last. This is not true. A tight, pulled look results from over tightening the skin without any pull on the underlying structures (SMAS). Pulling the skin in the wrong direction (abnormal vectoring) can also result in an abnormal appearance with lines going in the wrong direction. A secondary facelift can sometimes correct a pulled or vectored look.

4. How long will my facelift last? The results of a facelift can last forever but you will continue to age and the skin on your face will continue to sag. Some patients with poor elasticity will require a secondary facelift (minor tightening) in as little as 6-12 months following the first facelift. A secondary facelift generally involves simply tightening the skin with minimal alteration to the SMAS.

5. Is a “mini facelift” effective. Yes, a mini facelift can be effective but less so then a major facelift. The problem is agreement on what constitutes a mini facelift. Some consider a mini facelift to consist of skin excision only with short incisions. Others consider a mini facelift a secondary lift. One caveat to remember is that some non certified doctors promote the mini lift because they don’t know how to perform a more invasive facelift.

6. Where will the facelift incisions be made? Standard facelift incisions start just above the ear at the sideburn, continue down in front of the ear, and circle back under the earlobe and behind the ear. I usually make the post auricular incision straight up the ear without crossing into the hairline. This allows for the incision to hide completely behind the ear and not be seen when one wears their hair short. Be sure to ask if your incision will show when wearing short hair. This is a very common complaint from facelift patients.

7. Will a facelift remove wrinkles? Yes and no. A facelift can stretch the skin allowing for the wrinkles to look less prominent. The only wrinkles that are actually removed are the wrinkles adjacent to the skin that is excised. Most facial wrinkles require soft tissue augmentation (Radiesse, Restylane, Fat, ect.) and or wrinkle reduction (chemical peels, laser, ect.)

8. Will a facelift improve nasolabial folds or marionette lines? Yes and no. Most standard facelifts do not affect the nasolabial fold or marionette lines. Some special techniques and a particular type of facelift known as a mid facelift can improve these areas. Usually these areas respond best to soft tissue augmentation.

Most facelifts involve common principals of repositioning deeper structures, removing excess fat, and excising loose skin. Many can be performed under local anesthesia while the patient is awake. The face is infiltrated with anesthetic solution which numbs the face and reduces bleeding allowing for more precise dissection. Incisions are made under the chin and around the ear followed by dissecting the skin away from the deeper structures. The SMAS is then plicated (sutured up) to reposition the jowls and cheek tissue. The skin is then carefully removed and sutured back in place. Excess fat is removed from the neck, followed by tightening of the neck muscles (platysma). All sutures are removed in 5-7 days and recovery takes 1-2 weeks. Pain is minimal. Complications can include bleeding, infection, seroma, tissue loss, and nerve damage. Other tell-tale signs of a facelift which should be avoided include pulling of the external auditory canal, a pixie ear, disappearing sideburn, abnormal vectoring, and abnormal scarring.

Caveats

1. It is very difficult even for a plastic surgeon to determine which techniques work the best without performing a large number of that specific procedure. Ask your surgeon how many facelifts he has performed using specific techniques.

2. If you smoke, you may be a poor candidate for a facelift. Even if you quit smoking, you are still at high risk for tissue breakdown and scarring.

3. Some patients develop recurrent laxity of the facial skin following a facelift. This may occur as early as 2-6 months following the procedure. Don’t blame your surgeon for not pulling the skin tight enough! Recurrent laxity is more related to your genetic makeup and there is very little you can do to improve the elasticity of your skin.

4. Never leave your sutures in more than 5-7 days. With time sutures cut through the skin leaving small cuts which heal as “railroad track” scars. These can be very noticeable.

5. One serious complication is a hematoma which can lead to tissue necrosis and unacceptable scarring. The most common causes are aspirin, advil, alcohol, and herbal products all of which inhibit platelet function. Don’t take any of these products before or after your surgery. Ask your surgeon which other products to avoid.

6. Never place a heating pad on your face following your facelift. The skin lacks normal sensation and the heating pad can burn your skin.

7. Be sure to ask where your incisions will be located behind your ear. An incision that crosses into the hairline may leave scars which are easily seen if you wear your hair short. Ask about placing your incision totally behind your ear without crossing into the hairline.

If you are considering a facelift in Cincinnati or Dayton, choose a surgeon with the skill and experience needed to achieve natural, consistent results. Ask about computer imaging to preview expected results and ask to see before/after photos of actual patients. If you have undergone a facelift and are unhappy with the results, please schedule a consult to see what options are available for correction.

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Chemical peeling of the skin is one of the most reliable and cost effective ways to remove or diminish fine wrinkles, remove hyperpigmented areas, smooth rough skin, improve acne scarring, or treat precancerous lesions. Chemical peels rejuvenate the skin by removing upper layers of skin (epidermis and upper dermis), which are then replaced with new skin formation. Typically the new skin is more youthful and healthy appearing. Many types of chemical peeling agents are available including phenol, TCA, croton oil, salicylic acid, glycolic acid, and others. Chemical peels are classified by the depth of penetration (light, medium, deep) and the resulting improvement in the skin. Chemical peels can be repeated but caution is necessary as the patient has a slight increased chance of scarring.

Light chemical peels consist of salicylic acid or glycolic acid and can be repeated every 2 weeks. These are used more for maintenance following a peel or for correction of minimal skin deformities. Because of minimal penetration they are extremely safe with almost a zero chance for scarring or complications. These are commonly known as "micropeels"' and are performed by the nurse or aesthetician.

Medium depth peels are usually performed with trichloroacetic acid (TCA). Following degreasing of the face with acetone, a 30% TCA solution is rubbed into the skin with penetration into the upper dermis. The TCA can cause quite a burning or stinging sensation, which is minimized by application of ice water. Topical anesthesia may be required for certain patients. After 2-7 days of healing the old skin is shed and replaced with "new" skin that is smooth and free of blemishes. Post-operative redness is minimal and can be reduced by topical hydrocortisone. Complications can include hyperpigmentation and scarring.

Deep peels can be accomplished with TCA or phenol. Phenol has fallen out of favor due to the increased incidence of pain, scarring, and hypopigmentation (white, shiny skin). Patients seeking deeper peels should consider laser peels as they have a lower rate of complications and a higher level of effectiveness.

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Lip augmentation (enlargement) is one of the most important procedures to obtain full, sensual lips. Fuller lips are created by injection of materials or by implantation of products. Unfortunately, there is no one product which suits the needs of all patients. Permanent lip augmentation is very difficult to achieve and patients should plan on multiple procedures to maintain a long-term result. Many products are no longer popular due to ineffectiveness or complications. These include collagen, Cymetra, Alloderm, Sculptra, and silicone. Below is a discussion of the most commonly used products for modern lip augmentation.

Fat – One of the most common methods for lip augmentation. Fat is harvested from the body and injected with a small needle into the lips. The fat consists of living cells which can reside permanently in the newly grafted lip. Approximately 50 % of the living cells do not take and are resorbed by the body. Results last 6 months or longer and can be permanent. Complications are minimal and consist mainly of 2-3 weeks of swelling.

Radiesse – Consisting of synthetic calcium hydroxylapatite (similar to your bones), Radiesse comes in a syringe and is injected into the lips with a 25 gauge needle. It has the consistency of a thick paste with no allergic reactions reported. Local anesthesia is used to numb the lips and to diminish bleeding. Radiesse is injected just under the dermis and also along the vermillion border. Complications are rare but can include lumpiness. The more experience a surgeon has with injecting Radiesse the less chance of a patient developing lumps. Results are mostly long lasting (6-12 months) and may be permanent in some cases. Repeat injections of Radiesse will be needed to maintain a full lip.

Restylane – Recently FDA approved for cosmetic use, Restylane consists of non-animal hyaluronic acid in a gel base and is a substance which is naturally found in the human body. Restylane comes in prefilled syringes and is injected with a very small 30 gauge needle directly into the superficial dermis. Hyaluronic acid is temporary filler (not permanent) and therefore repeat injections will be needed every 6-12 months. Complications are minimal but can include slight irregularities at the injection site. Due to a high satisfaction rate among patients and minimal chance for allergic reactions, Restylane has replaced collagen in most plastic surgery offices.

Artecoll – consisting of polymethylmethacrylate microspheres suspended in collagen, artecoll continues to be evaluated by the FDA. Known as a permanent implant, artecoll is injected via a small needle into the deep dermis of the lips. If lumping develops, it could be very difficult to resolve due to the permanent nature of the product. Most surgeons are waiting for FDA approval before using this product.

Gore-tex – The gore-tex implant is a soft, white, microporous polymer similar to the material used in gore-tex garments. Considered to be a permanent, over 4 million implants have been used worldwide. Placement is accomplished with small incisions in the corner of the lip and subsequent threading into place just under the skin. Complications can include palpability, hardness, and restriction of movement (stiffness) of the lip.

Final thoughts on lip augmentation – Fat is great for lip enlargement especially if multiple facial areas will be grafted. Radiesse is the most common method I use for the lip. If a patient desires minimal augmentation or a “Paris lip” I prefer Restylane. Sometimes a combination of products are used (sandwich technique). I have not used artecoll due to concerns with lumping and I don’t care for gore-tex because of its tendency to cause a stiff lip.

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Aging takes its toll on the lips. Lines and wrinkles form around the mouth, the space between the nose and mouth lengthens, the "cupid's bow" shape of the lips diminishes, and the corners of the lips begin to sag. Lip lift is a procedure designed to restore a more youthful appearance to the lips. In the procedure a small strip of skin is removed either at the corners of the mouth or between the nose and mouth. Lip lift is performed in the office setting using local anesthesia and requires less then one week of recovery. Scars are hidden under the nose or in the natural lines of the face. If you desire a fuller, more youthful set of lips, choose a surgeon with the skill and artistry necessary to achieve your goals. With over a decade of experience in peri-oral rejuvenation, Dr. Martin possesses the expertise needed to create beautiful, natural looking lips.

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The forehead is one of the prime areas where the visible signs of aging make themselves apparent. A high hairline, forehead lines, worry (corrugator) lines, and sagging eyebrows can all lend to a tired or angry look. Goals in rejuvenation of the forehead and brow area include lowering the hairline, eliminating forehead wrinkles and lines, elevating saggy eyebrows, and filling areas deficient in soft tissue fill. Nonsurgical procedures for forehead rejuvenation include chemical peels, Botox, and soft tissue augmentation. Surgical options for forehead rejuvenation are discussed below.

Coronal brow lift – Once the gold standard in forehead lifting, coronal brow lift involves removing a strip of scalp from ear to ear and excising the frown lines (corrugators). The forehead skin is then pulled tight causing elevation of the brows and diminished forehead wrinkles. Although the coronal brow lift achieves excellent results, the resulting scar across the scalp (from ear to ear) and the development of new techniques has diminished the popularity of this method. Despite the complications with the “open” brow lift, some surgeons still use this approach as their preferred method of brow lifting. There is nothing wrong with this method if you can accept the resulting scar in the hairline. If you do not desire a large scar, choose an endoscopic brow lift.

Endoscopic brow lift – Developed in the early 1990’s, endoscopic brow lift has the advantages of natural, long lasting results with minimal scarring. The procedure is performed through 5 small hairline incisions (1-2 cm each) which allow for elevation of the brows and resection of the frown muscles via the endoscope. No skin or scalp is removed and fixation is accomplished with 2 small absorbable screws that disappear in 1 year. Sutures are removed in one week and recovery is 1-2 weeks. Since the endoscopic brow lift requires special training, choose a surgeon who has completed a special course in this technique. After performing endoscopic brow lifts for over 12 years, I believe this approach offers a superior, long lasting aesthetic result with the least amount of complications.

Endotine TransBleph – This newer procedure is performed via an upper blepharoplasty incision and involves fixation of the brow with a bioabsorbable implant. This allows the patient to have an upper eyelid lift and brow lift in office without the need for an endoscope. Some frown muscles can be excised with this approach but forehead lines will not be affected. The procedure takes less then 1 hour and has a 1 week recovery. Complications can include palpability of the fixation device. I am currently using this technique in certain brow lift cases. For more information go to www.coaptsystems.com.

Feather lift/Thread lift – A newer, less invasive method of brow lifting that involves placement of sutures from the brow to the hairline. Currently undergoing intensive research, concerns include palpability of the sutures and lack of longevity. Click here for more information.

If you are seeking forehead rejuvenation, choose a surgeon who possess the training and sophisticated techniques needed to achieve the excellent results you desire. In Cincinnati and Dayton, Dr. Kurtis W. Martin has a 12 year experience of extraordinary results in performing forehead rejuvenation.

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Patients with microgenia (retruded or small chin) frequently seek chin augmentation to obtain a more normal appearance. In men, a small chin may be perceived as a passive or docile trait. In women, a strong chin can define the jaw line and lead to a more youthful look. Chin augmentation is accomplished by placing an implant directly in front of the bone via an incision either inside the mouth or under the chin. Implant materials vary from surgeon to surgeon and include solid silicone, hydroxyapatite (synthetic bone), porous polypropylene, as well as others. Many different sizes and shapes of implants are used and your surgeon will select the shape best suited for you and your expected result. Chin augmentation is usually performed under a local anesthetic with sedation and takes approximately 1 hour. Recovery is 1-2 weeks (mostly swelling) and complications can include bleeding, infection, implant malposition, and nerve damage. If you desire a less invasive method of chin augmentation, consider soft tissue augmentation of the chin. Imaging with side by side comparisons of before/after results is helpful in allowing the surgeon and patient to achieve expected results. If you are considering a chin augmentation in Cincinnati or Dayton, please visit the office of Dr. Kurtis W. Martin to undergo advanced computer imaging allowing you to choose the result you desire.

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One of the most apparent areas to reveal the aging process is the neck. Loose skin, excess fat, jowling, and wrinkles can all lead to a heavier, older appearance. Many factors contribute to aging of the neck including genetics, weight gain, and sun exposure. . Don’t waste your time and money with products that claim to lift the skin in the neck area. They simply don’t work. Certain nonsurgical procedures (Thermage, Fraxel, etc.) may have some effect in tightening the skin. As with most areas of the body, true rejuvenation of the neck requires surgical intervention. Based on a clinical exam, Dr. Martin will recommend the procedure best suited to your particular problem. Below is a discussion of the different procedures for rejuvenation of the neck.

Liposuction – Most neck lifts require some form of fat removal. For patients with excess fat and a good cervicomental angle, liposuction only will yield a superior result. The fat that is removed can also be used for soft tissue augmentation in another location One of the most common questions regarding liposuction of the neck is “Will the neck skin sag”. The definitive answer is no. During the procedure the entire neck area undergoes surgical undermining which causes formation of scar tissue in between the skin and deeper tissue. As this scar tissue (collagen) matures, it causes shrinkage and contraction of the skin. A liposuction of the neck takes less then 1 hour and is accomplished under local anesthesia in the office. A garment is worn 1-2 weeks and complications are minimal. Dilute steroids are placed into the surgical area to speed up the healing process. To view photos of neck liposuction, click here.

Mini neck lift – This procedure consists of liposuction of the neck, jowls, and lateral jaw area plus tightening of the neck muscles (platysma). This is all accomplished via a small incision just under the chin. The neck muscle is tightened to create a sharper and more attractive angle of the neck. Skin is usually not removed in this procedure but allowed to shrink up due to the liposuction. Post operative recovery is similar to liposuction. This procedure is not indicated for patients with large amounts of skin in the neck area. Complications include some wrinkling of the neck skin, seromas, and hematomas. Click here for pictures of mini neck lifts.

Neck lift – For patients with large amounts of skin an excisional neck lift may be indicated. This procedure begins with liposuction of the neck and tightening of the platysma muscle followed by excision of excess skin via incisions around the ears. Usually a face lift is combined with a neck lift because of the possibility of abnormal vectoring (wrinkles) in the face.

Direct neck lift – Indicated for patients with large amounts of skin, a direct excision neck lift can produce quite dramatic results. This procedure involves liposuction of the neck followed by excising the excess tissue in a vertical fashion. This results in a very tight lift but has the disadvantage of creating a scar from just under the chin to the base of the neck. Most often the scar heals very well and therefore is very inconspicuous. The direct neck lift is a 1-hour in office procedure under local anesthesia with minimal recovery. Dr. Martin prefers this technique for massive weight loss patients. For pictures click here.

If you are considering a neck lift in the Cincinnati or Dayton area, Dr. Kurtis Martin has the experience and skills necessary to achieve the results you desire. With a 1 hour in office procedure, you can look 10 years younger and 10 pounds lighter!

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Has anyone ever said “you look tired” or “you must have been up all night” when in fact you feel great? The fact is changes around the eyelids can lead to an aged, tired appearance. Youthful eyes have no excess fat, smooth skin, no lid laxity, and an almond shape. Undesirable changes in the upper lids include excess skin and fat as well as ptosis (droopy eyelid) which can obscure your vision. Undesirable changes in the lower lids include excess fat and skin and ectropion (laxity) leading to a dry eye. Surgical procedures to rejuvenate the eyelids involve removing excess skin and fat and tightening of lax eyelids. Blepharoplasty will not correct crow’s feet nor correct excess skin in the eyebrow area. Botox will be needed to correct crow’s feet and a brow lift will be needed to correct brow ptosis. Most eyelid surgeries are performed in office under local anesthesia with minimal discomfort and recovery. Below is a discussion of the common methods of rejuvenation of the eyelids.

Upper blepharoplasty – Excess skin in the upper lid is carefully measured and marked after being cleaned with an antiseptic solution. Local anesthesia is injected to numb the area and to limit bleeding. A strip of skin is removed along with a strip of eyelid muscle. In some patients the eyelid muscle is preserved for a more natural look. Fat pockets are then dissected and excess fat removed. If the eyelid is droopy (ptosis), a repair can be completed at this time. Following a short healing period of 3 days the sutures are removed. After a few weeks of healing the scars become imperceptible. Complications are rare and can include over tightening of the lid skin, bleeding, and incomplete removal of fat.

Lower blepharoplasty – Preoperative evaluation includes amount of skin and fat as well as evaluating the elasticity of the lower lid by performing a “snap back” test. For laxity of the lower lid a canthopexy or canthoplasty may be needed. Following cleansing with an antiseptic, local anesthesia is injected. An incision is made 2-3 mm from the lash line and a flap is developed. Excess skin is removed followed by removal of fat from all 3 pockets. Sometimes fat is preserved and rolled under the nasojugal groove. Following the surgery one should keep their head elevated and ice the lower lids for the first day. Sutures are removed after 2-3 days and recovery is very quick.

Transpalpebral lower blepharoplasty – For patients with fatty lower eyelids and minimal skin, a lower eyelid lift with an incision inside the eyelid may be used. This has the advantage of no external scar but may require a peel of the lower lid skin.

Ptosis repair – Ptosis of the upper eyelid occurs when the eyelid drops down toward the pupil. The cause of ptosis is multifactorial but advanced age is one of the most common causes. Repair involves suturing the levator aponeurosis (a ligament) which elevates the lid to a more normal position. This procedure may be covered by insurance.

TCA peel – Excess wrinkling of eyelid skin can be improved by chemical peeling. Chemical peeling requires 2-5 days of recovery and has minimal complications.

Orbicularis lift – For patients with lax lower lids or festoons an orbicularis lift may be indicated. This involves pulling the muscle of the lower lid upward and suturing it into place. Suspension of this muscle supports the lower lid leading to a more youthful look.

Canthopexy/Canthoplasty – These procedures tighten the lax lower lid by repositioning the lateral canthus (corner of the eye) or by shortening the lower lid. Laxity of the lower lid can lead to ectropion (outward bowing of the lower lid) which can cause dry eye syndrome. Ectropion can also lead to an aged appearance. The elasticity of the lower lid is evaluated by performing a snap back test. The eyelid is pulled down by the surgeon and the degree of “snapback” is measured. Inability of the eyelid to return to a normal position or an excessive distance of pull down may indicate the need for a canthopexy. Your surgeon will decide which type of canthopexy or canthoplasty is indicated to achieve a normal appearance.

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Soft tissue augmentation typically refers to augmenting (enlarging) areas of the face but may also include the hands or body. Facial wrinkles, lines, acne scarring, and contour abnormalities can also be improved by augmenting soft tissue. Augmentation can be accomplished by surgically implanting material or by simple needle injection of products.

Commonly augmented areas of the face include cheek bones (zygoma), naso jugal grooves (the line directly under the lower lid), sub brow area, chin, lips, and the jaw line. Wrinkles (rhytids) may be improved or eliminated in the frown lines, crows’ feet, nasolabial folds, marionette lines, and the sub labial crease.

To achieve a more youthful look one must analyze the factors which cause an aged appearance. With age comes a thinning of skin, loss of fat, and drooping of soft tissue.

This causes a loss of volume and subsequent wrinkling of the skin. Rejuvenation of the face can include surgical and non-surgical means. Surgical methods include repositioning of the droopy tissue (facelift) or implantation of solid implants (chin or cheek.). Non-surgical methods include needle injections of specific products. For the most impressive results a combination of products may be used. There are a myriad of substances which can be used for soft tissue augmentation and many of the most promising products have been introduced over the last 5 years. Below is a list of the most commonly used products by Dr. Martin.

Artefill is the first and only FDA-approved non-resorbable filler for wrinkles of the face including nasolabial folds or smile lines. It is very effective for acne scars also. The material is composed of the combination of Artefill Precision-Filtered Microspheres, Artefill Purified Bovine Collagen amd lidocaine for comfort. The 15 minute procedure is performed in the doctor's office and there is minimal discomfort.

The tiny microspheres are PMMA (polymethylmethacrylate), which is widely used in medicine. They remain intact at the injection site and provide permanent structural support to correct the wrinkle (unlike other wrinkle fillers presently available).

In order that patients may receive treatments, a simple test dose is administered 30 days prior to the treatment. There is no charge for this.

For more information, please contact our office to understand how this new treatment can help you achieve the results you have been looking for, with permanent effects!

Fat – One of the earliest and most commonly used products for soft tissue augmentation is your own fat. Advantages of using your own fat include no rejection issues, lower cost of material, and possibility of permanent results. Another advantage is a virtually unlimited supply of grafting material (unless you are very thin). For this reason Dr. Martin recommends fat when grafting the entire face. Disadvantages include longer post-operative swelling and the need for a harvesting procedure. Fat is harvested from any area of the body using gentle liposuction harvesting techniques. If you are planning on having a liposuction you should consider adding a fat grafting procedure. Once harvested, the fat is then centrifuged, washed, and placed into a syringe where it is injected into its target area using a special needle. The fat cells that are harvested are alive and will graft into their new location. On average 50% of the cells resorb over the next 3-6 months. What’s left after 6 months will usually last many years and can be considered permanent.

Radiesse – Earlier known as Radiance, Radiesse consists of calcium hydroxylapatite microspheres suspended in a polysaccharide gel. Radiesse is basically synthetic bone and similar to the hydroxyapatite found in our bones and teeth. Hydroxyapatite has been used for many years in reconstructive surgery including dental surgery and bone reconstruction of the cheeks, cranium, and chin. The product comes in syringes of 1.3 cc’s and 0.3 cc’s. Radiesse is FDA approved for medical use but not for cosmetic applications and is therefore used as an “off label” product. So what happens when we place hydroxyapatite in soft tissues? Over time the hydroxyapatite is resorbed and replaced with your own collagen creating a long lasting augmentation. Results typically last 6 -12 months but can be permanent. Advantages of Radiesse include moderate cost per application, long lasting results, and the ability to augment deeper wrinkles. Disadvantages include the possibility of lumping which can be very difficult to correct. When choosing a plastic surgeon to inject Radiesse, make sure he possess the knowledge and experience necessary to achieve outstanding results with minimal complications. Dr. Martin has an extensive 4 year experience and currently uses nearly 150 syringes of Radiesse per year. For more information go to the Bioform website at www.bioforminc.com.

Restylane – Recently approved by the FDA for cosmetic use, Restylane is a non-animal hyaluronic acid occurring naturally in the human body. It has a jelly like consistency and comes packaged in a 0.4 cc or 1.0 cc syringe. Restylane is injected directly into the dermis (middle layer of skin) or if indicated may be injected into deeper tissues. Advantages include no need for sensitivity testing (like collagen), minimal to no downtime, and low rate of complications. Disadvantages include some chance of lumping and less ability to augment a deeper wrinkle. Restylane lasts 6-12 months on average so repeated injections will be necessary. Cost is typically $ 500 per syringe. For more information go to the Restylane website at www.q-medesthetics.com.

Sculptra – One of the newest soft tissue fillers to be FDA approved, Sculptra is a poly-l-lactic acid polymer similar to a substance already used in absorbable suture material. Scultra is injected by needle into the dermis to achieve augmentation in the face. Advantages include minimal contour abnormalities and longer lasting results. Disadvantages are higher cost and need for retreatment. For more detailed information log onto the Dermik website at www.sculptra.com.

If you are considering soft tissue augmentation, trust that Dr. Martin has the skill and experience needed to achieve the result you expect.

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As a prominent feature of the face, normal appearing ears are necessary for a youthful, rejuvenated appearance. Oversized, droopy, and wrinkled earlobes can cause one to look older and less attractive. Congenital ear deformities (protruding ears) in children can lead to diminished self-confidence and psychological problems. Although much is written concerning congenital problems of the ear, very little is written on cosmetic rejuvenation of the earlobes. Below is a summary of the most commonly treated conditions of the ears.

Prominent ears – Usually a congenital deformity (present at birth), prominent ears consist of a wide conchal bowl (the bowl shaped part) and a wide conchal-schaphoid angle. This causes an ear to look larger and to protrude more than normal. In school aged children ear deformities can lead to ridicule and harassment from other children, eventually leading to psychological problems. Unless treated at a very early age with non-surgical means, prominent ears will require plastic surgery for correction. Surgical correction of the ears can begin when the child reaches 6 years of age, with the overall goal to set back the ear to an appropriate angle. Most procedures are performed under local anesthesia in the office. An incision is made on the backside of the ear (post-auricular sulcus) and the ear itself eventually hides the resulting scar. The cartilage in the conchal bowl is resected and sutured to the base of the ear followed by diminishing the angle of the ear with further cartilage suturing. The sutures are absorbable and therefore do not need to be removed. Recovery lasts 1-2 weeks and involves wearing a headband to keep the ears pressed tightly against the head. Complications are minimal with the most common complication being slight recurrence of the deformity (due to cartilage memory). If recurrence develops a secondary procedure can be performed.

Enlarged/Droopy Earlobes – Earlobes which are too large, misshapen, or too droopy can result in an aged appearance. Loss of connective tissue and diminished elasticity contribute to saggy earlobes. Rejuvenating the earlobes involves removing a wedge shaped piece of tissue from the middle of the earlobe. Suturing then restores a more youthful shape and contour. All procedures are in-office under local anesthesia with minimal complications. After 4 weeks of healing an earring may be replaced in the earlobe.

Split Earlobe – Split earlobes are the result of trauma to the ear (having an earring pulled out) or wearing heavy earrings for long periods of time. Correction of a split earlobe involves a simple repair followed by placement of an earring in 4 weeks. This 30-minute procedure is performed in-office under local anesthesia.

Wrinkling of the Earlobes – Aging, sun exposure, and genetics all play a role in creation of wrinkles of the earlobe. Correction can include reduction, fat grafting, chemical peeling, and other soft tissue augmentation products.

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One of the most common questions patients ask is “will there be scars following my surgery”. Any surgery which requires incisions will leave permanent scars. Initially red and slightly raised, scars take 1-2 years to fully mature and fade to white. Many factors affect the quality of the final scar. Most important is the patient’s genetic ability to heal without excessive scarring or discoloration. Other factors such as trauma, type of closure, and location of scar will also affect the final result. Many products are available to improve scarring. The most effective and least expensive way to improve healing is to tape over the scar and leave it on at all times during the healing process. The tape constantly pushes on the scar causing the scar to flatten and thin out. Massage of the scar also helps healing but one would need to massage a great deal to have any effect. Other products claim to reduce scarring but effectiveness is very hard to prove scientifically. Some lasers and other treatments such as microdermabrasion can also improve scars. Don’t worry if you are unhappy with a scar as most scars can be improved with scar revision. Scar revision involves removing the old scar and resuturing the tissue in multiple layers. All of the sutures are placed under the skin to prevent railroad track type scarring. Steri strips or dermabond glue is placed over the incision to seal off the wound and keep it sterile. Sutures placed under the skin do not need to be removed and will simply dissolve over the next 6 months. Most scar revisions can be performed in the office under local anesthesia. Fees for scar revision depend on the length of the scar and the complexity of the repair. Some scar revisions may be covered by insurance if certain criteria are met.

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