Facial Plastic Surgery Blog | Facial Rejuvenation Procedures
FACE/NECK LIFT: A face/neck lift is a comprehensive facial rejuvenation procedure. This procedure encompasses rejuvenation for the face, the jowls and the neck. Removal of any fat underneath the neck including tightening of the anterior muscle platysmal bands and the muscles in the face is also included in the face/neck lift. This operation is a combination of a neck lift and a mini lift or a tuck facelift. The incisions are placed at the anterior temporal hairline and behind the ears and up into the retroauricular incision. They are placed in such a fashion that patients are still able to wear their hair up off their shoulders after the incisions have healed. There is also a 1-inch incision underneath the chin to allow sculpting of the neck structures. The facial muscles, including the superficial muscular aponeurotic system (SMAS) are tightened along the cheekbone area and the jowls are lifted. Any excess facial and neck skin is tightened and the fat above and below the platysmal muscle in the neck is removed. In addition, the neck muscles in the center front of the neck underneath the chin area are tightened, as well as the neck muscles in the posterior portion of the neck to accentuate and create a new defining jawline. Two Jackson-Pratt drains are placed underneath the neck area and left in place for a few days in the immediate postoperative period to remove blood and fluid from underneath the skin. The face / neck lift is performed under a general anesthesia and post operative pain is usually minimal. The surgery is performed at the Seattle Facial Plastic Surgery Center, which is a Medicare-certified surgery center under the direction of Dr. William Portuese. Board-certified physicians/anesthesiologists from Swedish Medical Center perform the anesthesia. Out-of-town patients can stay at one of the area’s three hotels within one block of the office.
MINI LIFT: The mini lift or tuck facelift has many description terms such as an S-lift, which is a minor variant of the mini lift. A mini lift involves tightening the facial cheek and jowls however, it does not address the neck, which is only addressed through a face/neck lift or just the neck lift. A mini lift is a procedure where the incisions are placed in the anterior temporal hairline along the sideburn and behind the tragal portion of the ear in a small portion behind the ear. The undermining that is performed is only in the high cheekbone area, and the muscles are tightened in the facial area (also known as the superficial muscular aponeurotic system or “SMAS”). The primary goal of a mini lift, tuck facelift or S-lift is to remove the jowls. This operation is usually performed under a general anesthesia but can be performed under twilight intravenous sedation. No drains are required for this operation and patients tend to get back to regular activities sooner with less bruising and swelling than a traditional face/neck lift. If there are preexisting neck conditions such as submental fat, skin laxity, and anterior platysmal muscle bands, this is not the correct operation for the patient. The surgery is performed at the Seattle Facial Plastic Surgery Center, which is a Medicare-certified surgery center, under the direction of Dr. William Portuese. Board-certified physicians/anesthesiologists from Swedish Medical Center perform the anesthesia. Out-of-town patients can stay at one of the area’s three hotels within one block of the office.
NECK LIFT: A neck lift is performed on someone in their 30s, 40s, or early 50s, when there is no excess neck skin. The goal is to remove fat and tighten muscles of the neck without removing any skin in the neck. If there is a laxity of skin in the neck, the neck lift is not the correct operation to perform. In the neck there is fat above and below the platysma muscle, and both need to be addressed. A 1-inch incision is placed underneath the chin area hidden in the submental crease, and there are two 1/2-inch incisions placed behind the ear in the retroauricular sulcus. Indirect liposuction is performed from the postauricular area to define the posterior jawline. Direct liposuction and manual sculpting and removal of fat in the entire submental area are performed after lifting up the submental skin area. Once the fat is removed above the platysmal muscle, the area is manually sculpted and additional fat is removed from underneath the muscle. This creates a better definition of the jaw line both from the side and front profile. A sharp delineation of the jawline is then created by sewing the anterior platysma muscles together. This is all achieved using the submental approach. The incisions are closed meticulously with fine sutures. In addition, Jackson-Pratt drains are placed underneath the skin in the neck to remove blood and fluid in the near-term postoperative recovery. These drains help to alleviate blood accumulating underneath the skin and are removed in a few days after the surgery. The neck lift is the correct operation for someone who has excess fat in the neck and desires a better neckline definition, however, has good skin tone and does not need any skin removal. This is usually done under a general anesthesia but can be performed under intravenous sedation or twilight anesthesia. The necklift is a much better alternative than traditional submental liposuction, which does not address subplatysmal fat or neck muscle tightening. The necklift surgery is performed at the Seattle Facial Plastic Surgery Center, which is a Medicare-certified surgery center, under the direction of Dr. William Portuese. Board-certified physicians/anesthesiologists from Swedish Medical Center perform the anesthesia. Out-of-town patients can stay at one of the area’s three hotels within one block of the office.
MID FACELIFT: The mid facelift is a common surgical procedure where the goal is to give a lift only to the cheek areas. This procedure is usually performed under a general anesthesia. The incisions are made in the temporal area and underneath the upper gum line, and a pulling and tightening effect is performed on the muscle and fascia layers of only the cheeks. An excellent alternative to this technique is to place cheek implants in the cheek area overlying the maxillary bone. As the face ages there is a volumetric reduction in the amount of fat and an overall volume loss of tissues in the cheek; therefore, sagging cheeks occur. Re-suspending the cheeks with a mid facelift helps. In addition, volumetric augmentation with cheek implantation works well. Cheek implants are placed through a gingival incision on the upper lip above the teeth, and they are placed on the natural cheekbone. They are undetectable both by look and feel, and they feel just like the patient’s own normal cheekbone. The mid facelift or cheek implants are usually performed on patients in their 40s and 50s who have limited aging only to the cheeks and do not require a facelift, a neck lift, or any other facial rejuvenation procedure. The cheek implants can also be performed in combination with a facelift if there is facial laxity and a flat cheek area. The surgery is performed at the Seattle Facial Plastic Surgery Center, which is a Medicare-certified surgery center, under the direction of Dr. William Portuese. Board-certified physicians/anesthesiologists come from Swedish Medical Center to perform the anesthesia. Out-of-town patients can stay at one of the area’s three hotels within one block of the office.
Lower eyelid surgery, performed by Dr. Portuese, is a popular procedure because it can rejuvenate eyes of any age. Whether a patient has genetic bags or they have acquired them with age, Dr. Portuese’s approach removes the cause of the bags under the eyes. No stitches are used in this surgery which makes for a simple recovery.
– Hi, I’m Dr. Portuese from Seattle, Washington. Today we’re gonna talk about upper eyelid surgery. The primary goal for upper eyelid surgery is to remove excess skin that’s usually touching the eyelashes or creating the hooded or tired look. The incision’s located right in the upper eyelid crease. We’re also removing a small amount of fat from the inner corner of the eyelid here that rejuvenates the upper lids and makes patients look more refreshed or well rested. The sutures that we use are dissolvable. They fall out in about a week, but you can anticipate about two weeks of visible bruising and swelling after the procedure.
Video Transcript: Hi, I’m Dr. Portuese from Seattle. Today we’re going to talk about revision rhinoplasty. A revision rhinoplasty involves another procedure performed on the nose, for patients who’ve had a previous rhinoplasty in the past. They’re much more difficult and much more complicated because of the fact that there’s been previous changes to the normal anatomy, and scar tissue formation in the nose from the previous procedure.
A good candidate for a revision rhinoplasty is someone who has realistic expectations about what we can accomplish. There are things we can accomplish, there are things we cannot accomplish. For example, if there’s a small indentation in the upper lateral cartilages, and there’s plenty of cartilage left on the inside of the nose, we can harvest a small piece of cartilage and put a little spreader graft in that area to build that little dent or that depression up.
Another good example would be somebody who maybe has a residual bump on the bridge of their nose, and we can file that down, or somebody who has, their nose is too scooped out, too much cartilage has been taken away, we can come back in and add an additional cartilage graft in that area, usually taken from the inside of the nose. But if there’s been a cartilage-depleted nose from prior surgery, then we may have to use a piece of ear cartilage to reconstruct the nose.
I would not recommend revision rhinoplasty in someone who has unrealistic expectations. There is no perfect nose. If you want a perfect nose, there’s no reason to undergo this type of procedure. There’s improvements, but nope, there is not a perfect nose.
Video Transcript: Hi, I’m Dr. Portuese From Seattle, Washington, and today we’re talking about placement of cheek implants. Cheek implants offer a permanent augmentation to the cheeks versus fillers that offer temporary augmentation. Cheek implants are manufactured in a large array of sizes, thicknesses and shapes. Today we’re gonna look at three different shapes of these implants. These are all size small. And the first one is what’s called a ubmalar Implant. These are sizers. These aren’t the actual implants. The actual implants are clear but this is a submalar implant. And this implant is used for patients who have a flat … the mid face is flat in the lower area down in here where they have buccal fat pad atrophy in this area.
But these implants go in this location and are performed to augment the lower mid face. The next one is a malar implant and that goes in the … that augments the entire mid face like this in a equal fashion. This is for patients who have more of a broader range of a flat cheek. This is a combined malar and submalar implant that is performed for patients who have an overall flat cheek and are really flat in the lower portion of their mid face. And this implant goes like this.
These implants are placed through an intra-oral approach above the teeth through the mouth usually under a brief general anesthesia as an outpatient surgical procedure. They can be removed at any time or they can be replaced with a larger or a smaller cheek implant. If you’re interested in a consultation?
Lip enhancement surgery is a group of procedures that can involve a variety of substances to increase the volume of the lips or surgery to reshape the lips. Lip enhancement surgery can be divided into procedures which increase the volume of the lips by adding material or procedures which reshape the lips utilizing various incisions. Occasionally, lip augmentation procedures are performed in conjunction with lip reshaping procedures. Most lip augmentation or lip reshaping procedures can be performed under local anesthesia.
Lip augmentation surgery can be performed by a variety of methods and there is no one method which is best for all patients. It is common in most practices that the patient makes various decisions regarding their lip augmentation surgery. Like everything in life, there are advantages and disadvantages for each option and every patient has different opinions and desires so you are encouraged to discuss the various options with your plastic surgeon at length to find out which option is best for you. Your board certified facial plastic surgeon will review a few common options and some of the advantages and disadvantages of each option.
There are several incisions used for lip reshaping procedures. For a lip lift procedure, the incisions are placed beneath the nostril sills and base of the columella of the nose. For a corner of the mouth lift procedure, the scars are placed at the junction of the pink portion of the lip and flesh-colored skin in the upper lip just above the corners of the mouth. The corner of the mouth lift scars are probably the most noticeable or visible of all the scars discussed so far. The most common incision used for lip augmentation is 2 small incisions near the corners of the mouth and is made outside the crease or fold of the corner of the mouth. The scars are almost inconspicuous and by avoiding the precise corner of the mouth, the risk of narrowing of the mouth is minimized.
Lip augmentation surgery can be of performed utilizing a variety of materials. A key distinguishing feature between materials is whether to use your own tissues to augment the lips or artificial tissues. Artificial tissues can include things such as Gore-tex and various types of plastic particles mixed with collagen or hyaluronic acid. In general, lip augmentation looks most natural when performed utilizing your own tissues. Several types of donor tissues can be used for lip augmentation and fascia (muscle lining), fat, tendon and dermis (the deeper layer of skin) have very successfully been used over the past 20 years with very good results. Sometimes, the donor material/site is determined by an associated procedure being performed at the same surgical setting such as a facelift or tummy tuck. You can discuss this with your surgeon during your consultation. Other materials such as Alloderm can also be effective and will become incorporated into your own tissue over time. Artificial materials such as Gore-tex or plastics do not incorporate into your own tissues and have a higher propensity to cause deformities with animation such as speech, eating or kissing.
Seattle has so much to offer its visitors. It is surrounded by evergreen forests and snowy mountains. Seattle is also leading the way in technology. It is home to the largest tech companies in the United States. Seattle has something for everyone. If you are looking for the latest club or get reconnected to nature, there is a place to visit in the Emerald City.
Every visitor to the city has to check out its famous landmark. The Space Needle was built in 1962 to celebrate the World’s Fair. It has become an iconic symbol of the city. The Space Needle has an observation deck where visitors can get incredible views of Seattle. For those wanting to dine with a view, the SkyCity restaurant is a good place to have a meal.
Pike Place Market
Pike Place Market is known for fish getting hurled through the air. This historic market opened in 1907. It is the oldest public farmers’ market in the United States. The market is where many of Seattle’s merchants, craftspeople, and farmers sell their goods in the city. For musical entertainment, you can often catch a street show by one of the local performers. The market can get a little crowded. Pike Place welcomes over 10 million visitors per year. For a unique experience, the Market Theater Gum Wall is nearby. This attraction is outside the main entrance of Pike Place Market. The wall is completely covered with chewing gum. The tradition started in 1993 when the patrons of the Theater stuck their used gum to the wall.
Seattle is surrounded by the beauty of nature. Discovery Park has over 534 acres of natural space for visitors to explore. The park is located on the shores of Puget Sound in the Magnolia neighborhood. Discovery Park is the largest public park in the city. It has 11.8 miles of walking trails. The park is also famous for the West Point Lighthouse. This spot offers great views of the city.
Museum of Modern Culture
The Museum of Modern Culture, or MoPOP, is dedicated to celebrating the best of contemporary culture. It was founded in 2009 by Microsoft co-founder, Paul Allen. The museum was originally known as the Experience Music Project but changed its name in 2011. The museum has many exhibits including props from the Marvel films to the early concert posters of Nirvana. MoPOP is home to the Seattle International Film Festival in the winter.
The Hiram M. Chittenden Locks are located on the west end of Salmon Bay. This lock system carries more boat traffic than any other lock in the United States. The site welcomes over 1 million visitors per year. They do not come just to watch boat traffic. The Carl S. English, Jr. Botanical Garden is located near the Locks. It has over 7 acres of flowers and trees. The Ballard Locks fish ladder is another spot to visit. Visitors can watch salmon pass through the fish ladder during the summer months.
Seattle is home to many exciting places to visit. Whether you want to see nature in action or take in a little history, Seattle has it all. It is the hidden gem of the Pacific Northwest. Learn more about what you can do in Seattle WA
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