When I see a patient who is concerned about aging in general and not sure what to do, it is my job to help them sort through the options and one of the options that we see in California quite a bit are people that have severely sun-damaged skin. They have spent lot of time as teenagers and young adults and even older adults in the sun. Some live in rural environments and are outside a lot, but if you have skin with lots of sun damage, the brown spots on your skin and wrinkles and sort of a roughened texture of the skin, laser resurfacing with a CO2 laser can be very effective. It takes off the top sun-damaged layers of the skin and gives you a younger, more youthful undamaged skin at the end of the process. Now it is a significant operation. It is like having a very deep sunburn. You need about two weeks to three weeks of your life to recover from this. We do the procedure in the operating room with an IV with an anesthesiologist and we take the top layers down to the deep dermal level, which is the deeper part of the skin so that you can generate or regenerate new skin. There is a certain amount of pain and discomfort. You have red baby-like skin for several weeks after surgery and the redness may last for a few months, but at the end of the time period often you can have a very dramatic improvement in the color, the softness, the smoothness, and removal of fine wrinkles and sunspots, so this is something that is worthwhile. We often do these procedures in January or February so that after the holidays you got some time to sort of hide out at home, but that can be a nice little adjunct to the surgeries that we do in other parts of the face. Often times, people will have droopy eyebrows on one side or both sides. That is actually allowing the skin of the eyelids to hang more dependently and so you can take out the eyelid skin, but often what you really need to do is lift the whole brow. I like to do what is called an endoscopic brow lift. It used to be that the brow lifts were done with an incision that went from here to here, from temple to temple and the problem with that was you had a long scar, often the sensation behind the scar was minimal or annoying, people would scratch a lot and with the endoscope, which is a small lighted tube that you can put in, we may make a little incision here, incision here, and incision here and I can go in and release the whole forehead over what is called the periosteum, the bony layer and then we can elevate this and secure it in position and get a very nice esthetic result, so this is something that most people do not think about and again this is my job to say this is something that may be helpful. A similar situation is a patient who comes in for a rhinoplasty and they are concerned about their nose and when you look at them in profile, they have a small recessive chin and you can enhance their appearance often quite a bit by putting in a small molded silicone chin implant. So, it is one of those things that the surgeon needs to point out to the patient to get the best esthetic result.
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