Patients will come in and often they will say, “I am not exactly sure why, but I feel that I look old, I feel that I look tired and can you help me figure out what it is,” and these are always challenges because there are multiple areas on your face that can cause you to look tired or old and what I like to do is I like to sort of start at the top and work down and in some cases people have eyebrows that are low and what we called ptotic eyebrows and it can make the skin on your upper eyelids look low, it can start to interfere with your peripheral vision and those are patients that we might talk about doing a browlift, lifting all of this up including your eyebrows. We will talk probably about whether or not surgery on your upper eyelids and lower eyelids would be beneficial. If you have extra skin, if you have puffiness of the bags, there are different procedures that can be done to make you look less tired, more awake, more alert. The people will say I have prominent folds here, prominent jowls and extra stuff on my neck and those are patients that can benefit from a facelift and what a facelift is, it is an incision that goes in the hair and then down inside the ear, around the ear back up and back into the hair, so that we can lift the whole side of the face up and back and I like to do what is called the double-layer facelift. We use what is called the SMAS layer or the deep layer initially to lift up and secure and that helps a lot along the jaw line, the neck line, and then we rotate the skin flap up in a little different direction a little more vertically to clean up the full and the mid level of the cheek to put it in a better position, so those are things that we commonly do. Another facial rejuvenation technique that I like is for lines on the lips and if we do a CO2 laser and do this area, which is considered an aesthetic unit, when you look at someone’s face, you see this whole area rather than doing say just the lip you do the whole area, but the laser takes off skin, the top layers of the skin in very predictable levels such that we do not go too deep and too superficial and it gives a uniform scarring and this can be very helpful particularly with deep wrinkles of the upper lip. Sometimes people are not concerned about certain areas. What I like to do again is listen to what their concerns are and help them get the result that they want.

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