Academic journal article Generations

Reversing the Normal Condition of Aging: A Plastic Surgeon Describes the Techniques

Academic journal article Generations

Reversing the Normal Condition of Aging: A Plastic Surgeon Describes the Techniques

Article excerpt

Risks and benefits.

A patient seeking facial rejuvenation from the services of a plastic surgeon is requesting a reversal of the normal condition of aging. Aesthetic surgery and related nonsurgical measures are performed to make the patient appear more rested or younger. A variety of procedures, in a continuum of invasiveness, are available to effect these changes.


When discussing aesthetic surgical procedures, it is important for the physician to assess the patient's motivation for seeking these physical changes. The surgical procedure will only affect the patient's appearance. Occasionally, patients request these procedures because of stress or disruption in their personal lives - dissolution of a relationship or threatened loss of a job, for example. While the aesthetic procedure may indeed make the patient appear more rested or younger, the physician must ensure that the patient understands that the procedure will not in itself result in changes in the person's life.

Certain preexisting medical problems are significant contraindications to surgical procedures. A patient with hypertension is at risk for bleeding both during and after the surgical procedare. Similarly, bleeding tendencies and even some dietary habits can cause excessive bleeding from a surgical procedure. Hypertension itself can be controlled both during and after the operation, but bleeding tendencies may preclude choice of an invasive surgical procedure. Most surgeons require patients to avoid excessive use of specific foods and vitamins and other dietary supplements (such as vitamin E and garlic extract) and nonsteroidal antiinflammatory drugs and aspirin. If excess bleeding should occur during the operation, it can be controlled but will add significantly to the surgical time. Postoperative bleeding can lead to prolonged bruising and staining of the skin or even a small collection of blood in a hematoma. An expanding or large hematoma will require surgical intervention to drain the collection and control the bleeding. Ignored, a hematoma can lead to discomfort, additional scarring, and even infection.

Patients with chronic allergies like those induced by molds or pollen will have eyelid swelling which can compromise the effect achieved by surgery. Similarly, patients with hypothyroidism will have swelling around the eyes. The patient's physical health should be as good as possible at the time of surgery to achieve the best result from the surgical procedure chosen.


Often, an individual's first concern about the aging face is the "bags" that occur around the socket of the eye, giving a tired appearance. This condition may be alleviated with blepharoplasty, or plastic surgery on the eyelid to remove excess fatty tissue. The rate of this procedure has increased 190 percent since 1992 (American Society ofPlastic Surgeons, 2001). The appearance of bags may be due to changes in the skin, muscle, or fat around the eyes or can be caused by forehead drooping. Through careful physical examination, the physician can determine which of these conditions is the cause of the patient's concem. If the forehead skin and musculature have become displaced, then drooping of the eyebrow may cause fullness of the upper eyelid. In that case, blepharoplasty alone will not correct the patient's condition and will result in a shorter distance between the eyebrow and the eyelashes, which gives the patient a harsh appearance.

The surgical procedure alone will not address fine lines commonly referred to as crow's feet (Klatsky, "liff, and Manson, 2000). Occasionally, particularly in older patients, drooping of the upper eyelid actually causes visual obstruction. Visual field testing by an ophthalmologist can document this condition. Most third-party insurance payers will consider upper-- eyelid blepharoplasty as a covered benefit to correct this condition.

The most common approach for blepharoplasty is external resection of excessive skin, muscle, and herniated fat around the eye socket, as needed. …

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