Face Surgery

Several techniques for brow lift exist. The individual method is chosen on the basis of the concrete case (form of the brows, their position, the anatomy of the patient) and the patient’s preferences.

For a slight lift of the corners of the brows and for the removal of wrinkles in the corner of the eye, Botox injections are sufficient

In more advanced cases, silhouette lift is an option. This method is not very long-lasting, however

More durable is a temple lift, including the eye region, which requires a small incision in the scalp

If the forehead skin is very loose and full of wrinkles, and if the distance between the eyes and the brows has noticeably narrowed, a full forehead lift is advised. The intervention is carried out endoscopically through a small incision in the skin. Through the cut, a mini camera is inserted and used to guide the surgical instruments under the skin. In this procedure, the skin is peeled directly off the bone in the forehead and brow area and around the eyes, and this “mask” is then lifted and anchored a little higher up on the facial bone structure. In this process, the muscles responsible for frowning may be cut to permanently prevent them from wrinkling the skin. This so-called subperiosteal endoscopic facelift is the most effective method for forehead tightening and brow lifting.

In bald men, the brows are lifted through an incision in the upper eyelid. This incision is part of the eyelid tightening and thus no additional intervention.

Tightening and padding are usually combined. The following individual methods are applied:

• Fat injections are used to repair deformed tear troughs, pad the jowls and enhance the cheekbones. The face is restored to its youthful oval shape and the deep lines between nostrils and mouth are smoothed. The stem cells in the body fat used in this procedure support collagen synthesis in the skin; it becomes tighter and more lustrous. Fat injections alone may be sufficient for younger patients. They are also a good contouring alternative for younger people with a flat mid-face.
• Of the lower eyelids pursues the goal of improving the tear sacs, padding the tear trough and correcting the transition area between lower lid and cheek. This procedure is frequently combined with a mid-face lift and fat injections.
• The mid-face lift is performed endoscopically through a small incision in the lower lid which is made during lid correction. Alternatively, an incision is made in the scalp. If the endoscopic procedure is performed through the lid, the skin is lifted either below or above the periosteum, the skin layer that covers the bone.

For the endoscopic mid-face lift, a mini camera is inserted under the skin and used to guide the surgical instruments. A mid-face lift is often combined with an endoscopic forehead lift. Access is also possible through an incision in the mouth.

• Silhouette lift: Non-absorbable polymer strands are inserted under the skin and fixed just above the hair line. The strands carry tiny absorbable cones that act as anchors for the skin tissue. This technique is simpler and far less invasive than a surgical face lift. It is particularly suitable for middle-aged persons whose skin shows the first signs of sagging. Local anesthesia is sufficient for this procedure, it is easy to apply and the recovery period is short. If no swelling or bruising occurs, patients can return to their normal lives the next day.

The following methods are applied:

• The face and neck lift usually involve an incision in front and behind the ear; it may be extended into the scalp. Excess skin is excised. If the neck skin can be easily tightened, an incision on the front side may be sufficient. The underlying muscles, including those responsible for facial mimic, are tightened and shaped with suitably placed sutures. If this is not done, the face will soon return to its old shape. Fat deposits on the neck are removed by liposuction. To correct the Turkey gobbler neck, the neck part is opened with an incision under the chin and the muscles are tied together. The result is a better contoured neck. A receding chin can be improved with a chin implant; good results can also be achieved with fat injections. The marionette lines are smoothed with fat injections. Any unwanted fat depots along the jaw line are suctioned off.
• For young patients with good skin elasticity, liposuction may be sufficient to enhance the contours of the neck. The fat obtained in this process can be used for chin contouring and marionette line improvement. (Liposhaping – link)
• A silhouette lift is suitable for persons with good skin quality who don’t want any scar traces. In this procedure, special strands are inserted under the neck skin and anchored below the ears. The lift can be complemented by fat injections and a chin implant.

Neck liposuction and silhouette lift traumas heal rather quickly. A bandage is applied which must be worn for 3 days. Patients are discharged the same day and can take a bath – except in the neck area. Face and neck lifts are accompanied by swelling and bruising which dissolve within a week. To speed up the skin tightening process, neck massages are recommended in the first 2 months.

After neck and face lifts, patients stay in the hospital overnight. The next day, the drains are removed. They can take a bath 48 hours later. The sutures are removed after 6 days. However, it takes up to 3 months until the face has acquired its final shape. The period depends on the scope of the intervention and skin thickness. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.

Swelling and bruising are normal side effects and dissolve almost completely within a week; it may, however, take up to 20 days before the last traces have disappeared. Bleedings are a serious complication. For this reason, patient must discontinue any medication that affects blood coagulation. High blood pressure must be reduced with suitable medicine. If all other means fail, postoperative bleeding must be stopped with surgical intervention. Persistent oedema may form on the neck, and it may take longer than expected before the neck is smooth and thin. The process can be supported with lymph drainage massage, radio wave and deep ultrasound treatment. In rare instances, neck and face operations can lead to lower lip paralysis and movement impairment. These side effects are usually temporary and resolve after a few days; sometimes, however, they continue for a couple of weeks.

The most feared complication is difficult scar healing, which affects mainly smokers, and excessive skin excision. Smokers are strongly advised to discontinue smoking at least for 3 weeks prior to the operation

The procedure often begins with lipo shaping. In this stage, the patient's own fat tissue is harvested from suitable sites, purified, and re-injected to restore lost volume around the eyes, in the mid-face, along the nose–mouth line, in the marionette line, and, if required, in the lips.

From there, the treatment continues with the following steps:

• Upper Face: The forehead is tightened and the brows are lifted. This intervention may be performed with incisions in the temple region or endoscopically.
• Eyelid and Mid-Face: The eyelids are addressed next. Endoscopic surgery of the mid-face is performed through an incision in the lower lid.
• Lower Face: An incision is made in front of and behind the ear; it may be extended into the scalp. Excess skin is then removed.
• Neck Procedures:
  • If the neck skin can be easily tightened, an incision on the front side may be sufficient.
  • The underlying muscles, including those responsible for facial mimicry, are tightened and shaped with appropriately placed sutures (to prevent the face from returning to its old shape).
  • Fat deposits on the neck are removed by liposuction.
  • To correct the "Turkey gobbler neck," the neck area is opened with an incision under the chin and the muscles are tied together, resulting in a better contoured neck.
• Chin and Marionette Lines: A receding chin can be improved with a chin implant or fat injections. The marionette lines are smoothed with fat injections, and any unwanted fat deposits along the jawline are suctioned off.
• Final Touches: Fine wrinkles on the lips (cigarette lines) are smoothed with microdermabrasion, while wrinkles around the eyes are treated with chemical peeling.

This comprehensive approach ensures that both volume restoration and skin tightening are addressed, helping to achieve long-lasting and natural-looking results.

Swelling and Bruising: These are normal and temporary side effects.

Bleeding: Bleedings are a serious complication.

Patients must discontinue any medication that affects blood coagulation.

High blood pressure must be controlled with appropriate medication.

If all other measures fail, postoperative bleeding may require surgical intervention.

Persistent Oedema: Oedema may develop on the neck and can take longer than expected to resolve, leaving the neck less smooth and thin.

This process can be supported with lymph drainage massage, radio wave treatment, and deep ultrasound treatment.

Rare Complications: In some cases, neck and face operations can lead to lower lip paralysis and movement impairment.

Although these side effects are usually temporary and resolve within a few days, they may sometimes continue for a couple of weeks.

Scar Healing Issues: The most feared complication is difficult scar healing, which mainly affects smokers and can be exacerbated by excessive skin excision.

Smokers are strongly advised to discontinue smoking at least 3 weeks prior to the operation.

Dermal fillers and fat injections are the most widely used methods. Fat injections are less popular, however, because they are accompanied by relatively long lasting swelling, they are not permanent and require a clinical environment for their application. They may be used as part of a general face rejuvenation treatment.

Off-the-shelf dermal fillings can be applied in an office environment. Application does not take much time, they do not cause excessive swelling and their effect is more easy to control.

• Filling and smoothing of the marionette line contributes significantly to a youthful look
• Shortening of the upper lip, which tends to extend with age, with a cut immediately under the nose
• Enlargement of the red lip section with a cut on the inside of the mouth
• Lifting of the corners of the mouth with the aid of Botox
• Women in particular complain about cigarette wrinkles that cause lipstick “bleed”. The most effective method is microdermabrasion. For tiny wrinkles special fillers have been developed.
• Drooping corners of the mouth can be permanently lifted by cutting the responsible muscle on the inside of the mouth.

With respect to their effect, they are divided into temporary, long-term and permanent materials.

• The most frequently used temporary substance is hyaluronic acid (HA); its effect lasts between 6 months and 2 years.
• Calcium hydroxyapatite, a substance that occurs in bones and teeth, and poly-L-lactic acid have a long-term effect. They last about 2 years.
• Synthetic polymers-containing substances, like methyl methacrylate and liquid silicon, are permanent. They are not decomposed. Due to the associated high risk, they are not recommended.

We distinguish the following five HA types:

Pure HA Products:

These products do not have filling properties but improve skin elasticity and moisture content. They are typically applied to areas like the neck and décolleté—for example, at the beginning of the summer.

Light Fillers:

Used against crow’s feet and small wrinkles, such as lip wrinkles. Medium-Strength Fillers: Ideal for treating wrinkles and lines like nose and lip lines, marionette lines, and frown lines.

Medium-Strength Fillers:

Ideal for treating wrinkles and lines like nose and lip lines, marionette lines, and frown lines.

Special Contour Fillers:

Specifically designed for the lips.

Deep and Firm Fillers:

Applied directly above the bone, these fillers are used to accentuate the cheekbones and improve the jaw line.

Additionally, all filler types are also used for hand rejuvenation. The more concentrated the dermal filler, the longer it lasts—medium-strength fillers typically last 9–12 months, while high-strength fillers can last for up to 2 years.

In the corner of the eye, between the eye brows and on the forehead. Other areas of application are the area around the mouth, and the neck. Applied between upper lip and nose, it lifts the tip of the nose a bit.

Mona Lisa lift: Tightening of the skin along the jaw line.

We distinguish mechanical, chemical and physical methods.

Microdermabrasion: A small, rapidly spinning wheel with a fine-grained abrasive surface is used to remove the top layer with its imperfections such as old scars, pimple traces, pigmentations spots and the tiny vertical wrinkles around the mouth.

Chemical peeling: The peeling agents are week and moderately strong acids such as fruit acids, trichloroacetic acid (TCA) and phenolic acid. They are used to smoothen eye wrinkles and to lighten skin spots.

Laser peeling: This technique is not without its specific problems and has fallen a bit out of favour. The newly developed fractional laser method has revived interest in this technique. Laser treatment smoothens wrinkles, lightens skin blotches and tightens the connective tissue in deeper skin layers.

Silicone and porous polyethylene (PE) are among the most commonly used synthetic materials in medical implants.

Silicone Implants:

• Silicone is a soft, flexible material widely used in various implant procedures, including chin augmentation.
• Its smooth surface allows for easy insertion and removal.

Porous Polyethylene (Medpor) Implants:

• Porous PE, commercially known as Medpor, is a high-density polyethylene implant characterized by a network of tiny pores.
• These pores facilitate tissue ingrowth, enhancing implant stability and integration with the surrounding tissue.
• The textured surface reduces the risk of implant migration.

Both materials have demonstrated biocompatibility and are selected based on specific surgical requirements and desired outcomes.

Four trigger points are distinguished:

• Between the eyebrows
• In the temples
• In the neck
• Behind the eyes and in the upper part of the nose

The basic idea behind migraine surgery is to loosen up the anatomical structures at the trigger points and to liberate the pinched nerves in order to stop them from sending headache-triggering signals to the brain. Positive reaction to Botox is a crucial indicator that surgery may help, and the patient must definitely be tested before any intervention. Depending on the trigger point, the following procedures are carried out:

• Between the eyebrows: With an endoscopic intervention through a cut in the scalp, muscle fibres between the eyebrows are cut and removed.
• Temples : With an endoscopic intervention, tiny nerves are severed.
• Neck: The muscle fibres around the triggering nerve are severed and removed.
• Behind the eyes / in the nose: At first a CT scan is recorded to identify any anomalies which are then corrected.

There are many ear correction methods. I prefer an incision behind the ear, after which some of the cartilage is carefully scraped off with a special tool. This reduction allows the ear to be positioned closer to the head. The incision is sutured to stabilize and fix the result.

This intervention behind the ear leaves no visible traces of the operation, the cartilage is not cut, and no skin is removed. Swelling after surgery is moderate and the result is permanent.