The Laser Facelift: The Mixto Fractional CO2 Laser Facelift

The Laser Facelift can be very effective in patients with Fitzpatrick Skin Types I-III. The fractional CO2 laser can effectively tighten the skin around the upper and lower eyelids, the nasolabial folds, and the pre-jowl area. The CO2 laser is also very effective at reducing dyschromias or pigment irregularities on the face due to sun exposure.
The fractional CO2 Laser works by producing a controlled burn to the surface of the skin as well as stimulating collagen formation in the dermal layer of the skin. It is therefore quite common for the appearance of the face to improve up to one year or more after the procedure.
It is becoming more common for many women with Fitzpatrick Skin Types I-III to undergo fraction CO2 Laser skin resurfacing to improve the skin texture and then returning to undergo a formal facelift 2 to 3 years following the laser treatment.


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Facelift Surgery. Deep Plane Facelift & Fractional CO2 Laser

While the neck is often a significant area of concern for many patients who present for facial rejuvenation, I find that the deep plane facelift is very effective at restoring the position of the cheek.

In the youthful face, the cheek is positioned beneath the lower eyelid so that a smooth contour exists between the lower eyelid and the cheek. As we age, the cheek begins to descend, causing a gap to be created between the lower eyelid and the cheek.

When performing facelift surgery, the surgeon repositions the cheek back to beneath the lower eyelid to restore this contour. Often after patients have a facelift they remark about the improvement in the appearance of their eyes. This is because the volume of the cheek is now repositioned into the proper location.

The patient in the above photograph underwent deep plane facelift, and CO2 laser to her lower lids and peri-oral rhytids or “wrinkles”. In the before photograph she is 89 years old, in the after photograph she is 89 years and 10 months.

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Facelift. Male Necklift

Traditionally as male individuals age, the greatest signs of aging occur in the neck. Males often do not have deepening of the nasolabial fold as seen in females. Therefore, I often find the best way to rejuvenate the face in males is to address the neck.

This can be done with the same incision as seen in female patients to address the lower face and neck or it can, in some males, be performed with the z-plasty on the anterior aspect of the neck. The incision is limited to the area beneath the chin and above the thyroid cartilage.

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Facelift. Deep Plane Facelift.

I enjoy all of the different types of facelift techniques that I have learned.

My preferred facelift technique is the deep plane technique. Which technique I perform depends upon the presence of jowling, the heaviness of the neck, and the depth of the nasolabial fold. I find that a significant amount of youth can be restored to the face with effective treatment of the neck in facelift surgery.

Appropriately addressing the neck requires a small incision beneath the chin to adequately correct the presence of platysmal bands or deposits of fat beneath the chin.

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Necklift. Male Facial Rejuvenation.

More male patients are seeking consultation regarding facial rejuvenation. Male patients often present to the office wanting to improve the appearance of their face and neck.

Prior to performing any procedures, I first determine if the jowls or nasolabial folds need to be addressed to create a more youthfull appearance. If a male patient has significant jowling or a deep nasolabial fold then we can proceed with a lower face and neck lift.

If there is no jowling and a nasolabial fold which is not deep then we can proceed with a necklift. The necklift can be performed with an incision in the neck itself, with an incision beneath the chin, or with standard facelift incisions. Another very effective means to address the aging neck in the male is with a platysmalplasty and neck z-plasty.

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Facelift. Necklift. Neck Liposuction

Patients frequently come to consultation asking whether or not they need a facelift, necklift, lower facelift, full facelift, etc. It is important to individualize each facial rejuvenation operative plan depending on the desires of the patient as well as the surgeon identifying those objective indicators of aging that can be corrected with surgery or another non-surgical modality.

For example, the patient in the above photograph did not like the appearance of her neck. While even the untrained eye would notice the neck laxity, when one examines the before photograph closely the jowling which obscures the mandibular border is easily identified. Therefore it was important to address the jowling as well as the neck to optimize the aesthetic outcome.

It is quite common the aging female patient to address at least the lower aspect of the face when addressing the neck. Almost invariably, when there are signs of aging in the neck, there are also signs of aging in the face. Therefore women will also undergo a facelift or other maneuvers to address the jowls and nasolabial folds.

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Facelift Surgery. Deep Plane Facelift

The deep plane facelift is a technique that can be used in conjunction with an upper and lower blepharoplasty as well as a coronal brow lift.While the deep plane facelift affords excellent correction of the nasolabial folds, jowls, and neck, I have found that the aperture of the upper eyelids can yield a significant positive impact on the aesthetic result on the overall youthful appearance of the face.

It is very common for women as they age to have an accumulation of skin on their upper eyelids. This accumulation of skin has been given the medical term, dermatochalasis. Often this accumulation can be asymmetric-meaning greater on one side versus the other and can create differences in the aperture of the eye.

It is important when correcting this asymmetry to note the location of the tarsal fold or eyelid crease.As you can see in the above photograph the patient's right eye has significantly more skin pre-operatively than the left eye. Careful notation of these asymmetries is important so that post-operatively the eyes can have equal apertures and yield an optimal aesthetic result.

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Facelift Surgery. CO2 Laser Blepharoplasty for Rhytidectomy

Facelift surgery is enjoyable for me from both a technical standpoint as well as the individuality of each case as it pertains to the patient. Some women require the lower third of the face to be addressed, others the midface, and some the brow and eyelids.

I enjoy the CO2 LASERS as an adjunct in many aspects facial rejuvenation. The Mixto CO2 laser can improve the fine lines of the lower eyelid, the crow’s feet, and the fine vertical lines around the mouth. The CO2 laser effectively tightens and improves the quality of the lower eyelid skin, and in some cases obviates the need for a lower blepharoplasty. The CO2 laser has proven to be very powerful for improving pigment changes secondary to sun exposure and sun spots known as seborrheic keratosis.

This patient is very happy with her results 4 months post-operatively from facelift, upper blepharoplasty, and CO2 laser to the lower eyelids and peri-oral rhytids.

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Laser Blepharoplasty

I have been very impressed with the results of the fractional CO2 laser for full facial resurfacing as well as for concentrated efforts on the upper and lower eyelids. Patients who are excellent candidates for fractional CO2 laser include younger patients with fair skin who are not quite yet surgical candidates for either upper blepharoplasty, lower blepharoplasty, facelift, or necklift.

Traditionally I have found that female patients in their late thirties and early forties who do not want aesthetic surgery and who are starting to develop skin laxity do great with these treatments in the areas of the eyelids, jowls, neck, and nasolabial folds.

Often these happy patients will return for their post-procedure appointments and say that their friends all ask, “Did you just get back from vacation?” or “You look so well rested”. I am very pleased with the results I am obtaining with the Mixto CO2 Laser and look forward to using it in conjunction with rhytidectomy in the months ahead.

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Facelift Surgery

While I enjoy all aspects of Plastic & Reconstructive surgery, facelift surgery is particularly enjoyable to me. Rejuvenation of the upper and lower eyelids is paramount to restoring a youthful appearance to the face.

As the face ages, the brow descends and skin accumulates around the upper lid and fat begins to herniate through the lower lid creating a tired appearance to the eye. While I do not encourage procedures during consultations, I often point out to patients who present for facelifts that small, subtle changes to the eye can yield a large difference. In this photograph one notices how effectively an upper blepharoplasty, or upper eyelid, procedure in conjunction with removal of fat from the lower eye can restore a youthful appearance to the face when utilized in conjunction with a facelift.

Facelift & Necklift Surgery

Facelift surgery can be particlarly rewarding for both the patient and physician. Frequently, I notice a youthful change in the appearance of the eyes without a single procedure being done to either the upper or lower eyelid.

I attribute this change to the repositioning of the cheek fat pad or malar fat pad back to the normal anatomical or pre-aged position. This restoration of volume not only recreates harmony to the lower eyelid and tear trough, but also improves the position and contour of the upper eyelid and seems to affect the overall aperture.

Facelift Surgery

Facelift surgery can be extremely rewarding for both the patient and surgeon. Typically patients who present for facelift surgery can range from 40 to 60 years of age. These patients almost invariably complain that despite having a good night of sleep, they continue to appear tired and then feel tired.

Blepharoplasty or eyelid surgery can enhance the surgical results of facelift surgery and significantly improve the surgical outcome. Quite commonly after facelift surgery, patients state that they have more energy, feel better rested, complain less, have fewer aches and pains, and are very happy with their decision to undergo facelift surgery.