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Eyelid Surgery & Other Facial Rejuvenation Options in Bellevue, WA

Your facial appearance contributes to the first impression that you create, and a rested, refreshed and rejuvenated facial appearance can bolster self-image and self-confidence. Aesthetic facial surgery can help to create a younger looking, yet very natural facial appearance. The commotion of daily life can be tiring, and frequently stress and exhaustion is all too apparent in our faces. Age, stress and lifestyle realities can leave their marks upon our visage, and Dr. Nygaard can help you present a brighter, more refreshed facial appearance to the world. Dr. Nygaard offers several options for facial rejuvenation, customized to help the individual patient put forth their brighter, more youthful, yet very natural facial appearance.

EYELID SURGERY -BLEPHAROPLASTY

Eyes are the windows to the world, and are a vibrant reflection of who we are, and how we see ourselves. Dr. Nygaard can help to restore a more rested, youthful and attractive appearance to the eyelid region and help patients proudly share their brightest eyes with the world. Blepharoplasty can be an effective way to help rejuvenate facial appearance, as the eyelids can be the first area to show signs of aging. The procedure precisely sculpts the eyelid region, removing excess skin and fat from the upper or lower eyelids, thereby restoring a refreshed, rested and youthful appearance to the eyes. With the aging process, the thin eyelid skin is stretched, creating heavy skin folds or hooding of the upper eyelids. Lower lid fat pads can become more visible and create puffiness, resulting in an older, more tired appearance, in the form of lower eyelid “bags “.

After blepharoplasty, the eyes appear brighter and often look larger, and the entire facial countenance can look more rested and youthful. Excess skin and fat pads are gently sculpted away through incisions hidden in the natural skin creases. Thin scars are present, but they fade away until they become virtually invisible. Although the procedure cannot prevent the eyelid region from continuing to age, typical results are very long-lasting and most patients do not need, or request, a secondary eyelid procedure.

The upper or lower eyelids can be addressed separately; however, most patients typically elect to have upper and lower lid blepharoplasty performed simultaneously, to refresh the entire eyelid region at the same time. The eyelids may be surgically sculpted by themselves, or the procedure can be done in conjunction with a browlift or facelift, to create a more youthful facial harmony.

What to expect:

  • The procedure is usually performed under IV sedation, with little to no awareness during the procedure. Occasionally, patients request a general anesthetic.
  • Some swelling and bruising will be present in the eyelid region, most of which is resolved by about 10-14 days post-op.
  • Temporary blurred vision, usually related to eye ointment.
  • Minimal discomfort, well controlled with medication and iced compresses.
  • Minor tearing abnormalities including “dry eye” sensations and minor light sensitivity, which typically resolve in a few weeks.
  • No contact lenses for 2-4 weeks.
  • With concealing make-up, most patients are back to work within about 10-14 days.
  • Strenuous activity should be avoided for 6 weeks postoperatively. Light activity can typically be resumed about 3 weeks post-op.

FACELIFT

Facial aging is inevitable as the years pass. The loss of youthful contours of the face can be due to a variety of reasons, including hereditary factors, gravity, significant weight fluctuations, environmental factors, stress, and lifestyle realities. The skin of the cheeks, midface and jowl region sags, folds of skin develop along the nose and mouth region, and neck and lower face tissues can become lax and saggy. Often, extra fatty tissue accumulates under the chin. These changes in facial appearance can make one appear old and tired, and facial aging often adversely affects self-image and even self-confidence.

A facelift is a surgical art form that can help patients to age gracefully and roll back the hands of time. Most patients seek a refreshed and natural appearance, and wish to appear rejuvenated overall, but not look radically “different”. Dr. Nygaard performs a very natural facelift, resulting in an overall significant improvement in facial appearance, yet avoiding an overly tight, “pulled” or “operated” look. Typically the results of a facelift last for about ten years or so, sometimes longer. A facelift cannot halt the aging process, and the passage of time will result in ongoing facial changes.

There is no standardized technique to performing a facelift. This is a highly customized procedure for each patient, based on individual anatomy and tissue characteristics, designed to achieve the best aesthetic results and the best improvement possible. The goals of a facelift are to achieve a natural, youthful, and refreshed appearance by restoring cheek volume, minimizing the sagging tissue in the cheek region, softening the nasolabial folds, and restoring a smooth jawline, with no jowls. In addition, the neck is contoured and excess loose and sagging skin and fat is removed from the neck region.

Facelift incisions are typically hidden in the temple region, around the ears, and along the lower scalp behind the ear, to minimize problems with hair loss. A small incision is also made in the crease under the chin to enhance ability to treat the neck area. The incisions follow the natural contours of the face to keep scars as inconspicuous as possible. The skin flaps are gently elevated off the underlying soft tissue. Facial fat can be sculpted, repositioned or removed, and the “muscle” layer of the face and neck are tightened to create a natural and long lasting result. The facial skin is then carefully re-draped and excess skin is trimmed. The incisions are sutured with fine dissolvable sutures. This results in elevation of the cheek complexes, corrects the laxity of the lower face and jawline, and creates an improved contour in the neck region. The eyelid region and the forehead are not contoured or changed with a facelift procedure, but these areas can be addressed with a separate blepharoplasty or browlift procedure, often performed in conjunction with a facelift, if desired.

What to expect:

  • The procedure is performed as an outpatient under general anesthetic.
  • Moderate facial and neck bruising for 2 to 3 weeks and most patients feel “socially presentable” by 2 to 3 weeks.
  • Moderate swelling for 4—6 weeks post-op.
  • Plan on 2 to 3 weeks off work.
  • Relatively mild pain, well controlled by medications.
  • A feeling of tightness in the face and neck region for about 2 or 3 weeks, which gradually subsides.
  • Diffuse and minor numbness of the cheek and neck area which resolves over several weeks.
  • The scar under the chin may be stiff and firm for several months but eventually heals and is soft and flat.
  • Perfect symmetry in any face is not obtainable, but the minor post-op asymmetries typically mimic pre-existing features.
  • Limit physical activity for 6-8 weeks following the procedure.

NECKLIFT

A necklift is a surgical procedure that improves visible signs of aging in the jawline and neck region. The loss of youthful contours in the lower face and neck can be due to a variety of factors including hereditary tendencies, significant weight fluctuations, gravity, environmental factors and stress. Some patients feel that they are not ready for a full facelift, because the upper face and cheek region is still pleasing in appearance. However, many patients will note excessive wrinkling and sagging in the neck skin, excess fat, a “turkey wattle”, or a double chin, and jowls. When the neck area does not match the upper facial appearance, a neck lift may be a good solution. A neck lift can rejuvenate this area and restore more youthful and attractive contours to the lower face and neck by tightening loose neck skin, removing excess fat deposits under the chin, improving jowls and correcting muscle banding of the neck.

A neck lift must be customized for each individual patient, based on the specific anatomy of the patient, the quality of their skin, and their anticipated outcome. Important factors include the degree of laxity or sag in the neck skin, the amount of excess chin and neck fat, the projection of the chin, the overall quality of the neck skin, laxity of the neck muscles, or the presence of neck banding.

Neck lift incisions are typically hidden around the ears and along the lower scalp behind the ears, to minimize hair loss. A small incision is also made in the crease underneath the chin. Incisions follow the natural contour of the ears to keep the scars inconspicuous. The neck and lower face skin flaps are carefully elevated off the underlying soft tissue. Excess fat can then be sculpted or removed, and the muscles of the neck can be tightened, like a corset, to restore a more youthful contour. Muscle banding in the neck can also be corrected. The goal is to create a natural and long lasting result. The lower face and neck tissues are then lifted and the neck skin is re-draped. Excess skin is carefully trimmed and the skin is sutured. This results in a reduction of jowling, tightening and smoothing of the lower face and jawline, and an improved contour in the neck. The upper face and cheek region are not altered or improved with the necklift. This procedure is not a “permanent” correction of the laxity in the neck region, as gravity and the aging process cannot be halted. However, most patients enjoy lasting improvement in the lower face and neck region for at least 10 years.

What to expect:

  • The procedure is performed as an outpatient under a general anesthetic.
  • Moderate swelling for 2 to 4 weeks post-op.
  • Bruising of the lower face and neck for 2 to 3 weeks. Make-up can be used to hide residual bruising after 2 to 3 weeks and most patients are comfortable and “socially acceptable” by 2 to 3 weeks post-op.
  • Relatively mild pain controlled by medication.
  • There is usually some tightness in the neck region for a few weeks.
  • The scar under the chin may be stiff or firm for several months but eventually softens and becomes inconspicuous.
  • Perfect symmetry in any neck and lower face is not obtainable, but the minor post-op asymmetries typically mimic pre-existing features.
  • Limited physical activity for about 6 weeks post-op.
  • Inconspicuous scars around the ears and along the hairline behind the ears.

MINI NECKLIFT

This procedure is a less invasive or extensive procedure than a traditional necklift, and involves contouring only of the area under the chin and the front of the neck. This procedure can be a nice alternative for any patient with a relatively minor degree of laxity of the neck skin, or a noticeable deposit of excess submental fat combined with looser neck skin. This procedure is also popular with male patients because of the short incision under the chin and lack of more visible incision around the ears. However, because this is a far less extensive procedure, the post-operative results are also much more subtle. This procedure cannot be expected to achieve the results obtainable with a standard necklift.

A mini necklift is performed through an incision located in the crease under the chin which is typically 2 to 2 1/2 inches long. The surgical approach allows for removal of the excess fat in the area under the chin (the submentum) and allows for tightening of loose neck muscles in a procedure called a platysmaplasty. Any neck muscle bands present can be surgically divided. Liposuction of the submental fat can be performed if needed. The neck skin is elevated in a smaller area, and is re-draped over the underlying tissue. A very small amount of excess skin can be removed prior to closing the incision. Therefore, correction of any loose neck skin is quite limited. Since this procedure does not involve incisions around the ears, or mobilization of the lower facial and jowl skin, a more limited amount of neck skin can be removed. Jowling and lower facial laxity is not addressed with this procedure. Relatively few patients are good candidates for this procedure, but with the right anatomy, a subtle but very pleasing improvement can be achieved in the neck and submental region.

What to expect:

  • Very minimal pain, usually requiring only a few days of medication.
  • Minimal swelling and bruising.
  • Slight numbness in the area beneath the chin or the front of the neck.
  • Subtle but pleasing contour correction.
  • The scar may be raised and prominent for several months but eventually fades and flattens leaving a very inconspicuous scar.
  • Contour improvement is limited to the area under the chin and a more subtle correction in the anterior neck.
  • A chinstrap is worn for about 10 days, and for another week or two at night.
  • Limited physical activity for a couple of weeks, more typical activity levels can be resumed after about 4 weeks.

BROWLIFT

A browlift is a surgical procedure designed to revitalize a drooping or lined forehead region, restore a more natural elevated eyebrow position, and reduce the heavy lateral hooding of the upper eyelid region. A tired or angry appearance around the eyes can be softened, and the whole eyelid area can be made to look brighter and more rested. The procedure can decrease horizontal forehead lines and minimize the “frown lines” between the eyebrows. Often the eyes themselves appear more open and alert following a brow lift.

Dr. Nygaard typically utilizes an open approach for the browlift, utilizing lateral hairline incisions in the scalp on each side, with a scar extending across the forehead at the hairline, where the scars are nicely hidden. Occasionally a coronal incision, (across the top of the head from ear to ear) is the best choice of incision, in certain patients. The best choice of incision is determined by the position of the patient’s hairline, their hair density, and the patient’s typical hairstyle. The forehead tissues, including skin, fat, and muscle are elevated; the position of the eyebrows is lifted, and the muscle that creates frown lines, or forehead furrows, is weakened. Excess skin and soft tissue is removed. The forehead flap is advanced, and incisions are carefully sutured and stapled together. A light dressing is placed. The correction and rejuvenation achieved with a browlift is usually permanent. There is a wide variation in the brow shape, and the position of the hairline, and individual forehead features, and the surgical plan will be customized with this procedure, depending on the patient’s anatomy.

Other facial rejuvenation procedures can be combined with a browlift. The most common combination involves a browlift and upper and lower eyelid surgery (blepharoplasty) to rejuvenate the entire upper face. A facelift or necklift, combined with a browlift is also a very popular facial rejuvenating procedure.

What to expect:

  • The procedure is typically performed under general anesthesia as an outpatient.
  • There is generalized tightness, and often a headache for the first few days after surgery.
  • Pain is quite minimal and is well controlled with medication.
  • There may be moderate swelling or bruising in the eyelid region, even if eyelid surgery is not performed at the same time. The bruising and swelling is typically more noticeable if eyelid surgery is performed at the time of the browlift.
  • There may be some numbness, occasionally permanent, in the scalp, or a long-lasting itching sensation which resolves over time.
  • Patients are usually “presentable” in public, and back to work within about 7 to 10 days, unless bruising around the eyelids is fairly noticeable.

LIPOSUCTION of the Chin

Excess fat can accumulate under the chin and along the jowls, creating a heavy looking, or aging neck region, which can make a patient look overweight. If the skin under the chin (submentum) and the upper neck skin tone is good, and the skin has normal elasticity, the excess submental and jowl fat can be removed by a liposuction procedure. The unwanted submental fat can be gently aspirated with syringe suctioning, using a tiny metal tube called a cannula. Very small incisions, only a few millimeters long, are placed behind each ear and under the chin. Even a small reduction in the submental fat deposit can create a very noticeable change in appearance. Submental liposuction creates a noticeable improvement in this area by both minimizing the excess fat deposits and inducing a slight tightening of the submental skin. A compression dressing, or chinstrap, supports the skin over the reduced fat deposit, allowing the skin to shrink down and re-drape over the improved contour of the neck. The internal tissue healing process assists in a degree of tightening of the skin which creates a smooth, less bulky contour to the submental area.

Poor quality, inelastic submental and neck skin, sagging muscles, advancing age and excessively heavy fat deposits in the neck may compromise the results obtained by liposuction alone. These patients are typically better candidates for necklift or facelift procedure, and any patient with laxity of the submental or neck skin should approach neck lipoplasty with caution.

What to expect:

  • The procedure typically performed under IV sedation.
  • Minimal bruising and swelling.
  • Minimal pain.
  • A chinstrap is worn continuously for about 10 days, and then for 2 to 3 additional weeks at night only.
  • The only downtime from work may be associated with having to wear the chinstrap.
  • Vigorous physical exercise is contraindicated for 2 or 3 weeks, at which point all activity restrictions can be removed.
  • The submental tissue may feel slightly firm or dense for several weeks after surgery but softens with time and gentle massage.
  • There may be patchy numbness, which typically resolves over a few weeks.

COMBINATION FACIAL PROCEDURES

Individual patient facial features can age in similar fashion, or at slightly different rates, depending on the individual. In order to maintain a harmonious and balanced facial appearance, it is frequently beneficial for a patient to address all concerns regarding facial appearance simultaneously under one anesthetic. Combining facial procedures such as blepharoplasty (eyelid surgery) and a facelift often creates a more balanced and aesthetically pleasing result. If the facial region is rejuvenated, but the eyelids are not addressed, the results may be a less balanced or harmonious appearance. On occasion, the area that was not addressed can look even “older” and detract from the improvement obtained in the area that was surgically improved. Combining facial procedures can also result in a single anesthetic and a single recovery period. It can also be slightly more cost effective to have multiple procedures performed at one time, as the surgical supplies and equipment utilization is the same. Often the same postoperative medications are used, and the same postoperative instructions are given. Individualized combinations of facial procedures will be reviewed with each patient and a customized surgical plan will be created to help the patient achieve the most balanced and aesthetically pleasing facial appearance. Various combinations of procedures are available and can include browlift, upper and/or lower eyelid surgery, facelift or necklift and submental liposuction. More information about each of these procedures is available in the appropriate sections on this website.

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