Water Boosting Foam Cleanser is appropriate for all skin types

-          Deeply cleans pores, leaving skin fresh and comfortable

-          Luxuriously rich, soap-free gel containing Panthenol (a moisture-protecting skin hydrator) and Allantoin (a soothing agent originally derived from the comfrey root)

A New Year’s resolution is a goal to be reached that year, a commitment a person makes to one or more lasting personal goals, projects, or to drop a bad habit.   To be effective, this goal should become a blueprint for your actions in the coming year.   Much research has been done on New Year’s resolutions and here are the top ten that people strive for, year after year:

1)      Weight loss!   Some 60% of US adults are overweight and losing weight is the number one resolution that people make, year after year.  Do something about it this year – come and hear how Lindora can help!

2)      Improve fitness levels, improve overall health and look fabulous.   This is where your gym, Orange County Plastic Surgery and Unique Tans can help you – come and learn more!

3)      To drink less alcohol or, for the sake of one’s health, to stop drinking completely.   Alcohol has been with mankind since the beginning of time.  A glass of wine with dinner will certainly not hurt anyone, but if you’re drinking more, maybe you should revisit this habit.

4)      To spend more time with family and friends.   Isn’t it amazing how quickly the children grew up to become fine young adults?   Seeing them just on holidays is not enough!

5)      To enjoy life more – to slow down, to smell the roses.  As we get older, we realize how quickly life is passing us by.  Are we enjoying the privilege of being on this earth to its fullest?

6)      To learn something new – how about learning a new language at Saddleback College or getting a pilot’s license? 

7)      To get out of debt – certainly something desirable that this last economic downturn taught many of us!

8)      Help others more.   We are so proud of our friends, Megan Lazar and Steve Jarman, who collect clothes and blankets all year and donate them to the homeless in Santa Ana each Christmas, a charity they started and maintain themselves!   How about helping them out, or starting your own version of a charity?

9)      Get better organized.    This was a more common desire before personal computers.  But definitely worth being more organized, especially as tax time approaches.

10)  Stop smoking!   A large percentage of smokers who quit every year begin their conquest of this bad habit on New Year’s Eve – go for it and do your health a big favor!

Lindora is considered America’s leading medical weight management provider.    I am certain that Lindora’s Chairwoman, Cynthia Stamper Graff, author of the best seller “Lean for Life”, will have a few copies of her book to give away!   This will be your first chance to come and hear about Lindora’s fabulous programs during one of our events.   Sherry Meredith from Unique Tans will also be present and show you how you can get that tanned look without using harmful UV rays – and Sherry usually gives away a few of her spray on tans as well.  Anne Floerchinger, our talented medical aesthetician, will be giving an overview of our MD Performance Professional Skin Care® line of products.   Tracey Prescott, our brilliant injection and laser specialist will be going over her contributions to our practice and let you know what you can do to improve your appearance in a minimally invasive way.   And of course, I’ll go over the newest and the greatest in plastic surgery.   

 The Fairmont always puts on a very nice dinner for us and the staff is very accommodating – we are looking forward to seeing you at our first special event of 2012.    Make your New Year’s resolution to look and feel better and to be healthier!    We expect this event to fill up quickly.    If you’d like to come to the seminar, hopefully with a few friends, or if you have any other questions, please contact the office at 949-888-9700.

I Googled the first ten pages for the search term “PIP implants USA” and read through numerous articles outlining the problems with PIP implants, which I’ll summarize in the next paragraph, and blogs and articles stating problems abroad but claiming that PIP implants were not sold in the United States! On page 7 there was an article on a site called Ripoff Review, Report: #57145, dated May 15, 2003 in which a lady from Texas complained that her saline implant ruptured 18 months after insertion and that PIP had not honored the warranty because they were no longer around. But surprisingly, there was no other mention of PIP’s being sold in the USA, just article after article about PIP implant troubles in other countries in the world – 30,000 women in France have PIP implants in place, 50,000 in the UK, 25,000 in Columbia, similar numbers in Venezuela, Germany and Australia, 4,300 pairs in Italy, and so forth, 400,000 women overall, but nowhere could I find a reference to how many were inserted in the United States.

What’s the issue with PIP implants? Reuter’s news agency has quoted the PIP lawyer, Yves Haddad, earlier this month as admitting that most of the prostheses sold by PIP since 1991 were produced using an industrial grade silicone that was not approved by health authorities, a silicone that was not intended for implantation – a silicone that was designed for use in mattresses! And this was done by the company founder for financial reasons, industrial grade silicone costs about a fifth as much as medical grade silicone! Haddad stated that PIP did manufacture a “high end”, medical grade silicone implant for use “by higher end clients” but nowhere could I find which of these implants was sold in the USA. The French government has come out and stated that there is no higher risk of developing breast cancer in women with PIP implants, but did say that the industrial grade silicone was more irritating to tissues once the implants ruptured and have recommended that all women with such implants have them replaced with current, approved implants. France is covering the cost of removing such implants but the patients will be responsible for replacement costs if they chose to have another implant inserted. Italy and Venezuela have offered similar plans to remove the implants at the government health care system’s expense, while not paying for replacement surgery. Germany and the UK have suggested that patients with PIP implants see their surgeons and make an individual decision regarding the advisability of removing and replacing the implants but will not cover costs through insurance or government health plans.

So what does Orange County Plastic Surgery recommend? First of all, all implant patients should replace their implants if they are 20 years old. The inside of the scar tissue surrounding a breast implant will calcify over time. These calcifications not only make cancer detection more difficult, but the roughened surface invariably cause the implant shell to rupture with time! For your peace of mind, a ruptured implant containing medical grade silicone has not been shown to lead to any increased incidence of any diseases but the liquid silicone can cause a local tissue reaction and the creation of a mass that, by mammogram or physical exam, cannot be differentiated from a cancer (without removing the lump and having a pathologist examine it). We should note that the implants we use today have a cohesive gel, the consistency of a gummy bear candy, and this gel will not run or leak after a rupture, a big advance over any kind of gel implants from the 80’s or 90’s. We recommend any patient who knows that they have a PIP implant in place replace it as soon as convenient. Reports I read online suggest that the industrial grade silicone is very irritating to local tissues and a massive inflammatory reaction, formation of many masses, and so forth can result! So if you have a PIP implant from that era, or are not sure of your implant manufacturer and your implants were inserted during the 1990’s or early 2000’s, may I suggest that you get the implants replaced. We do not have the resources that France has but I would like to help the unfortunate ladies who may have a PIP implant in place and for the next three months, will offer to remove any patient’s breast implants from that era without charging our usual professional fee! As in France and other places that insurance or the government is covering the cost of the removal, you will have to pay for insertion of new implants if you chose to do so. You will also be responsible for the cost of lab work, the surgery center and the anesthesiologist’s fees, things that are independent of our office and not under our control. So if you have any concerns about your implants, do call to set up a complimentary consultation (949-888-9700 or toll free 888-822-6277).

Photo above shows a ruptured implant from the above mentioned era being removed – note the liquid gel exuding from an opening in the scar tissue surrounding the ruptured implant.  The next photo is of the same scar tissue, turned inside out, after the implant was removed and the liquid silicone washed off.  Note the sharp calcifications along the upper third of the capsular lining – this 20+ year old implant did not have a chance of not rupturing.

This is a time of giving and, often, overindulging! Whether we are talking about drinking alcohol, eating rich foods or buying presents, the best advice I can give you is to do everything in moderation! Make some good New Year’s resolutions to eat well, exercise, enjoy and show love to your families and your friends. About a year ago, Anne Floerchinger, our fabulous Orange County Plastic Surgery medical aesthetician, made a pledge to improve her health and this decision has resulted in a tremendous success story that could serve as motivation to some of you! I’d like to share Anne’s story with you.

Anne was born in England. Anne attended London’s prestigious Barrett College for two years, studying skin care. At age 21 she move to the United States and continued what has turned out to be a 50+ year dedication to skin care. She served as Helena Rubinstein’s training director for beauty consultants in the United States. She studied skin care at Purdue University in Indiana for four additional years. She served on the Education and Cancer Committees for the state of Indiana and spent many years training aestheticians. 15 years ago, when husband Gary retired, they decided to move to Orange County to be closer to her daughter’s family. She worked in Rancho Santa Margarita at Skintique for a number of years. I first met Anne ten years ago. Anne came to us for a facelift/brow lift/blepharoplasty – this is Anne’s photo at age 62 before she had her lift and the second photo was taken 8 years later when she turned 70! Needless to say, doing a facelift on someone heavy, with a lot of stretched skin, is a technical challenge. But Anne did look better after her lift and was pleased with her results.

Shortly after I did Anne’s facelift, we had an opening at our office and I offered Anne the position of our medical aesthetician. For the past ten years, we have been blessed to have Anne’s knowledge and skillful hands available for our patients. But this is where the story gets really good! Anne knew that she was overweight and not doing her overall health any favors. A year ago, Anne made a commitment to improving her health! She knew from past experiences how difficult loosing weight could be and decided to seek professional help. After much research, she found this help at the local Lindora office. Lindora is a controlled weight loss program run by medical professionals. The nurses at Lindora taught Anne to count her carbs and to limit carbohydrate intake. She checked in at Lindora weekly for an initial 10 week program, was weighed and counseled. Her ketones were checked to make sure she was in a fat burning mode. She received B6 and B12 shots from the nurses at Lindora. She started going to a gym once a week and walked 20 min daily. Nothing dramatic at first but Anne did lose 35 pounds in those initial 10 weeks! Instead of calling it quits, Ann signed up for another 10 week program and has kept working with Lindora – to the point where today she has shed a total of 75 pounds! But as with all significant weight loss, loose skin is left as a reminder of the prior self! Anne is on the schedule for a little tightening here and there in 2012! Congratulations, Anne for sharing your success story.

Since seeing Anne succeed so amazingly in such a short time, I decided to explore more about Lindora. Lindora is considered America’s leading medical weight management provider. Lindora is a local company with headquarters in Costa Mesa. I have spoken to the Lindora Chairwoman, Cynthia Stamper Graff, author of the best seller “Lean for Life”, and am pleased to announce that we have decided to participate together in our first event of 2012 together at the Fairmont Hotel in Newport Beach on January 26th. As usual, we will have a number of talented speakers and give away many fabulous prizes, including Sherry Meredith from Unique Tans. This will be your first chance to come and hear about Lindora’s fabulous programs during one of our events. The Fairmont always puts on a very nice dinner for us and the staff is very accommodating – we are looking forward to seeing you at our first special event of 2012. Make your New Year’s resolution to look and feel better and to be healthier! We expect this event to fill up quickly. If you’d like to come to the seminar, or if you have any other questions, please contact the office at 949-888-9700.

During this past year, my lovely wife, Tina, launched a new company and a new skin care line, MD Performance Professional Skin Care®. It has been pleasing to watch the line grow, to see sales increase and now, the last few months, to see our line featured in a number of magazines (like the November 2011 issue of Dermascope!) It has taken forever and a day to get our brochures done but they are now completed and look great! Hopefully, the MD Performance web site will be finished before the Christmas Holiday! 2012 promises to bring us much more interesting and good news about MD Performance®, so stay tuned!

This has been an interesting year for me. About a year ago, I received a phone call, asking me if I would consider becoming the Honorary Consul for the Republic of Latvia here in the Southwest. I consented, made a trip to the embassy in Washington right after Thanksgiving and to Riga, Latvia in March to visit the foreign ministry. While in Riga, I spent a few days teaching at the main medical school, Stradins Medical School. This was followed by a visit to Orange County by the Prime Minister of Latvia with a large delegation in July, the official opening of the consulate there, and a whirl wind few days spent with diplomats, politicians and the Secret Service! Since that time, I have been amazed by how many calls and letters I get as the Consul, and how many events we get invited to attend! In the last week alone, we have been to the Japanese Consulate in Los Angeles for the inauguration of a new consul and to celebrate the Emperor’s Birthday, to San Diego to celebrate the 60th anniversary of the founding of the Latvian Lutheran Congregation there as well as Independence Day, and in Los Angeles to celebrate Latvia’s Independence Day! I did say “we” because my wife Tina comes to all consular events with me – does that make the long drives to LA or San Diego more pleasant! Next July, we will be traveling to Riga and bringing a trade delegation from the United States…………..so it never seems to end!

On a personal note, all four of our children are employed, all four of our elderly parents as well as all of our brothers and sisters were able to make it down for our son, Justin’s wedding this fall. We all thank God for our good health and our families! We look forward to a good year and wish all of you the same!

It’s never to late to start to plan for the Christmas Holidays – our annual Christmas Soirée will take place here at the RSM office on December 6th and we hope you can make it.

I hope you are all enjoying a great summer!

I will keep this one very brief.

A friend of mine, movie producer Robert Kline, is organizing the West Coast Film Festival in San Juan Capistrano this month, in conjunction with Warner Bros Studios and Lionsgate. On his behalf, I’d like to invite you to enjoy this So Cal gem and attend the festival. The August 21st opening night film is Casablanca–a legendary love story with themes of patriotism and heroism against oppressive forces. It is the face of Warner Bros. and is being presented by Warner’s for the premiere. We would appreciate it very much if you would attend and support the presentation of this iconic classic film. Below you will find West Coast Film Festival’s one sheet for an introductory overview. Please visit www.westcoastfilmfest.com for a complete picture and regencymovies.com to purchase tickets online at San Juan Capistrano Regency Theatre or at the box office. Hurray, tickets won’t last! The San Juan Capistrano Theatre with Rick’s Cafe upstairs depicts the film, Casablanca’s Rick’s Cafe. We would greatly appreciate your support for the inaugural West Coast Film Festival from August 21-25, 2011.

My wife Tina and I will be there, see you there!

Our line includes four different cleansers for different skin types, four different high performance moisturizers, eight different high performance anti-aging products, a product to help control acne, a silicone based scar formula, a high performance sun block and three prescription only products.   A number of the products are also packaged in 1 ounce (30 ml) travel sizes which can be brought aboard airplanes in carryon luggage.   We are currently working on a men’s line and hope to come out with those products by the end of this year.     In subsequent articles, I will describe each of the products in detail.

In February of this year, the company MD Performance Inc. was born and the first products arrived.   The products were initially sold through our practice, Orange County Plastic Surgery, and were very well received!    We are now branching out, selling our products at various spas, though independent sales representatives and even exploring opportunities abroad.   Angela O’Mara and Giles Raines have been chosen to handle the domestic sales representative – anyone interested in this business opportunity should contact Angela or Giles directly at (949) 760-1522.

Our web site, www.mdperformance.com is currently under construction but will contain a wealth of information about our products and company – and training videos for the sales representatives.  Learn more about Orange County Plastic Surgery and our skin care line, MD Performance Professional Skin Care ™ by following us on Facebook or Twitter.

www.facebook.com/OCPlasticSurgery

www.facebook.com/mdperformance   

www.twitter.com/OCPS                     

Before I start speaking about the Latvian School Graduation, I want to share some background about my childhood. My parents left Latvia as the Soviet Union was invading in the mid1940’s and ended up in the western zone in Germany as the war ended.  I was born in a refugee camp and lived there until we emigrated to Canada in 1951.  My father worked in hard rock mines and I grew up in Northern Ontario, about 700 miles northwest of Toronto. Aside from an aunt who lived there, the Latvian population consisted of our family!   My parents spoke Latvian with us, taught us to read and write Latvian, taught us Latvian songs (never did do the folk dancing thing) and, whenever we visited Toronto or other cities, we usually visited other Latvians. As a child, I even visited the Latvian Song Festivals in Toronto and Cleveland on occasion. I really want to thank my parents for taking the time to teach us our language and heritage! After graduating from the University of Toronto School of Medicine, I came to the USA (Columbia University for general surgery and Harvard University for plastic surgery, then took a teaching job at the University of California San Francisco and discovered that I’d never want to move away from California!).  When my children were born, I did speak Latvian with them and I tried taking them to Latvian school in the Bay Area but that did not last long – a choice had to be made Saturday mornings between baseball and Latvian School, and by the time my son was 7 years old, baseball won out (and I cannot say that was the wrong decision – my son was a very good baseball player, got a scholarship to Loyola Marymount University in LA and played four years of NCAA Division I baseball). My parents visited many times from Canada and made sure that we continued speaking some Latvian. My children and I are fortunate to even be able to speak Latvian! At the graduation ceremonies yesterday, children from kindergarten through the 8th grade got their diplomas.  Each class also performed in some way – singing, dancing, performing a play, reciting poetry. I could not believe how much these children had learned, how well they recited poetry, sang, danced and acted!   Some of the songs brought tears to my eyes – I had learned them as a child, still knew the words but probably had not heard the songs for close to 40 years! These children are so lucky to live in an area with an abundance of Latvian children they can have as classmates and dedicated adults as teachers! I congratulate all of them and wish them continued success with their studies! It is a good thing to remember your heritage and only makes a life richer experience!

Main photo: Kindergarten students performing “Sesi Mazi Bundzanieki” (6 little drummers)

I did a number of aesthetic procedures in the Bay Area these last few days and gladly, all the patients are doing well! I saw a number of new patients, and as often happens, when I’m reviewing their medical history at the beginning of a consultation, I notice that many patients tell me if they have had their appendixes out or shoulders operated on, but many fail to mention, unless I specifically ask that question, if they have had prior aesthetic surgery! Sometimes patients seem surprised by my question and tell me they thought the question about prior surgical procedures just applies to “real surgery”! Well, I have to stress that aesthetic surgery IS real surgery and prospective patients should not be shy about mentioning what procedures they have had previously, particularly the patients are asking me to improve that same part some more because it was not done to their satisfaction or because normal aging has caused some relapse of the bothersome condition.

One can also ask how aesthetic surgery differs from other types of surgery. I’d say that the main difference between the two is that aesthetic surgery is always elective surgery and cannot be deemed medically necessary! General surgeons, orthopedic surgeons, gynecologists and the like make a decision to operate based on a history, a physical exam, laboratory and other tests – they make a diagnosis and recommend a procedure based on the problem and do not take psychiatric issues into consideration. If a deranged patient has appendicitis, an appendectomy will be recommended to the patient or care giver, regardless of mental illness. With elective plastic surgery, however, the plastic surgeon must also take a history, do an examination, do appropriate tests but before making a recommendation, the patient’s psyche and motivation must be evaluated and psychiatric issues sorted out! The goal of aesthetic surgery is to enhance a person’s body image and self esteem – we have to know in advance what makes a patient tick, why the patient is asking for a particular procedure, decide if the patient has realistic expectations regarding the final results, and decide if the patient will be happy with the expected final result. Patients must have a sound reason for wanting a procedure and have reasonable expectations of the result – for example, if a patient is ambivalent about a procedure but I detect that the spouse is encouraging an enhancement here or there, I’ll tell the patient right there and then that they are not a candidate for the procedure. If I perceive that a patient does not have realistic expectations or is unlikely to like the result, I will not operate on a patient! But we’ve all seen patients who are not mentally sound, or who do not have a realistic expectation of what the procedure will do for the person, get a surgical procedure. Such patients become a total nightmare for the surgeon during the follow up period and rarely are happy with the results – asking for more surgery soon after the procedure, threatening law suits and bad mouthing the surgeon to anyone who will listen. All of are taught to stay away from such patients – how does it happen that such patients get through our defenses? First of all, many patients who have an abnormal body image have been turned down at other doctor’s offices and may have figured out what to say, what not to say, that would raise a red flag for an examining physician or his staff – they lie and say things that the doctor wants to hear! But some patients get through simply due to a doctor’s ego or inexperience, thinking that he or she can improve a patient who others have failed to help!

The goal of all our aesthetic procedures is patient satisfaction. It matters not how great a result we think we have achieved if a patient walks away dissatisfied. To a large part, patient satisfaction stems from reasonable expectations, and thus our need to fully educate our patients before considering surgery, and to evaluate a patient’s psyche before offering surgery.

Above is an example of a 74 year old Japanese female that I had helped with a facelift some 17 years earlier. She came back requesting another facelift. She had been an excellent patient the first time around; her motivation to look better was sound. I did not think that she has enough laxity to benefit from another lift but when I asked her specifically what bothered her, she pointed to her many fine lines and brown spots. I recommended that she consider a facial skin resurfacing procedure. We decided on a chemical peel, did a phenol peel and she was very happy with the final result!

In my last article, I shared my lecture on facial rejuvenation surgery. This post will summarize my second talk on ancillary procedures, which are frequently performed in conjunction with facelifts to complete the facial rejuvenation package.

We have discussed previously that my goal during facial rejuvenation is to make a person look younger—to turn the clock back so to speak, but the leave the patient looking as natural as possible. In order to rejuvenate the appearance of someone with a droopy neck, it is frequently necessary to address weathered and wrinkly skin, aging eyes, droopy brows, frown lines between the brows and forehead, weak chins, thin and wrinkly lips and fat loss within the face, all items that normally occur with aging. Without doing so at the same time as the facelift is performed will result in a lack of harmony and incomplete facial rejuvenation.

Performing a facelift does not change the texture of your skin. There isn’t much point in having a nice, tight neck if your skin tone is aged and sun damaged. Each and every facial rejuvenation procedure for us begins and ends with good skin care! Every facelift patient is encouraged to visit our aesthetician, Anne Floerchinger, for facial skin analysis and a treatment plan before surgery, as well Oxymist treatments and facials after surgery. The cost for these skin treatments is included in the price of our facelift package. Anne then puts patients on the correct products for long term skin care and is available as a consultant in the future should new skin care problems arise.

This skin care program suffices for the fast majority of patients but occasionally, we see patients with severely sun damaged and wrinkled skin that surpasses Anne’s capabilities to improve. In such patients we discuss the possibility of performing a skin resurfacing procedure with a laser during the same operation as the facelift.

Not removing such a person’s wrinkles will result in tightened neck skin but insignificant overall improvement if the skin remains wrinkled like a prune! The following is an example of performing ancillary procedures at the time of a facelift to enhance the final results.

The above example shows a 79-year-old female before surgery, and two years following a facelift. In addition, she had a brow lift to raise the brows and remove the lines between her brows and forehead, excess skin removed from her upper and lower eyelids, and her face resurfaced with a CO2 laser, all in one four-hour operation!

The above example also addresses eyelids. Tightening the above ladies skin and removing wrinkles but leaving excess eyelid skin or bags would not have left her with a balanced appearance. Another area that we frequently address at the time of facial rejuvenation surgery is the chin.

In patients with a weak chin, it is virtually impossible to obtain a pleasing neck contour without adding to the length of the lower jaw by adding a small chin implant. This is done through the same incision under the chin that all facelift patients get to allow us access to the neck fat and lax muscle bands—no additional cuts are necessary to add a chin implant and this adds but a few minutes to a facelift procedure.

Above example shows a 53-year-old lady before and after a facelift procedure, along with a brow lift, upper and lower eyelid surgery to remove excess skin and lower lid fat, and a small chin implant to improve the appearance of her profile.

Finally, as we age, all of us experience a loss of facial fat (except the obese), a thinning of the cheeks above the jowl, a thinning of the lips, and sagging of tissues in the midface region. In such patients I address the midface sagging with a midface lift, and add fat to the lips and cheeks to restore youthful fullness to the face.

This family photograph of a 22-year-old son, 55-year-old father, and 88-year-old grandfather clearly demonstrates normal aging in three generations. Note the youthful fullness of the youngest man’s face, the sagging of the face and brow droop that occurs in the 50s, and the facial descent, sun damage and loss of facial fat in age.

This is an intraoperative view of a fat injection into the tear troughs and cheek to restore youthful roundness during a facial rejuvenation procedure, which also included a facelift, brow lift and upper eyelid blepharoplasties.

This is the before and after of a 60-year-old female whose rejuvenation included the perioral area, the area around the mouth. During normal aging, lips sag, thin and begin to develop vertical lines. Fullness was restored with microfat grafting and the surface wrinkles improved with a CO2 laser resurfacing. Such fine touches help balance the final results so that the lips match the neck, the neck matches the eyes, the eyes match the brows, and the patient is left with a natural, balanced and rejuvenated appearance.

What follows is a brief summary of the introduction to my first presentation, outlining the history of aesthetic facial surgery.

Plastic Surgery: The Early Years

No one knows who performed the first facelift procedure, but by 1910 they were being performed by a few German surgeons and the rare surgeon in the USA. These procedures were associated with much secrecy for a number of reasons.

First of all, there was much public distain for surgery performed for vanity reasons, both by the general public as a whole and by the well-known surgeons of the day.

Academic vs. Aesthetic Surgeons

The top academic plastic surgeons, as late as the 1980s, frequently published numerous articles about reconstructive surgery, but rarely published articles on aesthetic surgery. Yet these same surgeons not infrequently performed aesthetic procedures to supplement their income. These academic surgeons were less than complimentary toward surgeons who chose to pursue a career doing solely aesthetic surgery.

In the early 1990s, there was also a secretive attitude by aesthetic surgeons – in part because of a desire to avoid the wrath of plastic surgery leaders, but also in an effort to keep their surgical techniques a secret from other surgeons! This combination of factors caused aesthetic procedures to be performed in private nursing homes and clinics, far from the eyes of peers or young plastic surgeons trying to learn the trade.

Tord Skoog’s “Natural Facelift”

Relatively few articles appeared in the plastic surgery literature about facelift surgery prior to the 1970s. From a technical point of view, a rather primitive, skin-only procedure was performed by most surgeons until the mid 1970s. At that time, a very forward-thinking Swedish plastic surgeon, Tord Skoog, analyzed the aging face and came up with the understanding that the main culprit in sagging facial tissues was a drooping of underlying muscles and deeper tissues. So he came up with the idea of lifting these underlying muscles in an effort to produce a more long-lasting, natural facelift procedure. Unfortunately, Dr. Skoog did not live long after this ground-breaking article and did not get to see how he revolutionized the field of facial rejuvenation.

A Plethora of Plastic Surgery Techniques

During the last 35 years, there has been an explosion of articles and textbooks on facial aesthetic surgery. Now many top plastic surgeons openly have decided to pursue careers in aesthetic surgery, and aesthetic surgery is being openly taught in university centers to plastic surgery residents.

Today, a plethora of techniques exist to address the aging face, ranging from mini-lifts such as the “Life Style Lift” to skin-only facelifts and a variety of deeper plane procedures, which address the underlying sagging muscles.

Achieving Long-Lasting, Natural Results

Interestingly, most of the procedures can produce significant facial improvement but they vary greatly in longevity of the results. Yes, a lot depends on patient expectations, but most of my patients do expect a longer-lasting result and a natural appearance. This can only be achieved if the underlying muscles are lifted and repositioned where they were in youth.

With so called mini-lifts or “Life Style” lifts, a small area is undermined around the ear and the skin pulled back for a very temporary improvement, but the muscle sagging is not addressed. We see many patients who have chosen these lesser procedures and then are in to see us a year later because the jowls have recurred or neck laxity has returned—understandably so, since the sagging muscles causing theses issues have not been repaired.

In order to achieve a long-lasting and natural-appearing facelift, we believe it is necessary to elevate the skin, replace the muscles where they were in youth, and resect excess skin—but NOT to pull the skin tight. Young people do not have sagging muscles, but they do not have tight skin!

The following examples illustrate our approach to facial rejuvenation:

A 45-year-old Orange County Plastic Surgery patient before, and a year after a face lift and brow lift. Note that the neck bands and jowls have been addressed, the wrinkles between the brows removed and the brows subtly lifted—a few millimeters to where they were in youth. As part of the normal aging process, a hollowness starts to appear in the mid-cheek area, as the underlying muscles sag, creating the jowl. Lifting those muscles creates a more youthful, rounder face. The appearance of rejuvenation is created by addressing these underlying structures, not by pulling the skin tight!

Two more photos of the same Orange County Plastic Surgery patient, taken at age 23 and 30 years later—some 8 years after the “Natural Facelift” procedure. Note that the fullness of the cheeks, the lack of jowls or neck bands, and the brow elevation have persisted, closely resembling a look the patient had in her youth!