The Surgical Hairline Advancement/Forehead Shortening Procedure
No other procedure, even hair transplants, can lower the overly high hairline more quickly, and in many cases more impressively, than the Surgical Hairline Advancement (SHA), also known as the Forehead Shortening Procedure. This is because the SHA involves the moving forward of the entire frontal hairline, then removing all the excess forehead skin that has created by this movement. Depending on just how elastic or mobile the scalp is, the hairline can be brought forward and lowered by as much as 2 inches (5cm) or more, in this single procedure that takes just 90 or so minutes to perform.
Procedure: Hairline Advancement
Procedure details: In order to be a good candidate for the hairline lowering surgery, as demonstrated on this patient, there needs to be good to very good scalp laxity, which can be assessed by firmly pushing the hairline as far forward as it will go. In this case, the hairline will be able to be lowered by around 3cm.
Not every person who desires a lower hairline is a candidate for this surgery. First, there must be good to very good laxity of the scalp in order to permit adequate lowering. Second, the hairline must be permanent, so most men (who are at risk of developing male pattern hair loss) and some women who have experienced some frontal hair loss are advised against having the surgery. Plus the SHA truly is a surgical procedure involving making a fine line incision along the front of the hairline, so many patients will choose to have hair transplants instead, preferring this less surgical approach. However, for those who want and are appropriate candidates for the SHA, there are very few doctors that truly specialize in them, plus have the proficiency to perform transplant as well should the patient want a more rounded out hairline (the SHA moves the entire hairline forward, rather than rounding it out which needs to be achieved through transplants either at the same time as the SHA or at a later date. Dr. Epstein is truly an expert in the SHA, as he learned this technique from his mentor Dr. Sheldon Kabaker of California, the surgeon who largely developed the technique, and Dr. Epstein is one of the leaders in the technique. To learn more about the SHA, please click here.
- Procedure : Advancing and lowering the frontal hairline while removing the excess forehead skin, all through a single incision made along the entire hairline.
- Anesthesia : Usually local and oral sedation, can be twilight intravenous or even general anesthesia if desired.
- Recovery : Usually no bandages, and any swelling that occurs takes 3 days or so to resolve, presentable the next day with a hat and in 5 days in most cases without a hat.
- Other : Hairline sutures removed (can be done by the patient or a local doctor) at one week. If hair grafting performed at the same time, the hairs are obtained by the FUE (follicular unit extraction) technique so heal up in a few days.
Upper Lip Lifts and Lip Sculpting to Repair Scarring From Prior Silicone Injections
Like the procedure above- the Surgical Hairline Advancement procedure- there are very few doctors who are truly experienced in performing the upper lip lift, as well as in sculpting lips that have been distorted by prior silicone injections. In the upper lip lift, the upper lip is made shorter, resulting in more teeth show. Additional aesthetic benefits include outward projection of the vermillion to create a “pout”, and in women to restore a more feminine diamond shape to the upper lip. As women and men age, the upper lip usually becomes longer due to the effects of gravity- sometimes a long upper lip is the result of genetics. By removing the excess upper lip skin through a well-concealed incision right underneath the nose, this elongation can be permanently reversed. This procedure is not a replacement in most cases for filler injections, for it accomplishes much more than injections, plus is irreversible, so patients need to be properly educated. The big fear of patients understandably is of scarring, while other risks include minor change to the shape of the nostrils and or other parts of the bottom of the nose- however, in Dr. Epstein’s experience, these are problems that are virtually avoidable in all patients. In fact, Dr. Epstein lectures on his technique for the upper lip lift (as well as lip sculpting) at national and international plastic surgery meetings.
The other lip procedure regularly performed, unfortunately because the indication for performing it is preventable (by not having silicone injected to the lips), is the lip sculpting procedure. Silicone is the typical cause of lip scarring and distortion, characterized by irregular bumps and asymmetries, but a similar permanent filler called Biopolymer® which is particularly popular in Latin America as well as south Florida but also done worldwide can also be the culprit. The distortion typically does not develop until years after the silicone was injected, and sometimes can respond to injections of steroids that suppress the scarring. However, when this does not occur, oftentimes patients have no choice but to have the lips repaired by what Dr. Epstein calls the lip sculpting procedure, in which he meticulously excises small portions of the lip to bring them back to a more normal aesthetic shape and size.
Upper Lip Lift
- Procedure : Shortening the elongated upper lip, resulting in more upper teeth show and or a more outwardly rotated fuller lip, depending on whether just skin is removed or if a small amount of muscle tightening is performed, through a fine line “bull’s horn” or “seagull” incision made along the bottom of the nose.
- Anesthesia : Usually local and oral sedation, can be twilight intravenous.
- Recovery : No bandages, short recovery time. Sutures removed at one week.
- Other : The lip shortening and outward role are limited to the central one-half or so of the upper lift.
Lip Sculpting for the Repair of Scarring and Distortion from Prior Silicone Injections
Sculpting of the Face and Neck
From liposuction to full facelifts, to blepharoplasty and browlifts, there are a variety of surgeries that can address patients concerns with the neck and face region. Some of these concerns may have been present for years – such as a poorly defined full neck – while others are the result of aging. An individually tailored approach needs be taken with each patient, addressing the unique aging process, anatomy and goals. As an experienced surgeon focusing exclusively on the neck upwards, Dr. Epstein is able to customize the surgical procedure to address only those areas of concern. Patients are offered a choice beyond “eyes and full facelift”, to make sure that the proper procedure is performed.
Natural appearances. Long-lasting results. Avoidance of tell-tale signs such as loss of sideburns or pulled earlobes. In the hands of a skilled, confident surgeon, each expectation can be assured. Since his first facelift and blepharoplasty performed in 1990, Dr. Epstein has continued to develop his proficiency and skill with these facial and neck procedures, developing a reputation for consistency and excellence. And results should be expected to be long lasting, for the surgery involves the return of the muscles and other deeper structures such as the midface cheek fat pads into their original, more youthful positions.
The following procedures are provided:
- Procedure : Fat removal permitting sculpting and definition of the jawline and neck.
- Anesthesia : Usually local and oral sedation, can be twilight intravenous.
- Recovery : 3 days of compressive strap dressing, mild bruising, presentable at 3 days, full exercise in 10 days
- Other : One to three tiny skin incisions made; most effective typically when performed by the age of 45 in women, 40 in men, to assure adequate skin elasticity
- Procedure: A necklift is the removal of fat and/or excess skin, sometimes with tightening of the neck muscles. Can be extended (as in “extended necklift”) to address concerns along the jowls and jawline.
- Anesthesia : usually twilight intravenous, but many patients choose local and oral sedation
- Recovery : The patient is wrapped with a compressive dressing for the first 2 days, afterwards a velcro® strap dressing is applied for 3 to 5 days. Most patients with longer hair are presentable at 5 days, but when the hair is kept short (as in men) they are presentable within 7 to 10 days.
- Other : Incision typically runs along the upper neck hairline within the hair, behind the ear in the crease, and usually extends to just around the earlobe
- Procedure : Mid-facelift is the tightening of the facial muscles, elevation of the cheek fat pad to a more youthful position, eliminating or significantly lessening the jowls through a combination of deep suturing and liposculpturing. Properly performed, there is no loss of the sideburns, and incisions are concealed.
- Anesthesia : sometimes local with oral sedation, other times with twilight intravenous
- Recovery : with the limited mid-facelift, a Velcro® strap dressing for the first 3 to 5 days; with more extended work, a compressive dressing is worn for the first 2 days, followed by the strap dressing for another few days. Patients usually presentable as soon as 4 days afterwards assuming the hair is long enough to cover the ears, otherwise 6 to 7 days with some makeup, coinciding with the time the sutures are removed from the front of the ear. Full activity including exercise at 7 days.
- Other : incision carefully concealed within the sideburn, extending along creases in the front of the ear, behind the “pointer” or tragus along the ear canal, and wrapping delicately around and behind the earlobe (note: in men, to avoid sideburn/beard hair growing into the ear canal, the incision is usually made all along a crease in front of the ear).
- Procedure : Really a combination of necklift and mid-facelift, the full facelift addresses all areas of concerns with aging of the lower and middle two-thirds of the face and neck.
- Anesthesia : Usually twilight intravenous, can be general anesthesia if desired.
- Recovery : Full compressive wrapping of the face and neck for the first 3 days, afterwards a strap dressing worn for the next 3 days. Bruising typically resolves by 6 to 8 days, but can last as long as 2 to 3 weeks concealable with makeup. Most patients presentable at 6 to 7 days with makeup to conceal bruising as long as the hair is long enough to cover the ears, otherwise for men and women with shorter hair, 8 to 10 days before they are presentable. Light exercise at 5 days, full exercise at 10 days.
- Other : Incision runs through the sideburns, in front of the ear in a skin crease and extending back into the ear “pointer” or tragus within the ear canal, wrapping around the earlobe and back of the ear along their creases, then back along the neck hairline; tightness but not pain is typically what patients feel for the first 3 weeks; performed properly, there is no distortion of the earlobes.
Plastic Surgery for Men
With one of the largest surgical hair restoration practices in the country, Dr. Epstein has been afforded an opportunity to build up a portion of his practice that few other plastic surgeons have been able – male cosmetic surgery. Browlifts, neck lifts, submental liposuction, rhinoplasty, and eyelid surgery are some of the more common procedures he offers, and that he lectures on regularly at plastic surgery conferences.
The Eyes and Forehead – Blepharoplasty and Browlift Surgery
As part of his armamentarium to address concerns with the face, Dr. Epstein regularly performs blepharoplasty and browlift procedures on a regular basis. The result is a more youthful, rested appearance of the eye and forehead region, one of the most important areas of the face.
Blepharoplasty surgery involves the removal of excess fat and skin from the upper and/or lower eyelids. While there is not typically an increase in the amount of fat, through a combination of genetics and aging, the muscles containing the fat weaken, making the fat appear more prominent. Brow lifting can be achieved through a variety of techniques (endoscopic, hairline, midforehead), which address to varying degrees the descent of the eyebrows and the wrinkling of the forehead. These procedures are delicate work dealing within millimeters of exactness, in the hands of an experienced surgeon, can result in subtle to significant cosmetic changes, depending on the patient’s goals.
- Jowl and Chin Implants : Restores volume of the jaw along the jowls that is normally diminished from aging or genetics
- Hair transplants : Using the normally discarded hair-bearing skin from the sideburns and neckline when performed with a facelift, the existing hairs can instead by dissected out using advanced microscopic hair transplant techniques and transplanted into areas of thinning along the scalp
- Otoplasty : In the occasional patient with protruding ears, this represents the ideal time to repair them, most importantly because ears returned close to the sides of the head help conceal any incisions made behind the ears
- Earlobe reduction : To reduce in size overly large earlobes that are usually the result of aging and/or a lifetime of wearing heavy earrings
- Buccal fat removal : Removes the “baby fat” that creates a full rounded facial appearance. A 45 minute long procedure done under local anesthesia and if desired oral sedation, that creates impressive results