FACELIFT surgery is designed to ameliorate sagging neck and jowl skin. These changes result from the continous pull of gravity and the diminished skin elasticity which results from aging and sun damage. Although chemical and laser resurfacing can improve the appearance of the skin, facelifting corrects the severe sagging and contour deformities in the cheeks, jowls and neck regions. Excessive fat in the neck and jowl can be liposculpted through a tiny incision under the chin. A browlift or forehead lift can be incorporated via endoscopic or conventional surgery through incisions hidden behind the hairline or within the creases of the forehead. The shape and position of the eyebrows can also be rejuvenated. The surgery is performed as an outpatient under "twilight" anesthesia and is performed through incisions in the hairline, temple, around the ear, and into the scalp behind the ear. The underlying muscle layer is tightened and sometimes a "deeper" plane beneath the cheek area can be lifted to correct deep creases around the nose and corners of the mouth without causing a "stretched" appearance. Recovery with return to regular social activities takes approximately two weeks. RHINOPLASTY is a cosmetic procedure to improve the appearance of the nose by reshaping both the cartilage and bone framework. The procedure is performed under "twilight" anesthesia to minimize swelling and discomfort. Often a deviated septum or turbinate reduction can be combined with rhinoplasty to improve the function of the nose as well. Incisions are placed inside the nostrils and across the columella to maximize exposure as well as to preserve important suspensory ligaments which preserves the structural integrity of the nasal framework. A small cast is applied and although the patient will be presentable in 7-10 days, the final surgical result will not be realized before one to two years. DR. ORISEK not only performs primary rhinoplasty but has developed a large referral practice from other physicians to perform difficult rhinoplasties or correct failed rhinoplasties. CHIN AUGMENTATION or reduction can be performed through an incision beneath the chin or inside the mouth under twilight anesthesia. Gortex® or autologous bone is most often employed for augmentation. Chin augmentation is often performed in conjunction with rhinoplasty to correct disproportionate facial profiles. Liposuction of excess fat from under the chin can be performed at the same time. FACIAL SKIN RESURFACING with various treatments including glycolic acid peels, TCA or phenol peels, and ULTRAPULSE® laser can be very effective in rejuvenating the face without surgical incisions. For acne scars and severe facial scars, dermbrasion can be particulary effective in improving a patient's appearance. LIP AUGMENTATION with ALLODERM® has become a popular procedure to increase the size of the lips and help smooth wrinkles in the lips. The substance used is FDA approved and is "freezedried" human dermis which has been harvested from human cadaver skin. Although there is some resorption, it appears that this particular grafting material results in some lasting augmentation. The material can also be "threaded" beneath the skin to improve the appearance of deep lines around the nose and corners of the mouth. FAT AUTOTRANSPLANTATION is another modality to fill facial contour deformites which result from aging. The patient's own fat is harvested from the upper buttock area and is injected beneath the skin of the face. This procedure is performed in the office under local anesthesia. BLEPHAROPLASTY or surgical rejuvenation of the eyelids involves removing excess skin and fat from both upper and lower eyelids. The incisions can be hidden in existing crease lines and sometimes inside the lower eyelid. This is one of the most frequently performed facial procedures and can be performed under "twilight" anesthesia. It is relatively pain free and the patient may resume normal social activities in 7-10 days. Alternative treatment can change the shape of the upper eyelid fold to "Westernize" the eyelid of Asian patients. Often with blepharoplasty, a brow lift can also be performed to rejuvenate the shape and location of the eyebrows. FACIAL FEMINIZATION SURGERY has been an area of particular interest to Dr. Orisek. Procedures which feminize the face include scalp advancement, forehead and brow recontouring, and brow lifting as well as profile adjustments achieved by reshaping the nose, chin (especially chin reduction), lip and cheek augmentation, lip lifting and reduction of the Adam's apple (cosmetic laryngoplasty). All procedures are performed on an outpatient basis under local or general anesthesia.