Plastic Surgery Practices

Nose surgery, or "rhinoplasty," is a cosmetic procedure that corrects the deformity of the nose and improves the appearance of the face. Nose deformities can occur as a result of developmental or subsequent injuries. The most appropriate age for rhinoplasty is 17 or older, considering the development of the facial bones.

Preparation for surgery

After the doctor-patient interview, the nasal structure should be examined and defects in the nose should be detected. The patient is photographed and a computer-aided image is created. Taking into account the patient's requirements, how the changes in the nose, and how patient's face will look after the surgery are illustrated by the computer aided work. It is important to remember, however, that computer-generated images are only intended for patient-doctor discussion. Computer-generated images are not intended to depict the post-operative nose, but to better explain the surgery to the patient. It is often not possible to achieve the ideal shape the computer shows. Then some blood tests will be done if it is decided to have the surgery.

Nasal shape examinations

The nose, skin, cartilage and bone structures are carefully evaluated. It is often almost impossible to achieve the best result on noses with thick and oily skin, fleshy and thick nasal tip, and asymmetry in the nostrils. There are other factors that play a role in the outcome. The presence of wounds, previous surgeries, complicated injuries, the patient's lack of cooperation with the doctor, and the patient's failure to follow the doctor's instructions may also affect the outcome.

Surgery

The surgery can be performed under local anesthesia, sedation anesthesia+local anesthesia, and general anesthesia. Sometimes it may be necessary to take cartilage from the ear or elsewhere, or to use synthetic materials in the operation.

It may be necessary to make an incision to the nasal wings to reduce their size, or an incision to the base of the nose in open rhinoplasty. These may leave scars in the form of lines. The surgery takes about 1-2 hours. At the end of the surgery, the patient is given some rest and then sent home upon recommendation of the physician.

The bone or cartilage removed from the nose may be reused for support. A tampon is placed in the nostrils after surgery. The tampon is removed after 2-5 days.

An external cast is applied to the nose for 10-12 days. During the first week, swelling and bruising of the face and eyelids may be observed. These will disappear in 1-3 weeks. Nasal swelling may persist after the cast is removed. Although most of this nose swelling disappears in 3-4 weeks, it may take longer. However, it takes 6-12 months for the nose to take its final shape.

Postoperative Course and Complications

Initially, the swelling in the nose is sometimes asymmetrical, giving the impression that the nose is asymmetrical. This will return to normal over time. Moreover, when the nasal bandage is removed, the patient and the people around him/her may need some time to get used to the new appearance of the nose.

Despite the best efforts of the surgeon, nasal surgery can lead to complications in 20 percent of cases due to unavoidable factors. These include early bleeding, altered sense of smell, sometimes difficulty breathing, perforation of the nasal septum, adhesion, opening of the nasal dorsum or excess cartilage at the tip of the nose, and nasal wing size that may require revisional surgery. In this case, revisional surgery will be performed to correct these problems if deemed appropriate by the physician. In rare cases, permanent bruising may develop on the lower eyelids.

In rhinoplasty, a favorable outcome can never be guaranteed 100 percent. The result may not always be what the patient expects. Sometimes the patient is not satisfied even though the result is good. The risks of surgery and anesthesia should not be underestimated.

Razor blade scars or tattoos on any part of the body (especially on the arms, shoulders, and front of the body) start to bother after a certain period of time. Sometimes, especially in terms of social opinion, the questioning of people with tattoos can also become a problem. Such factors make patients to have them removed. It is not possible to remove them completely.

Razor scars can be operated on, perhaps leaving worse scars, to alter the image, and get rid of the questioning of people. This area of thc skin can be completely removed and then closed. In all likelihood, the new scar will be more prominent, more noticeable, and larger. The only advantage is that it can be seen as an accidental scar. In the case of a patient with a previous tendency to have a lot of scars, the corrective surgery may leave a much worse scar.

The purpose is to alter the image. The same method can be used for tattooing too. Another method is the balloon method. By placing a balloon in the healthy area, the healthy areas are enlarged by inflating the balloon, and after 1-1.5 months the undesirable tissue is removed with the balloon, This can help regenerate a brand new, and normal looking skin tissue. This may seem like a better method. However, it is more expensive and takes longer. This method may require 2 or sometimes even 4 surgeries. It would be wise to keep in mind that any surgery can leave behind a few unwanted scars. Furthermore, the skin on the arm is particularly thin, so when the balloon is inflated, the skin becomes thinner and may perforate, causing infection in the affected area. This can interrupt the procedure without any success. It is wise to consider all of these risks before deciding to undergo the procedure.

Scars and fine tattoos can only be reduced in size. Scars and tattoos cannot be completely removed.

Sometimes the appearance of the scars may not be better after the surgery and the patient may not be satisfied. So it would be wise to think about it very well and make a decision. The patient should consider every detail in light of the above information before deciding to undergo surgery. The risks associated with the surgery should also be considered. There is always a risk of postoperative infection. In this case, the recovery time will be longer.

Wrinkles on the upper eyelid and bags, wrinkles and sagging under the eyes due to excess skin give the face a tired and aged look. In order to save the patient from this look and make him/her look fresher and younger, the excess wrinkled skin on both eyelids, and the fatty tissue causing the bags are surgically removed. The result is satisfying for patients who expect not a perfect, but a better appearance from the surgery.

Age, skin texture, and physical characteristics play an important role in the success of these procedures. Most young patients do not have excess skin and wrinkles. In such patients, it is often sufficient to remove only the fat pads. However, at an older age, depending on the structure of the skin and the degree of laxity, excess skin should be removed from both lids. Since low-set eyebrows can impact the outcome of surgery for some people, it is recommended that brow and temple lifts be performed together for the best results.

For patients who only need their fat pads removed, this procedure can be performed through an incision on the inside of the lower eyelid. The procedure can be performed under local or general anesthesia. If performed under local anesthesia, patients can go home 1-2 hours after surgery. For surgeries performed under general anesthesia, patients stay in the center for 24 hours post-op or can be sent home after resting for a couple of hours, depending on their condition.

The operation takes approximately 1.5 to 2 hours. Whether the surgery is performed under general or local anesthesia, the patient is prone to the risks posed by the surgery. Alt göz kapağından deri kirpiklerinin 1-2 mm altından yapılarak dışarı doğru 1 cm kadar uzatılır. Üstte ise doğal göz kıvrımından (kirpiklere yaklaşık 8-10 mm uzaklıkta) yapılır.

Postoperative Course and Complications

Depending on the type of anesthesia, the patient can go home a few hours after the procedure. Swelling and bruising may occur on both eyelids for a couple of days. It is helpful to apply ice packs to the eyes. The patient may experience blurred vision in the first few days. The bruises will gradually disappear in 1-2 weeks. Sutures can be removed in 4-7 days. The patient may have watery eyes, sensitivity to bright light, and winds due to short-term lacrimation. It is helpful to wear tinted glasses for 2-3 weeks to protect eyes against wind and sun.

Since the incision is made on the crease, it will be invisible after 2-3 months. However, in very rare cases, it may remain slightly noticeable. Eyelids may turn inward or outward away from the eyeball (ectiopion), although this is rare. This may require revisional surgery. Sometimes bruising may take longer to disappear, and rarely the bruising mey be permanent, especially on the lower lid.

In addition to some of the physical changes that occur during puberty, some men may experience breast enlargement. For men, this can be distressing in terms of unwanted appearance and the fact that it is the focus of more attention, especially during the summer season. It may be decided to correct this condition if the test results show that there is no hormonal disorder. The age required to undergo this surgery is 18 or over. Surgery is the only treatment option for this condition.

Closed gynecomastia surgery

Liposuction is performed under local anesthesia. This procedure is particularly effective in cases where breast enlargement is caused by fat tissue. However, if the density of the breast tissue is high, surgery is performed either alone or in combination with liposuction.

Open gynecomastia surgery

Excess breast tissue is removed through an incision around the areola under local or general anesthesia. This leaves a scar around the areola that is usually not visible. However, this scar may remain noticeable in patients who are prone to scarring. With this procedure, the breast area may sometimes remain slightly prominent. In this case, it is possible to perform a revision procedure either at the same time or later using liposuction. It is advisable to wear compression garments after the surgery for 1-2 months. Full recovery takes 3-6 months.

Complications

Neither method alone may be sufficient. Revisional surgery may be required immediately or at a later date. As with any surgery and anesthesia, there are risks associated with surgery and anesthesia. Sometimes a hematoma can form under the skin. This may go away on its own or may need to be drained with a syringe. As with any patient, there is also the possibility of infection.

It is very common for young people to complain about their low eyebrows and want them to be raised. The most common request is to raise the eyebrows, especially the outer part of the eyebrows, higher than their natural position. This procedure can be performed under local or general anesthesia. The eyebrows can be lifted with the suspension method without an incision by using suspension material with only a needle. Another method can be applied by making a 4-5 cm incision on both sides of the scalp, removing a piece of scalp and suspending the eyebrows. The procedure takes approximately 1-1.5 hours. The patient can go home a few hours after the procedure.

Postoperative Course and Complications

Swelling and bruising may occur in the first few days. These disappear in 7-10 days. A tight bandage is applied for one week.

Antibiotics and analgesics are recommended to reduce the risk of infection and pain. However, despite all preventive measures, there is a risk of infection. This can prolong the healing process. Due to the incisions and sutures made on the scalp, hair loss may rarely occur in the affected area. Hair loss may be temporary or permanent.

Again, although very rare, patients prone to scarring may experience unpleasant scarring in the area of the sutures. The goal is to reduce the scar by scheduling massage and pressure treatments using a cream for this purpose. If there is a bald spot, hair transplantation can be performed. However, it is not possible to restore the normal hair density.

One of the most important issues is that the eyebrows may fall back to their original position. This can happen within 3-6 months and should be considered as an expected result. Of course, this means dissatisfaction for the patient. There are patients happy with their raised eyebrows, as well as patients whose eyebrows fell back. There is no guarantee. Patients should consider this risk before undergoing the procedure.

This type of surgery is usually performed to reposition prominent ears, mostly upright or nearly upright open scoop ears, closer to the head, flattening them and reshaping the missing folds. Although the protruding ear is not large, it looks larger than normal. This surgery can make the ears look smaller without actually reducing their size. Since the ear structure completes its development at the age of 5-6 years, it can be corrected by surgery at that age. Especially preschool children want to undergo this surgery of their own free will.

Since this type of surgery is performed at a young age (can be done at any age after 5-6 years), general anesthesia is preferred. After the age of 14-15, it is possible to perform this surgery with local anesthesia if the child prefers. The patient can go home a few hours after the surgery. The most preferred technique for this surgery involves making an incision behind the ear to reshape the ear cartilage. This method ensures that any potential scarring will be hidden behind the ear. The patient should know that undergoing surgery carries all the risks associated with surgery, although they are rare.

Postoperative Course and Complications

AAbandage is applied post-op for one week to reduce blood accumulation, and edema in the ear, reshape the ear, and prevent bleeding, and the patient is advised not to sleep on the ears. The stitches are removed within 1-2 weeks, depending on the condition. The patient should avoid activities that may directly affect the ear for 1-2 months after the surgery.

The child may return to school one week after the surgery. However, this period may be extended in case of complications. As a complication, the patient may develop bleeding in the early stages, subcutaneous bleeding in the ear, and a blood clot. The blood clot may disappear on its own or it may require drainage. The ear may become bruised, and this may last for a long time. Very rarely, an infection may develop despite medical treatment. Progressive infection may damage the ear cartilage, resulting in deformity of the ear. Sometimes the patient may still find the postoperative ear protruding. In this case, revisional surgery may be required.

It is a cosmetic surgery procedure that removes localized fat deposits to reshape and contour specific areas of the body.

Liposuction is not a weight loss solution. The goal is to refine and reshape body contours, particularly in body areas where there is excess fat deposits. It is a scarless method used on arms, knees, buttocks, inner and outer parts of the legs, front and back of the body, abdomen and waist area, neck, under the chin and breast area. Up to 4-5 liters of fat can be removed with this method. It is still controversial that 7-8 liters can be removed.

The success of liposuction depends on many factors. The fact that the patient is young, does not smoke, and that the skin in the area of application is tight and elastic will increase the success. However, with age, the skin becomes loose and sagging and cannot recover sufficiently, so the result is not as expected.

In patients over 30 years of age, liposuction may not give the expected result because the skin on the inner sides of the legs is loose, the skin of the abdominal area is loose and sagging in women who have given birth, and people who gain and lose weight frequently have such skin problems in other areas.

Instead of liposuction, it may be necessary to perform a tummy tuck (abdominal streching surgery) to correct sagging skin, especially in the abdominal area. As a result, liposuction in areas with loose and sagging skin (due to the inability of the skin to recover) may fail to produce the expected results. 

In addition, this procedure involves serious risks for people with systemic diseases (diabetes, hypertension, and heart disease). Moreover, undergoing a surgery is a risk in itself.

Procedure

It can be performed under general anesthesia, local anesthesia, or general anesthesia-assisted local anesthesia. The patient can be discharged the next day or the same day after a few hours of rest. Depending on the number and size of the areas to be treated, the procedure may be performed in a single session or in multiple sessions. Since excessive fat removal in a single session can disrupt the stability of the body, this situation should be well evaluated.

This technique involves making 0.3-0.5 cm incisions in the skin where the fat is to be removed, and the fat in the area, previously treated with medicated serum and inflated, is removed with an injector or vacuum using thin cannulas. The patient does not feel any pain during these procedures. After the procedure, the patient is advised to wear an appropriate corset. It is recommended to wear the brace for 4-6 weeks.

Complications

Bleeding is rarely seen in the early stages. Bruising may occur for one to two weeks. Patients can typically return to work in 1-4 days, though it may take longer. However, there is still a risk of infection. The risk of developing a fat embolism is low.

Asymmetry is possible after surgery. Problems such as insufficient removal or collapse of an area may occur. If this occurs, additional liposuction may be necessary to correct the problem.

It is important to remember that cosmetic results can take 3-6 months to appear. It should be noted that it may not be possible to achieve a perfect result with such interventions. In addition to the risks of surgery, the risks of local and general anesthesia must also be considered.

In addition to the aesthetic issues, women with large, sagging breasts often complain of discomfort due to the weight of their breasts. Such women may experience back and neck pain, rashes under the breasts, deep scars on the shoulders from bra straps, hunching over time, and difficulty choosing clothes.

Breast Reduction - Breast Lift Surgery

In addition to improving appearance, the goal is to eliminate physical distress. The main goal of breast lift surgeries is to achieve a cosmetic result. The recommended age for this procedure is 17 and older. For nursing mothers, the surgery should be performed at least six months after they stop breastfeeding.

The goal of breast reduction surgery is to achieve better-looking, straighter breasts by reducing and lifting them through the removal of enlarged fat, breast tissue, and excess skin. Additionally, large, sagging breasts tend to have sagging nipples. A normal nipple sits 18-21 cm above the middle of the collarbone. For patients with large, sagging breasts, this distance is much longer. Some patients have a distance of 30-40 cm or longer. These measurements may vary according to a person's physical condition. The surgery also aims to move the nipple to the normal distance.

Surgery

The main goal is to reduce the size of the breasts and bring the nipples to a normal level (18-22 cm), according to the person's physical structure. The surgery is performed under general anesthesia. Therefore, it should be performed in health centers that have suitable conditions for general anesthesia. Depending on the situation, the operation may take between two and a half and four hours. After the patient is prepared for general anesthesia and the necessary tests are performed, the surgical technique is planned and a drawing is made. A 5-8 cm vertical incision is usually made around the areola, extending from the nipple to the inframammary fold. A horizontal incision is also made in the inframammary fold. This results in permanent scars at the incision sites in this area. The length of the horizontal incision depends on the patient's physical structure and the size of the breast deformity.

Postoperative Course and Complications

The post-op patient can go home in one to two days and attend outpatient follow-up appointments. Initially, the patient may experience pain when moving their arms. Therefore, the patient is advised to rest for one to three weeks. A supportive compression bra or garment is fitted to the breast right after the surgery.

Bleeding and an anesthetic reaction may occur during the initial recovery stage. If bleeding occurs, the patient may require a blood transfusion. If an infection occurs, the appropriate treatment will be given. In rare cases, especially in patients with poor wound healing, nipple loss may occur due to a poor blood supply. Sometimes, small wounds or tissue loss may occur around the nipple and areola where the "inverted T" suture technique isused. This may require another surgical intervention.

These conditions can be treated during follow-up appointments. Since some milk glands and ducts are damaged during surgery, breastfeeding challenges may arise in the event of future motherhood. Nipple sensation loss may be temporary or permanent. The likelihood of these problems depends on the extent of the deformity before surgery.

Asymmetry in the breasts may occur after surgery. Significant edema occurs in the breasts for three to four weeks after surgery. It takes six to twelve months to completely disappear. Another problem is inverted T-shaped scarring that starts at the areola, extends vertically downward to the inframammary fold, and extends horizontally across the fold. These scars vary according to the individual. They can be either unnoticeable fine lines or bold, prominent lines that cause distress.

Externally applied creams and silicone materials can help reduce their appearance. Revisional surgeries can be performed when necessary. However, patients prone to keloid scarring have a high chance of scar tissue recurrence. Patiens with sensory defects or breastfeeding problems will not benefit from this procedure.

Breasts may sag over time. Revisional procedures can address general asymmetry and sagging.

Breast Augmentation Surgery

Breast augmentation surgery is performed to enlarge breasts that have become small due to underdevelopment or atrophy after childbirth. The goal is not a perfect look, but improvement in appearance. The procedure results in well-toned, supple, and larger breasts. Breasts can be enlarged using silicone implants of different sizes and characteristics. Patients with implants can give birth, and breastfeed. The surgery is performed under general anesthesia or sedation. Patients can go home after resting for a few hours. If necessary, the patient is monitored in the hospital for 24 hours. The surgery takes approximately one to two hours.

Surgery techiques may differ:

1. a) Implant insertion through a periareolar incision.
2. b) The implant can be placed through a 3- to 4-centimeter incision in the lower breast fold or through the armpit. Each method has different advantages and disadvantages. Additionally, the implant can be placed either under the breast tissue or under the pectoral muscle. However, it is best to leave the decision of which technique to use to the doctor. Each patient should be evaluated individually.

Types of Silicone Breast Implants

Silicone breast implants come in various types based on their shape and content:

1. a) In terms of content: The preferred types of silicone breast implants are gel-filled and saline-filled. They have a consistency that is closer to natural breast tissue. However, saline-filled implants can leak over time, causing the breasts to loosen. Such leakage is not typically associated with serious health problems.
2. b) In terms of shape: There are three types: teardrop, high, and normal profile. Those with a slightly rough or textured outer shell are also preferred.

To date, research studies have not found any evidence that silicon is carcinogenic. However, it is impossible to predict the results of future research studies.

Postoperative Course and Complications

Patients are recommended to wear tight, elastic, supportive surgical bra right after surgery. The bra should be worn for two to three months. Massaging instructions are provided, and massaging 10 days after surgery is recommended.

Antibiotics are administered to reduce the risk of infection. However, there is still a risk of infection. Bleeding may occur in the early stages. Though rare, the patient may require additional surgery due to bleeding. Since silicone is a foreign substance, the body may react to it. If this occurs, the silicone implant must be removed immediately.

In delayed cases, the body may find a way to expel the silicone, and this can damage the inner and outer breast tissue. If an infection develops, the silicone implant must be removed. There may be slight asymmetry after surgery due to existing asymmetry of the breasts that went unnoticed before surgery. Correction may be necessary.

It may take anywhere from one to two weeks to five to six months for the swelling and bruising on the breasts to disappear.

Contracture can develop if the recommended massage is not performed, is performed inadequately, or is performed completely. Contracture can cause pain and deformity. This condition is usually unilateral, but it can also be bilateral. If the condition does not improve with external intervention, another surgical procedure may be necessary.

Scarring is usually not noticeable on the nipple. Scarring in the inframammary fold tends to become less noticeable over time. However, scars may remain noticeable in patients prone to scarring. There are various methods to treat this condition. While the treatment works very well for some patients, it may not work as expected for others. Such undesirable outcomes cannot be predicted beforehand. Individual factors play a role. Patients are advised to wear a supportive surgical bra for at least three months following surgery and then transition to a regular bra. Deformation is inevitable during pregnancy and breastfeeding due to the increase and decrease in breast volume. Loss of skin elasticity due to aging also leads to deformation over time. If the patient does not wear a bra, this happens earlier.

For some patients, a silicone breast implant can enlarge the breast, but it may not be enough to lift the breast or make it look better. If a breast lift is performed in combination with silicone breast implant surgery, an inverted T-shaped scar will form at the surgical site. As with any surgery involving anesthesia, there are risks associated with this procedure.

Hair transplantation, especially among older men, involves taking hair from the back of the scalp and implanting it into bald areas on the top or front of the scalp that are prone to hair loss.

Natural hair loss in men occurs symmetrically and in a certain order. It is also known that the hair at the back of the head and sides -behind the ears- is resistant to falling out. Hair loss can occur symmetrically or due to regional diseases such as ringworm, skin diseases, burns, and trauma. However, the treatment of these conditions requires different methods. In such cases, hair transplantation will not produce the desired results because the natural structure of the skin and subcutaneous tissues is disrupted.

Women can also experience localized hair loss. If the hair loss process is over, the back of the scalp is sufficiently dense, and the bald area is not too large, then a hair transplant can be performed. However, hair transplantation usually does not produce satisfactory results for women. It is important to carefully select patients for hair transplantation. Ensure that the bald area is not too large and that there is sufficient hair density on the back of the scalp.

Hair transplantation is performed in two ways.

FUT Method

It is a hair transplant technique in which a strip of scalp tissue containing hair follicles is removed from the back of the scalp, where the hair is densest. The tissue is then dissected into individual follicular units and transplanted into incisions made in the recipient area. Years ago, hair transplantation was performed using this method. Then, the FUE method became widespread.

FUE Method

It is a hair transplant technique where individual hair follicles in the form of mini grafts, typically 1, 2, 3 hair follicles per group, are extracted from the donor area with a micromotor without any incision in the back of the head and transplanted to the designated areas of the scalp. As a consequence of recent technological advances, this technique has become more sophisticated.

The grafts are taken one by one from the donor area on the back and sides of the head with a micromotor specially designed for hair extraction, under local anesthesia or sedation as deemed necessary and according to the patient's preference.

The procedure concludes with the implantation of the extracted and specially protected hair grafts into the micro incisions in the recipient site. After applying the appropriate dressing, the patient receives recommendations and suggestions for completing the treatment.

Points to consider

The results may not be satisfactory for patients with a very large bald area. No matter how small the area, one session is not enough for hair transplantation. Therefore, at least two or three sessions are recommended for this procedure. Sometimes, there may be a loss of sensation extending from the back of the head to the top. Small cysts in the form of ingrown hairs and associated infections may also develop. These may need to be removed, and antibiotics may be required. Rarely, very weak and sparse growth of transplanted hair can be seen. Immediately after transplantation, a bandage is applied to the scalp and stays there for two to three days. The length of time the bandage stays on varies depending on the patient's condition. After the bandage is removed, the patient is advised to bathe carefully. In the initial days, there may be swelling and bruising on the face. These will disappear within one to ten days.

During the first month, the patient should bathe carefully as described, avoid wearing a hat, avoid direct sun exposure, and avoid entering the sea or a swimming pool. Within three weeks after the transplant, the transplanted hair and the hair in the recipient site may fall out. There is no need to worry. The hair will grow back within three to four months. For patients scheduled for two sessions, the interval between sessions should be at least six months. Practitioners should exercise extra caution when treating patients with systemic diseases such as high blood pressure or diabetes. Patients should inform their doctors about their conditions. In cases of non-natural hair loss, it would be wise to consider methods other than hair transplantation.

Our faces wrinkle over time due to gravity, aging, sun exposure, and muscle movement. The texture and appearance of the skin can also be affected by other factors, including acne, chickenpox, keloids, injuries, and old age. Starting in middle age, lines on certain parts of the face—on the forehead, between the eyebrows, at the corners of the eyes, on the upper lip, and from the nose to the corners of the mouth—deepen. Neck lines and bands appear. Other than the deep lines on the edge of the nose, superficial lines can be removed or minimized with Botox treatment. Filling in the lines at the edge of the nose with a filler yields better results. If the lines between the forehead and eyebrows are very deep, a fat injection may help.

BOTOX (Botilinum Toxin-A)

It is a substance that reduces the activity of the facial muscles to which it is applied. It is most commonly used to eliminate wrinkles on the forehead, around the eyes, and on the chin. It is also used to treat neck lines and bands. It can also reduce sweating in the armpits and hands. A licensed and skilled healthcare provider determines the method and dose to be administered. The effective period varies from person to person but is 3-9 months on average. Repeat as needed. There have been no reports of serious or permanent side effects from Botox applications. However, patients should not have any muscle conditions.

Fat transfer

It is a method applied to fill the deepened lines or depressed area on the face. It involves purification of the fat taken with liposuction method from an area of the body, and injecting it into the targeted area. Most of the injected fat is absorbed by the body within 3-6 months. Therefore, this procedure may need to be performed in two to three sessions. Injecting a large amount of fat does not mean it will remain in the area longer. Any slight asymmetry that develops after injection can be corrected later. Initially, there may be some swelling and redness in the area of the injection for one week to 10 days. Such symptoms resolve over time. There is always a risk of infection. Patients can go home after this procedure performed under local anesthesia.

Fillers

Other injection preparations may also be used. Examples include collagen and hyaluronic acid. They are effective for 12-18 months. This method is inadequate for cases involving old, sagging facial skin and proliferating wrinkles. It would be wise to combine this procedure with a facelift.

Facelift and brow lift

A face lift may be suitable for minor sagging of the face, depending on the needs of the patient. Brow lift techniques are also used to elevate low-set eyebrows. It is necessary to examine and evaluate the patient, as well as understand their expectations, before performing the procedure.

After a certain age, as the facial skin ages and loses its elasticity, wrinkles, and eventually sagging begin to appear on the face, making facial lines more noticeable. It may not be enough to eliminate facial lines with fillers or Botox. Interventional procedures for wrinkled skin may be required. In some cases, a forehead lift may also be necessary.

Facelift surgery can be performed after the age of 35-40 years, or even earlier for people who have tired and aged appearance. Tired appearance and wrinkles on the face make the person look even older. The focus of the facelift is on the cheeks, forehead, cheeks and under the chin.

All can be done at the same time or separately. Normal facelift surgery involves the scalp above the ear, the scalp that passes in front of the ear and extends behind the ear at the bottom, and from there back to the scalp. An incision is made, the skin is stretched as much as necessary, the excess is removed and sutured. Meanwhile, the fat tissue and fascia on the cheek are lifted using suspension material. This provides sufficient lift and eliminates sagging.

A forehead lift is a procedure that is performed by making an incision in the scalp above the forehead. Sutures are completely hidden in the scalp. For the jowl, the sagging is eliminated by fascial suspension (platysma) with a small pocket under the chin. Sometimes liposuction can also be helpful in this area. 

Postoperative Course and Complications

It is a surgical procedure performed under general anesthesia and takes 2-3 hours. Patients are usually discharged 24 hours after the procedure, and will will have outpatient follow-up appointments scheduled by their healthcare providers to check on their healing. These procedures involve potential risks related to surgery and anesthesia.

Following surgery, facial, forehead, and eyelid swelling (edema) and bruising (ecchymosis) are common and usually subside within 7-10 days. It can take 6-12 months for the swelling to resolve entirely and the final cosmetic appearance to be realized. Occasionally, a hematoma (bleeding under the skin) may develop. If it doesn't resolve on its own, a minor procedure can remove it.

Patients are treated with antibiotics to reduce the risk of postoperative infection. Despite precautions, infection remains a risk, and its severity could necessitate extended treatment or even revisional surgery.

Skin loss from circulatory problems is another risk, especially for patients who smoke or whose wounds heal slowly, in addition to the risk of infection. In such cases, revisional surgery may become a necessity.

Although rare, moving the facial nerves closer to the surface in front of the ear during surgery can lead to nerve damage and related issues like eyelid, eyebrow, and lip movement disorders.

The risk of this complication is extremely low if the surgery is performed with precision and the patient has a typical nerve distribution –meaning the nerves are not superficially located because of an unusual anatomical arrangement.

Sometimes pressure on the nerve due to edema in the area where the nerve is located can temporarily cause such a problem. But this condition goes away with time.

Minor balding may sometimes occur at the suture site on the scalp. Usually the balding is temporary, but in rare cases it can be permanent.

Patients prone to scarring may find it distressing to have visible suture scars under the chin, in front of the ear, or around the ear. Typically, these scars are not troublesome.

Sometimes it may not be possible to achieve the perfect result. The goal is to achieve a better appearance. This is directly related to the patient's expectations.

Recently, such procedures have been performed using the closed (endoscopic) method, but this method has not yet been developed to the desired level. This surgery is more risky for patients with systemic conditions such as diabetes, high blood pressure, and heart disease. Heavy smokers are also at serious risk.