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Allen J. Rosen, M.D.
The Plastic Surgery Group
37 North Fullerton Avenue
Montclair, NJ 07042

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Dr. Rosen
Perhaps two decades ago, a facelift meant an incision that ran from behind one ear, across the top of your head to behind the opposite ear. The eventual result was something like weight lifting where iron pumpers chant, “Big arm, big weight!” Only in plastic surgery, the appropriate chant is more like, “Big incision, big recovery.”

Plastic and cosmetic surgery have become so popular, many more patient-friendly techniques have been developed in the last decade. And one of the major gripes among patients has always been the time out required for recovery from surgery. Most Americans lead full, busy lives so taking two weeks from their normal routines to recover usually just isn’t feasible. “The current trend in plastic surgery is using the smallest incisions possible,” says Allen J. Rosen, M.D., a board-certified plastic surgery in Montclair, New Jersey. “Plastic surgeons still occasionally use the long scar method on a few select patients but most patients want tiny, barely noticeable incisions.”

Besides accommodating patient demands for fewer long scars, medical science found a longer-lasting facelift also required some work on the deeper tissues under your facial skin.

“Just pulling the skin up tighter results in a ‘windblown’ look,” says Dr. Rosen who is also an assistant clinical professor of plastic and reconstructive surgery at the University of Medicine and Dentistry of New Jersey and co-author of Beauty in Balance, a new book about common sense approaches to cosmetic plastic surgery.

The “virtually scarless” concept started by putting incisions in either hidden or inconspicuous places. Probably the leading example is a breast enhancement procedure known as trans-umbilical breast augmentation (T.U.B.A.) where the surgeon starts the operation through a crease in the patient’s belly button. The other most common places surgeons start a breast augmentation is making an incision in the intermammary fold, the place where the bottom of the breast meets the chest wall; the bottom edge of the areola, the dark ring of skin surrounding the nipple and in the armpit which is known as the transaxillary approach.

Another current trend, buttocks augmentation, fills out and makes more shapely a woman’s derriere by inserting a curvy implant through an incision made in the gluteal fold, the crease of skin where the buttock meets the lower leg. Or, if the patient really wants a hidden scar, the surgeon parts the cheeks of her buttocks and places a tiny incision near the anus. While that method has a higher risk factor of infection due to its location, nobody -- but nobody, with the exception of a proctologist – is ever going to see the scar.

In some upper eyelid surgery, the surgeon starts his work by placing an incision inside one of the crow’s feet at the corner of the eye. A nose shaping operation, or rhinoplasty, as the procedure is known to doctors, places incisions inside the nose. Likewise, most cheek implants enters patients’ faces through an incision in the gums. A chin implant is frequently inserted on the under side of the chin so the scar faces your shoes.

Popular areas for incisions in procedures of the face are in the hair-bearing sections of the temple and behind the ear lobe where the ear meets the skull.

“I did a mid-face lift this week through one incision inside the mouth in the upper gums and through one incision in the hair-bearing section of the temples,” says Dr. Rosen. That might not sound exciting at first blush, but Dr. Rosen, using those two points of entry, and a special, high-tech dissolvable device known as an endotine, was able to reach down through three layers of skin, muscle and fat, lift the patient’s mid face from his skull, move the sagging flesh upwards and tack it all down. (That flesh and tissues naturally grow back to the bone again after having been moved.) The procedure also removes the much-maligned, aging-associated nasolabial fold, that large crease of skin running from the edge of the nose to the corner of the mouth.

Plastic surgeon also have at their disposal new developments like Contour Threads which can lift sections of the face by being placed in the face through tiny puncture holes, smaller than the width of a pencil. “Surgeons can basically place smaller incisions in areas that become virtually imperceptible and can still getting the same – if not better, in some cases— effects than with the classic, longer scar facelift techniques,” says Dr. Rosen. However, traditional techniques still have a critical place in our armamentarium, but each patients needs to be customized. One size fits all, does not work anymore.”

Rejuvenation surgery is also able to accommodate scar-leery patients by using injectable fillers – like Restylane, Hylaform, Radiance, Cosmoderm or fat transfer, all of which puts plumpness and volume back under the skin. Part of the appearance of natural aging is because the face loses much of its fat layer over the years, leaving sagging skin while allowing some bones to protrude. With added fillers, the aging skin is again, no pun intended, fleshed out. And while your eye may be drawn to plastic surgery ads promising no bruising or swelling, be assured of one thing: there’s always bruising and swelling along with recovery.

It’s just that today’s plastic surgeons are doing more procedures to hold recovery to a minimum so you can return to your normal activities as soon as possible.

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