Facial Rejuvenation

Seeing. The future.

Facial Rejuvenation

by Heidi L. Jarecki, M.D.

BOTOX

Facial rejuvenation describes a wide variety of treatments and procedures seeking to maintain or restore the texture, appearance and/or position of the face. As time passes the skin and other soft tissues of the face are subject to potentially damaging forces such as ultraviolet light, repeated muscle contraction, and gravity. Altered pigmentation, rhytids (wrinkles), loss of skin elasticity, and drooping or sagging of the skin may result. Treatment options for facial rejuvenation are numerous and include such options as non invasive therapies (light emission treatments, microdermabrasion, chemical peels), injectible therapies (botulinum or BOTOX®, collagen or other filler agents) and surgical treatments (blepharoplasty or eyelid lift, brow lifts and midface lifts).

Non-invasive therapies

Non-invasive treatments are numerous and include such options as light emission treatments, dermabrasion and microdermabrasion, and chemical peels. Light emission treatments use a variety of wavelengths of light to reduce wrinkles and pigmentation while improving skin tone and texture. Chemical peels utilize various types and concentrations of chemical substances to improve skin texture, decrease pigmentation and decrease wrinkles. Trichloroacetic acid and glycolic acid are two commonly used chemical peel agents. Microdermabrasion mechanically removes the most superficial layer of the skin, while dermabrasion also affects a deeper portion of the skin.

Injectible therapies

Botulinum toxin, or BOTOX® as the most popular form of the protein is known, is an agent that inhibits muscle contraction, thereby preventing unwanted wrinkles from appearing. It is commonly used cosmetically to treat frown lines in between the eyebrows, smile lines at the edges of the eyelids, horizontal wrinkles across the base of the nose and wrinkles in the forehead. BOTOX® is also used for a wide variety of other purposes. The effects of BOTOX® are temporary as the nerves affected regenerate their ability to communicate after a period of approximately three months. BOTOX® treatments are done in the office without the need for any anesthesia. A treatment involves several injections into specific muscles using a very small needle. Most patients say the injection feels like a small pinch and any discomfort is minimal. Results are visible in as little as two to seven days. Periodic treatments with BOTOX® are needed to prevent reappearance of the unwanted wrinkles.

Treatment of wrinkles present without muscle movement is often carried out with dermal fillers. Collagen or hyaluronic acid based products are among the most commonly used. Collagen is a component of the skin involved in elasticity. Hyaluronic acid is a compound that draws water into an area, thereby softening or eliminating the wrinkle. Typical locations of use for dermal fillers include the brow (for harsh frown lines), lower cheek crease, and lips (both to fill out thinner lips and to treat lines around the lips). Dermal fillers are also administered in the office setting with cold compresses or local anesthetic given prior to the treatment. Oftentimes, the area injected will need to be massaged afterward to achieve the best cosmetic result. Depending on the agent used, the effects may last several months or longer.

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eau claire 715.834.8471

menomonie 715.235.8335

rice lake 715.234.8444

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Eyebrows an open window into your emotions

Seeing. The future.

Eyebrows an open window into your emotions

by Heidi Jarecki, MD

Happy, surprised, melancholy? When it comes to expressing emotions brows tell it all. Eyebrows set the tone for a face and are key conveyors of mood. An appropriately positioned and shaped brow contributes to a pleasant, alert facial outlook, while a droopy or sparse brow conveys tiredness or sadness. Apart from their role in expression, eyebrow position can also influence side vision and apparent eyelid position. Sagging brows are a surprisingly common and often unappreciated cause of side vision loss.

Though many think of eyebrows as just hair, there is more to the brow than first meets the eye. The eyebrow has three parts–head, body and tail–with the head being the most midline and the tail located closer to the temple. Brow shape and position differ considerably in men and women. Generally more full, the male brow sits at the level of the superior orbital rim, the bone above the upper eyelid. In contrast, the female brow is higher, somewhat thinner and arched. Though often subject to the whims of fashion (recall the thick brows of the 1980s Brooke Shields and the pencil thin brows of the 1960s) some generalities hold true with regard to the female brow. The head of the female brow rests at the superior orbital rim. The body arches upward, reaching a highest point directly above the lateral canthus (the corner where the upper and lower eyelid meet) before the tail tapers to a gentle end. Many brows have been optimized to achieve a certain look via tweezing, brow pencils or powders and/or permanent cosmetics (tattooing). All this effort is undertaken because an appropriate brow shape and position gives an awake, attentive and fresh facial appearance.

FIG 1: Brow drooping blocks side vision and a sad facial appearance. FIG 2: Repairing brow drooping restores vision and an alert appearance.

Eyebrows accomplish their important role in conveying mood and emotion through the interplay of several muscles. The frontalis muscle covers the forehead and is the only muscle to raise the brow, while several other muscles act to bring the brow down. Over time the combined force of the brow depressors tends to win out over the single brow elevator and drooping or sagging results. Adding to the problem, the frontalis muscle only supports the inner two thirds of the brow. The outermost third, the part most prone to sagging, has no elevating muscle support. This brow droop is known as brow ptosis and is extremely common. Eyebrows sit atop a fat pad which extends up the forehead underneath the frontalis muscle. When the brow and the fat pad droop, they can press down on the lid, blocking side vision.

“Eyebrows accomplish their important role in conveying mood and emotion through the interplay of several muscles.”

Normally the eyebrow moves independently of the upper lid, but extreme brow raising can elevate the lid somewhat. Extreme brow raising (technically called frontalis recruiting) is a common compensatory behavior that attempts to improve side vision when drooping brows or lids are causing an obstruction. Brow raising lifts the brow fat pad, thereby relieving weight from the upper lid. Often times, brow ptosis goes unnoticed because brow raising becomes habitual. Constant brow raising can cause headaches and a feeling of tiredness in the face and eyes.
Just as extreme brow raising helps elevate the lid and smooth out the eyelid skin, brow drooping causes an appearance of redundant upper lid skin. I have spoken to many patients whose concern is their extra eyelid skin, but the real problem is a saggy brow causing the eyelid skin to bunch together. Fixing the brow position fixes the lid problem.
Repairing brow ptosis uses a variety of approaches. For minor brow ptosis, for which simple cosmetic improvement is sought, well placed Botox® or other like products can be used. For brow ptosis affecting vision or more moderate to severe ptosis, brow elevating surgery is indicated. Incisional options include directly above the eyebrow, through a deep wrinkle in the forehead, through an incision at the hairline or via several small incisions in the scalp through which a small endoscope is used. The approach used depends on a variety of facial characteristics, as well as the purpose of the surgery. Endoscopic approaches may be seen as cosmetic interventions by some insurance carriers. Browplasty surgery is generally outpatient surgery and the most common concerns after surgery are bruising and swelling that generally last one to two weeks.

Eyebrow shape and prominence can be modified in a host of ways: tweezing, brow powders and pencils and tattooing being the more common. Brow tinting can add appropriate color and topical products, like the lash serum Latisse®, hold promise in restoring lost brow hair.

Schedule your appointment.

By submitting this form, you are granting: Chippewa Valley Eye Clinic , 2715 Damon Street , Eau Claire, WI, 54701, permission to email you. You may unsubscribe via the link found at the bottom of every email.

Locations

eau claire 715.834.8471

menomonie 715.235.8335

rice lake 715.234.8444

affiliations