Prima Face

Blepharoplasty, Facelift, Browlift,Rhinoplasty, Skin and Facial Rejuvenation are all important components of any anti-aging plan at Prima Center for Plastic Surgery and our Atlanta Georgia practice. 

The main emphasis of Facial Plastic surgery is to acheive a balanced face with refined facial contours and aesthetic definition. Our board certified plastic surgeons,  Dr. Jeff Zwiren and Dr. Phillip Nakano and our dedicated team at Prima Center for Plastic Surgery are focused on results oriented programs and procedures that allow our patients to reach their aesthetic goals. 

Blepharoplasty Eyelid Lift Video
Blepharoplasty (Eyelid Lift Surgery)
Brow lift or Forehead lift
Minimal Access Cranial Suspension (MACS) Facelift 
MACS lift Video
Rhinoplasty (Nasal Surgery)
Rhinoplasty / Nasal Surgery Video
Neck Lift
Neck Liposuction
Facial Augmentation - Cheek and Chin Implants
Chin Implant
Cheek Implants

Media Update - Articles of Interest


Fat may be to blame for baggy eyelids - St. Petersburg Times

Liposuction Doesn't Offer Health Benefit, Study Finds - The New York Times
Radiesse Established as Dermal Filler
A new look at age-old antioxidant to battle photoaging

60 needles, no Botox: the face of cosmetic acupuncture

To find stem cells, scientists focus on fat

Fat assets: Your behind's foe is your face's ally

Panel urges revised warning on facial fillers
  
 

Blepharoplasty

How many times have we looked closely at our selves and thought, I am looking more and more like my mother everyday. Aging is a gradual thing, it creeps silently along for the first 30 to 40 years then it leaps. One day you are young and the next day you appear old. Time sits still for no one. For some individuals, a youthful quest is a relentless passion. As we age the area around the eyes is the first to show these visible signs of aging. Heaviness develops around the eyebrow with sagging of skin and the development of deep creases and folds. The youthful fullness of the eye area becomes harsher as sharp lines of demarcation develop between the skin of the lower eyelid and that of the cheek. The youthful free flowing transition zone between the lid and cheek becomes interrupted by the underlying definition of the bony cheek. A skeletoniztion of the face becomes more and more obvious. Heavy bags and darkening of the skin develops further adding to a tired sad appearance.

The procedure itself is generally performed as an outpatient. Recovery from eyelid surgery includes some pain. Most patients can expect some associated swelling and bruising. There are many things that can be done to swelling and bruising including ice, elevation, control of blood pressure and the restriction of using any aspirin products in the peri-operative period. Also there are herbal products such as arnica and bromelan, if taking prior to the procedure will effectively speed up the recovery process.

There are many ways to prepare yourself for this procedure and to understand if you are a good candidate. First and foremost you must be in good general health. The better the quality of your skin, the better the result and the longer it will last. It is critical to stop smoking prior to surgery. Smoking can seriously effect wound healing. If you do smoke you will be required to quit several weeks before the procedure. If you have any serious eye or health conditions it will be important to let your surgeon know. He may request approval from your eye physician prior to surgery. Medical conditions such as glaucoma, dry eye, a detached retina, thyroid disorders, cardio vascular disease, high blood pressure or diabetes can cause intra operative as well as post operative complications.

When you consider any surgical procedure you must also evaluate the risks as well as the benefits. There are some risks to all procedures, but careful planning and evaluation will help to keep these to a minimum. Surgery is definitely a team event, patient cooperation as well as participation is critical for a good result. After the surgery you may experience dry eyes, bleeding, infection, or scarring.  For more information about blepharoplasty and eyelid lift surgery contact the board certified plastic surgeons at Prima Center for Plastic Surgery

  		 



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The first and only FDA-approved treatment for people with inadequate or not enough eyelashes

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blepharoplasty Video
          

The MACS LIFT

 Minimal Access Cranial Suspension Facelift

Many patients who are interested in facial rejuvenation are opting for a new technique the MACS-lift (Minimal Access Cranial Suspension). Over all this is a less invasive technique to achieve facial rejuvenation that has a recovery period as short as 14 days.  Typically individuals are grocery store ready in 7 days and socially ready by 2-3 weeks – For major photographic events, like a wedding, a minimum of 3 months is suggested.  The procedure is particularly well suited to individuals with mild to moderate mid face sagging, aging of the lower eyelids area, mild to moderate jowls and mild to moderate neck skin laxity. 

 Mild to Moderate Mid Facial laxity
 Loss of Youthful Appearance shape of the lower eyelids
 Deep Nasolabial Creases
 Marionette Lines
 Downward turning of the corners of the mouth
 Mild to Moderate jowls
 Mild to Modearte Neck Skin Laxity

The MACS-lift limits the incisions to the skin-hairline junction just above the ear, proceeds around the sideburn, around the curves of the front of the ear and ends with a small extension just behind the ear lobe.  The area of skin and cheek undermining is much less than with a traditional facelift.  This translates to a more rapid procedure, with less risks and complications.  Several purse string suture of a non-dissolvable material are used to reposition the deep layers of the cheeks, midface, jowls and neck to a more normal, natural, rested and youthful position.  As apposed to the Thread lift or other less invasive procedures the MACS-lift pays special attention to the vectors of aging.  This procedure was developed to reverse and reposition the facial tissues to their youthful position.  Over time there is a direct vertical sagging of the face.  To correct this vertical aging the lift must also be in the vertical direction.  Several other less invasive and ‘gimmick’ type surgical procedures do not address this important concept.  Our experience has shown that went the properly selected individual chooses a MACS-lift for facial rejuvenation a subtle and natural look is achieved.  The MACS-lift, like all forms of facial rejuvenation, should in reality be considered a repair maintenance procedure.







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MACS Video
  

Rhinoplasty surgery

 

Dr. Jeff Zwiren and Dr. Phillip Nakano agree that when asked, What feature of your face would you most like to change, most people say their nose. 
The Plastic Surgeons at Prima Center for Plastic Surgery acheive excellent results in rhinoplasty surgery.  Our patients know that while having a large or crooked nose is a common complaint, it can be corrected with a rhinoplasty.  Rhinoplasty is one of the most challenging yet satisfying plastic surgical procedures   The results the results are not only create physical beauty but work to restore self-confidence.  A Rhinoplasty or nose surgery is tailored to each patients individual anatomy and desires.  The procedure itself can change the shape of the tip of the nose or the size of the nose.  Other features can be reduced such as the width of the nostrils, the height or length of the nose and the angle between the lip and nose. 

 

There are portions of a rhinoplasty surgery that can be considered cosmetic and portions that are considered reconstructive.  If the surgery is done to improve breathing difficulties due to airway blockage then this is considered reconstructive surgery and is usually covered by insurance.  This may be done as well to correct deformities due to injury, trauma or a birth defect. 

 

 The best candidate for a  rhinoplasty is seeking  improvement the appearance of the nose.  This candidate should be physically healthy, psychologically stable, and have realistic expectations.  During the initial consultation, the plastic surgeon will evaluate the structure of your nose and face and discuss the possibilities for enhancement.   This will be a detailed consultation including an external and internal nasal examination.  The anatomy of the nose will be discussed as well as the options for surgery.  The nose is essentially a tent.  The poles of the tent are bone and cartilage, the canvas of the tent is the skin.   Surgically the underlying structures can be altered allowing the overlying skin to redrape.  The thickness of the skin as well the overall structure of the bone and cartilage will influence the final shape.  This will be discussed at the time of the consultation.    Computer imaging is very helpful since it allows both the surgeon and the patient to explore possibilities and understand what can and can not be accomplished surgically. 

 

There are some changes that will be noticed after the nasal splint is removed.  The profile will be improved.  It will, however take more time for the tip of the nose to show its final shape.  It takes several months for the swelling to subside.  Final healing may take as long as one year. 

 

The surgery itself usually takes 2 to 3 hours depending upon the degree of complexity of the procedure.   During surgery, the skin of the nose is separated from its supporting framework of bone and cartilage.  The next step involves the reshaping of the underlying cartilage and bone.  These structures can be either reduced or enhanced depending upon the desired shape.   There are may suture techniques and cartilage grafting techniques that are useful in creating the new nasal framework.  This will be a very individual process.   After this frame work is completed the skin is then allowed to redrape.  A splint is typically applied and sometimes nasal packing is needed.    

 

During the first twenty-four hours after the procedure you will notice some swelling of the face and eye areas.  Many patients report a mild ache of the upper face and sometimes a headache  Pain medication will be prescribed to keep you comfortable.   Elevation and ice are always beneficial.  The swelling and bruising may peak at day two to three.  Most of the swelling and bruising will be gone by two weeks.  Camouflage make up can be very beneficial at this time.  (See Camouflage make up tips following facial surgery)

 

The nasal splint will be removed at day six or seven.  Every day the nose will get better and better.  The results of a rhinoplasy can be subtle or dramatic, depending upon the patients desires.  The overall satisfaction rate is quite high with large gains in self confidence and self-esteem.
For more information about rhinoplasty in Atlanta Georgia contact us today.

  
 Rhinoplasty Video  

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Neck Lift

 

One of the most visible signs of aging is the neck area.  A neck lift is a cosmetic procedure designed to remove the sagging or drooping skin of the neck as well as correcting sagging muscle.   Men and women of all ages often consider neck lift surgery.  A very frequent comment following neck lift surgery, from friends and family is that the patient has lost weight following the surgery.   During a neck lift the excess skin , fat and tissue are tailored to eliminate wrinkled and sagging skin.  The remaining skin is sometimes stretched and removed and other times it is allowed to redrape on its own.  The ultimate result is a youthful and aesthetically pleasing neck shape and contour. 


There are several different forms of neck lift

 

Cervicoplasty: this procedure removes only the excess skin, it can be combined with liposuction if needed. 

Platysmaplasty: this procedure involves the correction of the underlying muscles of the neck along with liposuction.  This can be combined with skin removal if needed. A platysmaplasty is generally performed through an incision in the crease under the chin.  This gives access to the muscles of the neck called the platysma.  These muscles become loose and detached from the underlying tissue with aging and create the turkey gobbler type neck appearance.  With increasing severity of loose skin and excess fat, a greater degree of skin undermining must be done.  This may require an incision around the base of the earlobe.  This allows for wide dissection and undermining of the skin allowing it to redrape with out the need for actual skin excision.  If the degree of skin excess is too great then the platysmaplasty will need to be combined with a cervicoplasty for removal of this excess skin.    

   
 Liposuciton is frequently performed in conjuction with a neck lift.   Liposuction can be performed through a small incision below the chin.  Using a hollow tube, called a cannula, the fat is suctioned out.  It is important to leave a contouring layer of fat to provide a youthful appearance

Recovery following a neck lift, of course, depends upon the extent of the surgery.  Some may be back to relative normal in one week while others will take more time.    Most people return to their normal routine after 10-14 days.  

 The plastic surgeons at Prima Center for Plastic Surgery are accomplished in all forms of facial rejuvenation including neck lift and liposuction.  During your consultation we will discuss all options available to you.  For more information contact us today. 


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Neck liposuction



Liposuction of the neck can be an excellent way to get rid of extral fat of the neck.  Fat typically accumulates either in the area just under the chin, called the submental zone or along the sides of the neck.  Just a small amount of liposuction of this area can make a tremendous difference in your profile and contour.  LIposuction of the neck can be  performed under local anesthesia and typcially takes 1 - 2 hours.  Following the procedure you will be instructed to wear a suppor garment for the first 3 - 4 days.  This helps the skin redrape.  Once the bruising goes away the contour of the neck will look better and better.  This is a highly successful procedure when performed on the appropriate individual.  For more information about neck liposuction contact us today. 


Facial Augmentation – Cheek and Chin Implants

 

 There are many ways to achieve facial balance and symmetry.  A subtle augmentation of the cheek bones or advancement of the chin can create an entirely new facial contour.    Great advances have been made in the design of facial implants over the past several years.  Greater attention has been placed on making the implants conform to anatomical features.  They fit like a glove over the existing bony facial skeleton to enhance facial contours.   These new implants are specifically designed for cheek and chin augmentation.  The implants that are in the most common use are made of a soft, FDA-approved silicone.   Facial implants can be used alone or in conjunction with other procedures for a more complete rejuvenation.  

 

The nose and the chin share a unique relationship when is comes to balance of the face.  Chin implants can be used as an isolated procedure to strengthen the jaw line.  Often both a chin and cheek implant can be used to achieve the desired aesthetic effect.   When considering a change in the shape of the nose we must also observe the chin because a rhinoplasty can bring out a weak chin. Cosmetic chin surgery adds definition to the jaw and balances the appearance of a large nose.


There are many different ways to perform a chin augmentation but typically it is done through an external incision placed in the small groove under the chin.   Once this incision is made a pocket is created to accept the implant.   The pocket is made just on top of the bone and care is used to protect nerves in this area.  The appropriate sized chin implant is then placed inside the pocket. Once the implant is in position, the skin will be closed with sutures. Some bruising and swelling of the chin area is expected for 7 to 10 days.   

 

For cheeks that lack definition, Cheek implants can add bold to subtle changes to create an enhanced shape.  If the cheek is flat, a cheek implant will define the face.  As we age the cheek contour tends to decrease and an implant will restore lost contour. A check implant is usually can be placed through an incision inside of the mouth.  Once the pocket is created over the existing cheek bone an appropriately sized, contoured, anatomic implant can be inserted and manipulated into place.  Once they are positioned, the incision, inside of the mouth, will be closed with dissolvable sutures.   Swelling in the midface area usually last from two to three weeks.  Cheek and chin implants give  the plastic surgeons at Prima Center for Plastic Surgery another tool to create a facial profile that is completely in harmony with all facial features.  For more information about cheek or chin implants please contact us.


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Brow lift or Forehead lift

One of the more noticeable signs of aging is a downward descent of the eyebrows.  The normal position of the eyebrow arch is 1 cm above the orbital rim.  With increasing looseness of the skin and tissues of the upper face there may be a drooping of the eyebrows, eyelid skin hooding, deep forehead furrows and vertical frown lines between the eyebrows.  To correct this problem and to restore to restore a youthful contour to this area a brow lift (also called forehead lift) can be performed.  In a typical brow lift the structures of the forehead are tightened or altered to smooth the forehead, raise the upper eyebrows and improve frown lines.

There are many different techniques for forehead lifts and these must be individualized for each patient.  

 

1.  Classic forehead lift - involves a continuous incision made behind the hairline

 

2.  Hairline incision - performed at the anterior hair line and typically used to shorten a long or high forehead

 

3.  Endoscopic brow lift performed using an endoscope, which is carefully inserted under the skin and used to lift and tighten the skin and underlying muscles

 

 

4. Lateral brow lift / Lateral Galeapexy  - This is a limited lateral brow lift that will elevate the outside part of the eyebrow and forehead.  

 

A brow lift may be performed alone or in conjunction with other procedures, such as a facelift or eyelid surgery.  It is not unusual for a  to desire surgical correction of upper eyelids when in fact it is the sagging or drooping of the brow that causes an overly tired appearance and heaviness of the eyelids.