Cosmetic Dermatology

The Concept Underlying Our Rejuvenation Approach

Traditional cosmetic surgery techniques are larger procedures designed to create dramatic improvement and correct any asymmetry or non-ideal shape and proportion. In many of these patients, this dramatic reduction in perceived age coexists with tell-tale signs of these procedures that are obvious to the casual observer. Examples include the “wind tunnel” look after a face lift, the hollowed out look of the eyes after a blepharoplasty, and the over-lifted eyebrows resulting from a brow lift.

At the California Skin Institute, our techniques create significant improvement and rejuvenation, however the changes appear natural and do not create the obvious tell-tale signs of cosmetic surgery. Our approach centers on identifying the age defining feature(s) of a person’s appearance and selecting minimally invasive, local anesthesia procedures to correct those features and create more youthful appearance. Our approach evolved over a decade and began with developing an understanding of the aging process and how our appearance is perceived by others around us. The process began with careful observation of our patients and critical analysis of our techniques and their outcomes.

Let us try to explain…

Imagine that you are having dinner at a local restaurant with friends and are asked to guess the age of the woman in the red dress sitting at the table across the room. You glance over, trying not to be obvious, and answer within a few seconds. Your guess turns out to be very accurate and within a few years of her actual age. What if we then asked you to explain exactly how you arrived at the age of 55 instead of 65 without looking back at the woman? Would you be able to describe how you came to your conclusion in a logical manner? Could you list the physical attributes that influenced your answer? Most likely you would not be able to convincingly support your guess for the woman’s age.

How are you able to guess someone’s age within a few seconds of observation and be fairly accurate each time — but not be able to explain your answer?

We believe that during those few seconds of visual inspection, you are subconsciously assessing a variety of facial and skin features (freckling, wrinkles, eyelid puffiness, neck fullness, skin color) to reach your conclusion. Since this inspection process is subconscious for most of us, we often cannot describe how we came to decide on someone’s age. Our age estimate is often a “gestalt” or impression based on our life experiences. This “lay person” assessment is different from a cosmetic surgeon who makes a conscious calculation of facial and skin features to make his/her conclusion (i.e. the nasolabial fold extending from the nose to the corner of the mouth becomes visible in the mid-20′s and begins to form a fold in the early 30′s).

Since our assessment of a person’s appearance is partially subconscious, it is often difficult to verbalize our conclusions regarding features that age us or changes in appearance. For example, after a recent hairstyle or hair color change, have you ever received numerous compliments from friends regarding recent weight loss or looking less tired? Your friends subconsciously noted a change in your appearance, however they are unable to accurately specify the change that makes you look better. Instead, you are complimented with their best guess. Our friends and family, despite knowing us quite well, are not perceptive enough to remember every single feature of our appearance.

Our techniques at the California Skin Institute are divided into the non-invasive rejuvenation techniques that include injectable products such as BOTOX® Cosmetic for muscle induced wrinkles, wrinkle fillers to replace lost volume of the face and hands, laser and light procedures for pigmentation, redness, and fine lines, and medically supervised skin care regimen. These procedures are selected for you based on your age defining features that would respond best to these treatments. These procedures are performed in the office, with topical, local, or no anesthesia, and have no to minimal downtime. In skilled hands, these procedures can transform an older face to that of a more youthful and rested individual in one or a few treatments. Often, these procedures are combined into one visit frequently.

For patients where these non-invasive techniques are not enough to achieve their desired outcome, the California Skin Institute is on the advancing edge of cosmetic dermatologic surgery performed with local anesthesia. Our approach to rejuvenation surgery focuses on choosing minimally invasive procedures performed with local anesthesia to improve the facial features that primarily contribute to the observers’ subconscious assessment of our age. By selectively rejuvenating the face with minimally invasive surgical procedures without visible scarring or distortion, dramatic reductions in perceived age can occur without the tell-tale signs of major cosmetic surgery. The goal is to look younger without anyone being able to tell why (unless you volunteer that information!). This approach is in contrast to some cosmetic surgeons who utilize a combination of face lift, neck lifts, and brow lifts under general anesthesia as the basis of their rejuvenation regimen. These major procedures take weeks to heal and often produce scars or mild distortion of facial features that are easily recognized by others as the result of cosmetic surgery. Our local anesthesia cosmetic surgery techniques are designed to provide subtle and natural rejuvenation that leaves others wondering why you look younger. A typical example of this approach is illustrated below:

An Example of the Minimally Invasive Cosmetic Surgery Approach to Facial Rejuvenation

SCosmetic Dermatologyheryl (44-years-old) initially consulted with a number of cosmetic surgeons to learn about the options available to obtain a more youthful appearance. Each recommended a variety of procedures including a full face and neck lift, brow lift, upper eyelid lift, and a lower eyelid lift through the skin. Sheryl was quoted $25,000 (in 2000). She was informed of the extensive risks and recovery of an extensive, multi-hour procedure under general anesthesia. Months might be needed for complete healing and she could not ride her horses for at least 6 weeks. Sheryl consulted with Dr. Morganroth to see if local anesthesia, minimally invasive procedures could achieve her goals of a natural rejuvenation.

The traditional cosmetic surgeons recommended an extensive incision (in red) to allow for surgical lifting of the face, neck, and brow. The skin and supportive structures would all be lifted in the direction of the yellow arrows. The upper and lower eyelids would be rejuvenated through incisions through the skin of the upper and lower eyelids (red line). No recommendations were made for improvement of the skin. Overall, a five hour procedure under general anesthesia.

Dr. Morganroth recommended a safer, less invasive, less expensive, and faster healing rejuvenation process based on his assessment of the specific facial features that made her look older to others. A face lift, although a viable option, was not necessary and she could avoid general anesthesia. Dr. Morganroth identified a loss of the jawline definition that could be improved with a liposuction technique without a single suture (yellow box). The lower eyelids could be rejuvenated with a laser technique without visible incisions and sutures. The upper eyelids would be treated similar to the other surgeons’ recommendations (blue box). And skin rejuvenation, one of the most significant signs of her age, would respond well to laser resurfacing and TCA chemical peeling (green box). The only visible incision (shown in red at the upper eyelids) would be hidden in the upper eyelid crease.

Sheryl decided to have her rejuvenation procedure with the California Skin Institute. She was able to return to her normal activities at one week. These two photos show her before picture (left) with her after photos (right) which were taken 2 years and 3 months following her procedure. She continues to have a long lasting and natural rejuvenation outcome with more youthful eyelids, a sharper jawline and neckline, and more evenly pigmented skin (even after two plus years of ongoing sun damage while riding her horses). Most importantly, there are no tell-tale signs of cosmetic surgery such as visible scarring, wind-tunnel facial appearance, asymmetry, or scarring that requires a change in hairstyle.

The Evolution

Dr. Morganroth is a fellowship-trained dermatologic surgeon who trained in a unique, multi-disciplinary setting with a laser and dermatologic surgeon, oculoplastic surgeon (eye plastic surgeon), and facial plastic surgeon during his surgical fellowship. This opportunity allowed him to develop techniques that are combinations of the best features of these specialties. Furthermore, his collaboration with private practice plastic surgery and facial plastic surgery colleagues and the Stanford Facial Plastic Surgery fellows that he trains in facial reconstruction provide additional opportunities to share techniques that result in novel approaches to rejuvenation surgery and facial reconstruction. His techniques are the basis of the California Skin Institute’s philosophy and techniques.

This multidisciplinary training background and Dr. Morganroth’s attention to detail are the basis for our unique approach to rejuvenation surgery. Our techniques cater to the patient interested in a “freshening up” of their appearance while avoiding major cosmetic surgery that requires general anesthesia, increased risk of complications, and a prolonged recovery. Toward that end, we utilize proprietary techniques that produce dramatic results with minimal risk, minimal downtime, and minimal to no visible scarring. All procedures are performed under local anesthesia in our in-office outpatient surgery center.

Many of our cosmetic patients, originally planning on major cosmetic surgery, are surprised to find that their rejuvenation goals can be achieved, if not surpassed, by less expensive and less invasive procedures that provide a natural result without the “tell tale” signs of cosmetic surgery (i.e. scars requiring makeup or hair styling changes, distortion of facial features such as the “wind-swept” look). Typical healing times for these procedures range from one to ten days. Most liposuction and neck rejuvenation patients return to work in three days and eye and facial rejuvenation patients require one week for recovery.

Our team of physicians, Patient Care Coordinators and nurses provide you with excellent, comprehensive care throughout the consultation, pre-op, procedure, and recovery phases of your rejuvenation procedure. A maintenance regimen will be designed to prolong your results and continue the skin rejuvenation process. We collaborate closely with our colleagues in facial plastic surgery, plastic surgery, and oculoplastic surgery and can help you to coordinate a team approach to your rejuvenation procedure to provide the best techniques that these specialties have to offer.

Are You a Candidate For Minimally Invasive Cosmetic Surgery?

There are many options for those interested in learning more about rejuvenation surgery:

  • Schedule a one-on-one consultation appointment with one of our physicians
  • Schedule a one-on-one consultation appointment with one of our Patient Care Coordinators
  • Attend one of our monthly evening cosmetic surgery seminars
  • Ask for complimentary brochures or information sheets

Our goal is to provide state-of-the-art procedures in a caring and supportive environment. This commitment includes providing all of the resources necessary for our patients to make an educated decision. Please ask us how we can help you research the best approach for your rejuvenation goals.

The California Skin Institute specializes in providing rejuvenation procedures in a caring and thoughtful environment. All of our providers have excellent training and focus on providing the best outcome available. The procedure repertoire is very broad and ranges from simple injectable procedures for wrinkles, to lasers to reduce skin redness and wrinkles, to combination facial rejuvenation procedures that create multi-decade reductions in perceived age.

* Individual results may vary and are not guaranteed.

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