Post-Pregnancy Surgery

Pregnancy and breast-feeding often take their toll on the mother’s body, resulting in excess abdominal skin with stretch marks and sagging, deflated breasts.

Plastic Surgical procedures can help with these demoralizing changes.

Timing. It is generally recommended that the woman wait until she has completed her child bearing before going ahead with a “Mommy Makeover, “ as it has been called. Additional pregnancies will stretch out a repaired abdomen or lifted breasts and, as a general rule, it is better to wait until the woman is sure she will have no further children. Of course there are exceptions to this rule. For example, if a woman has a divorce after the first child and feels uncomfortable getting back into the dating scene, it may make sense to undergo surgery, even if there may be additional pregnancies in the future.

Abdomen. The most common procedure on the abdomen is an abdominoplasty or “tummy tuck.” If there is extensive amounts of excess skin and stretch that extend above the belly button, a full abdominoplasty is usually necessary. If the excess and stretch marks are limited to the lower abdomen, a more limited or “Mini abdominoplasty” may be adequate. The surgeon should attempt to keep the scar as low as possible so that it may be hidden in most underwear. The recovery after standard abdominoplasty is more painful than after facial procedures (such as a facelift) and is similar to the recovery after a C-section. Ouch! Surgery makes such a dramatic difference, however, that most patients feel that it is definitely worth it.

Breasts. The effects of pregnancy and breast-feeding on breasts are greater for larger breasts. Patients who start with an A or B cup frequently do not suffer extreme deterioration in their breast shape/size. Larger breasts, on the other hand, tend to sag and deflate. The result are breasts that may need either a lift (mastopexy) or an implant (augmentation) or BOTH.

These procedures can be done separately or together depending on the needs of the patient, the recommendation of the surgeon, financial considerations etc.

Some women go through pregnancy with minor changes and require no surgical help afterwards. Others, however, for no known reason, develop significant changes in their bodies. For these latter women, plastic surgery can often help tremendously.

Tear Trough and Lid/Cheek Junction

Discussion: continuation....According to Codner and Ford, the tear trough deformity overlies the muscular triangle formed by the orbicularis pculi, the lavtor labii superioris, and the levator alaeque nasi muscles. They also point out that, with age, there is postseptal fat herniation and prezygomatic fat ptosis that accentuates the defect. Barton et al. referred to the tear trough triad: (1) heniation of orbital fat, (2) tight attachment of the orbicularis along the arcus marginalis. and (3) malar retrusion.

Regarding the issue of apparent descent of the lid/cheek junction, Lambros has pointed out that the lid/cheek junction is in fact stable over time and the perception of the descent is attributable to herniation of the orbital fat following orbital septal and preseptal orbiculairs oculi muscle attenuation.

These shadows exaggerate the tear trough deformity and palpebromalar groove. Furthermore, skin atrophy leads to darkening of the preseptal skin, causing an increase in contrast and therefore an accentuated lid/cheek junction. Our study suggests that the tear trough deformity is not related to facial "descent, the arcus marginalis, the orbital rim, or the junction of the levator labii superioris alaeque nasi muscle and the orbicularis oculi muscle. To be continued....

Tear Trough and Lid/Cheek Junction

DISCUSSION: continuation.... Loeb described three theoretical malformations that cause what he termed the nasojugal groove. These include (1) fixation of the orbital septum at the level of the inferomedial portion of the arcus marginalis; (2) the existence of a triangular gap limited by the lateral portion of the angular muscle on one side and the medial portion of the orbiculares oculi muscle on the other; and (3) the absence of fat tissue from the central and medial fat pads subjacent to the orbicularis oculi muscle in the area below the groove . Loeb also noted that this natural sulcus may be inconspicuous until neighboring fat pads grow and exaggerate the defect. To manage these spatial derangements, Loeb described a number of treatment options, including (1) transplant of free fat grafts; (2) sliding fat from the medial and central hypertrophic fat pads; and (3) liposuction of excess fat on the cheek region.

If I have a specialty, it is the Facelift.

NYC Patients frequently ask, "What technique do you use- SMAS, deep plane, short scar, MACS-lift.?" The answer is, "Whatever technique the patient needs." To have only one technique at your disposal calls to mind the adage, "If you have a hammer, the whole world looks like a nail!"

The truth is that every patient is different, with an aging pattern all his/her own, with a unique skin type, with a particular pattern and color of hair, individual medical issues/medications and personal expectations. An experienced surgeon has many tools available, not just hammers, and chooses the combination of techniques and procedures that best suit that patient. I have performed every conceivable facelift procedure, and try to choose what is best for each patient.

Dr. Thorne's technique
www.CharlesThorneMD.com

That being said, there are certainly procedures I use and others I do not. My philosophy of facelifting, like my philosophy on all cosmetic procedures, is to do as LITTLE as possible to give the patient the result he/she seeks. The goal is NOT to do as much as one can think of. This approach of minimal intervention for maximal results leads to more consistent results, fewer complications, and is least likely to result in an "operated look."

The technique I use most often consists of skin undermining, vertical elevation of the posterior SMAS and platysma, suspension of the cheek fat, and selective liposuction and lipoinjection. I do NOT redrape the skin vertically. I do not like the appearance of neck skin pulled up on to the face-the neck skin has different pigmentation, different creases and belongs in the neck! I frequently combine the procedure with elevation of the outer part of the brow only. See section on browlifting. I hate conventional browlifts, which tend to make people look older, stranger and surprised.

Goal of facelifting

The goal in facelifting, for most patients, is to make the patient look like herself/himself, just a crisper version. An occasional patient wants/needs a more dramatic change but this is the exception, not the rule.

Harmony and avoiding the "facelifted look."

Almost every patient tells me that they don't want a "facelift look." What do they mean? In addition to avoiding over-correction in any area, the key is to keep the face looking harmonious as a whole. If one part of the face is out-of-synch with the rest of the face, it does not look natural. It looks artificial or "man made." An occasional patient will ask me to correct only the neck. I rarely agree to such a request because I fear creating disharmony-a tight neck with uncorrected jowls! Not a good look. My goal is to make you look BETTER, more harmonious than when you started, not to create a disharmonious, operated appearance. I would rather have your friends say, "She looks great," than say, "She had a facelift!"

To see before and after images, just click Facelift.

To read Charles Thorne's facelift chapter in The Plastic Surgery Book, please click Plastic Surgery Book

For more information, please click here.

Tear Trough and Lid/Cheek Junction

DISCUSSION: Continued... Flowers described a set of factors contributing to the formation of the tear trough deformity, including (1) descent of the cheek with the junction of cheek skin and eyelid skin occurring at a lower point than usual; (2) a muscular defect between the orbicularis muscle and angular head of the quadratus labii superioris muscle; (3) underdevelopment of the suborbital malar complex (hemiexophthalmos); and (4) a progressive loss of facial fat with age. Flowers focused his efforts on developing alloplastic implants designed to fill varying degrees of tissue inadequacy. In a related observation, Freeman noticed that the formation of the nasojugal deformity was associated with the inferior migration of the sub-orbicularis oculi fat pad. to be continued....

Charles H. Thorne MD
Plastic Surgery - New York City

Facelift-State of the Art

In October I moderated a panel discussion at the 25th Anniversary Meeting of the Northeastern Society of Plastic Surgeons on the subject, "Facelift--State of the Art". The concept was, "How far have we come in facelifting in 25 years?"

The consensus was that most of the "new" techniques have NOT delivered what they promised. While it is true that the big operations of the past may no longer be necessary, it is also true that 'small operations mean small results.' Another way of saying it: 'If it seems too good to be true, it probably is!'

It was agreed that a good facelift will require a week or two of recovery--not a month or two, but not an hour or two, either.

Charles H. Thorne MD
Plastic Surgery - New York City

I have been practicing plastic surgery in New York City for 20 years and have been lucky to be listed in the Castle and Connolly and New York Magazine "Best Doctor" publications many times. Although I enjoy the leadership positions that I have in plastic surgical societies, my editorial position with the Journal of Plastic and Reconstructive Surgery, and my position on the American Board of Plastic Surgery, my real interest and expertise is performing surgery and taking care of patients. Making people happy never gets old.


Charles H. Thorne MD
Plastic Surgery - New York City

Tear Trough and Lid/Cheek Junction

DISCUSSION: continuation...
In the suborbicularis plane, the tear trough and the lid/cheek junction differ. Along the tear trough, the palpebral portion of the orbicularis oculi muscle is rigidly attached to the bone, with no dissectible anatomical plane deep to the muscle. it was not technically possible to dissect above the periosteum and below the muscular attachment. Along the lid/cheek junction, however, the orbicularis muscle has a ligamentous attachmentto the bone by means of the orbicularis retaining ligament. Unlike the tear trough region, there is a plane deep to the muscle into which material can be injected or surgical dissection performed. Although there appeared to be on main orbicularis retaining ligament, there were several weaker ligamentous attachments between the orbital rim and the attachment of the main orbicularis retaining ligament. To be continued.....

Charles H. Thorne MD
Plastic Surgery - New York City

Tear Trough and Lid/Cheek Junction

DISCUSSION: The anatomical features that explain the external landmarks known as the tear trough and lid/cheek junction exist in three different planes: at the skin level, at the subcutaneous plane, and at the suborbicularis plane. In the subcutaneous plane, the tear trough and lid/cheek junction corelate with the junction of the palpebral and orbital portions of the orbicularis muscle. Along the tear trough, there tends to be a particularly obvious cleft between the two portions of the orbicularis muscle. In addition, there is virtually no fat between the skin and the muscular junction, accounting for its visibility as a cutaneous landmark. Further contributing to external visibility is the fact that the eyelid skin above the landmark and the cheek skin below the landmark have distinctly different textures and thicknesses. In addition, the malar fat pad begins precisely at the same muscular junction, providing further definition. To be continued.....

Charles H. Thorne MD
Plastic Surgeon New York City

Tear Trough and Lid/Cheek Junction

RESULTS: Continuation....
Although the anatomy of the tear trough and its lateral continuation, the lid/cheek junction, were identical in the subcutaneous plane, this was not the case deep to the orbicularis. Rather, the palpebral portion of the orbicularis was rigidly attached to the maxilla where it takes origin. Laterally, however, along the lid/cheek junction, the attachment between the orbicularis muscle and the underlying bone was ligamentous (the orbicularis retaining ligament). In this region, there was a dissectible plane deep to the orbicularis muscle.

The orbicularis retaining ligament was attached to the underlying zygoma caudal to the arcus marginalis at the orbital rim. The orbicularis retaining ligament was furthest from the rim in the midpupillary line (4 to 6 mm) and terminated closer to the rim near the lateral canthus (2 to 4 mm). To repeat, the orbicularis retaining ligament did not arise from the infraorbital rim but, like the cutaneous landmark overlying it, was several millimeters caudal to the rim.

Finally, attenuation of the orbital septum accompanied by orbital fat herniation was transmitted through the relatively lax palpebral orbicularis, further accentuating the tear trough. This was especially evident medially, where the strong orbital orbicularis attachments originate.

Charles H. Thorne MD
Plastic Surgeon New York City