Facial Procedures

Dr. Graivier knows that small details can make a big difference in how you look, and you feel about yourself. North Atlanta Plastic Surgery & Day Spa offers a wide range of facial cosmetic surgery options. Dr. Graivier will help you put your best face forward with procedures such as:

• Mid-Face Cheeklift
• Endoscopic Forehead Surgery
• Neck Lift
• Injectables
• Rhinoplasty

Mid-Face Cheeklift

The mid-face cheeklift is a revolutionary new technique to combat facial aging. The goal of the procedure is to elevate the soft tissue of the cheeks to a higher position on the facial bones. This will decrease the hollowing in the area below the eyelids and diminish the folds on either side of the nose and mouth. The downward corners of the mouth and the jowls will be improved, and cheek fullness will increase, giving your face a more youthful appearance.

The procedure can be done through a lower eyelid incision or with the assistance of an endoscope inserted through incisions inside the mouth and in the hair. Dr. Graivier was one of the first plastic surgeons in the world to perform these procedures and has lectured internationally on these techniques in facial rejuvenation.

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Endoscopic Forehead Surgery

The goal of forehead surgery is to reposition the forehead skin and eyebrows and remove the frown lines that form between the eyebrows, resulting in an angry or tired expression. Very often, an elevation of the outer portion of the eyebrows will also improve the appearance of upper eyelid drooping.

Until recently there has been significant reluctance to have a brow lift because of the resultant scars and the possibility of hair loss and sensory loss of the scalp. In order to alleviate many of these problems, the brow lift can now be done with endoscopic assistance through three small incisions in the scalp. These incisions are approximately 5/18 of an inch in length and present a much lower risk of hair loss or elevation of the hairline. They also have the advantage of a much quicker recovery period.

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Neck Lift

People of all ages often see the first signs of aging in the neck and jowls – whether it be loose skin (nicknamed the “turkey gobbler neck”), muscular bands, excess fat, or a lack of definition in the jawline and neck angle, All of these conditions can be treated with a neck lift. Neck lift is the treatment that is preferred over a full facelift when the rest of the face has not shown signs of drooping. It is a much easier to recover from this procedure, and the cost is significantly lower as well.

The areas addressed with the necklift are the neck and jowls. The marionette lines running from the corner of the mouth to the chin are also significantly improved by this procedure. To put it simply, this technique is the neck portion of the face, cheek, and neck lift. It was developed by Dr. Graivier in 1994 and has shown long-lasting and excellent results.

Dr. Graivier believes that to have a long-lasting and natural result, the deeper support structures of the face and neck need to be re-supported. In the necklift, an incision is made under the chin and just in front of the earlobe. The incision extends behind the ear into the scalp. (For men, the incision is under the hairline so as not to change the hairline.) Liposuction is performed, and then the skin is elevated gently off the neck muscles. The muscular bands are removed, and the muscle is re-contoured to give an improved angle to the neck. Long-lasting sutures are then placed against the bone behind the ear and woven into the muscle from one side to the other. Several rows of sutures are placed, forming a new support structure for the neck. Essentially a sling has been made, and this gives good long-term support and contour to the neck. The skin is then re-draped, and any excess skin is removed. Closure is without tension, resulting in a very fine scar.

Recovery from this outpatient procedure is approximately five to seven days, at which point makeup can be applied. Some swelling will be present, but this will resolve completely after three months. You should be very presentable for social settings after 10 days.

Dr. Graivier has followed up on his early neck lift patients and found that the results of this procedure that he developed in 1994 have stood the test of time. The results are natural, do not look over-pulled, and they appear to last. He has taught this procedure to numerous plastic surgeons worldwide.

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Injectables

North Atlanta Plastic Surgery & Day Spa also offers a less invasive method of handling aging and wrinkles around the face. Dermal fillers such as BOTOX® Cosmetic, Sculptra®, Radiesse®, Juvéderm®, ArteFill®, and Restylane® may be injected under the skin to fill wrinkles and eliminate fine lines. With confident artistry, Dr. Graivier will offer you a unique combination of fillers to give your face the best results possible. The procedure is generally painless, and can be done in under half an hour.

At North Atlanta Plastic Surgery & Day Spa, we are also now offering ArteFill®, an exciting new development in anti-wrinkle technology. This permanent, non-resorbable injectable not only corrects lines and wrinkles around the mouth and eyes, but it actually becomes part of the skin. Tiny, round microspheres injected above the skin's fat layer provide long-term support for permanent wrinkle correction, and will not be reabsorbed by the body like other dermal fillers. Dr. Graivier recently performed the first injection of ArteFill® in the state of Georgia — another example of how he and North Atlanta Plastic Surgery & Day Spa are at the forefront of technology and innovation in the field of cosmetic enhancement.

The majority of these dermal fillers may also be used for lip augmentation, as well.

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Rhinoplasty

Rhinoplasty surgery reshapes and resizes the nose to achieve an aesthetic goal. The appearance of one's nose is a matter of personal preference. If you are unhappy with the appearance of your nose, rhinoplasty surgery can improve its appearance utilizing the most modern technology in cosmetic surgery today. Rhinoplasty can remove the hump on the bridge of the nose, reshape the tip, narrow the nostrils, reduce or increase the overall size of the nose, increase the angle between the nose and the upper lip, and offer many other improvements.

Many factors have to be considered in making sure a patient's expectations are reasonable. These would include the thickness of the nasal skin and the underlying support structures of the nose. A person with very thick nasal tip skin will not have the same result as a patient with a very thin tip where cartilage can be seen underneath the skin. In addition, many people wish to retain the ethnic quality of their nose while changing a specific area.

Unless a congenital or traumatic nasal deformity has occurred, insurance will not cover this procedure. Surgery for nasal airway obstruction due to a deviated septum or enlarged inferior turbinates is often performed at the same time as rhinoplasty. These procedures may be covered by insurance. Sinus surgery may also be performed at the time of rhinoplasty.

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Consultation

During your consultation, Dr. Graivier will inquire in detail about the areas of your nasal appearance that bother you. You may bring pictures of noses that you like to the consultation, but your anatomy may not make it possible to achieve those results. Dr. Graivier will examine the external and internal parts of your nose. He will also determine if you are having nasal airway obstruction, and if this needs to be dealt with at the time of rhinoplasty. You will then have pictures taken, and a digital imaging program will allow you to show Dr. Graivier what you would like your nose to look like.

It is imperative that you make your desires known to Dr. Graivier during your consultation. The digital images will be printed for you to take home before making final decisions as to your desired nasal appearance. Keep in mind that the final result after surgery is often better than the altered images.

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The Procedure

The operation is done in an outpatient surgery center, usually under general anesthesia. The surgery can be done through either an "open" or "closed" approach. The open approach entails an incision on the columella, which is the area between the two nostrils. This approach leads to better exposure of the nasal tip cartilages and is often used in patients with very asymmetric tips or overly bulbous tips. In the enclosed approach, the incisions are on the inside of the nose. If the nostril bases are to be narrowed, there will also be an incision along the edges of the nostrils. These incisions heal extremely well and are barely perceptible in the future.

If the width of the nose needs to be narrowed, then the nasal bones will need to be fractured, which will cause more bruising and swelling than in those patients in whom fracturing is not necessary. An external splint will be placed after the surgery, which will remain for six days. If nasal packing is necessary, Dr. Graivier uses a small amount of absorbable material which usually goes away on its own. A nasal drip pad will also be placed and usually needs to be changed several times in the first 36 hours.

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Recovery

You will use cold compresses on your eyes for the first 48 hours to help reduce swelling and bruising (although some is expected). You will sleep with your head elevated for two weeks following surgery. A humidifier by the bedside may be helpful, along with a glass of water to help moisten your mouth. Your diet will be limited to clear liquids for three days. The base of your nose should be cleaned with a Q-Tip and peroxide, and Vaseline should be applied twice a day. Do not: blow your nose for 10 days following surgery; bend over or lift heavy objects for at least two weeks; wear glasses for at least three weeks.

When the splint is removed six days after surgery, your nose may be larger than it was prior to surgery. This result of swelling is not unusual. It will take at least six weeks for much of the swelling to diminish. It will take even longer if an open approach was used. The nasal tip may be firm for quite some time, but this softens with time. Patience is a necessity after nasal surgery.

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If you would like more information about our facial cosmetic surgery procedures, or any of our spa services, contact the North Atlanta Plastic Surgery & Day Spa today!