Face & Neck Services
Face-lift procedures have changed considerably over the past two decades. Dr. Gulin not only tightens the loose skin of the face and neck, but also the underlying muscles resulting in a smoother natural appearance, which lasts considerably longer than traditional techniques. Often Dr. Gulin builds up the deficient areas of the face using fat transfer (injection).
Dr. Gulin offers a mid-face lift for patients seeking improvement for sagging cheeks or deep nasolabial lines located between the nose and cheek. These procedures are done through limited incisions with no visible scars. Often the depression between the upper cheek and the eyelid is improved or filled. Dr. Gulin often combines the mid-face lift with fat transfer (injection) to re-contour the cheek, fill nasolabial folds, or smooth the junction between the cheek and the eyelid.
Who Chooses a Mid-Face (Cheek) Lift?
Patients seen by Dr. Stanley P. Gulin at Plastic Surgery Associates of Naples-Fort Myers seeking a mid face (cheek) lift often wish to improve the sagging in their cheeks and prominence of the nasolabial folds located between the nose and lip and cheek area. There is often a distinct separation between the cheek and the lower eyelid with an upper cheek depression signifying the aging process. Many patients wish, in addition, to have a fuller appearing cheek, particularly when viewed from an oblique angle or three-quarter view. Usually these are younger or middle aged people who are starting to see the early signs of aging.
About the Procedure
All surgery is performed under twilight sleep sedation anesthesia at our fully accredited outpatient surgical facility. Surgery is performed through a small incision in the hairline. Depending upon the degree of improvement needed, the surgery can be performed in two ways. To simply lift the sagging cheek and lessen the nasolabial lines, support sutures are passed from two very small incisions in the nasolabial fold to the hairline incision where they are supported in the tissue underneath the scalp. At other times the cheek may be loosened through an incision in the mouth where again the cheek is raised and supported through sutures which pass from the cheek under the skin and again into the tissue underneath the scalp. This procedure not only smoothes the nasolabial folds and raises the cheek, it also elevates the corners of the mouth. Often Dr. Gulin uses fat transfer (injection) to additionally smooth out lines and depressions in the face in particular the nasolabial and marionette line areas.
After the Procedure
Swelling in the cheek can last from one to two weeks. Most people return to work in about one week. One is able to shower the day after surgery. The overall result obtained by Dr. Gulin at Plastic Surgery Associates of Naples-Ft. Myers, is a more youthful appearing mid face. Nasolabial lines are significantly smoothed, the cheek is fuller and at a higher position, blending into the lower eyelid skin.
Over the past fifteen years Dr. Gulin has developed his own personal technique for transferring (injecting) fat to the face to improve areas of depression, folds, and wrinkles. Often this procedure is done in combination with other facial procedures or alone under local anesthesia. Unlike many synthetic fillers, fat injections last for many years and are not rejected by the body.
Who Chooses Fat Transfer (Injection)
Many patients seeing Dr. Stanley P. Gulin at Plastic Surgery Associates of Naples/Fort Myers are concerned about lines, folds, and depressions in their face that have become apparent as they have aged. Many do not wish or are not candidates for a face-lift or other surgical procedure but would like improvement in these signs of aging. A number of other patients see Dr. Gulin not particularly for facial rejuvenation but to change the shape and contour of their face. They wish to have fuller cheeks, lips, or more contouring along their jaw line. In addition, these patients may also wish to smooth depressions either in the nasolabial area between the nose and lips and cheek or below the eyelids.
Besides improving lines and depressions in the face, fat injection brings in additional blood supply so that the overall quality of the skin on its surface is improved with better texture and color. Because of the stem cell properties of fat, there also is additional rejuvenation of the aging facial skin.
Over the past 15 years, Dr. Gulin has refined his technique of facial rejuvenation and facial contouring using one's own concentrated fat containing stem cells to which platelet gel is added. Fat transplantation provides needed volume and correction of lines and depressions. Stem cells help to improve the quality of the skin while platelet gel provides growth factors to nourish the transferred fat.
Fat transplantation replaces facial volume lost as result of aging, as well as re-contours various areas of the face. Sunken areas in cheeks, under the eyes, and around the lips and chin are markedly improved. avoiding the use of temporary tissue fillers or implants. Better facial balance as well as a look of health and vitality is obtained. Many times the volume improvement is sufficient alone, avoiding additional surgery such as a face or cheek lift.
About the Procedure
Fat transfer (injection) can be performed under twilight sleep sedation anesthesia or under local anesthesia with a small amount of oral sedation. All procedures are performed in Dr. Gulin’s on-site fully accredited surgical facility located in Naples, Florida. Fat is gently removed from the abdomen, hips, or inner thighs, prepared by centrifugation, and then gently injected with specialized blunt needles. No incisions are needed at the transfer site, while only single stitch incisions are used at the donor site.
After the Procedure
Most people resume their usual activities several days following the procedure. Patients having fat injections into the cheek and lip area may be swollen for up to a week or slightly longer. Mild bruising may also occur. Fat transfer (injection) as performed by Dr. Gulin at Plastic Surgery Associates of Naples-Ft. Myers, has been found to last for many years. The results are natural appearing. Although the grafts may feel firm for the first week or two, they gradually soften, blending into the surrounding tissue of the face or body. Dr. Gulin is able to perform any touch-ups under local anesthesia using fat that has been frozen and stored for up to four months following the initial procedures.
Many patients see Dr. Gulin to change the shape or fullness of their cheeks. Buccal fat reduction involves reduction of the deeper fatty tissue of the cheek, reducing a rounded or chipmunk-like appearance. At times the cheek instead needs to be made fuller, correcting any flattening or depression, particularly in older patients. Cheek improvement is often combined with liposuction of the jowl area or fat transfer (injection) to the nasolabial folds between the nose and cheek.
Who Chooses Cheek Contouring (Buccal Fat Removal)?
Patients seen at Plastic Surgery Associates of Naples - Fort Myers by Dr. Stanley P. Gulin seeking cheek contouring wish to have reshaping of the mid face portion of their face. This usually involves the malar prominence over the cheek bone and/or the lower cheek area. Many people seen by Dr. Gulin wish to have more fullness to the cheek area directly over the cheek bone. Other patients may wish to have fatty tissue removed from their lower cheek (buccal fat removal) giving their cheeks an overall more defined look with a chiseled appearance to their face.
About the Cheek Contouring Procedure
Depending upon what area of the cheek needs to be reshaped, the surgical procedure performed by Dr. Gulin may involve adding fat to the cheek itself using fat transfer (injection) or removing fat below the cheek prominence (buccal fat removal). Removal of fat from the buccal area is done through an incision inside the mouth to remove the cheek fat pads. Fullness along the jowl or lower cheek may be removed simply with liposuction.
Surgery is usually performed under twilight sleep sedation anesthesia in the fully accredited on-site surgery facility of which Dr. Gulin is the medical director.
After the Cheek Contouring Procedure
Most patients following this procedure return to work in several days. Mild cheek swelling may persist for up to one week. Minimal bruising is seen.
The result of the procedure by Dr. Gulin at Plastic Surgery Associates of Naples & Ft. Myers, is a more contoured cheek appearance. Particularly when seen in the oblique or three-quarter view, the cheek projects out from the face more. The lower cheek, after contouring, has a more defined look. The cheek appears more youthful and better contoured.
These patients seen by Dr. Gulin at Plastic Surgery Associates of Naples/Fort Myers seek improvement of the previous cosmetic surgery that they have had in the face, neck, or eyes. Patients are often unsatisfied with residual jowling and excessive skin laxity or fullness in the face or under the chin. A number of patients see Dr. Gulin because of their excessive scarring, earlobe deformity, or scarring around the hair line.
Many patients come to Dr. Stanley P. Gulin at Plastic Surgery Associates of Naples/Fort Myers for the correction of a previous cosmetic surgical procedure which has not met their expectations. These patients may have had surgery of the face, breast, or body.
Correction of previous facial surgery may address:
- Residual skin laxity, jowling, and cheek fullness.
- Lack of neck contour.
- Residual lines or depressions in the face.
- Noticeable scarring or hairline distortion.
- Carefully placed fat transfer (injections) to build up any depressed facial areas.
Correction of previous breast surgeries may involve:
- Removal of internal scar tissue around the implants (capsule).
- Repositioning of the implant or changing its size or type.
- Breast Reduction or Breast Lift (Mastopexy).
- Nipple or Areolar Scarring or Distortion Correction.
Correction of previous liposuction surgeries:
May involve selective high definition liposuction or carefully placed fat transfer to build up any depressed areas.
Body contouring corrections may involve:
- Removal of residual excess skin or fat;
- Ultrasonic tumescent liposuction (Lipo-Selection/VASER-Lipo) in the waist area;
- Correction of scarring resulting from the original surgery.
These types of problems are handled by Dr. Gulin at Plastic Surgery Associates of Naples/Fort Myers on a very individual basis and the type of procedure designed is customized to the nature of the exact problem and the patient’s individual desires.
A brow lift corrects a low positioned or sagging brow often in combination with improvement in the lines and furrows across the forehead and between the brows. Often only the outer or lateral portion of the brow sags producing not only a flattened brow but excessive eyelid hooding. Dr. Gulin uses a number of techniques including minimal incision and endoscopic techniques to raise the brow and reduce the lines in the forehead and between the brows. Raising the outer portion of the brow often produces a more youthful open-eyed look.
Who Chooses a Brow Lift?
Women as well as men consult Dr. Stanley P. Gulin of Plastic Surgery Associates of Naples & Fort Myers concerning the shape and position of their brows as well as the lines and furrows across the forehead and between the brows. With age the brow has sagged and the lines have deepened. In addition, many men feel that the sagging of the inner portion of the brows creates an angry look. Brow sagging causes the upper eyelid to have excessive skin and hooding with loss of the eyelid fold. In addition, the youthful arch of the brow is lost.
About the Procedure
The brow or forehead lift is performed in the fully accredited on-site plastic surgical facility located in Naples, Florida under twilight sleep sedation anesthesia. These procedures are usually done through limited incisions in the scalp or endoscopically through minimal incisions hidden in the hair using a telescopic camera-like device. Often only the lateral or outer brow needs to be elevated as opposed to the entire brow. Forehead lifting is also helped with fat transfer (injections) to the lines to soften even more their appearance. To loosen bruising and swelling, platelet gel is applied to the tissue.
During the brow or forehead lift Dr. Gulin may also perform eyelid surgery (blepharoplasty) to remove additional eyelid skin or bulging fat pads.
After the Procedure
Following your brow or forehead lift there may be mild bruising and swelling around the eyes for several days. Most people return to usual work activity in approximately three to four days. Full exercise is resumed in two to three weeks.
Following a brow or forehead lift by Dr. Gulin at Plastic Surgery Associates of Naples & Ft. Myers, the brow has a much more youthful appearance with a natural arch. The angry look between the brows is gone as well as the unwanted lines between the brows and in the forehead. The eye area appears to be better shaped and more youthful, revealing the rim of the bone above the eye.
At Plastic Surgery Associates of Naples/Fort Myers many men and women consult with Dr. Gulin to improve the tired or sagging appearance of their eyelids. Often the skin may lose its elasticity at an early age, producing sagging of the upper and lower eyelid skin and bulging of the fat pads in the eyelids. Heaviness to the upper eyelids may also be a result of sagging of the brows themselves. Dr. Gulin will often combine an upper eyelid blepharoplasty with a brow or forehead lift to correct these conditions. Depressions either above or below the eyelids can be corrected with delicately placed droplets of fat through fat transfer (injection).
Who Chooses Eyelid Surgery?
At Plastic Surgery Associates of Naples - Fort Myers Dr. Gulin is consulted by many women and men wishing to improve the tired or sagging appearance of their upper and lower eyelids. With aging the upper and lower eyelid skin looses its elasticity and the fat pads under the skin begin to bulge. In a number of men and women this is prominent even at a relatively early age. As one ages the heaviness to the upper eyelid skin is also a result of sagging of the eyebrows themselves. In addition, depressions may form below the eyelid where it meets the cheek tissue resulting in a trough-like appearance.
About The Procedure
Eyelid surgery (blepharoplasty) is performed under twilight sleep sedation anesthesia at the fully accredited on-site plastic surgical facility located in Naples, Florida. Surgery involves extremely well hidden incisions, either in the fold of the upper eyelid or just below the lash line of the lower eyelid. Through these incisions excess skin as well as bulging fat pads are removed. Dr. Gulin feels that his skin flap technique allows less interruption with the nerve supply to the lower eyelid muscle, avoiding a lax lower lid due to eyelid muscle weakening. Also Dr. Gulin may perform a brow lift to raise the outer portion of the brow to improve hooding and crows feet lines. To lessen bruising and swelling, platelet gel is applied to the tissue. In a number of patients the outer portion of the brow is also lifted using a lateral brow lift. The trough-like depressions below the eyelid adjacent to the cheek are often filled with droplets of fat using fat transfer (injection) or Restylane® or Juvederm® injection.
After The Procedure
Following your eyelid surgery (blepharoplasty) mild bruising and swelling will occur in the upper eyelids with slightly more bruising in the lower eyelids. Most people are comfortable going out in public in about four days following the procedure with the aid of eye makeup. The procedure itself is painless and the hidden incisions go on to heal extremely well.
Following an eyelid procedure by Dr. Gulin at Plastic Surgery Associates of Naples - Ft. Myers one has a much more rested and youthful appearance to the eye area. The results are still evident even 15-20 years following the procedure.
Rhinoplasty, or nose surgery, is one of the most common plastic surgery procedures performed today. It can reshape, reduce or augment a person's nose to achieve facial harmony and boost self-confidence. It may be performed as a reconstructive procedure to correct a birth defect or an injury such as a broken nose.
Rhinoplasty may be performed for functional rather than cosmetic reasons as well. Combining nose reshaping with septoplasty or endoscopic sinus surgery can effectively treat certain breathing problems, such as those caused by a deviated septum.
Why Choose Nose Surgery (Rhinoplasty)
Rhinoplasty is an excellent procedure for achieving the following:
- Balance the size of the nose with the other facial features
- Modify the width of the nose at the bridge
- Improve the nasal profile, including removing humps or depressions
- Contour a nasal tip that is too large, "boxy," drooping or upturned
- Change the angle between the nose and the mouth
- Narrow and reshape the nostrils
- Correct asymmetry or deviation
Who Chooses Nose Surgery (Rhinoplasty)
The best candidates for rhinoplasty:
- Are at least 13 years old
- Have finished facial growth
- Are generally healthy
- Do not smoke
- Are seeking rhinoplasty for personal reasons, not pressure from others
- Have realistic goals for the procedure
After The Procedure
For a short time after surgery, patients may experience puffiness, nose ache or a dull headache, some swelling and bruising, bleeding or stuffiness. Most patients feel like themselves within two days and return to work in about a week.
The results of rhinoplasty become gradually apparent as the days pass after surgery and swelling recedes. Swelling may reappear from time to time in the first year after the procedure. It is typically more noticeable in the morning and fades during the day.
Contact lenses can be worn immediately, but glasses may need to be taped to your forehead or propped on your cheeks for up to seven weeks.
Patients with realistic goals for rhinoplasty are generally very happy with the new shape of their nose. The exact results depend on the patient's nasal bone and cartilage structure, facial shape, skin thickness and age.
Improvement in the neck and jowl area may be performed alone. This involves tightening of the muscle bands underneath the chin as well as re-draping of loose skin. Usually the incisions used by Dr. Gulin are limited only to the back of the ear or under the chin. Men often complain of the turkey gobbler appearance in the central neck area and this can be addressed through a cervicoplasty using a Z-shaped incision hidden under the chin.
Who Chooses a Neck Lift?
Many women and men are seen in consultation by Dr. Stanley P. Gulin at Plastic Surgery Associates of Naples-Fort Myers because they wish to correct the excess sagging skin of the neck and improve the contour of the neck in the midline under the chin. In addition, jowling is often present giving poor definition to the jaw line.
Often these men and women are relatively young and seek better definition to the chin and neck area with a more contoured angle between the chin and neck.
About the Procedure
Neck lift surgery is performed under twilight sleep sedation anesthesia at the fully accredited on-site plastic surgical facility located in Naples, Florida. Surgery may involve an incision around the lower portion of the ear and under the chin or simply an incision just under the chin, depending upon the amount of skin laxity. Through the small incision under the chin the neck muscles are tightened and excessive fat removed. If excessive sagging skin needs to be removed this is usually accomplished through the incision hidden around the ear. In men Dr. Gulin is able to perform a cervicoplasty procedure, which tightens the neck skin through a Z-shaped incision placed only under the chin. To lessen bruising and swelling platelet gel is usually applied to the tissue.
Liposuction or tightening of the jowl area is often performed during the neck lift procedure.
After the Procedure
Following a neck lift procedure by Dr. Gulin at Plastic Surgery Associates of Naples-Ft. Myers, most patients return to their usual activity in approximately three to five days. The procedure may result in some mild bruising along the collar bone area. In some cases a chin strap is worn for approximately three days to assist in establishing the new contour of the neck.
After undergoing a neck lift patients have a more youthful outline to the neck and chin area, particularly in the profile view. There is no longer the hanging sagging skin in the middle of the neck and the lines and folds on the remaining portion of the neck have been smoothed out. The jaw line itself is more defined and youthful appearing.