FACE

Upper eyelid surgery is a cosmetic procedure that rejuvenates the eyes by removing excess bulk that covers the natural creases of the eyes. Patients often say they look more tired than they feel, that the eyelids feel heavy or in severe cases, affect their vision. Women who regularly use eye makeup and mascara will find that the extra skin on top of the eyelids causes creasing and smudging. The excess skin is removed surgically, if there is excess fat or bulky muscle, these are trimmed at the same time. When it comes to eyelid surgery, having an eye for aesthetics and detail is as important as the technical execution of the procedure. There are important differences in aesthetics between male and female patients. It is important that these differences be appreciated by your plastic surgeon in order for you to get the results that are harmonious with the rest of your facial features. Remember to ask me about this point and I will go over some photos with you during the consultation.

Will MSP or my insurance cover the cost of the procedure?

Yes, if it is affecting your vision, then our BC health plan will cover the cost of upper blepharoplasty. Surgery for cosmetic enhancement of the eyes are not covered by insurance.

How much skin will be removed?

It is important to distinguish what is possible vs what is aesthetically pleasing. This is always a decision that involves a discussion with the patient. I perform a thorough examination and use the patient’s old photographs as a guide.

Anesthesia: Local anesthetic

Time required: 1+ hrs

Recovery period: Sutures stay in place for 6-7 days. Most patients are able to answer emails or do virtual work the next day.

Dr. Forbes' preferences: Surgery on the face, especially near the eyes requires an even higher level of precision. Artistic intuition distinguishes a satisfactory outcome from an exceptional one. This is why I take great pride in producing beautiful blepharoplasty results for my patients. I hide the incision in the natural crease of the eyelid. Usually patients have more loose skin on the outer corners of the eyes so I remove more skin accordingly to create an open and lifted look. Conservative fat removal is done to reduce bulk but not too much to avoid hollowing of the eyes.

Cost: The cost of upper eyelid surgery / upper blepharoplasties with Dr. Forbes is $5100+

Asian Eyelid Surgery or Double Eyelid Surgery, creates a natural-looking eyelid crease in individuals with a “monolid”. Aesthetically it makes the eyes appear less tired, more open and for females, it makes eye makeup more apparent. Functionally, patients with heavy upper eyelids and a lack of crease can experience eyelash irritation. Double eyelid surgery is a common procedure done in Asia, I am one of the few plastic surgeons who offer this procedure in Vancouver.

Anesthesia: Local anesthesia

Time required: 1+ hours

Recovery period: Sutures stay in place for approximately 1 week. Most patients are able to answer emails or do virtual work within 2-3 days.

Technique: An upper eyelid crease can be created with sutures only, or an actual incision. While the suture technique sounds attractive as it is often advertised as “scarless”, the major downside is that the results may fail over time causing recurrence of the monolid appearance. The incision technique allows better control of crease height and placement, recurrence is exceedingly rare with this technique. You can guess what my preference is already, but I will explain more in the next section.

Dr. Forbes' preferences: Setting the crease height is a very important decision. This decision is made together with the patient. I use an incision technique because I have better control of the height of the new crease. In addition, this incision allows me to access the fatty tissue above the eyelid and trim it to create more of a desired shadow in the transition between the eyebrow and eyelid. Lastly, it allows me to angle the lashes to a slightly more upturned position which many patients find desirable.

Cost: Asian blepharoplasty surgery / double eyelid surgery with Dr. Diana Forbes is approximately $5000.

A Facelift is a surgical procedure that addresses signs of facial aging by lifting and tightening the skin and underlying tissues. Many people have explored non surgical options prior to committing to surgery. They serve an important role in the maintenance of your skin quality and texture, but you may find that ultimately surgical correction is required to fully reverse the clock. The facelift is an excellent operation to address loose facial skin, jowls and neck contour problems. Most patients who are good candidates for a facelift have some degree of facial volume loss usually in the central and lateral cheek region. Volume restoration using fat grafting is an important part of facial rejuvenation thus fat grafting is often combined with facelift.

Anesthesia: General anesthesia or IV sedation

Time required: 4+ hours

Recovery period: Sutures stay in place for 1 week, ok to start applying makeup at 10 days. Most patients are able to return to work and social activities in 2-3 weeks.

Technique: There are several different techniques. The incision for a full facelift is placed along the hairline in the temple region, in front of the ear at the junction of the facial skin and ear, around the tragus and earlobe and into the posterior hairline. This incision is meticulously planned to ensure that it is hidden as much as possible.

Dr. Forbes' preferences: I will do either a SMAS plication or a deep plane SMAS lift. There are advantages and disadvantages of each. Almost always, I perform the facelift in conjunction with fat grafting for volume restoration . There are several other procedures that will enhance the overall aesthetic result and can be done at the same time. Some examples would be skin resurfacing, upper blepharoplasty, upper lip lift, and chin augmentation. Each patient will have her/ his unique set of needs, we will have a comprehensive discussion and assessment in your consultation.

Cost: A full facelift procedure with Dr. Diana Forbes is $19000+. This cost may be higher or lower (mini facelift) depending on the additional procedure(s) required.

Loose skin around the chin and a neckline that is losing definition are common issues that people experience. This can be due to the natural aging process, the patient's own anatomy and genetics, or occupation with chronic poor posture. It can also happen after rapid weight gain or loss. Many people have explored non surgical options. They serve an important role in the maintenance of your skin quality and texture, but you may find that ultimately surgical correction is required to fully remove the loose skin and bulge underneath the chin. People who are good neck lift candidates are ones who are, firstly healthy, non smokers, who are willing to exchange their excess neck skin and loss of neck definition for a scar that is placed around the ears. Most of the time, patients who require a neck lift will also benefit from a face lift through the same incisions. Occasionally, patients are good candidates for neck liposuction, or deep neck tissue debulking. A thorough assessment is important to determine what type of procedure is required.

Anesthesia: General Anesthesia or IV Sedation

Time required: 3+ hours

Recovery period: Sutures and a surgical dressing stay in place for 1 week, ok to start applying makeup at 10 days. Most patients are able to return to work and social activities in 2-3 weeks.

Dr. Forbes' preferences: When I evaluate a patient for a neck lift, there are several factors to consider including: Skin quality, platysma anatomy, volume of fat tissue in the superficial and deep planes, presence of enlarged or ptotic salivary glands adding to the neck fullness and overall chin projection.

A Neck Lift is done through a similar incision as a facelift unless I determine that liposuction or a deep plane debulking is more appropriate. In a true neck lift, the deeper tissues are contoured and lifted, the skin is redraped and the excess skin removed surgically. The incision is then meticulously closed with fine sutures.

Cost: The cost of a neck lift with Dr. Diana Forbes is $19000+

Rhinoplasty is a surgical procedure that enhances the appearance and function of the nose by reshaping its structure. The needs of each patient determine the type of rhinoplasty performed. Asian Rhinoplasty often refers to a combination of procedures to enhance the nasal bridge by using a patient’s own cartilage (rib) or a silicone implant, and/or reducing the size of the alar curvature.

Anesthesia: General anesthetic

Time required: 3+ hrs

Recovery period: Swelling after rhinoplasty can last many months, especially with the open technique. Patients will usually have a nasal splint for 1 week after surgery. Bruising will resolve in approximately 10-14 days.

Technique: Rhinoplasty can be done in either an “open” or “close” fashion. This refers to whether there is an incision at the columella “open” or if the incision is entirely within the nostrils. Preservation rhinoplasty is a relatively new technique where the patient’s own cartilage and bony framework is retained as much as possible. For Asian rhinoplasty, to augment the nasal bridge, a silicone implant is frequently used

Cost: The cost of a rhinoplasty / Asian rhinoplasty is highly variable depending on the complexity of the surgery. Costs can range between $9800 - $17,900+