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					                           Rejuvenation of Myself
                              Katsuya Takasu, M.D.
                                 Nagoya, Japan

                                      Face Lift

My forehead has deep wrinkles.
The jaw is sagging. I have a double chin.
The cheeks are also sagging. What can I do to improve my facial contour?
According to computer simulation,
if I pull the forehead, the frontal hairline recedes considerably.
This will make me look older.
The result will not be good.
If I pull the jaw, the sag can be improved;
however, the correction seems insufficient without liposuction.
As you see in the simulation, lifting and liposuction seem necessary.
This way I can rejuvenate myself markedly. The sideburns recede,
but I can still save them.
Since this is the very face lifting of myself, I am being quite particular.


Unlike an ordinary procedure, the incision line is made just under the frontal
hairline.
The operation is performed under local anesthesia.
The main purpose of this lower blepharoplasty is SOOF transfer; therefore, the
ablation of the skin is minimal.


A small amount of orbital fat is excised, because the excision of a large amount of
orbital fat sometimes results in depressed eyelid.
The soft tissues are also moved.
The incision line is a zigzag.


The incision is performed in a zigzag line along the hairline. A thin layer of skin is
dissected and pulled.
The excision of the soft tissues is minimal.
The buccal fat is left untouched.
I can observe the operation on the monitor and give orders.
I make sure that the hemostasis is complete.


700 hair grafts are prepared from the excised skin behind the ears, and they will be
                                         1
transplanted on the frontal incision line.
The frontal muscles are left untouched. Only the thinly dissected skin is pulled.
In course of the operation, I sit up and check myself in the mirror.
This is because there is a considerable difference in facial coutours when one is
laid and when one is up, as you see in my case, too.
In spite of the lifting just performed, the jaw is still sagging.
After all, liposuction in the lower jaw is necessary.
The hairy skin behind the ears is excised and cut into 700 grafts.
By this hair transplantation along the frontal incision line, the scars will be
inconspicuous, and it will also create a natural hairline.
The method taken here is single hair transplantation.
While the surgeon sutures the wound, the technicians prepare the grafts for the hair
transplantation.
The biggest concern is whether the grafts will take root in the thinly dissected skin,
because the circulation of blood is extremely poor in the skin with high tension.
This is a totally new trial session.
Approximately 700 grafts have been transplanted.
I sit up, and again check myself in the mirror. The double chin has disappeared, and
the forehead has been rejuvenated.
This is a preoperative view.
This is a one-month postoperative view.
It seems that the hair transplantation was also successful. Most of the grafts have
taken root.


There is a dramatic improvement of the double chin, nasolabial folds and sagging
neck. The mouth area has also been improved.
This is an oblique view. The forehead has been lifted and sutured, but the frontal
hairline has not receded.
The cheeks are fully lifted.
Upper blepharoplasty has not been done in this photograph. The next photograph
shows the postoperative view of the upper blepharoplasty.


                                     Buccal Fat


Obese middle-aged men just like myself and the elderly have sagging cheeks or
their cheeks are to sag in the near future.
The correction of these sagging cheeks has been difficult even by a face lifting
operation that pulls the SMAS of the facial muscles.
Surgeons thought that the looseness of the skin and facial muscles was the cause
of the sagging cheeks;
                                            2
however, we have found that the sagging cheeks are caused by drooping buccal fat
pad.
There is 9-10 grams of buccal fat between the musculus masseter and buccal
muscle.
As one ages, buccal fat pad descends between these muscles.
By removing the buccal fat pad before it starts to descend, the cheeks can be
prevented from sagging.
Even if the cheeks have started to sag, a good improvement can be achieved by the
removal.
Under local anesthesia, a small incision is made in the buccal gingival. From there a
canula is inserted, and the buccal fat is suctioned by a syringe.
The canula can easily be inserted between the musculus masseter and buccal
muscle by a light downward push.
When the sagging cheek is lightly pushed upward from outside, the canula can be
inserted into the buccal fat pad, and the fat is suctioned with ease.
There is thin fibrous septum around the buccal fat pad; therefore, it is easier to
suction the fat when the septum is pushed broken and the fat is crumpled a bit by
fingers.
The incision is made by the first posterior tooth. The same procedure is repeated on
the opposite side.
In order to prevent postoperative bleeding, some cotton is placed in the gingival
crevice, and a compressor is applied around the cheeks for one full day.
In my case, about 3cc of buccal fat was removed.


                                     Exoderm


Exoderm is deep chemical peel invented by Dr. Yoram Fintsi, my dear friend.
I asked Dr. Fintsi to perform Exoderm on my face for further rejuvenation.
Exoderm was performed at Takasu Hospital near Nagoya, one of the medical
facilities that I manage.
In spite of the face lifting performed 6 months before this, there remain quite a few
fine wrinkles and stains.
No painkiller or tranquilizer is used.
It is quite painful.


My wife is being trained by Dr. Fintsi using my face.
One day later, the tape mask is removed.
The removal of the tape mask involves pain. A quick tear-off is the best way.
It is difficult to open the eyes due to some discharges from the skin.
After this, in order to promote crust formation, thymol iodide powder is sprinkled
                                            3
thoroughly on the face, and this powder mask will stay on the face for 7 days.
There is also a strong burning sensation when the powder is sprinkled.
I think that local anesthesia is necessary when Exoderm is performed on the elderly
patients.


This is an artificial burn.


One week has passed.
The crust formation is complete, and the powder mask and the crust are tightly
attached.
When the mask is removed, there appears a newly-born baby skin.


There is almost no pain involved in this mask removal.
At this point, you can see the improvement of the fine wrinkles.
Exoderm also contracts skin; therefore, my face is thinner than before.
You can also see an improvement of the fine wrinkles around the eyes.


                               Golden Thread Implants


Golden Thread Implants is an implant of a fine golden thread in the subcutaneous
tissue in order to prevent facial deterioration and sagging of the skin.
This implant is particularly effective for a patient who has had face lifting and who is
concerned about the reoccurrence of the sagging skin.
Under local anesthesia, a fine golden thread is implanted in the skin as if one were
doing some needlework. The technique required here seems quite simple and safe.
Golden Thread Implants can be applied to a correction or prevention of a drooping
breast.


In my opinion, presuming that a face-lift patient will have the second face-face
operation after several years, this procedure is very effective in the point that the
patient can delay the surgery until some years later.
This is immediately after the operation. There is almost no swelling except for the
swelling caused by local anesthesia.


This is a photograph taken right after the anesthetic injection, right after the implant,
and at the party on the night of the operation. Nobody noticed that a golden thread
was buried in my jaw. Intake of alcohol was no problem. The day after the surgery, I
visited Dr. Pitanguy at his house, and again I enjoyed drinking a good deal of
alcohol there; however, it did not cause any swelling.

                                           4
                                  Conclusion


As you can see the difference in the preoperative and postoperative views, the
outcome from these rejuvenation procedures was superb. I have rejuvenated myself
by 20 years. Thank you.




                                       5
Rejuvenation of Myself


           Takasu Clinic
 4/04/01   Katsuya Takasu M.D.   1
I find it quite comical that most aesthetic
surgeons look older than their patients.




   4/04/01                                    2
Unless we, aesthetic surgeons
become good examples,
patients are discouraged to visit
our clinics.
               Rejuvenation of
             aesthetic surgeon is
           more urgent a business
           than reconstruction of
 4/04/01     Japan s economy.       3
I made a resolution .

I will rejuvenate
 myself by 20
 years in one
 year.
4/04/01                 4
How do I cook this
55-year-old man?

4/04/01              5
4/04/01   6
Face lift
Liposuction
Chemical Peel
Golden Thread Implants




 4/04/01                 7
History of Face Lift


4/04/01                8
Classic Face Lift by Mario
Gonzales-Ulloa




4/04/01                      9
Incision Line of Mario Gonzales-Ulloa




   4/04/01                              10
Problems must be discussed
thoroughly between a patient and
a doctor.

 4/04/01                           11
4/04/01   12
Should the incision be made
on the vertex, my forehead will
be too broad.

        A broad forehead would
           make me look old.
  4/04/01                        13
Forehead Face Lift

Preservation of Muscles
and Periostea
Simple Excision of Skin
Incision of Skin in Zigzags
4/04/01                  14
My frontal muscles are
  NOT flaccid yet.

 It is nonsense to cause
 damage to good muscles and
 periostea.

 4/04/01                15
4/04/01   16
4/04/01   17
4/04/01   18
Even a superficial
flap anchors down
single hair
transplant!
4/04/01              19
4/04/01   20
Scars are inconspicuous
if hair transplantation is performed
under the incision line.

 The new frontal hairline will
  rejuvenate the whole face.

  4/04/01                         21
The flaccid SOOF is
making my face look older.


The mere excision of the lower eyelid
    skin is not effective enough.

4/04/01                           22
The result is almost the same
whether the skin alone is pulled or
the skin plus       are pulled.



    Pulling SMAS is not only waste of time but
     also meaningless.
4/04/01                                          23
4/04/01   24
4/04/01   25
4/04/01   26
The removal of buccal fat
is necessary to maintain
the maximum effect
of the face lift.



 4/04/01                    27
Drooping buccal fat
promotes the sagging
cheeks.


 4/04/01               28
As the face is rejuvenated,
the man himself is rejuvenated.
I hear that the most effective
rejuvenation procedure is deep peel.
l   When a man pretends to be cheerful and
    healthy, the magic is that the man
    actually becomes cheerful and healthy.
l   In a way, illness is created by the man s
    mentality.


    4/04/01                                     29
Chemical Peel
further rejuvenates
the skin.
  l Phenol   Peel Exoderm



 4/04/01                    30
    Deep peel is said to be as easy
    as sunburn peel.




l   Deep Peel causes
    NO pain or itch.

     4/04/01                      31
          Chemical Peel also creates
          a sharp,thin facial contour.




4/04/01                                  32
Peeling solution is applied on the
Peeling solution is applied on the
face.
face.                  l The great pain
                       l The great pain
                           was never
                           was never
                           expected
                           expected ..
                         l Deep Peel is
                         l Deep Peel is
                           absolutely
                           absolutely
                           painful.
                           painful.




  4/04/01                             33
Tape Mask remains on the
Tape Mask remains on the
face for 16 hours.
face for 16 hours.




 4/04/01               34
Tape Mask is
removed.




 4/04/01       35
Epithelium is attached to the back
of the tape mask.




  4/04/01                       36
Powder Mask is applied to the
Powder Mask is applied to the
face.
face.




 4/04/01                   37
 Powder Mask causes a burning
 sensation.

lI feel the face heavy.
lI feel the face heavy.
lI cannot open the
lI cannot open the
 mouth.
 mouth.
lI cannot open the eyes.
lI cannot open the eyes.
  4/04/01                       38
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4/04/01   40
4/04/01   41
4/04/01   42
Golden Thread Implants



 4/04/01             43
Golden Thread Implants
correct and prevent the facial
sag.
 l The   implants are just like a brassiere
     with shape memory alloys.


 4/04/01                                  44
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l



4/04/01   47