Expression Lift

Artwork by Dr. BYUN

What is Dr. BYUN’s Famous Expression Lift?

Over the years, many people begin to state that their main concerns are that they look sad, angry, tired, or mean as they age. Most of these people also recognize that they don’t feel the way they look. Chicago’s Top Plastic Surgeon Dr. BYUN is the master of his famous Expression Lift, which matches your outside to your inside. Using his signature Up and In technique with a muscle repair, your features will appear softer and more youthful, taking away any harsh exterior. Let your inner self shine through with the one and only BYUN Difference. Dr. BYUN loves to set his patients on the right path to aging well forever.

Patient 2046

This patient wanted to improve her tired, mean look. After world famous plastic surgeon Dr. BYUN’s Expression Lift, she looks more energetic and youthful. This is all based on a muscle lift with less skin resection.

Let’s dive into this case with more detail. When this patient came in, she expressed how unhappy she was when she noticed she began looking “mean” and “tired.” This can be viewed differently by different patients. This tired look usually stems from deflation of volume, and usually manifests in dark circles or midface volume becoming displaced. A mean look, oftentimes known as “Resting B**** Face” usually becomes more apparent when the corner of the mouth starts dragging south, creating unwanted heaviness in the lower parts of the face. In order to make a tired lower eye appear more energized, a Zone III Midface Muscle Repair with a Lower Blepharoplasty is oftentimes required. A procedure like this can cost $45k (Midface, Zone III $30k with a Lower Blepharoplasty $15k). To lighten a mean appearance, the drooping corner of the mouth, which is dictated by the complex facial expression muscles (which include the depressor muscles around the mouth, along with the masseter muscle) to be repositioned back to its original location. Such emphasis on this particular Zone (Zone II) is almost unheard of, or repaired by most other surgeons. Dr. BYUN developed his very own telescope technique, which folds the decided muscle groups back in without stretching them in an unnatural way. This is truly the BYUN Difference. This particular patient also had heavy upper eyelids, a downcurved brow, and a “chubby” upper eyelid fat pocket. All of these issues improved by having Dr. BYUN work on Zone IV, making the eye area appear more foxy and open.

If you are younger than the patient above, or have less damaged tissues, then you can benefit from a smaller section being touched, where the cost can be reduced. Dr. BYUN always says, the efficacy of his repair will last forever, because he changes the aging trajectory to be more positive, forever. He emphasizes the younger you are, you heal faster, and his repair will last longer. Most younger patients opt to start with the Zone that bothers them the most, and will repair more as needed, as they age.

Patients often choose to add upper eye, brow, and the neck area since the recovery time for additional procedures are about the same as the face muscle repair. Some patients also opt to add another Zone to their expression lift.

Dr. BYUN focuses on 4 areas of the face (4 Zones):

Zone I – Neck & Lower Face: (Best for someone with a “turkey neck” – the Platysma Muscle from the Neck to the Face)

Zone II – The Mouth Area, Chin and Jaw: (Best for someone with a Marionette Line, or a sad/mean look)

Zone III – Midface, Lower Eye & Cheek: (Best for someone with a tired look or dark circles, a heavy smile line(s) called Nasolabial Fold)

Zone IV – Upper face, Forehead, Upper Eyes & Brows: (Someone with heavy lids, sad eye shape, hooded brow or forehead lines)


Expression Lift FAQs

FAQs

WILL I BE IN PAIN?

You will not feel anything during the procedure, since anesthesia will be used. However, after the anesthesia wears off, you will feel some pain and discomfort. It is highly recommended that you start off taking Extra Strength Tylenol, every six (6) to eight (8) hours, alternating with Motrin. Please DO NOT MIX pain relief medications together at the same time. If you are experiencing a higher level of pain, please take the prescribed pain medication (Norco, or other prescribed pain medication).

HOW LONG DOES THE RECOVERY TAKE? WHEN CAN I GO BACK TO WORK & EXERCISE?

Depending on both the surgery and your own physiology (your body’s healing). During the first fourteen (14) days, we ask that you do not do any activity that increases your heart rate. This is to help the healing process, since the blood clot that has stopped the bleeding from the surgery dissolves in about ten (10) days. After fourteen (14) days, increase activity by ten percent (10%) each week as tolerated. Stop activity if you see a dramatic increase in swelling when you wake up the following day. At the one (1) week post-op visit you will be provided with healing instructions and what specific activities are allowed. Patients can usually return to work after one to two (1-2) weeks.

WHAT TO DO IF I BECOME CONSTIPATED?

Reduce Norco usage, walk around, and take an over-the-counter medication like Colace or MiraLAX. It is recommended that you start using an over-the-counter stool softening medication one (1) day before surgery and continue taking it until you no longer need to be taking Norco for pain.

WHAT DOES THE HEALING PROCESS LOOK LIKE?

Bruising, Swelling, and Stitches (which can pucker) are all NORMAL. Tissue firmness is NORMAL. Your body may not heal symmetrically, meaning one side may take longer to heal than the other,  this is NORMAL.  Any previous asymmetry may remain.

WHY ARE MY RESULTS UNEVEN?

Post-op asymmetry is NORMAL. Pre-existing asymmetry will continue since the human anatomy of left vs. right does not always match. Human tissue is naturally asymmetric. This applies to Breasts, Face, Eyes, and even the Nose.

WHY IS MY SWELLING LASTING LONGER ON ONE SIDE?

This is very common. The function of your Lymphatic System (which acts as a highway of Arteries, Veins, and Lymphatic Channels) is to filter out fluid from particular areas of the body. Lymph Nodes, Bone Structure & Tissue Shape are different from right to left, so when it comes to draining, the “clearance rate” of the swelling is also entirely different on each side. The heart is located on the left side of the body and distributes blood throughout the body using different paths & pressures. The drainage of the heart is not completely linear; thus another reason why Lymphatic Clearance is different on each side.

HOW SOON CAN I TAKE A SHOWER?

We recommend waiting forty-eight (48) hours to shower. Make sure you are steady on your feet. Do not soak the incisions and pat them dry when done.

CAN I GET MY SUTURES WET?

After forty-eight (48) hours, stitches can get wet. It is highly recommended, however, that only normal saline (over-the-counter medical cleaning solution) is used to clean the stitches. DO NOT use any cleansers or alcohol products on the suture site. Picking or pulling at the sutures is not approved and can cause damage. Pat dry the sutures if need be.

HOW OFTEN CAN I APPLY HEAT AND COLD PACKS?

Hot packs are NOT recommended due to a side effect of increased inflammation which can further delay the healing process. However, cold packs are recommended with frequent usage in fifteen (15) minute intervals.

HOW SOON CAN I GET ON A PLANE?

Every case is unique. Typically, short distances (short domestic flights) are okay. However, we recommend that you wait until you see Dr. BYUN’s team at the one (1) week follow-up appointment for final approval. Please keep in mind that extra swelling can occur due to pressure changes in the plane.

HOW LONG WILL IT TAKE FOR MY TISSUES TO HEAL SO THAT I CAN GO OUTSIDE/ LOOK PRESENTABLE?

There are many factors that determine the progression of the healing process, for these reasons, we cannot determine exactly how long it will take to heal. We do our best to follow your healing progression. During each follow up visit, we observe how your tissues are healing and we make the proper care adjustments if needed. Feeling comfortable and confident to go outside, and look presentable again, reflects both your personality and the healing ability of your tissues. Some individuals are proud to go out after just three (3) weeks, while others may still feel extremely shy to be seen out in public so soon. Much of the swelling will be resolved at the three (3) month mark. Most patients settle into their new look after six (6) months, but FULL healing can take one (1) year.

WHY ARE MY EYES SWOLLEN SHUT?

After surgery your body’s natural response is to swell. This is NORMAL and will subside within 1 – 2 weeks. This will be monitored, as you are assessed at your follow-up appointments.

WHY IS THE WHITE PART OF MY EYE RED?

Whether just 1 eye, or both eyes are experiencing redness, this is NORMAL. This is a small blood spot and is harmless. This is a very common side effect and will subside within a few weeks. This will be monitored, as you are assessed at your follow-up appointments.

WHY DO MY EYES TEAR ALL THE TIME?

Similarly, to eyes having difficulty closing all the way, eyes can also start to tear in an attempt to lubricate the eye. When this occurs, apply artificial drops and perform the eye exercises given to you at the 1 week post-op visit.

WHY CAN’T I CLOSE MY EYES ALL THE WAY?

This is very common with eyelid procedures, especially lower eye surgery. It is important not to force your eyes shut or wide open, as this will cause the sutures to potentially break. Blinking becomes weak after surgery; this is NOT caused by any nerve damage. Lubrication of the eye, normally performed by squinting, becomes less effective after surgery due to the suture presence & swelling in the area. This will normalize once the eyes are done healing.

A HELPFUL TIP: You should apply artificial tears during the day and perform simple eye exercises, as provided by staff during follow-up appointments.

WHY IS IT PAINFUL TO CHEW FOOD?

Dr. BYUN uses a special technique that involves muscle repair in which everything is done internally. Because of this, the muscles will have a harder time working while they’re healing (i.e. chewing & talking). This is only temporary as muscles usually repair within 1 week. We recommend a liquid diet right after surgery, advancing to a soft diet until the muscles are healed.

A HELPFUL TIP:  Have protein shakes & soups ready before surgery.

WHAT SHOULD I EAT IF IT HURTS TO CHEW?

Nourishment, especially protein, is needed for the healing process. Protein and meal replacement drinks (such as Ensure and Premier) are highly recommended. However, DO NOT use a straw, instead, use a finger to lift the top lip, and then drink normally to help maintain the surgical work.

WHY IS MY SCALP ITCHY?

This is common after face surgeries and it happens because new nerves are making new connections and healing after the procedure. The Supraorbital Nerve is located from your eyebrows and reaches all the way up through your forehead and onto your scalp. When this nerve is stimulated during surgery it can create a lingering itch. This will go away as you heal but may last up to 2 – 3 months. If this becomes too bothersome, we can help manage the itching at future follow-up appointments.

WHY DO I FEEL A NUMB SENSATION ON TOP OF MY HEAD? HOW LONG WILL THIS LAST?

The sensation of feeling numb on your head is due to the branches of the Supraorbital Nerve. The nerve runs along your eyebrow upwards and branches out onto your forehead. This nerve is responsible for sensation to your scalp, forehead and eyebrow. Think of it as a tree – the trunk of the tree is the nerve and the branches & leaves are the branches of the nerve. The trunk is never harmed but the leaves can fall off and then they regrow. Right now, your “leaves” are growing back and once they grow in, you should regain sensation back onto your head. This is only a temporary feeling and is NORMAL.

WHEN CAN I GET DENTAL WORK?

Since you’re still recovering from the surgery, we suggest you hold off all dental work, unless it is urgent or an emergency. Dental offices often manipulate the mouth to stretch wide for their procedures, which can alter and damage the surgical work.

HOW SOON CAN I USE MAKEUP TO COVER SCARS?

After 1 full week, all incisions should be closed. Once the incisions are closed, risk of infection or sensitivity to makeup will be minimized, if makeup is used. Makeup usage will need to be approved. This can be brought up at your one (1) week postoperative visit.

I AM INTERESTED IN MICROBLADING / TATTOOING MY EYEBROWS, WHEN CAN I DO SO?

It takes 1 full year for the face to recover from surgery. Due to residual swelling and sensitivity from the surgery, we suggest waiting 1 full year before microblading (tattooing) the eyebrows.

WHEN CAN I WAX MY FACE?

Waxing requires tugging and pulling of the skin to remove hair, with a common side effect of inflammation, therefore, waxing should not be performed for at least 6 months after surgery. Facial waxing will need to be approved by MD. Any waxing that occurs before the 6-month mark can alter the surgery results.

IS THERE MAINTENANCE REQUIRED AFTER SURGERY?

Yes. Whatever face wrinkles you had prior to the surgery will not fully disappear. This is mostly based on genetics, the environment, and the natural aging process. As swelling decreases, some wrinkles will reappear. Once you’re a client of Dr. BYUN, he will carry you through each step of the rejuvenation process, continuing to see you, observing results, and providing maintenance procedures as needed. Maintenance will help you maintain surgical results and prolong its longevity. These treatments may include Botox, PRP Injections, PRP Treatments, and secondary skin tightening. We also have a highly trained Aesthetician, who, under the supervision of Dr. BYUN works to help your skin look its best. Our Aesthetician tailors services to fit your needs after surgery, and to ensure the best results for the longest duration. You will age more gracefully than you did before.


BYUN Recovery & Postoperative Instructions for an Expression Lift

IMPORTANT: If you have the urge to vomit, sneeze, or cough let it out!

IMPORTANT: If you’re continuously vomiting, call the office.

IMPORTANT: If surgery is more than 5 hours, the Anesthesia Care Team may insert a catheter to monitor your body fluid during surgery. The catheter is removed at the end of surgery; discomfort is normal and present for 24 hours.

IMPORTANT: Sore throat feeling from the Endotracheal Tube placed by the Anesthesiologist resolves within 1 – 2 days; using ice chips or hot tea will help to soothe sore throat.


Immediately After Surgery

Start stool softener as directed: Colace, Miralax, or fiber supplements.

Start antibiotics (take with food).

Consume 1 protein drink per day.

ICE – Apply ice around the surgical area (please refer to the instructions below).

 Start pain management (see pain management options below).

Complete the above steps until your 1 week follow up appointment.


Aches & Pains

BLEEDING within the first 24 – 48 hours is normal.

Muscle repair of the face will cause muscle pain as you heal – most intense during the first few nights.

It will feel like a muscle ache, or toothache along the cheekbone and jaw areas (it’s not a bone pain – it is muscle).

Aches and pains will lessen as time passes and much of this muscle ache will go away within 1 week.


Pain Management Options

Start with Tylenol Extra-Strength & Motrin (1 – 2 tablets / capsules, alternating every 6 – 8 hours).

For Intolerable Pain: Norco, or other prescribed pain medication (take with food and as directed).

DO NOT drive and DO NOT mix Norco with Tylenol and Motrin (alternating okay).

If taking Norco, take with stool softener, as Norco can slow down digestion.


Monitor Swelling

ICE every hour for 20 minutes (while you are awake).

The first 3 days are the worst; majority of swelling subsides within 2 – 3 weeks.

Elevate head above heart level (prop head and back up on 2 – 3 pillows, continue this for 2 weeks).

Start foot exercises (foot pumping) – 10 times every hour (this helps to prevent blood clots).

Start breathing exercises (see steps below):

  1. Begin by taking a deep breath in (hold for 10 seconds) then exhale
  2. Repeat for a total of 10 times every hour
  3. Do these exercises for the first 5 days

Perform these foot and breathing exercises at your own pace. Foot and breathing exercises help to prevent lung collapse and pneumonia from anesthesia.


Dressing & Bandage Wraps

Immediately after surgery you will have a bulky dressing consisting of:

  1. Tape directly on your skin
  2. Gauze pads
  3. Gauze wrap
  4. ACE wrap

DO NOT REMOVE THE TAPE directly on your skin.

DO NOT remove bandages and/or dressings until after 48 hours, unless instructed by the doctor. You can expect the dressing/tape to be removed and replaced at your 48hr postoperative follow up appointment.

IMPORTANT – if you become uncomfortable and feel that the wrap is too tight, or that the wrap is

cutting off your circulation, it is okay to loosen the wrap or cut a small slit in the wrap to alleviate the tightness/pressure.


Cleaning Wounds

 It is ok to gently clean wounds with saline 1 – 2 times a day after your initial 48hr postop appointment.

 After cleaning wounds, pat dry with a clean gauze and apply antibiotic ointment.

More detailed wound care instructions will be discussed at your 24 phone follow up, or 48 hour in-person or virtual visit; as wound instructions may vary per patient.

PLEASE NOTE – if your 48 hr postop appointment is a virtual visit, please follow instructions provided by Dr. BYUN and the BYUN Recovery Team.


For Showering

We recommend waiting 48 hours to shower.

IMPORTANT – anything that is applied directly to the skin must remain on (even in the shower).

BE VERY CAREFUL when you shower.

IMPORTANT – try not to saturate the incision site(s) or sutures with water.

It is okay for water to splash the area, but please avoid soaking or submerging the incisions.

A sponge bath is recommended if you cannot avoid getting these areas soaked.

When you wash your hair, baby shampoo works best (it doesn’t sting).

After showering, brush your hair with EXTREME CAUTION as to not tug or pull on any sutures near the hairline; (even brushing the hair far away from the scalp can cause some tugging).


For Sleeping

Expect discomfort for the first few nights.

Protect your bed sheets/pillows with old towels or blankets as fluid/blood may be dripping from the incision areas within the first 24 – 48 hours after surgery – don’t worry, this is completely normal.

AVOID laying on one side of your body:

  1. This can cause an increase in swelling to that side of the body.
  2. This can worsen asymmetrical appearances and delay the healing process.

For at least 2 weeks, sleep using 2 – 3 pillows to elevate your head, neck, and shoulders.

It is ok to reposition yourself by slowly turning left and right, as long as you feel comfortable in doing so.

Should you have difficulty sleeping, Tylenol PM is the recommended sleep aid (as long as you are not taking the prescribed pain medication, such as Norco). Please DO NOT mix the medications.

If sleeping problems continue, please call our office to discuss with the BYUN Recovery Team.


Face Procedures – Information 1 – 2 Weeks Post Op

FACE TAPING – IMPORTANT

IMPORTANT – you MUST wear postoperative face tape as instructed by Dr. BYUN and the BYUN

Recovery Team

IMPORTANT – the purpose of postoperative face taping is to insure that the repositioned facial muscles create and maintain MUSCLE MEMORY; supporting muscle position and muscle integrity as you continue to heal.

Taping will be done for the first 2 – 3 weeks and will continue for 2 – 3 months (will vary per patient).

More detailed taping instructions will be discussed at and throughout your follow up appointments.

Taping acts as a “retainer” for the face muscles, which will help the muscles to heal in their intended position.

Taping will remind you to avoid using the cheek muscles, avoid smiling, and to avoid hard chewing.

Taping instructions will vary per patient.

REMOVAL OF TAPE

Tape can stay on for a few days if it is still holding.

Tape Removal:

  1. Remove tape in an upward direction.
  2. Start from the bottom of the tape.
  3. Move tape slowly upward.
  4. Remember to gently hold the skin as you remove the tape.

If the tape becomes itchy or is coming off, remove it for a few hours, then reapply new tape.

If the tape is too tight, it is okay to cut the tape to loosen it, allowing yourself relief from the pressure / tightness.


Ace Wrapping, Removal of Ace Bandage, and Further Instructions

IMPORTANT – you MUST wear the ACE wrap as instructed by the Dr. BYUN and the BYUN Recovery Team.

ACE wrapping should be done IN ADDITION to face taping (see face taping instructions in the next section).

Instructions on how long you will need to wear the ACE bandage will be discussed throughout your appointments.

ACE wrapping instructions may vary per patient based on procedure type.

ACE wrapping works like face taping by acting as a “retainer” for the face – creating muscle memory.

IMPORTANT – please review the ACE WRAP INSTRUCTIONS below for a step-by-step guide on how to properly wrap your head and face using the ACE bandage.

Ace Wrap Instructions

Step 1

  • Measure the ACE wrap, making sure it is long enough to circle from the chin to the top of the head.
  • Then cut the ACE wrap to the length of 22 inches – 24 inches.
  •  Adjust the length to your specific face/head     measurements.

Step 2

  • Capture the chin in the middle of the ACE wrap and pull both wings of the wrap upwards towards the top of the head.
  • Make sure to capture the cheek with the wrap as well; this will help to keep the muscle repair in place.
  • Apply a gentle, yet firm compression to the wrapped areas when completing the wrap around.

Step 3

  • Attach the wrap to itself on the top of your head using the velcro.
  • Make sure that the wrap is placed in the middle of your scalp.
  • The wrap should not be too tight that it is uncomfortable, but should feel snug and secure.
  • IT IS IMPORTANT that you DO NOT create a dent under the chin when applying the wrap.
  • The wrap should be applied with enough tension to support the tissue under the chin so that it is in a flat position.

What to Avoid After Surgery

IMPORTANT – Dr. BYUN and the BYUN Recovery Team will advise you on when you may resume activities.

IMPORTANT – activity can increase your heart rate which disrupts the healing process.

IMPORTANT – do what feels comfortable – if it hurts, STOP!

AVOID activity that will increase your heart rate.

AVOID bending over, strenuous activity, and/or lifting heavy objects for at least 4 – 6 weeks.

DO NOT EXERCISE – you can return to exercising and regular activity after week 3 or 4 (given MD clearance).

Once cleared by the BYUN Recovery Team, you can increase activity by 10% every week (as tolerated).

AVOID moving your facial muscles – less talking and smiling, rest the face muscles.

AVOID facial animation and minimize facial movements.

AVOID using the upper lip when talking and eating.

IMPORTANT – hold the upper lip with your finger when you eat or speak.

VERY IMPORTANTDO NOT massage the surgical site (this can ruin the repair work from surgery).

DO NOT make “O” or “TOO” sounds with the mouth.

AVOID using a straw (if you must – prop up the straw out of one corner of the mouth, and gently sip).

AVOID fully closing your mouth (keep lips slightly open by relaxing oral muscles, pressing tongue on the pallet).

DO NOT open your mouth wide when brushing teeth (go slow, slightly open mouth, and use a small toothbrush).

AVOID hard chewing (hard chewing will put too much strain on the cheek muscles).

DO NOT refrain from yawning or sneezing (let it out – as to not strain the repaired muscles from surgery).

DO NOT squint.

AVOID rubbing your eyes.

AVOID touching the swollen areas as much as possible until your follow up appointment.

DO NOT force your eyes to open all the way; only open your eyes as much as they can open naturally

during the healing process. Forcing your eyes open can cause the internal stitch to rip and lead to improper healing.

AVOID wearing contact lenses for at least 1 week – further instructions regarding contact lenses will be provided at your follow up appointments.

AVOID wearing clothing that needs to be pulled over the head.

NO CHEMICALS to scalp for at least 6 weeks after surgery (this includes hair dye and perm products).

NO MAKEUP for 1 week.

NO EARRINGS for 1 month.


Normal Side Effects

BRUISING can appear away from the incision, this is NORMAL – bruising will change colors as it heals.

PUCKERING after surgery is NORMAL and a great sign – this shows that your muscles are adhering to the tissues.

DO NOT massage the puckered areas – they will go away with time.

SENSATION, NUMBNESS, and TINGLING is NORMAL

New nerves awaken and grow after muscle repair; it may take up to 6 – 12 months for normal sensations to return.


Things to Remember

KEEP A POSITIVE MINDSET do not complain; we are here to help and support you throughout this process!

REPORT YOUR SYMPTOMS – report any major issues/concerns, however, please do not overanalyze your healing.

REMEMBER -natural changes will occur throughout the healing process; this is normal!

MENTALLY PREPARE YOURSELF yes, you will look bad for the first few months until healing is complete.

ACCEPTANCE – you must accept the fact that you’ve had surgery done.

TAKE TIME TO HEALplease be patient and kind to yourself while healing; take the necessary time to recover.


Be Kind to Yourself and Trust the Healing Process

BE PATIENT – the healing process takes months.

BE KIND TO YOURSELF – please avoid criticizing yourself and Dr. BYUN’s work.

AVOID social media, google research related to plastic surgery; do not spend too much time in front of the mirror.

THE “ALIEN LOOK” may last for between 4 – 8 weeks (depending on how your body heals).

REMEMBER – each patient is different; please do not compare!

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From Luxury Aesthetics to Reconstructive Muscle Repair, Dr. BYUN and staff are ready to craft the most beautiful you.

Dr. Michael Byun

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