FACE PROCEDURES


BLEPHAROPLASTY (Eyelid surgery)

I have seen some people after they have had their eyes done and have noticed that they have too much of the white part of their eye showing? How do you avoid this?

This may happen as the result of poor lower eyelid tone. Preoperatively, patients are examined for this potential deformity. Sometimes a tightening procedure called a canthopexy or canthoplasty is performed to provide better support to the lower lid. This is performed by suspending the corner of the eye at the latheral canthus to prevent "the white of the eye" or sclera from showing too much.

Should I have a brow lift instead?

Some patients request eyelid surgery, when in fact they are better off having a brow lift first. They often complain about hooding of the upper lids. Commonly, the eyebrows are too low and require elevation. The elevation of the brow that is performed during a brow lift procedure also can treat the hooding of the upper eyelid and may preclude the need for eyelid surgery completely.

I've seen people with very hollow looking eyes after their surgery. How do you prevent it from happening?

It is very important to perform a conservative upper eyelid procedure. The goal is to preserve the soft tissue so that the upper eyelid does not appear "hollow" but yet looks rejuvenated.

I have very puffy lower lids; can you treat them without adding scars to my face?

The puffy lower lids are usually due to pockets of fatty tissue. Sometimes the puffiness may be due to edema, or swelling, like that, which can occur in the lower legs. If it is due to fat then I can perform surgery using an incision on the inside of the lower lid. This eliminates any scar on the outer skin of the lower lid. Pockets of fat can be removed conservatively or redraped over the orbital rim to improve the contour.

What can I do about the fine wrinkles and loose skin of my lower lid?

Often the lower lid skin can be treated conservatively by direct excision. If there are only fine lines these can be treated by chemical peeling or by laser treatment.

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BROW LIFT

I am afraid to get a brow lift because I don't want to get that "surprised look." How do you avoid that?

Brow lift procedures are wonderful procedures to rejuvenate the upper 1/3 of the face. The "startled" or "surprised" look that patients are afraid of has placed a stigma on brow lift procedures. In actuality, a properly performed brow lift avoids this appearance while rejuvenating the forehead by softening vertical furrows between the eyebrows, relaxing the transverse forehead lines, and elevating the eyebrows to a more youthful position.

How do you perform the brow lift?

There are several ways to perform this surgery. I perform an endoscopic brow lift using 3-5 small incisions within the hairline. A small camera and other special instruments are used during this procedure. Sometimes an "open" brow lift is performed. This is a more traditional approach using a longer incision usually within the hairline.

Should I have my eyes "done" instead?

Brow lift and eyelid surgery are two very different operations that treat different things. In fact, sometimes patients have their eyes "done" and too much skin from the upper eyelids is removed. The removal of too much skin can actually pull the eyebrows even lower and give the patient an angrier look! Trying to correct the angry look at this point by performing a brow lift may prevent the eyes from closing properly and therefore the brow lift surgery may not be able to be performed successfully. On the other hand a brow lift can be performed successfully in conjunction with eyelid surgery.

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FACELIFT

How do I avoid that "pulled look" from a facelift?

The "pulled look" is commonly the result of actually pulling on the skin to give the lift and pulling it too tightly. Some surgeons use the skin to "lift" the face in a supero-lateral vector. The skin is pulled tightly to try to elevate the deeper soft tissues and as a result distorts the face. I usually mobilize the deeper layers of the face to obtain the proper contour and then only remove the redundant skin as necessary.

I just want my neck done and don't want the entire face done. Can you do this?

There are a select few individuals that only need "neck work" performed. If this is the case a limited incision can be made along the posterior ear and lobule as well as under the chin to treat this area.

If I have a facelift, do I need to have my eyes and brow surgery as well?

In the analysis of all new patients, I always examine the entire face and discuss treatment options as indicated. The surgery is individualized for each patient and is not necessary in everyone. If the patient could benefit from eye surgery and/or brow surgery, it can be staged at a later time or not done at all. This really depends on the individual patient's desires. Of course, if only the facelift is performed then a youthful lower 2/3 of the face will be out of "sync" with a tired looking upper 1/3 of the face. Nevertheless, the choices are always up to the patient.

I have seen a lot of patients who have had facelifts and they seem to have lost their sideburn and hair by their forehead. I have also seen people's ears that look funny after surgery. How do you avoid this?

One way to avoid the removal of the sideburn and temporal hair is to properly design the incisions for a facelift. In addition, the ear can sometimes be distorted looking like an elf or "pixie" as well. I spend a lot of time designing and properly closing the incisions so that the risk of these deformities is minimized. This also adds a lot of time to the overall surgical procedure, but it is well worth the result!

What kind of facelift do you perform?

The surgery is individualized for each patient, and I try to limit the length of the incision. In many individuals I can perform a limited scar facelift whereas in some I have to use a more traditional incision for more involved procedures.

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OTOPLASTY (Ear Surgery)

My child has prominent ears and wants this corrected. How old does he/she have to be?

The ear usually becomes 85% of its adult size by the time the child is 5 -6 years old. In addition the ear cartilage is usually mature enough to tolerate surgical manipulation at this time.

Where are the incisions for otoplasty placed?

The incisions are either placed in the fold behind the ear or sometimes in the crease along the rim of the ear. Restoration of a natural appearing ear can be performed by bending the cartilage and securing the cartilage with non-absorbable sutures.

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RHINOPLASTY (Nose Job)

How do I avoid getting a "plastic looking nose" if I am going to get a rhinoplasty?

It was very common twenty or thirty years ago for patients to have similar rhinoplasty results typically with an over resected nasal dorsum that left a "scooped out" appearance and an over resected nasal tip which left a "pinched" look. The nose often did not "fit" the face properly and left a very "plastic looking" nose sometimes with breathing difficulties. Today, most surgeons perform a rhinoplasty that will improve the appearance of the nose but just as importantly maintain adequate function.

I want an improvement in the look of my nose but I would like to maintain my ethnicity. Is this possible?

This is a question that is asked often. Most patients want to maintain their ethnic look but often with "softer" features. Some patient's just want a bump on their nose softened or removed, some want a flat nose to be raised, and still others desire slightly narrower noses. A natural result maintaining a patient's ethnic features is all possible by using subtle maneuvers to achieve surgical goals.

Do you have to break the bones?

Many patients who present for rhinoplasty complain that their nose is too big and they want a bump removed. The bones are gently shaven down to soften the bump. In doing so, the normal pyramidal shape of the dorsum of the nose sometimes becomes flat. In order to restore this pyramid shape, the bones have to slide inward from both sides. This is achieved by precisely cutting the bones and realigning them to recreate this pyramid.

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