Rhinoplasty:

Perhaps the most difficult cosmetic operation to master. However, the changes that come about as a result of a cosmetic rhinoplasty can be dramatic. More subtle changes can also be made so that the nose does not appear to have been altered. Most common complaint is the "hump" and this problem can easily be solved. Another common nasal problem is the "tip" where it may be too wide or bulbous in appearance. This too, can be solved through a rhinoplasty. There are many other segments of the nose that can be reshaped. The important point in this procedure is that the patient and the surgeon, before the operation, agree on the changes planned. Most of the changes can be done through hidden incisions and if an external incision is required, it will only be visible during the first few months of healing.

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Blepharoplasty:

Almost immediate improvement can be realized through this operation. With aging, the upper lid skin becomes lax and redundant. With careful analysis and planning, the excess skin, underlying muscle, and sometimes fat, can be removed to restore the youthful appearance. As a result of this operation, the patient will see a dramatic smoothing of the upper lid crease and the feel of "brighter eyes." This operation is not debilitating and recuperation is very short. This can be done under local anesthesia and sedation (no need for general anesthesia). Many can tolerate this operation very easily.

The lower lid aging process produces more challenging changes. Not only is the skin lax and have lost its elasticity, the muscle underneath has undergone similar changes. Additionally, the aging process has caused the fat underneath the eyeball to bulge outwardly causing a swelling under the eye. The combination of the upper lids being redundant and the lower lid looseness and bulging presents a very "tired" appearing eyes. All of these changes of aging has to be considered in planning the operation on the lower lids.

Because of the delicate location of the lids, these operations should be done by specialists who have been specifically trained and with much experience. Facial Plastic Surgeons have had advanced fellowship training and are qualified to perform blepharoplasties.

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The aging process causes downward movement of all structures of the face and the forehead and the brows are no exception. In addition to the "frown" type of facial picture, the downward drift of the brows and the forehead in general causes the upper lids to be even more redundant. Facial Plastic Surgeons are trained to include the forehead and brow position in relationship to the eyes when evaluating the face for cosmetic surgery. Performing upper and lower lid lifts will improve the facial appearance, but full benefit of rejuvenation of the upper part of the face is not complete if the brows are lower than normal. There are several approaches to lifting the brows/forehead. It can be done at the brow level; in one of the wrinkle lines on the forehead; at the hairline; up in the scalp; and finally can be done using endoscopic technology with mini incisions.

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Numerous children and adults alike have ears that stick straight out from the side of the head. This is a congenital condition that can be easily corrected. The problem with these ears is that the ears have not completed all the folding and grooving during development. This operation is designed to complete this natural process and present a normal appearing ear which are properly positioned on the side of the head. The recuperation is very easy with minimal discomfort.

Some ears will require additional sophisticated techniques to produce a normal appearing ear. These cases have to be individualized and if severe enough, may require grafting and staging of the procedures. Reconstruction of malformed ear is complicated and frequently requires more than one procedure to accomplish the desired result.

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Aging causes the skin and the underlying structures to drift toward the ground. Gravity exaggerates this process. If we can walk around on our hands, changes brought about by aging can be reversed without surgery. The problem is the loose extra skin and the underlying tissue which causes "jowls" (bunching of tissue along the jaw bone just behind the corners of the mouth) and the "wattle" (bunching of the tissue under the chin and into the neck). There are several other areas of looseness and excess. There may be excess fat in the face and the neck areas. The facelift surgically detaches some of the facial skin allowing access to the underlying tissue which can be tightened and held in more favorable position. The excess fat can be removed while the skin is detached. The unwanted skin of the face can then be trimmed. The incision lines are then closed carefully so that the resultant incision scar will be as camouflaged as possible.

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Most people need a little stronger chin to complement the facial profile. Stronger chin makes the nose look relatively smaller and gives the lower third of the face a better balance. In most cases, the additional chin can be achieved with an implant that has been time-tested. If a larger amount of chin augmentation is necessary, the chin bone itself can be moved forward. In some individuals, reduction of the larger than needed chin can be done by removing some of the chin. The amount of reduction or augmentation must be in proportion to the rest of the face, both in profile and in frontal projections. The facial cosmetic surgeon must be experienced in this analysis to provide accurate and artistic guidance to the patient. The position of the chin should always be included in the analysis of the nose.

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This is a nice addition to facial cosmetic reconstruction. Many people will have some additional deposits of fat in the face and/or in the neck area that can be judiciously removed via the liposuction apparatus. Liposuction of the neck area, especially the area under the chin is especially useful to bring back the angle under the chin and neck. This procedure can be done independently or in conjunction with other procedures. Some fat deposits are easily accessed and others are difficult to reach and the procedure can be performed under local or general anesthesia.

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Dermabrasion is a process where the necessary layer/s of skin is removed by friction. Surgeons utilize various types of wheels (diamond or wire bristle) to sand away the appropriate skin layer. This process, like the deeper peels, is painful and requires anesthesia. Unlike the peels, dermabrasion is ideally suited for coping with the acne scarring and other deeper irregularities. This process also allows the experienced surgeon to better define the depth of sanding.

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Like dermabrasion, laser resurfacing aims to remove the upper layer/s of skin. There are several types of lasers available for this purpose. Most surgeons use carbon dioxide unit with a computer pattern generator. This type of CO2 laser allows a very uniform depth of penetration of the laser beam to vaporize the layer of skin. Anesthesia is necessary to block the discomfort. Just like dermabrasion, laser resurfacing requires a couple of weeks of healing (all the crusting has fallen off) and couple of months of redness before looking entirely natural. Another laser, erbium-YAG laser allows the operator to take only the most superficial layer of skin. This ability makes this laser much safer in terms of preventing too deep of a removal. Additionally, it requires less anesthesia. The particular technique used to achieve the same result, refreshed and smoother looking skin on the face, depends on the wishes of the patient and the recommendations of the surgeon.

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Facial Skin Cancers are more common in the Caucasian individuals who have had much sun exposure. These cancers are easily recognizable to the trained eye. Any lesion that does not go away in several weeks or that was present previously, but has recently changed should be examined and if necessary, biopsied. Biopsies can be done in the office setting with very little discomfort. In most cases, if the lesion is a cancer, it can be removed (excised) and reconstructed in an office operating room under local anesthesia. Reconstruction of facial wounds from excision of facial skin cancers can be very challenging due to the closeness of all important structures. The final result depends upon the extent of excision necessary and the method utilized to reconstruct the defect and training and experience specifically in facial reconstructive surgery is critical.

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