Frequently Asked Questions
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Rhinoplasty or nose job to improve the widened nose is commonly performed. Additional images would help, however, based on your frontal view, it appears you have an ill-defined nasal tip which would benefit from refinement. In addition, dorsal augmentation or building up the bridge of your nose using septal cartilage or ear cartilage would provide a more aesthetic appearance. Seek a rhinoplasty expert for full consultation.
The Asian nose has certain classic characteristics that need to be understood when pursuing rhinoplasty. Most Asian noses have thicker skin, a low dorsum or bridge, are underprojected (do not stick out far enough from the face), and have a wide nasal base. It is important for you as the patient to recognize the changes you desire. Some rhinoplasty patients want to retain their ethnic nasal appearance or certain features of it. Others want a more Caucasian appearance to their nose. Seek an experienced ethnic rhinoplasty surgeon for full evaluation.
Botox can be used for injection to the masseter muscle, a large muscle that closes the jaw. Some patients may have masseter hypertrophy, or an enlarged muscle which makes the jaw look wide and widens the face. Botox will weaken this muscle and make it somewhat smaller. This may help the appearance of the jaw region. There are other muscles used for closing the jaw so botox injection to the masseter should not effect chewing significantly.
Botox can be used to inject the depressor anguli oris muscle which pulls the corners of the mouth down. Botox injection would temporarily weaken this muscle and cause the corners of the mouth to come up. This should be performed by a skilled professional as injection in the wrong area can lead to a crooked smile.
Typically, most women want their eyebrows elevated, but Botox can bring the eyebrows down as well. Depending on the location of injection and amount of units injected, you can alter the position of the eyebrow. It may however give you a heavy feeling to your forehead and brows. Hope that helps.
Botox is measured in units. You should always ask how many units have been injected into which areas. CC or cubic centimeter is a measure of volume which is equal to one milliliter. Botox should not be measured in cc's as there could be a different amount of units per cc depending on how the physician mixed it. It is also important to ask when your Botox was mixed or reconstituted as there is an amount of time after reconstitution where the Botox will no longer be as effective.
Every patient will age differently and develop wrinkles in certain areas at various times of their life. This is dependent on genetics, ethnicity, expressiveness, and environmental factors such as sun exposure and smoking. Botox is used more and more often in patients in their 20's for dynamic wrinkles or wrinkles in motion. It works extremely well as an injectable medication that will help prevent future signs of aging. Identical twin studies have demonstrated this well. Botox has been used for decades in children with spasticity without significant side effects. Botox or Dysport work extremely well around the eyes at low dosages. Hope that helps.
Revising a browlift scar can be difficult but not impossible. Your scars appearance can be improved with a scar revision using the trichophytic approach allowing the root hairs to grow through the scar itself.
Some people may have had low brows most of their lives and desire correction. A browlift should not make your forehead wider but can make it longer depending on the type of lift. If your brows are uneven, you may consider a chemical browlift with Botox or Dysport to provide more symmetry. An upper eyelid lift (blepharoplasty) can help with droopy eyelids or excess skin to the upper eyelids. See a specialist for a proper evaluation.
Eyelid surgery and a browlift are typically performed at the same time to avoid a second recovery and second anesthetic. Typically, in the operating room, the browlift should be the first procedure, followed by the upper blepharoplasty. This way, overresection of eyelid skin does not occur and tension is not placed on the eyelid incision after the browlift. Seek an experienced aesthetic surgeon for best results.
There are different types of browlifts depending on the location of the incisions. All brow lifts can raise a certain portion of the brow in a particular vector. A thorough evaluation by your surgeon is essential to decide which browlift is best for you.
Botox injection can be used for a "chemical browlift". Temporarily paralyzing certain muscles of the forehead can lead to the elevation of the brows in the right areas. Some physicans will inject Botox just before a browlift to weaken the muscles causing wrinkles in the forehead. I do not. Botox will last up to 4 months so this should be sufficient time after your last injection to evaluate the natural resting position of your brows currently. Open browlifts allow the surgeon to cut the muscles causing frown lines and forehead wrinkles leading to a better result. Endoscopic browlifts can weaken the muscle, but do not result in as impressive a result as the open approach in regards to wrinkles.
Cheek augmentation using fillers such as Juvederm, Perlane, or Radiesse can improve the aesthetics of one's face significantly. They provide volume in an area that has become deflated with age, or has always appeared flat. They can give the impression of higher cheek bones or truly complement and enhance a facelift. The injection is done in the office under local anesthesia and is an advanced injection so should be performed by someone familiar with the anatomy. I like to perform the injection deep so as not to have any irregularities at the skin level. There is minimal to no pain and my patients are social and can return to normal activities that same evening. Hope that helps.
The sizes of cheek or malar implants vary depending on the type of implant. Most surgeons use Terino or Binder implants. See an experienced surgeon to determine which implant and size is right for you.
Cheek augmentation can be achieved surgically with silastic implants or through injections in the office. Although this can provide fuller, younger appearing cheeks and give the appearance of a "high cheek bone", it does not enhance or improve jowling. Prejowl implants, injections, or a facelift may assist with your jowling issues.
Cheek implants can improve the appearance of bulging eyes. If the area below the eyes over the cheek is extremely flat or depressed, cheek implants combined with a lower blepharoplasty vs a lower blephraoplasty alone can give an enhanced aesthetic appearance. Lower blepharoplasty alone may lead to a hollowed out appearance to your lower lid region if the cheek is not addressed.
Permanent cheek implants for cheek augmentation are an excellent procedure for patients with deficient bony architecture in this area. These implants are inserted surgically through an incision under the upper lip and are secured to the underlying cheek bone. Cheek implants or malar implants are made of silastic which can be surgically repositioned, replaced, or removed if necessary. Minimal risks involved are malposition, assymetry, and infection.
Another option may be microfat injection into the cheek area. Fat can be more unpredictable than fillers in terms of absorption and duration, but typically lasts longer than filler injection. This is also performed surgically in the operating room.
Whether to have a chin implant versus a jaw advancement is based on patient preference, physician comfort with the procedure, degree of chin disproportion, and recovery time. The jaw advancement is a more involved procedure whose recovery is a little longer than with an implant. There is a slightly higher incidence of lower lip and jaw numbness after the advancement than the implant. An implant on the other hand, can only provide so much augmentation before becoming noticeable and un-natural.
Chin implants come in different shapes, sizes and types. Which implant is used is dependent on the amount of augmentation needed and the location of where the augmentation is needed along the jawline. The more commonly used implants are made by Implantech. You can go to their website to assess sizes and types.
A small chin implant would improve your profile. Otherwise, rhinoplasty would enhance your appearance on frontal view refining the nasal tip moderately.
It is important to provide and maintain harmony of the face on profile between the chin, cheeks, and nose. This can be established with a chin implant and rhinoplasty.
If there was a significant change in the appearance of your chin after the restylane injection, it would be best to wait until things have settled down to there pre injection state and ten pursue chin implant. Otherwise, you may have too small of an implant placed. Another option would be to inject hyaluronidase (enzyme to dissolve the restylane) into the area before the chin implant.
After placement of a chin implant, animal studies have demonstrated minor bony erosion. However, other studies looking at the bone radiographically in humans contest this. Nevertheless, a study by Binder showed that the aesthetic consequences of minor bony erosion after chin implantation are trivial and should not effect the overall result.
I've heard that supposedly Dysport (Reloxin) is better than Botox because the Dysport lasts longer. Has anyone else heard this? Does the Dysport being used outside the U.S. right now usually last longer than Botox?
Dysport, the new Botox alternative, has been out on the market now for close to two years and is gaining attention. Depending the dosage relative to Botox, Dysport should last just as long as Botox (3-4 months). Some of my patients have noticed the onset of action for Dysport is shorter (1-2 days) compared to Botox (3-4 days). Both work extremely well, are FDA approved, and when injected appropriately, provide wonderful results.
Dysport does contain cow's milk protein and those with an allergy to this substance should not receive Dysport injection. Botox injection is safe for those patients with cow's milk protein allergy.
A split earlobe can be easily repaired in the office under local anesthesia. If it is an old tear, the edges of the split are freshened and sewn back together. Typically, the earlobe can be repierced at 6-8 weeks after repair.
Repiercing of earlobes after they have closed should not be a problem. If the original piercing was elongated or torn and then healed, the new piercing should be placed away from the scar if possible.
Otoplasty, or ear pinning, can be done on patients who have assymetric ears as well. Your deformity (depending on its severity and complexity) would likely be addressed during the otoplasty procedure. See an experienced otoplasty surgeon for a full evaluation.
It is typically advisable to perform otoplasty on both protruding ears despite there being an assymetry between them. Overcorrection of the ears is typically performed (especially in adults) as it is expected to lose some of the correction due to sutures loosening or cartilage bending back to its old position. If only one ear is operated on, than the other ear may appear to be protruding in the future. Seek a surgeon who is experienced in otoplasty for a good evaluation.
As we continue to age, the fat in our lower lids will continue to become more prominent creating the appearance of "bags" under our eyes and causing a depression, hollow, or shaded area below them. This can give the appearance of tired eyes despite getting adequate sleep.
One option which is minimally invasive, is to inject Restylane, a facial filler just under this fat and efface this hollow between the eyelid fat and the cheek to give a smoother transition. Of course, Restylane is a temporary fix and will last 6-9 months.
Another option is to undergo a lower blepharoplasty, or eyelid lift. Here the fat is slightly trimmed or moved into the hollowed/depressed area. A small pinch of skin is also taken at the time of surgery. These results are longer lasting (5-6 years).
Eyelid surgery, or blepharoplasty, can frequently lead to mild bruising under the eyes. This typically resolves after 10 days. However, persistent bruising at 3 months after surgery may be the result of hemosiderin deposits in the skin. This may slowly fade and at times can take 6 months to 1 year before it resolves. IPL/ light therapy or laser treatment may expedite things.
I am a 28 year old woman with dark, sunken looking eyes. I have used Botox around the brow and to eliminate crows feet. When I retain water, my eyes look great due to the extra volume, so I am guessing that a filler of some kind would be in order. I am concerned about the type of filler though, as my skin is thin and pale. What would be the best procedure?
At 28 years old, it is likely to early to consider a blepharoplasty or eyelid lift. A great alternative would be filler (preferably a hyaluronic acid filler) injection into the depressed tear trough area in your lower eyelid. This is an advanced injection and should likely be performed by your physician or an experienced injector. Results should look wonderful though.
If you are opposed to surgery for the eyelids, then other considerations would be laser resurfacing of the eyelids for fine wrinkles and skin laxity.
If there are heavy bags and dark circles from these bags under your eyes, another consideration would be filler injection with Restylane or Juvederm to fill the hollowed region below the "bags".
However, if there is significant skin laxity and bulging of the fat of the lower lids, surgery is likely the best option.
Laser resurfacing of the lower eyelid will significantly improve the fine wrinkles of the lower lid and and tighten the skin in this area. However, it will not treat the bulging fat, heavy bags, or dark circles under the eyes. Blepharoplasty (eyelid surgery) will help address these issues.
A facelift can be performed on someone who is overweight. It appears that your weight has plateaued for some time now and you are staying healthy with diet and exercise. The overall result of your neck after a facelift or face and neck lift will also greatly depend on your neck anatomy and location of bony/cartilaginous structures. You will likely require significant contouring with liposuction. Seek a facelift specialist for a complete evaluation and treatment plan.
Everyone's face ages differently depending on genetics, skin care, and environmental factors. Patients in their 40's may start noticing some jowling, loose neck skin, and even banding of the neck muscles. You may be an excellent candidate for a short scar facelift where the incisions are minimal and the lift improves the jawline and neck laxity. See an experienced facelift surgeon for a proper evaluation.
A facelift will address the jowls, jawline, and neck. If have some depression below your cheeks it is an area that may make some patients look gaunt or thin. Fat grafting to this region works wonderfully if you are a good candidate. Seek an experienced surgeon for a fat grafting consultation.
A recent consultation with plastic surgeon suggested a full face lift to correct rolling acne scars. Scarring is quite significant. After doing research on this however, a facelift is not typically recommended as opposed to laser resurfacing. I am 45 and feel that I look appropriate for my age so I'm wondering what the benefits would be to the facelift as opposed to laser and in what order are these procedures done?
A facelift is a procedure that is performed to improve skin laxity in the lower face and neck. It addresses jowling, an ill defined jawline, and loose neck skin. A facelift will not improve skin irregularities from acne scarring.
Laser resurfacing or dermabrasion are excellent modalities to improve the appearance of skin irregularities from acne scarring. This type of treatment needs to be a little more aggressive than resurfacing for fine wrinkles so the downtime and risks are a little greater. Seek an experienced physician with resurfacing for this treatment.
A facelift will not help your melasma. Melasma is a skin condition leading to darker appearing splotches of skin due to sun exposure and hormonal changes. Treat your melasma with topical therapy and IPL.