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Question: I’d like a facelift to improve my jowls. Will my nasolabial folds get fixed as well?

Answer: If you are concerned with the appearance of your jowls, then a facelift procedure will take care of these areas quite well.  Though the nasolabial folds will be improved with a facelift, in order to adequately address these folds, I suggest the addition of fat injections to these folds at the same time as your facelift surgery.

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Question: It sounds like most aging in the forehead is treated with Botox. In what cases would you need a browlift instead?

Answer: Aging of the forehead is managed in a variety of ways depending upon what the issues are that are contributing to the appearance of an aging forehead. In cases where there are hyperdynamic lines of facial expression, such as in the area between your eyes and around your eyes, Botox and Dysport are the best choices. When properly injected, Botox and Dysport will soften these lines and prevent these lines from becoming more pronounced. Neuromodulators like Botox and Dysport will not decrease fine and deep lines in the skin of the forehead and in cases where the brow has fallen a considerable amount, surgery to elevate the eyebrow will be necessary to adequately rejuvenate the forehead.

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Question: I’m interested in eyelid surgery and wondering how you decide whether to make incision on the outside or inside of the eyelid.

Answer: The decision to make an incision on the inside or the outside of the eyelid pertains to lower lid blepharoplasty. In upper eyelid surgery, if there is excess skin, which is generally the case for upper eyelid surgery, then the incision is made to remove excess skin and therefor the incision is done on the outside of the eyelid.

In lower eyelid surgery, the decision to make an incision on the inside versus the outside depends upon a few different factors. The status of the skin, muscle, and to some extent the strength and tone of the lower eyelid will guide our decision to perform an external incision or not. The age of the patient and the status of the fat or bags of the lower eyelids will also be taken into consideration. Generally, in younger patients with very little excess skin, lower eyelid surgery can be performed without the removal of any lower eyelid skin and therefor the incision can be make on the inside of the eyelid. In older individuals, there is generally a combination of too much fat, excess skin and muscle, and laxity of the lower eyelid which will all need to be addressed to properly rejuvenate the lower eyelid and will require an external incision to be made.

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Question: My ears stick out much too far. What is done during otoplasty surgery to bring them closer to the head?

Answer: There are a few different approaches to otoplasty. The otoplasty procedure that will work best for any individual depends on a few different variables. The age of the patient and the overall shape and size of the ear, just to name a few. When a patient is very young, cartilage abrasion through small incisions in the ear and a proper fitting dressing may be all that is needed to correct the shape of the ear. Most patients require more than that.

There are a few schools of thought in how to best correct the shape of the ear. There are those who use cartilage cutting techniques, and those who use cartilage folding and suturing techniques. Sometimes a combination of the two techniques is necessary in very prominent ears. I tend to favor cartilage folding techniques. During the otoplasty procedure the poorly formed anti helix is created in the pinna using a Mustarde technique. If after the normal contour of the ear is corrected the ear still is sticking out, then I use a Furnass setback suture in order to bring the ear closer to the head on front and back views. I like the cartilage sculpting and folding techniques because they are reversible in the early stages and adjustable. More importantly, they leave the ear looking natural without any of the sharp transitions in the ear architecture that is so apparent in the cartilage cutting technique.

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Question: Is it possible for otoplasty to cause cauliflower ears?

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Answer: Otoplasty is a term used to sculpt an otherwise deformed ear. Otoplasty techniques can be used to correct a cauliflower ear. Otoplasty requires cutting, thinning, and suturing the cartilage of the ear. If an accumulation of blood or fluid in the cartilage of the ear should occur following an otoplasty procedure and goes unrecognized for a period of time, then theoretically a cauliflower ear can result from the otoplasty procedure. Cauliflower ear occurs when an auricle is damaged and blood or fluid accumulate between the cartilage of the ear and the blood supply to the ear, resulting in cartilage death and eventually disfigurement.

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Question: What is the purpose of the centrifuge in the fat transfer procedure? And how long after fat transfer can I expect to see results?

Answer: Fat transfer to the face has become a frequently requested procedure. The results of well performed autologous fat transfer are very satisfying for the patient and the surgeon. The major issue with fat transfer is being able to predict the exact amount of transferred fatwhich will survive in the transferred site. Most surgeons expect about a 20 percent reduction in the volume of transferred fat from the time it is injected to a few weeks following the procedure. Experienced surgeons are careful not to over inject the recipient site with fat as this transferred fat is very difficult to get rid of. What we have learned over years of studies in fat transfer is that the higher the concentration of pure fat, and the less trauma to the individual fat cells, the better the survival of individual fat cells. When fat is harvested from places like the abdomen, hips, or thighs, the fat is in a solution of blood and damaged fat cells. Centrifugation allows us to get rid of the impurities of the aspirate and harvest a highly concentrated mixture of pure fat cells which is the best substance to inject. The results of the fat transfer procedure can be realized immediately, however, because well performed fat transfer requires numerous injections of fat into the face, swelling and bruising will be present and last for a few weeks.

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Question: I’d like to improve the appearance of my neck. Can you tell me what the difference is between a neck lift and liposuction of the neck and what each is appropriate for?

Answer: Rejuvenation of the aging neck isa frequently sought after cosmetic procedure. There are numerous lasers available today that claim to beas effective asliposuction or surgery at neck rejuvenation, but, I have found these lasers are only minimally effective compared tominimally invasive methods and surgery.The type of neck rejuvenation that a patient may have performed will dependupon a few different issues. One of these is the degree of laxity of the neck, the anatomicalissues involved in aging of the neck,as well as the amount of surgerythata patient is willingto have in order to correct the laxity of the neck. Not all neckshave the same issues that lead to the appearance of aging. In some necks, the issue is only fat. Younger individuals are more likely to seekrejuvenation because of fat in the submental region and neck which does not respond well to diet and exercise. There are a few different methods of neck liposuction and they are all very effective. I employ traditional liposuction techniques and also use laser liposuction. Most younger individuals respond very well with traditional neck liposuction, however, individuals with some excess skin laxity along with fat are good candidates for laser liposuction as this has some increased benefit of skin tightening more than liposuction alone.

A neck lift is quite a bit more involved than simply liposuction of the neck alone. I frequently perform some liposuction in necks where the patient requires a neck lift. Neck lift surgery is necessary when there is an excessive amount of skin laxity along with neck muscle laxity and even excess fat. My neck lift procedure utilizes a small incision beneath the chin to address the bands of muscle that become noticeable in our necks as we age. The laxity of the skin and muscle is then addressed by elevating the skin of the neck and mobilizing it into well place incisions that are made behind the ear and into the hair bearing scalp behind the ear. The muscle sling that keeps the neck looking young is also suspended behind the ears. Recovery from liposuction and laser liposuction of the neck is a few days and recovery from a neck liftis about a week. The results of the procedure should last up to 10 years.

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Question: If you perform a cartilage graft from the ear to nose, will that area of the ear grow back?

Answer: I use cartilage grafts frequently in both primary and more often, in revision rhinoplasty. Cartilage grafts are my favorite source of grafting material for numerous reasons. Cartilage is an abundant source of grafting material in rhinoplasty and can be harvested from the nasal septum, the ear, and in more extreme cases the rib. More importantly, cartilage grafts will not be rejected as foreign material and the potential for infection from cartilage grafting of the nose is minimal. Cartilage will not re grow in areas from where it is harvested. It is important to understand this as a rhinoplasty surgeon so that the appropriate amount of cartilage is harvested. If the appropriate amount of cartilage is harvested then there will be no subsequent anatomical deformity of the ear or nose as a result of the cartilage harvesting.

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