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I am a 56 year old female and would like to have a forehead/brow lift and a Blepharoplasty done. I don’t want to have that “scared” or surprised look after surgery. How do I know this won’t happen?

First and foremost, knowledge and confidence in the surgeon that you choose is the most important step in achieving your desired goal. When combining upper eyelid surgery with brow lift, it is important to elevate the brows to the desired position and not to remove too much upper eyelid skin, which could impair eyelid closure and/or create a hollowed out look. I feel that a softly arched brow with lateral enhancement along with upper eyelid skin positioned several millimeters above the eyelashes looks the most pleasing. In my experience, I have not had a patient complain of their eyebrows pulled too high. As in any other cosmetic procedure you desire, ask your surgeon to show prior patient before and after pictures.

What is the difference between a brow lift and blepharoplasty?

A brow lift is a procedure that elevates your eyebrows to create more distance between your brows and upper eyelids. There are several ways to perform this procedure (I almost always do endoscopic brow lifts). Blepharoplasty procedures are surgery of the eyelid, either upper or lower, in which unwanted skin and soft tissue is removed or repositioned to give a more rejuvenated appearance. Many times, patients are candidates for both brow lift and blepharoplasty to achieve the desired result.

I am a woman and I am considering having brow surgery. I do not want anyone to know that I have had this surgery. Should I have open or endoscopic surgery and how long will it take before there is no swelling or bruising?

I almost always perform brow lift surgery via an endoscopic approach through small incisions behind the hairline. The brow and forehead region can remain swollen and bruised for up to three weeks, but most of this can be covered with makeup within ten to fourteen days. Also, hairstyles with bangs help camouflage postoperative changes. If you allow two weeks, I think that is enough time to heal unnoticed.

I’m in my late 20s and I’m considering a browlift which I know sounds crazy because of my age. However, I have very droopy eyebrows which I think are hereditary. Is it possible to get a browlift at my age?

It is possible to get a browlift at your age, but it is not very common. Persons with a family history of droopy brows usually do request earlier treatment for this condition, and I would consider it in carefully selected patients. Sometimes Botox injection can provide enough brow elevation to avoid surgical intervention for several years.

I’m a 45 year old man interested in a forehead lift. I have a rather unusual issue: I sleep on my stomach, and I’m wondering what effect a forehead lift would have on my sleep. Would sleeping on my stomach be painful after a brow lift?

Many people either sleep on their side or lie flat on their abdomen. After a brow lift procedure, I ask my patients to try their best to keep their head elevated to reduce swelling. It can be a bit difficult trying to sleep with your head elevated. I will sometimes prescribe a sleep aid to help my patients get better rest. I do not recommend sleeping on your stomach after brow lift.

People around me always think I am angry with them. My eyebrow always has this sort of furrowed look to it. I heard that a Forehead lift could help. Is that true or would Botox be a better option?

I would definitely tell you to start with botox injections to see if this would soften your medial brow region. This will also give you a “chemical” brow lift. Depending on your age and how your sagging brows affect your upper eyelids and eyes, brow lift (or forehead lift) combined with possible blepharoplasty is always an option at the desired time.

Since I had my brow lift (7 weeks ago) I have noticed that the skin on my forehead is really shiny. Is this a result from the surgery?

If you are seven weeks postop from your brow lift, you probably still have a bit of edema or fluid retention of the soft tissue of your forehead. This does impart a small amount of stretch on the forehead skin, which can give it a smooth, shiny look. It often takes about three months for this to completely subside, especially if you had other facial cosmetic procedures performed simultaneously.

I had a brow lift 4 months ago. It appears as if one of the endotines has dissolved OK but the other one has not. Now I am left with a strange uneven appearance because the one endotine is making my skin appear lumpy in that area. I try to cover this up as much as possible with my hair but it is really bothering me. Do you think there is something wrong?

I personally do not use the endotines when performing brow lifts. If it has been 4 months since your procedure, chances are the soft tissue of your brow and forehead has healed so that the endotine can be removed without affecting you cosmetic result. Endotines are absorbable, so if given enough time, this issue could resolve itself.

I’m a 28 year old Asian woman with hooded eyelids. I want to have surgery to have this corrected. Can you tell me how brow lift can help enhance my eyes?

If you have a significant amount of brow ptosis or sagging of the brows, this can impart extra skin that hangs down onto the eyelid platform. When this occurs more in the lateral brow over the outside corners of you eyes, this is called hooding. A brow lift can elevate either the medial brow, the lateral brow, or both depending on the patient. When the brows are too low, this causes the eyes to look smaller. A brow lift can enhance your eyes by elevating the sagging soft tissue off of your eyes and making them look larger, refreshed, and well-rested. More often, brow lifts are performed in conjunction with upper eyelid blepharoplasty.

I am interested in getting a browlift but want to avoid looking surprised all the time. How can you guarantee that I won’t end up looking overdone?

Patients need to be counseled about the changes of the brow and hairline with brow lift procedures. I perform endoscopic brow lifts in most cases. In my experience, I have not had any patients report to me that they feel like their eyebrows are too high. There have been instances where the concern is more of the hairline shift. Although there can be no certain guarantees, in virtually all patients once swelling has subsided and the brow skin has relaxed a bit, there is no concern of being “overdone.”

I’m considering a chin implant and would like to know what my options are for the implants themselves and what they’re made of.

Chin augmentation can be achieved by placing an implant or by advancing a segment of mandibular bone forward. A variety of implants are available for use, but I use a preformed implant made of silicone. It is placed next to the bony surface of the mandible through a small incision under the chin.

I’ve heard that cheek implants increase the projection of the cheekbones. I have really round cheeks, so I’m confused as to how adding volume to them can make my cheekbones more prominent. How does this work?

In general, patients receiving cheek implants have weak malar eminences, or cheekbones, resulting in mid-face flattening from an oblique view of the face. If your cheeks are very rounded, a cheek implant may not be recommended. Cheek implants are positioned over the majority of the surface area of the natural cheekbone resulting in a fuller more prominent mid-face.

As a professional boxer, it is a given that I will be hit in the face. If I get a chin implant, is there a risk of them breaking by getting punched?

As a professional boxer, I would council you to avoid facial cosmetic procedures until you have retired from boxing! Nevertheless, the chin implant I use is a soft silastic material that is placed into a pocket directly overlying the mandible. A hard punch could possibly split the implant, resulting in a palpable crease, but I have not seen this in my practice.

I’m 40, female, and I just got cheek implants a couple of months ago. I love them, but recently I heard that as you age and lose fat in your face, your implants can make you look harsh and manly. Is this true?

Preformed cheek implants fitted correctly to the patient should continue to look natural as the patient ages. However, in my opinion, cheek implants placed too high can sometimes be more masculine in an older individual. If loss of fat is an issue, fat injection or injection of a synthetic filler can work well in the cheek.

Can I get chin and cheek implants at the same time?

In my experience, patients have received either a chin implant or cheek implants at the time of surgery, but not both. They could be done at the same time if indicated.

I have really bad acne scars on my cheeks and on the sides of my chin. Can laser resurfacing help to smooth out my acne scarring?

Laser resurfacing is my treatment of choice for acne scarring.  I use a CO2 laser to accomplish this.  You would be a good candidate as long as your acne is no longer active.  Dermabrasion is another option for skin resurfacing, but I prefer the CO2 laser.  The most important factor in deciding to have this procedure is the healing period.  It takes several weeks for your skin to heal, and you will need to avoid direct sun exposure.  I tell my patients to plan at least 3-4 weeks “down time”.

I am in my mid-20s and have been exercising vigorously for over a year now. I have lost weight but cannot seem to lose my small double chin. Am I a good candidate for neck liposuction?

Many people have that “family trait” which gives them the fullness under the chin, despite working hard at losing it with exercise.  Since you are at a young age, your skin should respond very well to submental liposuction and retract upward to better shape your neck after that procedure.  I would consider you a good candidate if it is a distinct concern for you.

As I’ve hit my 40s, I’m starting to notice bags under my eyes that makes it look like I’ve got dark shadows there. What can be done about it?

As one ages, the soft tissue of the face starts to sag and also lose its thickness of the layer of fat under the skin.  With the lower eyelid and cheek, there can develop a separation between the cheek fat due to sagging, and prominence of the lower eyelid fat, leaving a groove between the eyelid and cheek.  A non-surgical way of addressing this is with an injectable filler that can fill in the gap between your lower lid and cheek.  This can work very well in experienced hands.  A more definitive way is with lower eyelid surgery and/or a mid-face lift.

My chin is really small and I’d like an implant to make me look more prominent. Is this procedure painful? How long does it take to heal?

Chin implants can be done under general anesthesia or IV sedation.  The pain at the implant site can be moderate in the first 24 hours but usually quickly subsides after the first day.  Many patients do not require much pain medication after that.  Sutures are removed from the incision after one week, and most of the swelling will subside in approximately 3 weeks.

I had a skin cancer lesion removed from my cheek with Mohs surgery and it left a big scar that’s impossible to hide. Is there any way to make it less conspicuous?

If your Mohs reconstruction was performed over a year ago, giving time for the scar to mature, scar revision could be considered.  Other options for visible scars include dermabrasion, laser treatments and sometimes an injectable filler for depressed scars.  A thorough evaluation would be required to make that determination.

What are some options available for non-surgical alternatives to the traditional facelift? What exactly can be done with less invasive methods and how effective are they?

In patients who have facial wrinkles due to soft tissue volume loss, fat auto transplantation is an alternative to traditional facelift. Fat injection is a significant part of my practice, however I mostly use it to enhance traditional facelift results. I believe that in general, less invasive methods yield less impressive results.

I’m a 50 year old woman, and I’ve been looking into different facial fillers. I recently read about fat transfer procedures, which sound intriguing. I have a little extra baggage I’d like to lose in the love handles anyway. Since the fat would be from my own body, would the results of a fat transfer last longer than from an artificial filler?

Fat transfer procedures can offer a long lasting and natural enhancement to the face. In my experience, fat injection lasts longer than an artificial filler, especially in the mid and upper thirds of the face. Also, I tell my patients that harvesting the fat does not contour or significantly reduce the donor site area because of the small volume that is required to remove.

As a 48 year old, I know it’s silly, but I’m afraid of needles. I’d like to get a facial fat transfer, but I don’t want to be awake during the procedure. Can a facial fat transfer be performed under general anesthesia?

Many fat transfer procedures that I perform are done in conjunction with other procedures, such as brow lift, facelift, or blepharoplasty. Most cases involving multiple procedures are done under general anesthesia or IV sedation, so fat transfer can definitely be performed in this manner. If you require fat injection only, you can still have general anesthesia, although most of my patients tolerate this procedure with mild sedation.

I’ve read that my own body fat can be harvested to fill facial wrinkles and augment lips. Are the results permanent?

I perform fat injection to fill wrinkles of the face.  I usually harvest it from the abdomen.  In my experience, fat injected in the upper portions of the face generally works a little better than fat injected around the mouth and lips, although it can in many cases provide years of results.  Unfortunately, fat can be unpredictable, and touch up injections may be required.

I’m 37 and there are a few things about my face that I’d like to improve. I figure that I’m probably on the young side to be considering a facelift, though I am bothered by the aging changes in my face. Are there ever benefits to getting a facelift early on or is it better at my age to consider other options like injectables?

Facelift procedures are usually performed on patients beginning in their upper forties and fifties. In younger patients, other procedures such as Botox and injectable fillers are more common. Surgical procedures such as submental liposuction are also helpful in younger patients.

Is it true that injectable fillers can be used for a nose job without the surgery? What changes can be made to the nose this way?

Injectable fillers can be used to provide minor contour chances to the nose, but I do not feel that fillers are an alternative to rhinoplasty surgery. Fillers are helpful in enhancing small depressed areas of the nose.

My 16 year old daughter wants to have a nose job. Her nose is not very large, but it is crooked and one nostril is visibly bigger than the other. I have heard of a non-surgical way to correct minor imperfections. Can you tell me about this new less invasive Rhinoplasty procedure?

It sounds like your daughter may have a deviated nasal septum causing the nostril asymmetry. Furthermore, she may have had nasal trauma in the past or was born with a crooked nose. Minor nasal corrections can be adjusted with injectables to fill subtle contours. Judging by the way you describe her nose, this definitely sounds like a surgical case. The good news is that many times, medical insurance will cover correction of her nasal abnormalities, especially if it is causing nasal airway obstruction.

I’m in my 40s and have developed some fine lines around my eyes over the past year. They’ve been bothering me more and more so I would like to fix them. Are fillers a good option for this and which one would be best? Also, how long will the results last?

Fillers are a good nonsurgical option for periorbital rejuvenation. They are particularly good for filling the groove between the lower eyelid and the cheek. For fine lines around the eyes, particularly in the crow’s feet region, I prefer Botox injection. The fillers that I use most are Juvederm and Restylane, and both of these products last an average of ten months.

I am a 20 year old Caucasian female and have already started noticing lines around my forehead and eyes. I don’t want to go under the knife just yet. Would receiving an injectable filler be a good option for me?

Hyperdynamic lines of the forehead and periorbital regions usually respond better to Botox injection rather than an injectable filler. Sometimes, however, patients who have deep wrinkles, especially in the brows, respond well to a combination of Botox and a filler. Because of your youthful age, I suspect that Botox alone will best suit you.

How are specific brands of injectable fillers chosen for each patient? Can someone have an allergic reaction to a filler?

I almost exclusively inject hyaluronic acid fillers in my practice. The most common brand that I use is Juvederm. I like this filler because it is soft and natural feeling, does not tend to form lumps beneath the skin, is completely absorbable and not permanent. There are reports of patients having allergic reactions to injectable fillers, but I have not personally seen it occur.

I have deep frown lines between my eyebrows that I’d like to fix, but I am worried about the toxicity of the chemical fillers. What are the long terms effects on health and skin after using these injectable fillers?

I almost exclusively use injectable hyaluronic acid (HA) fillers in the face.  There are several products available which work well.  This is composed of a naturally occurring substance found in the skin and is not made from animal products.  Although mentioned as a potential risk, I have never seen an allergic reaction to this product after injection.  There are studies which suggest that this type of filler stimulates collagen formation which is desirable in long-term reduction of wrinkles.  This is an absorbable filler that lasts approximately 10 months.  I know of no long term deleterious effects after injection of HA fillers.

I’m starting to see fine vertical lines above my upper lip and little cracks in the corners. Can you make them go away?

I most commonly treat these lines around the lips and mouth with an injectable filler.  This usually lasts 10-12 months, although some studies suggest that fillers stimulate new collagen formation and can provide a longer result.  It takes approximately 5-10 minutes in the office setting.  For deeper lines of the lips and face, sometimes dermabrasion or laser resurfacing is the better option.

I’d like to get fuller lips with injectables but I’ve seen some really fake looking “fish lips,” even on celebrities! Is there a secret to natural looking results?

Short answer, I just say no to bigger lips.  Many patients forget what they originally looked like before entering the world of injectable fillers.  I tend to be very conservative with injecting lips and often show patients their original photographs before repeating injections.  I almost always avoid injecting the entire length of the lip, sparing the lip area at the corner of the mouth.  This can maintain a natural transition of the upper and lower lip and not create a “fish lip” appearance.

There are so many brands of fillers! What’s the difference between them and how do I choose which one I want?

I exclusively inject fillers composed of hyaluronic acid (HA).  This is a naturally occurring substance in the skin and not made from animal products.  They are produced in varying viscosities.  For example, a smaller particle sized filler would be a good choice for small lip lines, and a larger particle sized filler would be a good choice for a deep nasolabial fold.  Also, HA fillers are not permanent and provide a natural soft enhancement.

What can be done when too much fat was taken out above the eyes and below the eyes?

I almost always avoid removing fat from the upper and lower eyelid during blepharoplasty to prevent these complications. Excessive fat removal from above or below the eyes can lead to a hollowed appearance.  Injection of a filler can be safely performed around the eyes to reintroduce a healthy appearing look.  I recommend autologous fat injection into the upper eyelid and brow region for hollowing in that area.  For the lower eyelid region, I try to avoid injecting fat because of the propensity for creating palpable and visible lumps over the orbital bony rim.  In selected patients, I sometimes inject a conservative amount of hyaluronic acid filler into the lower eyelid region for improvement in contour due to excess fat removal.

I am an Asian male and would like to know if there is a difference between how a Blepharoplasty is performed on an Asian vs. Caucasian?

There is a distinct difference between the technique in which an Asian upper eyelid is performed compared to a non-Asian eyelid. Many Asians seeking blepharoplasty are unhappy with the puffiness and lack of upper eyelid (or pretarsal) crease, yet most patients want to maintain their ethnic appearance. In these cases, surgery is aimed at creating the pretarsal crease in eyes that are absent a fold. In general, a minimal amount of overhanging soft tissue is removed, and the skin is then attached to the tarsal plate of the upper lid to create the crease several millimeters above the eyelash line. Minimal fat is removed to avoid westernization of the eyelid. Eyelid symmetry is of utmost importance, and patients should choose a surgeon who routinely performs Asian blepharoplasty procedures.

I am a 56 year old female and would like to have a forehead/brow lift and a Blepharoplasty done. I don’t want to have that “scared” or surprised look after surgery. How do I know this won’t happen?

First and foremost, knowledge and confidence in the surgeon that you choose is the most important step in achieving your desired goal. When combining upper eyelid surgery with brow lift, it is important to elevate the brows to the desired position and not to remove too much upper eyelid skin, which could impair eyelid closure and/or create a hollowed out look. I feel that a softly arched brow with lateral enhancement along with upper eyelid skin positioned several millimeters above the eyelashes looks the most pleasing. In my experience, I have not had a patient complain of their eyebrows pulled too high. As in any other cosmetic procedure you desire, ask your surgeon to show prior patient before and after pictures.

What is the difference between a brow lift and blepharoplasty?

A brow lift is a procedure that elevates your eyebrows to create more distance between your brows and upper eyelids. There are several ways to perform this procedure (I almost always do endoscopic brow lifts). Blepharoplasty procedures are surgery of the eyelid, either upper or lower, in which unwanted skin and soft tissue is removed or repositioned to give a more rejuvenated appearance. Many times, patients are candidates for both brow lift and blepharoplasty to achieve the desired result.

I am a 72 year old lady and my eyes are sagging. My eyelids basically cover my eyes. Can Blepharoplasty help an old lady like me?

Upper eyelid blepharoplasty is a very safe and effective surgery in patients your age. As long as you have no serious medical conditions that would preclude you from the procedure, such as requiring constant blood thinning medications, this procedure will benefit you immensely with minimal down time and virtually no postoperative pain.

I am both near sighted and far sighted and have poor vision. I am getting eyelid surgery on my top eyelids. How long after having Blepharoplasty, can I wear my contact lenses and glasses?

Glasses can be worn immediately after your surgery, but not so for contact lenses. The soft tissue swelling of the upper eyelid can impart a minor change in the shape of your cornea. This sometimes creates a suction cup effect, inhibiting removal of the contact in the eager patient! I like to wait two weeks postoperative to allow contact wear, and I have the patient put them in and take them out while in clinic to ensure safety.

When I was 22 I was in a punk rock band and I got smashed in the face with a guitar. Ever since my eye hasn’t been the same and has looked droopy. I’s only gotten worse with age. Is there a way that Blepharoplasty can fix my eye?

I would need to evaluate you before making a recommendation, but it sounds like you may have either a dehiscence of the muscle that elevates your eyelid, or excessive scar tissue that is impinging eyelid elevation. I perform repairs of both of these conditions, but I doubt simple blepharoplasty will fix your problem. Another possibility is that you sustained a bone fracture around your eye that may need to be addressed. The periorbital region is very complex and requires thorough evaluation.

I did some research on Blepharoplasty. It says that you can modify an eye lid and that excess tissues and fat can be removed. Can you do that for anyone at any age? I’m only 27 but I’ve always felt like my eyelids looks puffy and unattractive.

You are a little young for eyelid surgery, unless you want to change your ethnicity, such as Asian eyelid surgery. It sounds like you have a heredity for heavy eyelids. In the next two decades of your life, you may notice aging changes of your face that may change immensely. I have seen individuals become very thinned out on their face after an early adulthood of fullness, and vice versa. My advice to you…do not have surgery on your eyes right now.

Will my eyes be bothered by contacts after I have eyelid surgery?

I ask my patients who wear contacts to avoid wearing them for 2-3 weeks after upper and/or lower blepharoplasty. I do not want any pulling or stretching of the upper or lower eyelids after surgery. Also, the temporary swelling of the conjunctiva of the eye interferes with proper fitting of the contact.

Four years ago I had a blepharoplasty procedure and I loved the results. Within the last couple of months, however, I’ve noticed that the area around my eyes has begun to look like it did pre-surgery. Would you recommend a second eyelid lift?

Most patients who seek a repeat blepharoplasty procedure will have had prior blepharoplasty approximately 10-15 years prior. Sometimes, if there is a return of excess skin, or sagging around the eye, this can represent a soft tissue depletion that can be improved with volumetric enhancement in the form of an absorbable filler or autologous fat.

I wear a lot of heavy make up for my job as a cocktail waitress. How long after my eyelid surgery will I be able to wear my eye makeup again?

After blepharoplasty procedure, I usually allow makeup wear to resume about 10 days after surgery. The sutures are removed after one week, and the topical ointment is discontinued. Makeup can be resumed several days after this.

I am 30 and I’ve always been embarrassed by my “Marilyn Monroe” mole on my upper lip. Can this be removed without extensive scaring?

If you are excessively concerned about your mole, the small thin scar is almost always less visible that them mole after healing.  Sometimes patients opt out of having the mole removed when they begin to see it as a personal unique trait of their face.  I always have them consider it that way…..like Marilyn Monroe!

Is there any permanent non-surgical procedure for under eye puffiness?

If your puffiness is from excessive fat, no.  This is a surgical matter.  However, I have seen lower eyelid puffiness as a result of untreated allergies, fluid retention, and other medical conditions which has responded to treatment from your primary care physician.

I have deep frown lines between my eyebrows that I’d like to fix, but I am worried about the toxicity of the chemical fillers. What are the long terms effects on health and skin after using these injectable fillers?

I almost exclusively use injectable hyaluronic acid (HA) fillers in the face.  There are several products available which work well.  This is composed of a naturally occurring substance found in the skin and is not made from animal products.  Although mentioned as a potential risk, I have never seen an allergic reaction to this product after injection.  There are studies which suggest that this type of filler stimulates collagen formation which is desirable in long-term reduction of wrinkles.  This is an absorbable filler that lasts approximately 10 months.  I know of no long term deleterious effects after injection of HA fillers.

I just turned 50 and my upper eyelids droop so much that I cannot wear eye shadow and other makeup looks silly. I’m interested in eyelid surgery but I don’t want to have permanent scarring. What results can I expect?

Upper eyelid surgery remains one of the most common facial cosmetic surgeries performed in the United States every year.  The vast majority of patients report exactly what you are saying.  Removal of the extra eyelid skin that you are unhappy with will restore visibility of your eyelid platform for successful application of eye liner and eye shadow.  Patients who consult with me will have their digital photos taken and will be shown their simulated results on computer.  This greatly helps in patients understanding the expected results.

As I’ve hit my 40s, I’m starting to notice bags under my eyes that makes it look like I’ve got dark shadows there. What can be done about it?

As one ages, the soft tissue of the face starts to sag and also lose its thickness of the layer of fat under the skin.  With the lower eyelid and cheek, there can develop a separation between the cheek fat due to sagging, and prominence of the lower eyelid fat, leaving a groove between the eyelid and cheek.  A non-surgical way of addressing this is with an injectable filler that can fill in the gap between your lower lid and cheek.  This can work very well in experienced hands.  A more definitive way is with lower eyelid surgery and/or a mid-face lift.

Would an eyelid lift change the amount of upper lid showing when my eyes are open?

Of course.  That is the goal of upper eyelid surgery, or blepharoplasty.  Removal of the excessive upper eyelid skin results in improved visibility of the eyelid platform which would better show your eye shadow and lash lines.  Care is always taken to not remove too much skin and soft tissue which could result in a hollowed appearance of the upper eyelids.

I know most who get eyelid surgery have it performed when they’re older. I’m only in my 30s but I’ve already got a hooded, puffy appearance to my upper eyelids. Should I wait?

I have performed upper eyelid blepharoplasty in patients in their 30’s.  It is not very common, but if you have a familial trait that bothers you, it is a very easy procedure to have done.  In my view, the sooner you do it, the more years you will enjoy the results.

Would Botox take care of the really bad crows feet around my eyes?

I often inject Botox into the crows feet area in both younger and older patients.  However, if you have a lot of excessive skin around your eyes in this area, you may be a better candidate for upper and/or lower blepharoplasty surgery.  For prominent crows feet, Botox will lessen but probably not eliminate the lines present.

I’m 54 years old and I’ve had dark bags under my eyes for a long time now. Will a blepharoplasty help to completely remove the bags?

Darkening of the skin under the eyes can be due to shadowing from overlying fat, or pigmentation of the skin from a variety of causes.  Often, addressing the fat during surgery to smooth out the bags will eliminate the shadowing effect, providing an acceptable appearance.  However, in patients who have persistent darkening under the eyes, I will offer phototherapy treatments to treat the pigment problem.

Is it possible for my eyelids to droop back to their original position after an upper eyelid blepharoplasty surgery?

The aging process continues in everyone.  After upper eyelid surgery to remove extra skin, eventually the skin redundancy will recur.  Patients who seek another blepharoplasty surgery will usually have had their initial procedure around 10 years prior.

I’m having Mohs surgery for a spot beneath my eye. After my reconstruction will I still be a candidate for a blepharoplasty?

I have performed blepharoplasty in patients undergoing Mohs reconstruction of the lid.  These are usually smaller defects that need reconstruction.  Larger defects may need reconstruction followed by possible blepharoplasty later.  If you are desiring upper blepharoplasty, this can be performed at the same time.

What is the difference between a facelift and a mini facelift? I’m 60. Will a mini-facelift do anything to reduce sagging in my neck and chin area?

I get this question very frequently. There are many variations to a facelift, from the placement of incisions to how you dissect and suspend the deeper structures, to attain and maintain a long lasting youthful appearance. A mini facelift usually has shortened incisions and less dissection of the soft tissues of the face that you want to have lifted for a very long time. My general philosophy is mini facelift-mini result…unless it is a younger patient with isolated areas to treat. I would probably recommend a standard lower facelift, which would give you a more comprehensive, long lasting result. Many patients try to cut corners and do less, while expecting the same result, but I always say “if you don’t want to do it right the first time, you will need to set aside more time to do it right later.”

I’m a woman in my 50s with a lot of fat and excess skin in my neck area. I think I may be a good candidate for neck liposuction, but I work full-time and I’m concerned about recovery time. How long should I expect to be out of work after this procedure?

If you have good skin elasticity and in general good health, neck liposuction can be a very easy procedure to undergo with a fast recovery. If you do not need a lower facelift, and just liposuction, you will only have a small bandage under your chin for a week that is virtually unseen. Most patients will go back to sedentary work after 2-3 days, but there may be a minor amount of bruising in the mid to lower neck. Swelling is a minimal in almost all patients. I do not routinely have my patients wear a restrictive garment around their necks postoperatively. It usually takes three to four months to fully appreciate the results due to minor swelling.

What are some options available for non-surgical alternatives to the traditional facelift? What exactly can be done with less invasive methods and how effective are they?

In patients who have facial wrinkles due to soft tissue volume loss, fat auto transplantation is an alternative to traditional facelift. Fat injection is a significant part of my practice, however I mostly use it to enhance traditional facelift results. I believe that in general, less invasive methods yield less impressive results.

My neck is losing its tone and starting to sag. I would like to have a neck lift, but I am worried that I may have visible scarring. Can you tell me where the scars will be located and how big they will be after neck rejuvenation?

Every patient is different when it comes to planning rejuvenation of the neck. In general, I place a small incision beneath the chin so I can safely remove excess fat and tighten the deeper soft tissues of the midline neck for a sharper contour. For a neck lift, I place incisions in the crease behind each ear for minimal visibility. For a lower facelift, I place the incisions behind the ears and in front of them as well. This allows for removal of excess skin. They are concealed as best possible around the ear canal and sideburn region. I always reassure my patients that they should be able to wear their hair any style they choose once healing has occurred without the worry of scar visibility.

I’ve heard that facelifts and nose jobs are sometimes performed under local anesthesia and sedation, instead of general anesthesia. I don’t want to be under full anesthesia either. What sedation are brow lifts typically performed with?

I almost always use general anesthesia for rhinoplasty procedures. Most facelifts are also performed under general anesthesia or IV sedation. The anesthesia I use for endoscopic brow lift is general, but I will use IV sedation for other brow lift techniques.

I’m 42, so I don’t think I need a surgical facelift, but I would like to make myself look more youthful. What risks are associated with a laser facelift?

I perform CO2 laser resurfacing. This provides generalized tightening of the face and reduces wrinkles and acne scarring. The risks of laser resurfacing are infection of the skin, prolonged redness, lightening of the skin, and areas of increased pigmentation. Overaggressive laser treatment can lead to scarring as well. Following the specific postoperative guidelines which include topical applications, oral medications and avoiding direct sun exposure minimizes these risks.

I’m looking into non-surgical alternatives to a face lift. I’ve heard of two different methods. I’m a 52 year old woman. I smoked for 25 years, but I quit 10 years ago. Which procedure: the threadlift, or laser lift, would be more likely to yield the best results for me?

Recent studies have shown that the thread lift does not provide appreciable long lasting results. This has led many surgeons to abandon this procedure. I personally do not perform this operation. I do however believe that CO2 laser resurfacing provides an overall tightening of the facial skin. Many former smokers who have deep wrinkles and moderate sagging of the skin benefit from full face laser resurfacing. This does, however, sometimes cause lightening of the skin, and healing time can be just as long as standard surgical facelift.

I am a 22 year old exercise fanatic. I want to have an Otoplasty procedure done. How soon can I start exercising after my surgery?

You can start on light treadmill walking after 10-14 days, but wait approximately 3 weeks for full exercise. Ear pain will most likely be your limiting factor until then. Also, do not wear earphones or sunglasses for approximately one month.

My son is 5 years old and has very large ears that also stick way out from his head. I feel he is a candidate for otoplasty. My husband and I always tell him he is perfect just the way he is. He will start school this fall and we are concerned about the social ridicule he will most likely receive. Should we approach this surgery with him now or wait until the children start making fun of him in school?

If your son has outstanding ears but hasn’t expressed to you self-consciousness about them, I see no reason to pursue an otoplasty at this time. However, if he is keenly aware of this issue, otoplasty can be performed as early as 6-7 years of age once the ear further matures in size. If he has not shown any concern for his ears, surgery can be delayed indefinitely. A gentle way to approach the subject is to ask him if he likes his ears better “this way” while you hold them back closer to his head. No matter whether otoplasty is performed as a child or an adult, it remains one of the most satisfying, long-lasting procedures performed.

My five year old son has very large protruding ears. I know that he will endure ridicule and teasing if we do not have this corrected. I would like to know if it is safe to have an Otoplasty performed on a child and what type of anesthesia and medication will be required?

Otoplasty is one of the most rewarding procedures I offer. I usually like to wait until approximately 6-7 years of age, depending on the growth and maturity of the patient. For children, I perform otoplasty under general anesthesia as an outpatient surgery. The surgery takes approximately one and a half to two hours and an overnight dressing is placed. Oral pain medicine and antibiotics are given for several days after surgery. Adult patients may undergo this procedure in an office based procedural room. When otoplasty is performed on a child, the ears retain their shape into adulthood as the patient continues to mature.

I’m 27, and I just got engaged. My fiance loves me the way I am, but I’d like to get ear surgery to fix how far my ears stick out as a surprise. I think she would love the new look. My wedding is in nine months. Is there enough time for me to get ear surgery and be completely healed by the wedding?

You have more than enough time to undergo otoplasty and be healed before your wedding. I would recommend approximately three months of healing before your wedding, so you have a few months to make your decision. You may want to hint around to your fianc that you are serious about doing it. I believe it is better for your significant others to be aware of your intentions so that it doesn’t come as a total surprise to her.

My child is only 4, but the children at preschool make him feel bad about how much his ears stick out. It makes me very sad that he has become sensitive about his appearance at such a young age, but he has asked me why his ears are so different. He seems very upset about it. Is he old enough for an otoplasty?

I generally perform otoplasty in children a little older than your son. I would recommend wait another couple of years. His ears will be a more mature size, and he will tolerate the postoperative recovery more smoothly. Parents usually will wait until their child is in early grade school to have this procedure done.

I’m a junior in high school, and I have a chunk out of one earlobe from my earring getting caught and ripping out when I was 13. I’m very self-conscious about it, and I want it to be fixed so I can look great in my senior pictures next year. How long would I have to take off school to recover from ear surgery?

This is a relatively easy procedure that I perform in my office procedure room. It is done with local anesthesia and usually takes about twenty minutes to complete. The earlobe can be repierced after two months of healing. If you want to wear earrings for your senior pictures, plan to have your earlobe repaired at least two months prior. You only need to take off time from school the day of your procedure. You can return to school the next day, but refrain from strenuous activity for a couple of weeks.

I fly a lot for business trips. I want to get an otoplasty to fix how my ears droop at the top. My ears tend to be sensitive to pressure changes, so I experience a lot of discomfort when I fly. Will it be even more uncomfortable to fly while I recover from my otoplasty?

The ear discomfort that you currently experience is probably due to inability to equalize the pressure differential between the cabin pressure and the space behind your eardrum. After otoplasty procedure, there will be some discomfort of the external ear, or auricle, but an airplane flight should not cause an increase in ear pain. I ask my patients not to travel after surgery for at least a week. By then, most of the postoperative pain will be greatly diminished.

I’d like to get my ears pinned because they protrude very far and are mouse-like. How long does this surgery take? Is it invasive?

Surgery for protruding ears is called otoplasty. This typically takes approximately 1 1/2 to 2 hours and can be done under general anesthesia, IV sedation, or local anesthesia. An incision is made behind the ear, through which the cartilage can be trimmed and reshaped for a more desirable appearance. A dressing is placed over the ears for 1-2 days. This is a very rewarding procedure for my patients.

My ear lobes are incredibly large and I would like to reduce them by almost half. Can this be done during typical otoplasty surgery?

Ear lobe reduction is a relatively straightforward adjunctive procedure that can be done during standard otoplasty surgery. There are many techniques to reduce large ear lobes. I usually will mark the proposed earlobe edge to the degree I feel would look the best and have the patient view it in the mirror to confirm. Ear lobe reduction does not increase the postoperative healing time or discomfort.

How is incisionless otoplasty performed? Are there any scars or tissue damage after the procedure?

The incisionless otoplasty is performed by threading needles with suture through precise areas of the skin behind the ear. Once the suture is threaded beneath the skin and passed through the cartilage, it is tightened to the desired degree thereby pinning the ear back. There can be small pinpoint scars where the needle was introduced through the skin, but the amount of scar tissue is negligible.

I’m thinking about ear pinning surgery but am apprehensive because I don’t want the scarring to be noticeable. Will it be? Will I be able to wear a ponytail or will the scars be too visible?

Otoplasty incisions are placed behind the ear in a vertical fashion. There are no incisions on the front of the ear, but there may be some redness of the auricle for several days. Because the incisions are placed on the back side of the ear, I have not found this to be a problem in any of my otoplasty patients. Once adequate healing has taken place, you should be able to wear your hair in a ponytail without concern for visible scarring.

My daughter was born with really large, prominent ears that stick out. She’s only 10 but she gets teased a lot at school and she’s begging me to do something about it. Is she too young for ear pinning surgery?

Absolutely not.  Otoplasty can be performed any age after 5-6 when the ears have reached full size.  In adults, this can be performed under local anesthesia, but I would recommend performing your daughter’s otoplasty under anesthesia.

Is it better to have Mohs surgery and reconstruction performed by a dermatologist or to have Mohs surgery performed by a dermatologist and then have the reconstruction performed by a plastic surgeon?

It depends on the location and size of the defect to be reconstructed.  The Mohs surgeons I work with are very adept at reconstructing defects that they feel comfortable with.  For more complex Mohs defects, I will usually get consulted for the reconstruction.

I had a skin cancer lesion removed from my cheek with Mohs surgery and it left a big scar that’s impossible to hide. Is there any way to make it less conspicuous?

If your Mohs reconstruction was performed over a year ago, giving time for the scar to mature, scar revision could be considered.  Other options for visible scars include dermabrasion, laser treatments and sometimes an injectable filler for depressed scars.  A thorough evaluation would be required to make that determination.

I’m a 40-year-old woman and I had Mohs surgery on the tip of my nose, leaving me with missing skin. Will I ever look normal again?

Nasal tip defects resulting from Mohs surgery can vary in size, shape, and depth. There are also a variety of ways to reconstruct these defects. This includes direct closure, transferring adjacent skin (flap closure), or a skin graft. While there will be a scar in the region of the reconstruction, in most cases, the end result is a normal appearing nose.

I’m having Mohs surgery for a spot beneath my eye. After my reconstruction will I still be a candidate for a blepharoplasty?

I have performed blepharoplasty in patients undergoing Mohs reconstruction of the lid.  These are usually smaller defects that need reconstruction.  Larger defects may need reconstruction followed by possible blepharoplasty later.  If you are desiring upper blepharoplasty, this can be performed at the same time.

I’ve heard that the nose continues to grow as you get older. Is this true? I’m only 25 and getting a nose job next month and that seems like a lot of years for my nose and the results of my nose job to change.

As a person ages, subtle changes occur to the nose. The nasal skin can become thicker especially at the tip of the nose. Also the nasal tip may droop due to relaxation of the soft tissue attachments of the cartilage. This gives the appearance of the nose “growing.” Because these changes usually don’t occur until the fifth or sixth decade of life, you should retain the shape of your nose for many years after your surgery.

I have a deviated septum and would like to get this fixed. I’ve also considered getting a nose job for many years. If I get the deviated septum fixed, would this be a good time to get the nose job done? Can both procedures be performed at the same time?

A deviated nasal septum can certainly be performed at the same time as a rhinoplasty. Many patients of mine have breathing difficulties and an undesirable nasal appearance. I believe that it is best to address both problems with one operation.

I run on a regular basis and would like to know how soon after my rhinoplasty surgery that I’ll be able to get back to my usual routine? Will I have any issues with breathing while running? And what are the concerns if you start being too active too soon?

After your rhinoplasty procedure, you will have swelling on the inside of your nose that will affect your breathing. In general, you should wait three to four weeks to resume a light workout. It takes approximately six weeks for the nasal bone and cartilage remodeling to stabilize. You should avoid any strenuous activity before this time that would risk accidentally hitting your nose. Too much vigorous activity before the nose heals could result in unforeseen nasal injury and a suboptimal result.

I’m of Chinese descent and looking to get a nose job. Is it fairly common in Asian rhinoplasty to perform chin augmentation at the same time?

It is not uncommon to perform a chin augmentation at the same time as rhinoplasty in those patients who have a weak chin. Most patients undergoing rhinoplasty do not require a chin implant, but when indicated it provides a balanced profile with dramatic results.

I’m not happy with the results of my nose job and will need to have a revision rhinoplasty. I believe I’m going to need some sort of graft used and I would like to know what the difference is between artificial and natural implants and what their pros and cons are.

I always try to use a natural implant in the form of a nasal septal cartilage graft or an ear cartilage graft. Cartilage can easily be carved and shaped and used to modify the nasal tip region. Because it is your own substance, it incorporates into it’s new location with minimal complications. However, if all you need is a graft to enhance your profile an artificial graft can be safely used. Success of any graft depends on avoiding infection, avoiding undesirable visibility of the graft, and providing a natural appearance.

When I was 15 years old, I got into a car accident and broke my nose. It has been slightly askew to the left ever since. Is there any way Rhinoplasty can fix that?

Patients who have had significant injury to their nose during an accident resulting in a crooked nose are candidates for a nasal fracture repair. This is not considered a cosmetic rhinoplasty procedure, and this will be filed under your medical insurance plan. However, if you desire any cosmetic changes, such as nasal tip reduction, there may be a reduced cosmetic rhinoplasty fee with your surgery.

I am a 25 year-old female, and I have a serious hump on my nose. Can Rhinoplasty fix that hump?

Yes, that is one of the most common reasons patients schedule rhinoplasty consultations. Another common nasal deformity complaint is a big nasal tip. Also, I will evaluate the inside of your nose to see if you have any breathing difficulties that could be addressed during your rhinoplasty procedure. During the initial consultation, we will take a picture of your nose and computerized digital imaging and simulation will be performed to show you your desired changes to your nose.

The tip of my nose points way up, kind of like an elf. I’d like to fix this problem with a rhinoplasty. Can the tip be flattened without removing a lot of tissue? I think my nose would be too flat if too much was removed.

It sounds like you have an over-rotated nose that may be a little too pointed. Correction of this often involves lengthening the nose to create a less “turned up” appearance. Modification of the nasal tip mostly involves repositioning the tip cartilage rather than resecting too much, which could weaken nasal tip support. Also, placement of cartilage grafts onto the nasal tip can soften undesirable features.

I really want to get a nose job, but I can’t even manage tell my hairstylist what kind of haircut I want. How can I communicate what I want my nose to look like?

Most patients who I see for rhinoplasty consultations generally know what they do not like about their nose. For instance, the nasal bones and/or tip is too wide from the front view, or the profile is undesirable. I find it extremely valuable to perform digital image simulation during consultation to show what I think is cosmetically acceptable. Patients sometimes do not know exactly how to voice their desires, but seeing the changes available to them through imaging helps express likes and dislikes. I would encourage you to seek out a rhinoplasty consultation, although you might not know what you want. Sometimes the solution is much more straightforward than you think.

I’m 22, and I only want minor nose adjustments, so I’m interested in getting a non-surgical nose job. It worries me though, that the internet claims that these procedures take only 15 minutes. Are non-surgical nose jobs performed with less concern for precision?

Minor adjustments to the nose can be made with the use of a variety of injectables. This is intended to correct minor contour irregularities but not to impart a major change to the nose. This can only be done with surgery. Because this procedure involves the injection of a small amount of product, precise placement takes only a matter of minutes. If you want a significant, long-lasting change to your nose, I would recommend surgical intervention.

When I was younger I was playing baseball and the ball hit me right in the face. My nose was broken and has ever since been crooked and has a bump. Can rhinoplasty fix these issues? What would be done?

Patients who have had significant injury to their nose during an accident resulting in a crooked nose are candidates for a nasal fracture repair. This is not considered a cosmetic rhinoplasty procedure, and this will be filed under your medical insurance plan. However, if you desire any cosmetic changes, such as nasal tip reduction, there may be a reduced cosmetic rhinoplasty fee with your surgery.

I broke my nose once as a child, and then again at the age of 25. I’m 35 now, and seeking a nose job to repair the damage. Is it possible to do this, or is there likely too much damage? Is it a problem if too much time passes?

Yes, it is certainly possible to have your nose repaired after more than one injury and also after years have passed since the last injury. The extent of damage varies from patient to patient, and some cases are more complex than others. This can only be determined by a thorough examination of your nose. Nasal fracture repair should always address the nasal airway, and nasal breathing difficulties can be corrected during this operation.

During my rhinoplasty surgery is it possible to also get a mole removed from the right side of my nose?

Yes, that could be done at the same time, depending on the size of the mole and the goals of your rhinoplasty surgery. A thorough preoperative physical examination will confirm whether this would be possible.

I am a 15-year-old female who desperately wants a nose job. My grandmother says that I am too young for this surgery, is this true?

Rhinoplasty surgery is recommended once the nose has reached maturity. I usually recommend waiting until the junior or senior year of high school to consider rhinoplasty procedure.

I know people get nose jobs to make their nose smaller, but is it possible to make the nose bigger? My nose is really small for my face.

Most rhinoplasty procedures are to make the nose smaller, but sometimes, patients have insufficient nasal projection of either the nasal tip or the nasal dorsum.  Depending on your nasal characteristics, the nose can be augmented or enlarged using your own cartilage and/or bone or using specially made implants designed for the nose.  I would certainly encourage you to come in for a consultation to explore your rhinoplasty possibilities.

After a revision rhinoplasty surgery, how long does the swelling last for?

Revision rhinoplasty surgery can take somewhat longer to heal than primary rhinoplasty. Most of the bruising and swelling will subside after 2-3 weeks, but a small percentage of residual swelling will persist for several months. It may take up to a year for the subtle swelling to fully subside.

How long after getting rhinoplasty will the bruising and swelling disappear? My fair skin shows bruises well and I’d like to return to work without any disfiguration.

Most of the bruising and swelling after rhinoplasty will subside between 2-3 weeks after surgery.  Depending on your profession, you may return to work after the dressing is removed seven days postoperatively as long as there is no strenuous activity required.  However, if you want to safely avoid work without visible bruising, plan to take off work 2-3 weeks after your procedure.

What are the advantages of having a surgeon who is both an otolaryngologist and a facial plastic surgeon perform my rhinoplasty?

As in any surgical procedure you seek out, I advise you to choose a surgeon in your area who is experienced, provides good postoperative results, takes excellent care of their patients, and has a good professional reputation.  Patients requesting rhinoplasty surgery often suffer from nasal obstruction and/or chronic sinus issues.  As a board certified facial plastic surgeon and otolaryngologist, I always address these issues with my patients.  CT scanning of the sinuses may reveal if there are any other problems present.  If recommended, sinus surgery and nasal airway relief procedures can be performed at the same time as rhinoplasty.  This is a significant advantage in choosing a surgeon who is both an otolaryngologist and facial plastic surgeon in performing your surgery.

I have a nasal hump that I’d like to get rid of but I’m not ready for surgical rhinoplasty. Is there a non-surgical treatment option?

A visible nasal hump best seen on profile view is called a dorsal hump.  If it is small and you have a depression in the upper portion of your dorsum (called the radix), sometimes an injectable filler could improve your profile temporarily.  The fillers I use last approximately one year, but I very rarely use them for nasal contouring.  This would be only a temporary fix.  Surgery is the standard of care for correction of a dorsal hump.

Is there any way to get an idea of how my nose will look after a rhinoplasty surgery before I agree to go through with the procedure?

Yes, there is.  When patients consult with me for rhinoplasty, I always obtain digital photographs.  During the consultation, I provide simulations of the photographs on a computer software program to show the patient what I think would be an appropriate reshaping of the nose.  This not only allows the patient to see themselves with a different nose, but also to make sure that both myself and the patient have the same goals in mind.

I’m 35 and I have a large bump on my nose. I also don’t like my profile. My mouth looks small. Am I a candidate for rhinoplasty?

If you are in good health, you would be a great candidate for rhinoplasty.  In my practice, that is the number one most reason for patients desiring to have their nose reshaped.  It sounds like you may have a small chin as well.  Often patients are candidates for chin implantation, or chin augmentation.  One may achieve dramatic results by combining rhinoplasty with a chin implant.

I have a deviated septum, my nostrils uneven, and I have difficulty breathing through my nose. Can a rhinoplasty help me?

I perform a septoplasty at the same time as rhinoplasty if the patient has a deviated septum.  Also, nasal obstruction can occur due to large inferior turbinates.  These can be reduced in size to improve nasal breathing as well.  Lastly, rhinoplasty surgery should address the nostril shape and size.  A physical examination of your nose would allow your surgeon to discuss the available options for you.

I recently broke my nose in a car accident, which left my nose crooked and disfigured. Is it possible to fully reconstruct my nose to its original appearance with a rhinoplasty?

Nasal reconstruction after injury dies not guarantee that your nose will be restored to its original appearance.  For minor injuries with little deformity, chances are better that the nose will be very close to pre-injury appearance.  However, with more severe injuries, there is no guarantee that there will not be some permanent visible alteration of the nose.

Can revision rhinoplasty narrow the shape of my nostrils?

Nostrils can be narrowed during either primary rhinoplasty or revision rhinoplasty.  If the nostrils are too wide or flared,  they can be reduced in size by removing a carefully measured amount of skin from the part of the nostril that is next to the cheek skin.  This can even be performed as an isolated procedure on the nose, without performing a complete rhinoplasty.

Last year I had a rhinoplasty procedure to get rid of a bump on my nose. Now my nose indents instead of smoothly slanting downwards. Is there a way to correct this?

It may happen, that during reduction rhinoplasty, a profile hump can be over-resected and result in a depression and not a smooth appearance.  Minor indentions can be corrected with injectable fillers that can improve the appearance.  More significant depressions in the profile that give a “scooped out” look may require a revision rhinoplasty.  Often, nasal septal cartilage or auricular cartilage or a manufactured product such as Goretex can be used as grafts to augment the profile for a smoother look.

I am a 27 year old black male. As a teenager I had horrible acne. Now as an adult where the worst of the acne was has very dark scar tissue. Will dermabrasion treatments fix this?

I would consider conservative dermabrasion in very small areas of the face in very select cases in patients with no history of keloid formation. However, in my experience, I have more often performed scar revision for non-active acne scarring in African American individuals.

I have a thin scar under my lip that I would like to remove. I am a 42 year-old African American woman and I read that women with darker skin have lower success rates with skin resurfacing, is that true?

In my experience, scar revision can be very successful if the scar is widened, depressed, or elevated, even in darker skinned individuals. I would not recommend skin resurfacing as a primary treatment for scars such as this, however, but possibly excising unwanted scar tissue and performing a scar revision surgically to minimize the visibility. If your scar is minimal but you want some improvement, I would recommend conservative dermabrasion treatment.

I used to wear long heavy earrings for years. My right earlobe ripped and my left lobe is nearly torn, too. I want to wear my mother’s heirloom earrings to my daughter’s wedding, can you fix my lobes?

Yes, torn earlobes are a common problem. It is a relatively simple office procedure in which the scar tissue within the torn part of the earlobe is removed and the lobe is sutured together to recreate the natural curvature of the ear. Re-piercing the earlobe can be done approximately 6-8 weeks after repair. If you want to wear your mother’s earrings to the wedding, schedule your procedure at least two months before the big day.

I have a large scar on my upper left cheek that I would like removed. What is the process of scar revision? Is the scar completely eliminated after the procedure?

I would need to evaluate your scar to fully answer this question. However, in general, scars that are wide, elevated, depressed, or aligned in an unpleasing direction on the face can be revised. There are several techniques to revise scars that include removal of the scar tissue and meticulous skin closure. The final result is a much less visible, thin, flat scar. Scar tissue is not completely eliminated after scar revision.

I am 30 and I’ve always been embarrassed by my “Marilyn Monroe” mole on my upper lip. Can this be removed without extensive scaring?

If you are excessively concerned about your mole, the small thin scar is almost always less visible that them mole after healing.  Sometimes patients opt out of having the mole removed when they begin to see it as a personal unique trait of their face.  I always have them consider it that way…..like Marilyn Monroe!

I’m a 42 year-old, relatively fit mother of three. I lost a significant amount of weight after I had my last child. While I have done a good job of getting into shape and I’m generally happy with how my body looks, I do have some sagging skin around my neck and jaw areas that I’d like to address. Would you recommend a mini facelift for someone in my situation?

It sounds like you have excellent health and take pride in maintaining it. Most patients your age start to see that small amount of skin sagging beneath their jawline and chin, and that can be very distressing to someone who has never had that before! Nevertheless, I try to counsel my patients to start rejuvenation strategies of the face with conservative measures…good consistent skin care, minimization of lines with injectables, and adequate hydration. However, in patients with isolated neck aging, I will possibly recommend submental liposuction or a limited neck lift to correct their problem.

What is the difference between a facelift and a mini facelift? I’m 60. Will a mini-facelift do anything to reduce sagging in my neck and chin area?

I get this question very frequently. There are many variations to a facelift, from the placement of incisions to how you dissect and suspend the deeper structures, to attain and maintain a long lasting youthful appearance. A mini facelift usually has shortened incisions and less dissection of the soft tissues of the face that you want to have lifted for a very long time. My general philosophy is mini facelift-mini result…unless it is a younger patient with isolated areas to treat. I would probably recommend a standard lower facelift, which would give you a more comprehensive, long lasting result. Many patients try to cut corners and do less, while expecting the same result, but I always say “if you don’t want to do it right the first time, you will need to set aside more time to do it right later.”

I recently noticed that my neck is wrinkly and saggy. Which procedure do I need, a neck lift or a neck liposuction?

Liposuction of the neck is a good procedure in individuals that have excess fat beneath their chin and also have good skin tone or elasticity. Patients who get good results from submental and neck liposuction are usually in their thirties to early fifties. Patients who have excess skin sagging in the neck usually will require a neck lift or lower facelift to tighten the deeper soft tissue laxity and remove the excess skin to achieve the desired result.

I am really interested in neck liposuction but I am really nervous after hearing horror stories about liposuction. What can you tell me to reassure me that the procedure is quite safe?

Liposuction of the neck, also termed sub mental liposuction, is a very safe and easy procedure. I usually perform it in conjunction with other procedures, such as lower facelift. However, in young healthy patients who have only an excess of sub mental fat, this procedure alone is very effective. I usually perform neck liposuction in an office based setting under sedation, and the procedure usually lasts approximately  thirty minutes. As with any procedure you are considering, research your surgeon and their credentials. To this date, I have not experienced any serious complications from liposuction of the neck.

I’m 50, female, and I have a great body for my age. My only problems are my face and neck. I’m considering having neck liposuction and a facelift. Can these procedures be performed at the same time?

The nomenclature of these procedures can be confusing. Neck liposuction can be performed as an isolated procedure. A facelift can be performed as an isolated procedure as well, but a facelift operation includes addressing the neck in one way or another. Depending on the patient, I either perform neck liposuction or direct fat excision with platysmal muscle tightening as part of the facelift surgery. It is not a matter of can they be done at the same time. They should be done at the same time.

I’ve heard that during neck liposuction, the incision is sometimes made in the mouth. If this is done, will I have to be cautious about what I eat after neck liposuction? If so, how long?

I have always used an external incision under the chin for neck liposuction. The resulting scar is often hard to find, once healed. I do not see any benefit in making an intraoral incision. Nevertheless, I ask my patients refrain from vigorous chewing for one week to limit movement beneath the chin.

I have a lot of extra skin and fat on my neck. I definitely want to do something about it, but I’ve been having trouble finding the clarity I need: What is the difference between a neck lift and neck liposuction?

Liposuction of the neck is a procedure in which a very small incision is made under the chin and sometimes under the earlobes. The liposuction instrument can be inserted and the fat removed. I recommend this procedure in individuals who have a small to moderate amount of sub mental fat excess and good skin elasticity. Patients who have more substantial fat and skin excess in the neck require a neck lift. During this procedure, an incision is made under the chin and behind each ear in the post auricular crease. Through these incisions, fat is removed, the platysma muscle is tightened, and excess skin can be removed. Physical examination will determine which operation will best suit you.

I’m a corporate lawyer and wear a tie on a daily basis. Will I have to go without a tie post necklift?

If you have a direct neck lift performed, there will be an incision line down the midline of the front of your neck.  You will probably want to wait 3-4 weeks after your surgery to wear a buttoned shirt with a tie.  Soon after this, you will certainly enjoy wearing a tie because of your new neck contour and younger look.

Short of a full neck lift, will anything get rid of a “turkey gobbler” neck where there’s loose skin?

There is a very effective procedure called a direct neck lift in which the loose skin is removed at the site of the “turkey gobbler”.  This is more appropriate for the male patient who doesn’t mind having an incision under the chin and neck in the front.  Most patients are tired of the loose skin interfering with shirt and tie wear.  The incision heals with minimal scar visibility and avoids incisions around the ears.

I recently read that dermabrasion has pretty much been replaced by laser resurfacing. Is this true? Are there ever times when dermabrasion is a better option?

I perform laser resurfacing more often than dermabrasion, but it has not completely replaced that procedure. Laser resurfacing is valuable for treating the entire face to improve deep wrinkles and/or acne scarring. I use dermabrasion for more isolated areas, such as scar revision or perioral wrinkles.

I’m a 35 year-old white male with some significant acne scars on my face. I’m considering a skin refinishing treatment. I see you perform Dermabrasion. Can you explain the difference between Dermabrasion and a chemical peel? Are skin reactions common with Dermabrasion? What kind of results could I expect?

If you have some isolated areas of acne scarring, dermabrasion is a good method of treatment. As I have said before, deeper acne scars need to be removed before dermabrasion will provide the final optimum result. Dermabrasion is the process of removing outer layers of skin with tactile force, like sanding down a surface. A chemical peel removes those outer layers by placing an agent onto the skin that causes the outer layers of skin to peel off, leaving a fresh new layer to resurface. I personally do not perform a deep phenol peel which could help your condition, but I do perform laser skin resurfacing which I feel works well. With both dermabrasion, laser resurfacing, and chemical peels, there is a risk of skin lightening. The deeper you go, the longer it takes for you to heal, but the results are more dramatic.

As a middle aged woman, I am concerned about the skin on my face beginning to wrinkle. I know that chemical peel procedures use acids to dissolve the top layers of skin and that laser skin resurfacing does the same thing. How do I know which procedure will work best on my skin?

The procedure that is the best for you depends on your skin quality, the depth of your wrinkles, and your desired “down time”. For minor wrinkles and pigmentation of the face, I prefer the 35% TCA peel, which is performed in my office procedure room under oral sedation and takes about 45 minutes. Your skin will peel to its new fresh layer in about a week, and makeup can resume in about 2 weeks. For deeper wrinkles throughout the face, I prefer CO2 laser resurfacing. This is a procedure performed under general anesthesia as an outpatient. The skin is red for a bit longer, but makeup can be applied between two and three weeks after the peel.

I have ice pick acne scarring on my cheeks and I was told that laser resurfacing was a good option but someone else mentioned dermabrasion. Can you explain the pros and cons of each procedure?

In my opinion, laser resurfacing is a better method of treatment for acne scarring. It can more readily provide a uniform removal of the outer skin layers throughout the entire face. However, dermabrasion is very helpful in treating more isolated areas of concern. For deeper, pitted acne scars, I will often perform surgical excision of these areas several weeks prior to resurfacing to improve the overall result.

I have sunspots on my face, which are dark and patchy. Can laser resurfacing fix this so my complexion more even?

CO2 laser resurfacing is a good form of treatment for deep wrinkles and acne scarring.  It also lightens the skin and can be very effective in removing areas of hyperpigmentation.  If you have superficial hyperpigmentation and mild wrinkling and/or slightly large skin pores, you may be a good candidate for a TCA peel.  This type of peel has a shorter down time and quicker healing phase than the CO2 laser.  Laser resurfacing will certainly provide a more even complexion.

I have really bad acne scars on my cheeks and on the sides of my chin. Can laser resurfacing help to smooth out my acne scarring?

Laser resurfacing is my treatment of choice for acne scarring.  I use a CO2 laser to accomplish this.  You would be a good candidate as long as your acne is no longer active. Dermabrasion is another option for skin resurfacing, but I prefer the CO2 laser.  The most important factor in deciding to have this procedure is the healing period. It takes several weeks for your skin to heal, and you will need to avoid direct sun exposure.  I tell my patients to plan at least 3-4 weeks “down time”.

I’m starting to see fine vertical lines above my upper lip and little cracks in the corners. Can you make them go away?

I most commonly treat these lines around the lips and mouth with an injectable filler.  This usually lasts 10-12 months, although some studies suggest that fillers stimulate new collagen formation and can provide a longer result.  It takes approximately 5-10 minutes in the office setting.  For deeper lines of the lips and face, sometimes dermabrasion or laser resurfacing is the better option.

What is BroadBand Light?

BroadBand Light (BBL) is an innovative technology that sets new standards for skin conditions associated with aging, active lifestyles, and sun damage. BBL procedure delivers a flash of light to the skin, targeting pigment and small blood vessels and many other skin conditions. The result is less redness and less pigment in damaged skin.  Recent studies have shown that BBL has actually “awakened” DNA genes of youth that have become silent.

What is ProFractional Therapy?

ProFractional laser therapy is a laser treatment that creates vertical channels in the skin in only a percentage of the surface area of your face.  This allows the untreated skin adjacent to the lasered area to provide new collagen formation to improve the overall appearance.  Because only a portion of skin is treated, the recovery time is shortened.  It is effective for acne scarring and pigment and general skin texture.

What is a MicroLaserPeel?

A MicroLaserPeel (MLP) is a lighter form of laser treatment that removes a thin layer of damaged skin to improve texture and provide a more youthful appearance.  It provides superior results depending on the patient’s needs, because it can be administered with great precision of depth.  It is custom tailored to the patients specific skin conditions and desired outcome.

What is a laser peel?

As we age, the effects of sun damage and environmental pollutants take their toll on our skin, creating wrinkles and pigment irregularities, especially on our faces.  A laser peel can be very successful at reducing or eliminating these conditions, and in fact it is the best way to address the problematic lines that occur around the mouth and eyes.

What can be done when too much fat was taken out above the eyes and below the eyes?

I almost always avoid removing fat from the upper and lower eyelid during blepharoplasty to prevent these complications. Excessive fat removal from above or below the eyes can lead to a hollowed appearance.  Injection of a filler can be safely performed around the eyes to reintroduce a healthy appearing look.  I recommend autologous fat injection into the upper eyelid and brow region for hollowing in that area.  For the lower eyelid region, I try to avoid injecting fat because of the propensity for creating palpable and visible lumps over the orbital bony rim.  In selected patients, I sometimes inject a conservative amount of hyaluronic acid filler into the lower eyelid region for improvement in contour due to excess fat removal.

I am an Asian male and would like to know if there is a difference between how a Blepharoplasty is performed on an Asian vs. Caucasian?

There is a distinct difference between the technique in which an Asian upper eyelid is performed compared to a non-Asian eyelid. Many Asians seeking blepharoplasty are unhappy with the puffiness and lack of upper eyelid (or pretarsal) crease, yet most patients want to maintain their ethnic appearance. In these cases, surgery is aimed at creating the pretarsal crease in eyes that are absent a fold. In general, a minimal amount of overhanging soft tissue is removed, and the skin is then attached to the tarsal plate of the upper lid to create the crease several millimeters above the eyelash line. Minimal fat is removed to avoid westernization of the eyelid. Eyelid symmetry is of utmost importance, and patients should choose a surgeon who routinely performs Asian blepharoplasty procedures.

I am a 56 year old female and would like to have a forehead/brow lift and a Blepharoplasty done. I don’t want to have that “scared” or surprised look after surgery. How do I know this won’t happen?

First and foremost, knowledge and confidence in the surgeon that you choose is the most important step in achieving your desired goal. When combining upper eyelid surgery with brow lift, it is important to elevate the brows to the desired position and not to remove too much upper eyelid skin, which could impair eyelid closure and/or create a hollowed out look. I feel that a softly arched brow with lateral enhancement along with upper eyelid skin positioned several millimeters above the eyelashes looks the most pleasing. In my experience, I have not had a patient complain of their eyebrows pulled too high. As in any other cosmetic procedure you desire, ask your surgeon to show prior patient before and after pictures.

What is the difference between a brow lift and blepharoplasty?

A brow lift is a procedure that elevates your eyebrows to create more distance between your brows and upper eyelids. There are several ways to perform this procedure (I almost always do endoscopic brow lifts). Blepharoplasty procedures are surgery of the eyelid, either upper or lower, in which unwanted skin and soft tissue is removed or repositioned to give a more rejuvenated appearance. Many times, patients are candidates for both brow lift and blepharoplasty to achieve the desired result.

I am a 72 year old lady and my eyes are sagging. My eyelids basically cover my eyes. Can Blepharoplasty help an old lady like me?

Upper eyelid blepharoplasty is a very safe and effective surgery in patients your age. As long as you have no serious medical conditions that would preclude you from the procedure, such as requiring constant blood thinning medications, this procedure will benefit you immensely with minimal down time and virtually no postoperative pain.

I am both near sighted and far sighted and have poor vision. I am getting eyelid surgery on my top eyelids. How long after having Blepharoplasty, can I wear my contact lenses and glasses?

Glasses can be worn immediately after your surgery, but not so for contact lenses. The soft tissue swelling of the upper eyelid can impart a minor change in the shape of your cornea. This sometimes creates a suction cup effect, inhibiting removal of the contact in the eager patient! I like to wait two weeks postoperative to allow contact wear, and I have the patient put them in and take them out while in clinic to ensure safety.

When I was 22 I was in a punk rock band and I got smashed in the face with a guitar. Ever since my eye hasn’t been the same and has looked droopy. I’s only gotten worse with age. Is there a way that Blepharoplasty can fix my eye?

I would need to evaluate you before making a recommendation, but it sounds like you may have either a dehiscence of the muscle that elevates your eyelid, or excessive scar tissue that is impinging eyelid elevation. I perform repairs of both of these conditions, but I doubt simple blepharoplasty will fix your problem. Another possibility is that you sustained a bone fracture around your eye that may need to be addressed. The periorbital region is very complex and requires thorough evaluation.

I did some research on Blepharoplasty. It says that you can modify an eye lid and that excess tissues and fat can be removed. Can you do that for anyone at any age? I’m only 27 but I’ve always felt like my eyelids looks puffy and unattractive.

You are a little young for eyelid surgery, unless you want to change your ethnicity, such as Asian eyelid surgery. It sounds like you have a heredity for heavy eyelids. In the next two decades of your life, you may notice aging changes of your face that may change immensely. I have seen individuals become very thinned out on their face after an early adulthood of fullness, and vice versa. My advice to you…do not have surgery on your eyes right now.

Will my eyes be bothered by contacts after I have eyelid surgery?

I ask my patients who wear contacts to avoid wearing them for 2-3 weeks after upper and/or lower blepharoplasty. I do not want any pulling or stretching of the upper or lower eyelids after surgery. Also, the temporary swelling of the conjunctiva of the eye interferes with proper fitting of the contact.

Four years ago I had a blepharoplasty procedure and I loved the results. Within the last couple of months, however, I’ve noticed that the area around my eyes has begun to look like it did pre-surgery. Would you recommend a second eyelid lift?

Most patients who seek a repeat blepharoplasty procedure will have had prior blepharoplasty approximately 10-15 years prior. Sometimes, if there is a return of excess skin, or sagging around the eye, this can represent a soft tissue depletion that can be improved with volumetric enhancement in the form of an absorbable filler or autologous fat.

I wear a lot of heavy make up for my job as a cocktail waitress. How long after my eyelid surgery will I be able to wear my eye makeup again?

After blepharoplasty procedure, I usually allow makeup wear to resume about 10 days after surgery. The sutures are removed after one week, and the topical ointment is discontinued. Makeup can be resumed several days after this.

I am 30 and I’ve always been embarrassed by my “Marilyn Monroe” mole on my upper lip. Can this be removed without extensive scaring?

If you are excessively concerned about your mole, the small thin scar is almost always less visible that them mole after healing.  Sometimes patients opt out of having the mole removed when they begin to see it as a personal unique trait of their face.  I always have them consider it that way…..like Marilyn Monroe!

Is there any permanent non-surgical procedure for under eye puffiness?

If your puffiness is from excessive fat, no.  This is a surgical matter.  However, I have seen lower eyelid puffiness as a result of untreated allergies, fluid retention, and other medical conditions which has responded to treatment from your primary care physician.

I have deep frown lines between my eyebrows that I’d like to fix, but I am worried about the toxicity of the chemical fillers. What are the long terms effects on health and skin after using these injectable fillers?

I almost exclusively use injectable hyaluronic acid (HA) fillers in the face.  There are several products available which work well.  This is composed of a naturally occurring substance found in the skin and is not made from animal products.  Although mentioned as a potential risk, I have never seen an allergic reaction to this product after injection.  There are studies which suggest that this type of filler stimulates collagen formation which is desirable in long-term reduction of wrinkles.  This is an absorbable filler that lasts approximately 10 months.  I know of no long term deleterious effects after injection of HA fillers.

I just turned 50 and my upper eyelids droop so much that I cannot wear eye shadow and other makeup looks silly. I’m interested in eyelid surgery but I don’t want to have permanent scarring. What results can I expect?

Upper eyelid surgery remains one of the most common facial cosmetic surgeries performed in the United States every year.  The vast majority of patients report exactly what you are saying.  Removal of the extra eyelid skin that you are unhappy with will restore visibility of your eyelid platform for successful application of eye liner and eye shadow.  Patients who consult with me will have their digital photos taken and will be shown their simulated results on computer.  This greatly helps in patients understanding the expected results.

As I’ve hit my 40s, I’m starting to notice bags under my eyes that makes it look like I’ve got dark shadows there. What can be done about it?

As one ages, the soft tissue of the face starts to sag and also lose its thickness of the layer of fat under the skin.  With the lower eyelid and cheek, there can develop a separation between the cheek fat due to sagging, and prominence of the lower eyelid fat, leaving a groove between the eyelid and cheek.  A non-surgical way of addressing this is with an injectable filler that can fill in the gap between your lower lid and cheek.  This can work very well in experienced hands.  A more definitive way is with lower eyelid surgery and/or a mid-face lift.

Would an eyelid lift change the amount of upper lid showing when my eyes are open?

Of course.  That is the goal of upper eyelid surgery, or blepharoplasty.  Removal of the excessive upper eyelid skin results in improved visibility of the eyelid platform which would better show your eye shadow and lash lines.  Care is always taken to not remove too much skin and soft tissue which could result in a hollowed appearance of the upper eyelids.

I know most who get eyelid surgery have it performed when they’re older. I’m only in my 30s but I’ve already got a hooded, puffy appearance to my upper eyelids. Should I wait?

I have performed upper eyelid blepharoplasty in patients in their 30’s.  It is not very common, but if you have a familial trait that bothers you, it is a very easy procedure to have done.  In my view, the sooner you do it, the more years you will enjoy the results.

Would Botox take care of the really bad crows feet around my eyes?

I often inject Botox into the crows feet area in both younger and older patients.  However, if you have a lot of excessive skin around your eyes in this area, you may be a better candidate for upper and/or lower blepharoplasty surgery.  For prominent crows feet, Botox will lessen but probably not eliminate the lines present.

I’m 54 years old and I’ve had dark bags under my eyes for a long time now. Will a blepharoplasty help to completely remove the bags?

Darkening of the skin under the eyes can be due to shadowing from overlying fat, or pigmentation of the skin from a variety of causes.  Often, addressing the fat during surgery to smooth out the bags will eliminate the shadowing effect, providing an acceptable appearance.  However, in patients who have persistent darkening under the eyes, I will offer phototherapy treatments to treat the pigment problem.

Is it possible for my eyelids to droop back to their original position after an upper eyelid blepharoplasty surgery?

The aging process continues in everyone.  After upper eyelid surgery to remove extra skin, eventually the skin redundancy will recur.  Patients who seek another blepharoplasty surgery will usually have had their initial procedure around 10 years prior.

I’m having Mohs surgery for a spot beneath my eye. After my reconstruction will I still be a candidate for a blepharoplasty?

I have performed blepharoplasty in patients undergoing Mohs reconstruction of the lid.  These are usually smaller defects that need reconstruction.  Larger defects may need reconstruction followed by possible blepharoplasty later.  If you are desiring upper blepharoplasty, this can be performed at the same time.