Plastic Surgery Frequently Asked Questions

I keep hearing about something called finesse rhinoplasty. What is this?

Q) I keep hearing about something called finesse rhinoplasty. What is this?

A) Finesse rhinoplasty refers to a surgical procedure on the nose where very, very minimal changes are made. This type of surgery received its name because the changes are very specialized and also they need to be performed in a very skilled and meticulous manner to get a good outcome because the change desired is very, very subtle.

My 15-year-old daughter has been asking for a nose job.

Q) My 15-year-old daughter has been asking for a nose job. I, however, do not feel it is appropriate for someone her age to have such a serious cosmetic procedure. What are the risks of a teen having this kind of surgery?

A) Risks for cosmetic rhinoplasty in a teenager can be divided into two groups: the physical complications of the surgery and the psychological complications. The physical complications of the surgery are the same as complications that can occur with any rhinoplasty procedure, including failure to correct the deformity, collection of blood in the skin, infection in the skin or trouble breathing afterwards, just to name a few. The psychological component may be different in a teen depending on the maturity of the teen. If they are not fully psychologically developed, they may not be able to withstand the psychological changes that occur in having such surgery. The self-image will change as well as changes in appearance and their relationship with peers and how they think of themselves. Therefore, it is very important to consider both of these factors and make sure that a patient in the younger age group is mature enough and psychologically ready to undergo rhinoplasty. If not, it is wise to delay the procedure for a few years.

After a recent boxing injury in which I took a severe blow to the nose, I've had trouble breathing.

Q) After a recent boxing injury in which I took a severe blow to the nose, I've had trouble breathing. Will a rhinoplasty procedure fix this problem?

A) Breathing trouble in the nose after traumatic injury to the nose is very common. It is best to examine the nose and see what the cause of the problem is. If the nasal bones of the nasal septum are deviated, septorhinoplasty surgery may be needed. However, if there is a lot of soft tissue swelling in the nose, it may be hard to tell whether or not surgery is indicated. So, it is best initially to wait and see if things improve. Quite often if the nose is broken, at the time of the break the person himself or a coach may try to re-set the nose, they may go to the nearest emergency and have the nose re-set which may prevent having trouble breathing after the procedure. Rhinoplasty alone, in general, is used to improve the aesthetic appearance of the nose not to fix the breathing problems.

My nose bothers me all the time. From a profile view it looks like it has been pulled down.

Q) My nose bothers me all the time. From a profile view it looks like it has been pulled down. I'm not sure if this is what is called under projected or not. I know that rhinoplasty can decrease the size of a big nose, but can it lengthen it as well?

A) With modern techniques in rhinoplasty, the projection of the nose or how far it projects can be changed. The nose can also be re-balanced to make a larger nose look more symmetrical and appear smaller. Rhinoplasty procedures can also be done to lift the nose. It is important to identify what the deformity is to decide on what needs to be done to balance the nose. The most important things for nose are balance, symmetry and harmony. Balance of the nose refers to balance with all the structures of the nose in the right proportion to each other. Harmony means in relation to the nose, to the face and proportion making sure that everything is the right size.

My husband has a nose that seems to push over to one side.

Q) My husband has a nose that seems to push over to one side. It doesn't bother me but seems to bother him. I constantly see him pushing it over to the other side. I'd like to give him a nose job for our anniversary present, a rhinoplasty surgery for his nose.

A) Rhinoplasty is very good at straightening a twisted nose. These problems can be difficult to correct but with an accurate diagnosis and modern techniques, the nose can be straightened. Your husband is trying to straighten his nose himself, but it is very difficult without a surgical procedure to actually move the nasal structures in a permanent way. Congratulations on your anniversary.

Can a nose that is too narrow cause difficulty in breathing?

Q) Can a nose that is too narrow cause difficulty in breathing? My 6-year-old daughter has trouble breathing through her nose when she is breathing heavily.

A) It is very important for a surgeon specializing in rhinoplasty to also have knowledge of the anatomy and the different things that can affect the child. Quite often in the pediatric age group it is important to consider the tissues at the back of the nose called adenoid. This tissue can obstruct the nose and can cause nasal obstruction. Also in this age group, it is important to examine the mouth to make sure the tonsils are not large. These may cause snoring or in some cases sleep apnea. The other area to examine is the nasal mucosa. Any allergies can also cause swelling of the nasal mucosa which can lead to some obstruction of the child's nose.

I had a nose job a couple of years of ago and I'm satisfied with the shape although the nostrils do not seem even.

Q) I had a nose job a couple of years of ago and I'm satisfied with the shape although the nostrils do not seem even. Should I have this corrected or just forget about it?

A) Human beings are not perfectly symmetrical. In fact, if you take a picture of any person and use a symmetric algorithm on the computer, you can see that almost no one has a perfectly symmetrical face. In fact, what's more important, a face that looks perfectly symmetrical on a computer also has a very unnatural appearance. Slight asymmetries in the face and in the human body are normal. If there is a minimal nostril asymmetry and you're happy, nothing further need be done.

I'm an African American female and I'm in my mid-60s.

Q) I'm an African American female and I'm in my mid-60s. I've been doing my research about the mini facelift. I'd like some more information on this process. What is the recovery length? What kind of anesthesia will be used?

A) In facelifting, there are many different types of surgery performed as a facelift. In recent times, the mini facelift has become very popular. It generally involves smaller incisions, and the advantage of this is less anesthetic, quicker recovery time, less bruising and also less cost. However, the trade off maybe that the result does not last as long as the complete facelift. Depending on the procedure, the anesthesia can very. Local anesthetic techniques with IV sedation maybe used.

While it's still a little early for me to be scheduling anything, I think it's safe to say that I want to have a facelift and probably a neck lift within the next two years.

Q) While it's still a little early for me to be scheduling anything, I think it's safe to say that I want to have a facelift and probably a neck lift within the next two years. I'm currently 52 and I'm experiencing sagging and hanging in those areas. I don't really have the time now but when things slow down a bit this is something I plan to do for myself. Now, I'm in a research mode. There are so many plastic surgeons out there, I want to make sure that I choose someone who is extremely qualified. What board certification should I be looking for in a surgeon? Should I ask for referrals from patients? Is there some kind of database to go to to evaluate the surgeon's expertise and qualifications?

A) It is very important to find the right surgeon that works for you. There are surgeons who perform surgery on the face and they usually have residency training in either plastic surgery or otolaryngology, head and neck surgery. After this, they go on to specialize this practice and may have a period of training with another surgeon. In addition, the surgeons may go to various courses to keep up on the newest techniques. It is important to make sure that if you're having a surgical procedure it is performed by a surgeon. Surgeons should have board certification from either the American College of Surgeons or the College of Surgeons of Canada or some other body depending on where in the world the surgeon practices. After this, it is important to make sure that the surgeon continues to keep his knowledge upgraded and demonstrates that his knowledge is up to date. The American Board of Facial Plastic and Reconstructive Surgery offers very rigorous examination and evaluation of surgeons and finding someone certified by this may be a good choice for your procedure. Patient referrals are also very good. However, if the surgeon is giving you the referral of the patient, it is unlikely that this surgeon will give you someone who will not speak favorably of them. So this has to be evaluated carefully. It is also important to go to the surgeon's website and examine their philosophy and get a sense of the surgeon. After this, the next step should be to narrow them down to two or three people depending on your time and your inclination, and then actually visit the surgeon's office and speak to the surgeon. Sitting and talking to the surgeon is probably one of the best ways to understand them and whether or not they will be the best person for you. It is also important to remember that there is not just one surgeon in the entire world who can perform the procedure so you will be able to successfully narrow it down to a small group. Choose the one that is best for you. It is also important to remember that you may have a long relationship with this surgeon and, as such, you should make sure that you like the surgeon.

How high an SPF should I wear on my face when we're there and what other precautions should I take with regards to sun exposure?

Q) I'll be having a facelift in September. My husband and I usually spend the winter, December to May, in Southern Florida and I know I'm supposed to limit my sun exposure after surgery. How high an SPF should I wear on my face when we're there and what other precautions should I take with regards to sun exposure?

A) SPF, or sun protection factor, is a formula to calculate how well the sun is blocked. This is very important not just for after surgery but also in the long term to prevent your face from aging and showing photo damage. In general, I would like to recommend an SPF of 30. This is very powerful and will block the sun. I also would like to state that the sunscreen that blocks UVA and UVB is to be used on the face. Also, when you're out it's best to use a hat and to avoid being out too long or getting burnt. These are good practices for everyone.

Twenty-five years ago when my mother was 50 she had a facelift.

Q) Twenty-five years ago when my mother was 50 she had a facelift. She was pleased with the results and did look younger after the surgery. However, while I never would have told her this, I think she did look a bit pulled and unnatural too. She also had a lot of postoperative pain and swelling that lasted for several weeks. What kind of changes have been made in surgical technique over the past quarter century? I'm the age my mother was when she had a facelift. Should I expect better results and an easier recovery if I decide to have a facelift?

A) Over the last 25 years there has been a remarkable breakthrough in the face-lifting procedures. The level of the dissection has changed and now the surgeon has a choice of many different planes. For example, a facelift procedure that is done very close to the bone or subperiosteal dissection may lead to a lot of edema that lasts for a long time, whereas in the more superficial plane they may have less edema and recover more quickly. Also, using techniques to suspend the underlying tissues the result may be longer lasting. There's also a better knowledge of the vectors of pull or how the skin should be draped to have a more natural result. There's also been an increasing use of endoscopic techniques so that the minimal incisions can also be used with the face-lifting procedures. Also, the anesthesia and general care of the patient is also improved and the monitoring of the patient is also improved to make this a very effective and safe procedure.

I am a 27-year-old male who's considering otoplasty.

Q) I am a 27-year-old male who's considering otoplasty. I'm wondering if the procedure would leave noticeable scars. Where are the scars located? What can you do to try to conceal the scars?

A) The scars of otoplasty are not noticeable. They're located behind the ear. During the surgery, techniques are performed so that when the incisions are closed the scar is as fine as possible. Also, there is little pinching or pulling as there is a minimum amount of tension or pulling on the skin when it's closed so the skin drapes nicely and minimizes the scars.

Is it possible to have my earlobes reduced in size during otoplasty?

Q) Is it possible to have my earlobes reduced in size during otoplasty?

A) During otoplasty, earlobe reduction can be done with great results. Often, however, this may not be necessary and after the ear has been repositioned and placed in its proper relationship to the side of the head, with the cartilages in the ear properly modified, earlobe reduction may not be necessary.

Is it safe to go diving after otoplasty?

Q) Is it safe to go diving after otoplasty? I had my surgery five months ago and recovery is doing great. I'll be leaving for a honeymoon in a few weeks and I'm wondering if I can go scuba diving. Do you think it will be safe?

A) Five months after an otoplasty everything should be healed and provided there are no complications, everything is fine. It's very safe to resume your normal activities including scuba diving.

Is there some sort of procedure that can give more shape to the upper lip, more of a Cupid's bow shape?

Q) Is there some sort of procedure that can give more shape to the upper lip, more of a Cupid's bow shape?

A) The shape of the upper lip can be modified quite well using injectable fillers. It can give a full and very pleasing appearance to the upper lip.

What is a lip lift?

Q) What is a lip lift?

A) A lip lift is a procedure where incisions are made usually directly under the nose to elevate the position of the lip. It is important to make sure that this is not done too excessively as the upper and lower lip may not meet. It's also important to make sure that what is needed is a lip lift and not an increase in the volume of the lips.

How does your practice decide whether to use human or bovine collagen for lip augmentation?

Q) I've been doing research on collagen treatments for the lips. How does your practice decide whether to use human or bovine collagen for lip augmentation?

A) My general philosophy for all procedures is to use natural tissues. My first choice is always using tissues in the patient's own body. If this is not available, my next choice is to use naturally derived tissues that have been treated in a way so that they do not generate any immunological response with no potential for autoimmune problems and also minimize any risk of any infectious disease being transferred. Therefore, I'd like to use materials that are injectable that are non-allergic and non-immunologic.

My neck looks really lumpy since my neck lift.

Q) My neck looks really lumpy since my neck lift. Is this just part of the healing or will it get better?

A) After neck lift sometimes there are some irregularities. It's important to let the neck heal and to allow the tissues to regenerate and to redistribute well.

If a neck lift is performed along with a chin implant, what would be the benefit?

Q) If a neck lift is performed along with a chin implant, what would be the benefit?

A) The incision for the neck lift is in the same position for a chin implant so it's easy to use the same incision on both procedures. The neck lift can be performed using an endoscopic method which is less invasive than other techniques requiring neck and chin incisions to manipulate the neck muscles. The type of technique is based on the problem and what is most appropriate. Endoscopic procedures are used when very minimal changes are needed and this works well. A more traditional procedure may be used if more work is needed to bring the neck to the upper position.

In your opinion which procedure is most effective in shaving years

Q) In your opinion which procedure is most effective in shaving years off a midlife male's appearance, a neck lift or a facelift?

A) This really depends on the patient. A general facelift is very good at rejuvenating the face. However, many males in their midlife just have a sagging neck and if this is corrected they often appear much younger.

Would Juvederm injections in this area fill it up?

Q) The area of my face surrounding my nose is very sunken and hollow. Would Juvederm injections in this area fill it up?

A) Juvederm is a hyaluronic acid filler which is very good for restoring volume. There are a number of options ranging from craniofacial surgery, which is very aggressive depending on what the actual defect is in the midface, to injectables. Injectables are good options because they are quick, safe and do not require major surgery.

I am a 24-year-old male with a crooked smile.

Q) I am a 24-year-old male with a crooked smile. Can injectable fillers such as Juvederm be used locally to straighten my smile?

A) What is the cause of the asymmetry to your smile? If it is related to a nerve or a muscle, Juvederm may be good at improving the appearance at rest. However, when the person is animated or smiles then the asymmetry there may be seen. If the problem is just part of the soft tissues that are involved in your smile mechanism and one side of the face is a little bit thinner or have atrophy, then a filler may be of benefit. The needles used for injectable fillers are very, very small. Also, many different techniques are used to make sure that the pain is minimal and the needles are tolerated well by the patients.

With all the injectable fillers available

Q) With all the injectable fillers available, what factors should I consider when choosing treatment for my problem?

A) New fillers are coming out on the market on a regular basis and it's very complex to know which filler is the most appropriate. Things to consider with the fillers are whether or not they are permanent, whether or not they are long-lasting or whether or not they are short and temporary. You also want to consider the type of filler and if this filler is used for fine lines or deeper lines.

I can't breathe well through my nose, can you fix this?

Q) I can't breathe well through my nose, can you fix this?

A) Septorhinoplasty is a very good procedure to fix breathing through the nose and also to improve the aesthetics of the nose. Surgeons with a background in the functional aspects of the nose take particular care to make sure that when the changes are made to the nose there are also changes to preserve the breathing and in many cases enhance the breathing.

How do I know if I'm a candidate for rhinoplasty?

Q) How do I know if I'm a candidate for rhinoplasty?

A) If you are unhappy with the shape of your nose or have trouble breathing from your nose, you're a potential candidate for rhinoplasty. With many recent events in rhinoplasty, very good results can be obtained to improve both the breathing and the appearance of the nose.

How old do I have to be to have a rhinoplasty?

Q) How old do I have to be to have a rhinoplasty?

A) Two things come into consideration in determining the age of the rhinoplasty patient. The first is the character of the nose. If the patient is very, very young, the nose maybe small and the actual surgery may be very difficult to do. Also, in younger patients who are growing, the growth of the nose may be changing and surgery and the final appearance of the nose may be adversely affected by the growth. The second aspect of the rhinoplasty surgery is the psychological aspect. Changing the shape of your nose changes the appearance of your face and it may change your body image and your perception of self. The patient has to be able to handle this in a mature and intelligent fashion. The patient also may view themselves differently and people around them may view them differently after rhinoplasty, so they must be able to handle these psychological aspects. The patient also must be able to handle the postoperative period with the bandages and the potential swelling of the nasal region. In general, the time when rhinoplasty can be performed successfully taking these two major factors into account is usually in the teenage years. However, for patients with cleft lip or other special circumstances, rhinoplasty may be performed sooner.

How long does a rhinoplasty take?

Q) How long does a rhinoplasty take?

A) The surgical procedure of rhinoplasty takes a few hours. The exact length of time depends on how the procedure is done, whether or not an excision is made outside of the nose or whether or not all the incisions are on the inside of the nose, and exactly what needs to be done.

What is the recovery length for rhinoplasty?

Q) What is the recovery length for rhinoplasty?

A) The recovery period is generally well tolerated by most patients. Patients may have some swelling of the nasal region and some bruising under the eyes which is generally improved in the first week. Quite often a cast is placed on the nose and this is also removed in one week. If the patient has any stitches in the bottom part of the nose on the columella, these are usually removed anywhere from four to seven days. The final appearance of rhinoplasty takes longer to be achieved.

What kinds of questions should I ask a potential rhinoplasty surgeon?

Q) What kinds of questions should I ask a potential rhinoplasty surgeon?

A) It's important to ask the surgeon what experience they have with rhinoplasty. Because rhinoplasty is a very complicated operation, it's best to seek out a surgeon with a special interest in rhinoplasty. It's also important to ask the surgeon what their qualifications are. The surgeon should be board certified by recognized organizations and should be in good standing with these organizations. Quite often a great deal of this information can be obtained by visiting a surgeon's website.

Can I have other cosmetic surgery at the same time as rhinoplasty?

Q) Can I have other cosmetic surgery at the same time as rhinoplasty?

A) Rhinoplasty can be performed with many other procedures. This is very convenient and avoids patients having multiple anesthetics. Quite often having multiple procedures at the same time is also more cost effective than having them at different times.

Chin Augmentation ~ Results you can Expect?

Q) a list...telling advantages of a chin implant for augmenting. my chin is so lacking in definition!

A) Mentoplasty or chin implant can improve the profile. In patients with a chin asymmetry or retruded chin, an implant offers an opportunity for profile improvement. Other methods to achieve this could include orthognathic surgery (jaw surgery) and this may be the best method if serious malocclusion is present.

The best method to choose the correct chin procedure for you is to visit a surgeon who performs this procedure and to discuss your options. Best of luck.

Are There Surgeons Who Specialize in African American Rhinoplasty?

Q) Are there surgeons who specialize in African American rhinoplasty? If so, how do I verify that they have a lot of experience with doing nose surgery on African Americans, or is it rude to ask?

A) The great news for patients today is that there are many excellent surgeons throughout North American excellent training and with extensive experience in rhinoplasty in patients of African origin. It is best to ask the surgeon this directly and also ask to see the results.

Non-surgical Nose Job Procedures to Reduce Nose Size?

Q) Are there any non-surgical procedures to make my nose smaller, or is surgery my only option?

A) Most people who want a smaller nose are really saying they are not happy with the balance and proportions of the nose. Injecting a filler agent (the "liquid rhinoplasty") adds volume to the nose and is great for some deformities. Consult a surgeon with experience in surgical and non-surgical options to decide what is best for you

Juvederm Bruising in Toronto

Q) I had restaylne in the past and it really bruised. the bruises lasted over 3 weeks!! Is juvederm similar in that I will get bruising from the injection?

A) Any needle that penetrates the skin can cause bruising. Placement of the needle and injection technique are important to minimize this problem. Avoid any medications that may promote bleeding (ASA, NSAIDS etc.) Many injectors advocate arnica montana (available at health food stores) to reduce the chance of bleeding.

Facelift Without Surgery

Q) What's the best procedure that works like a facelift with minimum fuss? I am 52 years old and have decided that I want to improve the look of my face. My choices are filler injections or the new signature lift, which takes about 90 minutes. After reading some of the reviews on the injectables, I am a little apprehensive. I have a wedding to attend in July and I want to look my best. Can someone please let me know about the best procedures that I can do that does not require general anesthesia, with minimal down time and allows me to look like I had a facelift?

A) A surgeon with expertise can guide you on the best options for facial rejuvenation. Each case must be considered unique. You may require filing of lines or restoration of volume or skin tightening. The exact approach for you will determine the nature of the procedure you require.

Can a Non-surgical Nose Job Make my Nose Bigger or Wider?

Q) Is there a way for the non-surgical nose job to make your nose bigger or wider? I ask this because as a man, I feel my nose looks weak for my appearance, and I am wondering if this procedure can help me out.

A) Adding filler to the nose can make the nose wider and bigger. However, what most patients desire is a balanced nose in harmony with the face. An accurate assessment of your nose and face (including chin) is the best step to determine how to achieve your goals.

How Much Does a Facelift Cost?

Q) I cant seem to find any where how much it costs to get a facelift. can the doctors give me estimates or ranges of cost to expect from a traditional face lift please?

A) Depending on the country and surgeon the cost of a Facelift can vary widely. The range is $5000 -$15000+. The cost may or may not include laser resurfacing and other ancillary procedures. Make sure you compare apples to apples, if you decide to shop around

How Much Does Juvederm Cost?

Q) What is the Cost of Juvederm? Are Juvederm injection prices expensive?

A) Generally prices range from $400-$800. However, it is more important to find an experienced injector who can accurately place the filler for maximal effect. If the price is low, but the injector needs twice as much to gain the desired effect or does not create the look you desire, the cost may be too high.

How young is too young for a rhinoplasty

Rhinoplasty is a surgical procedure to reshape the nose.  Many young patients may arrive at the office to learn about the procedure.  The age range of the patients seeking this procedure is trending lower.  This is a function of our society and the age in which patients begin to take great care in their personal appearance.

From a surgical standpoint two important considerations determine when a rhinoplasty should be performed.  The first consideration is the physiology, growth and development of the nose.  The second is the psychological maturity of the patient undergoing the procedure.

The nose completes most of its growth generally by age 15 in women and age 17 in men.  To operate on the nose at an earlier age may affect growth and development.  However, not all patients are equal, and it is best to look at other characteristics of puberty and maturity to correlate with the nasal growth to estimate when the maximal growth is complete.

The psychological maturity is a much more difficult factor to assess.  We all know that our thinking as a 17 year old is much different than our thinking as a 30 year old. In most places consent can be legally obtained from a 16 year old.  However, a surgeon is ethically bound to a much higher standard.  It is best to take a careful history and make sure that the client fully understands the surgery, along with the risks and benefits.  Consultation with the parent and also alone may be beneficial.   The history should also carefully rule out Body Dysmorphic disorder (abnormal preoccupation with body image), early onset depression or schizophrenia or any other emerging psychological condition.  If this is suspected in the history, a prompt referral to a psychiatrist for further evaluation may be beneficial prior to considering any surgical procedure.  The surgeon must assess how the patient will tolerate the immediate post operative procedure with a potential for pain and discomfort.

Narrowing the bottom of the nose

A frequent complaint in my office is that "my nose is too wide at the bottom".  The patient frequently refers to the nostrils (or more correctly the "nasal ala") and wants these narrowed.  This is possible with alar base reduction techniques.

The first step is to determine if this procedure is indicated.  The nose may be out of proportion due to a low dorsum, or disproportion of the nostrils with the other surrounding structures.  The patient may require a different procedure to balance the nose and make the bottom of the nose "fit" with the face.

If it is determined that the alar base is too wide, the next step is to determine the best method to narrow the base.  There are a variety of procedures to narrow the base.  Many different incisions may be used to place an incision in a place where it will be inconspicuous.  However, all incisions leave scars.  It is not possible to make an incision without leaving a scar.  The skill involves placing the incision so the scar will be least visible.  Only the most experienced surgeons in rhinoplasty should consider this procedure.  The results can seriously deform a nose and after completion this is a difficult problem to correct.

Alar base complications with complaints from patients having had this done is one of the commonest problems I see in the office.  If not completed by someone with experience in this area the results can be very unsatisfactory.  Frequently I counsel patients not to have this done since the initial diagnosis is not correct.  Often a better solution to the aesthetic challenge the patient is facing will give them a result they will be happy with.  Patient coming to my office after having this procedure looking for a revision are often unhappy to hear that I cannot improve the appearance.  They will have to live with the result.

How do you decide when a nip and tuck is just not the right thing to do?

Cosmetic plastic surgery is unique in the field of medicine.  By definition, the procedure does not need to be performed, it is purely elective.  This central tenet means that the safety, quality and results associated with the procedure are of the highest standards and all pain minimized.  Another unique aspect of cosmetic plastic surgery is often underappreciated.  For a patient to undergo a surgical procedure with significant cost and some pain involved, they must perceive some benefit. In the case of a patient undergoing a cancer operation the benefit is clear, the surgery will save your life.  In the case of a patient undergoing a procedure to repair a broken nose, the surgery will allow the patient to breathe.  In the case of a cosmetic patient the benefit of surgery is more abstract.

Cosmetic surgical patients are willing to undergo the cost, pain and time involved for a procedure because they hope to feel better after the procedure.  The patient hopes to undergo a change in their state of mind based on altering their physical appearance.  This is similar to when a patient goes to the gym to exercise or begins a diet regimen. The cosmetic surgeon is using surgical tools to affect a psychological state.  A state of well being, improved self esteem, and confidence can all occur from cosmetic surgery.  However, because cosmetic surgery in its essence changes a state of psychological being, patient selection is important.  Certain patients may have psychological challenges that make cosmetic surgery not the best choice to address these concerns.

How can the patient identify if they are probably not suited for a cosmetic procedure.  All human beings are imperfect.  It is natural to want to improve a flaw, but we all understand that we cannot change everything, we cannot improve everything.  If you are spending a great deal of time looking and thinking about a certain imperfection or body part flaw this is a sign to pay attention to.  If this perceived imperfection is changing the way you dress to conceal the flaw or the way you live your life, this is a warning sign. Patients should be very careful to consider the impetus for the cosmetic surgery.  The best cosmetic surgeon is not going to help you save a failing marriage or revitalize a flagging career.  The patient and surgeon should be honest about what the surgery can, and more importantly cannot achieve.

The best way to address your concerns is to visit the surgeon and freely express your doubts and fears.  The experienced cosmetic surgeon will be able to determine if cosmetic surgery is right for you or whether you may be best helped by other interventions.  The surgeon's primary concern is your psychological well being, if that is improved by surgery or some other means the surgeon will happily refer you to the most appropriate person.

When do I need a chin implant?

Mentoplasty or chin reshaping is a procedure to change the profile of the chin.  This procedure may be frequently combined with a rhinoplasty (nose reshaping) to enhance the patient profile.  In order to understand if you could benefit from such a procedure you need to understand some basics of the science of how your teeth fit together (dental occlusion).

When a patient comes to the office seeking a change in the appearance of the chin, the first step is to assess how the teeth fit together.  The chin may be understood as the front part of the mandible, which holds the teeth.  If it is in very forward or very retruded position, the teeth may similarly be placed in an unfavorable position.  Depending on how unfavorable and any other dental issues, this may need to be corrected.

If the dental occlusion is satisfactory and a cosmetic change in the chin is all that is required a chin implant may be a very effective method to improve the appearance of the chin.  An incision is made either under the chin or inside the mouth and an implant is placed.

If dental occlusion needs to be corrected or more major facial skeletal procedures are indicated, the chin can be reshaped using techniques to break the jaw and reposition the mandible.  This is a much bigger procedure than a chin implant with the potential for more serious complications.  Procedures are also available to slice some of the chin anteriorly, reposition it, and hold it in a new position.

Rhinoplasty in patients of African, South Asian or East Asian origin

Rhinoplasty or nose reshaping is widely regarded as one of the most complex cosmetic surgical procedures.  The surgeon must have sound surgical skills, a detailed knowledge of anatomy, and a wide range of techniques to treat various deformities. In addition to all these skills, a sense of artistry is needed to combine everything into a balanced aesthetic nose.  Balance. Harmony. Proportion.  These are the fundamentals of good rhinoplasty surgery.  The nose of a patient of African, South Asian, or East Asian origin poses unique challenges to gain a superior result.  Many of the analytic tools used to assess a Caucasian nose are not always useful.

Typically the alar width (base of the nose) is wider resulting in a different shape to the ala and a wider tip.  The nasal dorsum may not be a high as a Caucasian nose.  The skin is generally thicker, and different techniques may be necessary to effect changes in the shape of the nose.  These are just a few of the differences that must be clearly understood by the surgeon to achieve a superior result.  The surgeon must completely understand this type of rhinoplasty and how to use the inherent characteristics of that particular patient and shape of the nose to advantage.

It is best to choose a surgeon with extensive experience with this type of rhinoplasty. If such a surgeon is not available in your community, it may be best to search for a surgeon with these skills.  Asking the surgeon to show you some of his patient results is the easiest way to determine his experience with this type of complex surgery.

What is an otoplasty or ear reshaping, how is it done, is it effective

Otoplasty refers to any procedure to reshape the ears.  There are various techniques used to achieve this goal.  An incision can be made behind the ear and sutures placed in the cartilage to reshape the ear.  The cartilage can be incised or abraded to change the shape of the ear.

This procedure is used for ears that are very prominent. The ear may be larger than normal but more often only appears prominent due to loss of some cartilage folding and a deeper central part of the ear (conchal bowl). An otoplasty reshapes the ear.  It can be performed in a variety of methods ranging from incisions on the back of the ear to limited incisions in the front of the ear.  Cartilage can be abraded, cut or sutured to recreate natural folds.  The procedure may include a suture to decrease the distance from the ear to the side of the skull. It does not commonly result in major changes to the external canal which is responsible for allowing ear plugs or hearing aids to fit and any changes to the shape of the ear are unlikely to affect how headphones are worn.

Ear reshaping is commonly performed on children around age four or five.  This is a good time before classmates begin to notice the prominent ears which can lead to ridicule with the potential for psychological trauma.  The procedure is also done on adults to correct similar deformities at any age.

The procedure is usually very successful in repositioning the ear cartilage into a more favorable position and improving the aesthetic appearance of the ear. After surgery post op pain is usually mild, but not uncommon

There are various techniques for the procedure of ear reshaping and it is best to discuss whether or not this procedure is right for you with the facial plastic surgeon.

What's new in cosmetic fillers, what's best for me?

Fillers are an area of rapid expansion in facial plastic surgery.  New fillers are receiving approval very rapidly.  When used appropriately the results can lead to a very natural aesthetic enhancement.

Fillers are products used to replace volume or fill lines.  They are useful in lines on the face such as wrinkles, deep lines around the mouth (nasolabial folds).  They can also fill out hollow cheeks for a volumizing effect; enhance lip appearance with a more full lip.

Fillers are injected into the skin or directly beneath the skin to have their effect. The type of filler determines where it is placed.  There are many techniques for injection depending on the site and the goal of the injection.

Three major fillers are: hyaluronic acid, collagen and calcium hydroxyapatite.  The fillers last a varying amount of time. The injectable process may involve some anesthesia (ice, topical agent or injectable) prior to the injections.

Consult a facial plastic surgeon with experience in fillers.  The surgeon should not only have experience in fillers, but also other techniques of facial rejuvenation since a patient may feel that they need a filler, but another procedure would be more appropriate.  Before booking a consultation, carefully consider how long you want the filler to last. Many people like the idea of a long lasting filler, but if the result is not what the patient had envisioned, they may be unhappy that the appearance cannot be changed for some time.

At the consultation ask the facial plastic surgeon what are available fillers.  The surgeon should be able to discuss all the fillers on the market to help the patient decide what will best  suit their needs.

How to choose a facial plastic surgeon

Choosing a surgeon for facial plastic surgery can be a very difficult process.  The internet has afforded the patient a myriad of choice to find a surgeon.  However the patient is often confronted with an overwhelming amount of information. It may be difficult to filter conflicting reports and make a decision.  A surgeon's website may post a myriad of qualifications, beautiful before/after photos and great testimonials.  These can all be misleading.  How do I know what to believe and choose the best surgeon to perform my procedure?

Word of mouth is one good place to start.  If someone has had a procedure and been satisfied this is a good person to put on your list. If you have interacted with a surgeon and find that person fulfills your vision of a "good surgeon" this is also a good start. 

The appearance of a website is important in the sense that it should be professional.  The most attractive website does not mean that the surgeon is the most suitable for you.  Experience, training, integrity and a commitment to excellence are the most important qualities of the facial plastic surgeon.  The most important and the most difficult to assess is a commitment to excellence.  If the surgeon is dedicated to constant improvement, over time that surgeon will have consistently superior results. Integrity and honesty are important since not all surgeons do all procedures and it is important for a surgeon to state that they do not do something, and refer the patient to someone else.  It is important to avoid a surgeon who will do any and all cases.  A good approach is to begin by comparing surgeons using characteristics of their practice that are hard to embellish or modify.  How many years has the surgeon been in practice?  This is easily searched from the governing body of the State (USA) or Province (Canada).  Does the surgeon have any malpractice judgments against them?  This may be available based on the laws in each State or Province.  See if you can ascertain what procedures the surgeon is most skilled at performing.  Do you know anyone who has had surgery from that surgeon?  How did they find the experience?  Remember that the surgeon may provide you a list of satisfied patients to contact, but this is a self selected list.

Consider visiting a few surgeons, usually you will find one surgeon who you feel most comfortable with; this is the best surgeon for you.  This does not mean they are the "best surgeon".  The truth is there are many qualified surgeons skilled at performing the procedure you desire.