How many rhinoplasties can a patient have?
The complexity of any surgery increases as the number of procedures increase – that’s due to scar tissue that forms during the healing phase postoperatively. Scar formation is natural and expected following any surgery. The amount and type of scar formed by each individual, however, varies based on their genetics and overall health status.
The more rhinoplasties a patient has, the more scar formation there is, and the higher their risks are for certain postoperative outcomes – namely, cosmetic imperfections, infection, and tissue ischemia. It’s important to discuss these risks with your surgeon preoperatively, particularly in a revision case.
The other unique aspect of rhinoplasty surgery is the fact that surgeons use cartilage from the nose (typically the septum) to reshape the nose. If a patient has had prior nasal surgery, their bank of available cartilage is likely depleted and their surgeon may need to use cartilage from elsewhere (i.e., ear, rib, or irradiated donor cartilage).
Soooo there’s no strict number of rhinoplasties a patient can have. The important thing to know is that the complexity of the surgery increases and certain risks increase with more nasal surgery.
Thread lifts: how long do they last?
Not long enough. And that’s why I strongly advocate against patient undergoing thread lifts. Not only are their effects short-lasting but they also carry and fairly high risk of skin bunching, infection, scarring, and thread extrusion (where the body pushes the thread towards the skin surface.
Thread lifts were popularized several decades ago, promising to bring along stellar results without the cost, downtime, or invasiveness of surgery. But they failed to yield meaningful results for most patients and that’s why they fizzled out. Fast forward to now and they’re being marketed again by their manufacturers and many non-surgical providers. If you ask most surgeons, they’re not a proponent of thread lift. Their effects don’t last and most patients are relatively unhappy with their results. You’ll really never be able to achieve a surgical result with non-surgical techniques.
Pricing of cosmetic surgeries: how do surgeons’ price their procedures?
Costs of various cosmetic procedures varies widely.
Think of a taco. It costs less than a dollar at Taco Bell and well over $25 at your nearest swanky Tex-Mex restaurant. Cost is dependent on regionality, market dynamics, environment, and chef expertise. The same can be said for various surgical procedures.
In cosmetic surgery, cost is often dictated by the level of training and experience of your surgeon and their staff, the region of the world they practice in, and the current market. When considering price of a cosmetic procedure, it’s important to inquire about what all is included – surgeon’s fee, anesthesia fee, operating room fee, supplies/materials, medications, postoperative supplies, prescription medications, follow up appointments, etc.
Mother nature and gravity…does a facelift always include a neck lift?
Typically, yes. The term ‘facelift’ is used to describe a surgical procedure that improves the visible signs of aging in the mid-face, lower face, and neck. It is able to address skin sagging, deepening of the fold lines between the nose and the corner of the mouth (nasolabial folds), sagging fat pads, jowls along the jawline, and loose skin and muscle laxity under the chin and within the upper neck region.
Not all facelift techniques are the same. Just as a tailor may approach hemming a dress a bit differently based on that particular dress and their previous experience, one surgeon’s facelifting techniques may vary slightly from their colleague’s.
A concurrent neck lift is often paired with a facelift because the aging process is not isolated to the face – it affects the neck as well. In order to achieve a natural, youthful result throughout the face, jawline, and neck, surgical lifting and tightening is required within both the face and neck regions.
Can you have surgery for a stuffy nose?
A stuffy nose can be addressed during nasal surgery. The important thing for the surgeon and patient to investigate preoperatively is the etiology for the stuffiness. If there is a structural reason for the stuffiness, meaning something physically blocking the normal flow of air, that can usually be surgically addressed during the surgery. Two common examples of structural blockages include: a deviated septum and/or enlarged turbinates.
If the stuffiness comes and goes, it’s more likely to have a non-structural cause. In these patients, medical treatment (rather than surgery) is usually advised. Examples of these types of causes of stuffiness include: allergies, viral illnesses, etc.
Is otoplasty covered by insurance? The grey zone and who determines coverage
Unfortunately, this is not a straightforward answer. More often than not, otoplasty is considered a cosmetic, elective procedure and is therefore not covered by insurance. However, there are instances were insurance may pay for the procedure based on its reasoning.
There are grey areas when it comes to health insurance coverage – there are no fixed rules as to when or if a health insurance company will cover something. The rules change over time and from one company to another. Some may cover a particular procedure while others won’t. The decision is ultimately made by the insurance company and not your surgeon.
If the ear being addressed is considered to be a congenital deformity, it’s more likely that it will be covered by insurance. This is more likely the case in young children.
Will an otoplasty (aka, ear pinning) affect my hearing?
An otoplasty is a surgical procedure intended to alter the size, position, and/or shape of the external ear. It is customized to the individual and involves altering the ear in order to improve its appearance and/or symmetry. During the procedure, cartilage can be reshaped or excised via an incision behind the ear. Varying suture techniques are employed in order to yield the most natural looking external ear.
An otoplasty has no effect on the middle or inner parts of the ear, which are responsible for hearing. In certain rarer scenarios, a patient may require an otoplasty as well as surgery for their hearing. These procedures are staged (performed at different times).
How painful is otoplasty?
Pain varies from individual to individual and is difficult to predict preoperatively. The majority of patients will have some degree of discomfort following the procedure. This is typically treated with Tylenol and occasionally, a patient may require prescription pain medication for the first few days.
Postoperative pain and discomfort are worst in the first 2-3 days after the procedure. Thereafter, pain should slowly improve each day. If pain is worsening and not improving, it’d be appropriate to reach out to your surgeon’s office.
In order to minimize pain, it’s important to follow your surgeon’s instruction in terms of wearing an ear dressing, reducing strenuous activity, and eliminating the potential to bump, hit, or cause inadvertent damage to the area during the healing phase.
Help! How do I get rid of my double chin WITHOUT surgery?
There’s two points to note in this answer.
Figuring out what’s contributing to the submental fullness, or ‘double chin.’ Sometimes it’s extra subcutaneous (meaning just under the skin) fat while other times, it’s excess deep fat, enlarged submandibular glands, hypertrophied platysmal and/or digastric muscles, or a combination of the above. Your surgeon is typically able to diagnose the reason for fullness with a physical exam. By knowing which layer(s) of the neck is problematic, you’ll have a target of what to tackle in order to achieve improvement in the fullness.
It’s difficult, if not impossible, to achieve surgical results with non-surgical techniques. There are some technologies on the market that use radiofrequency, microneedling, and/or fat dissolving medications to address the most superficial layers of the neck – namely, the skin and layer of fat just beneath the skin. The problem with non-surgical modalities is that they’re not able to target deeper structures in the neck, and thus, often fall short in providing a sculpted neck and jaw line. Surgically, surgeons are able to address each layer of the neck and target the specific area(s) that are contributing to that individual patient’s fullness.
Can you change the shape of the nose without surgery?
You can. The term ‘liquid rhinoplasty’ is a term used for reshaping the nose with non-surgical injectable fillers. When a patient desires minor changes in their nasal appearance and aren’t interested in going under the knife, injection of fillers can subtly raise the nasal tip, smooth a hump along the bridge, and/or camouflage asymmetries. This hyaluronic acid filler dissolves slowly over time and typically lasts 1-2 years after placement.
And while all filler placement carries a small but real risk of vessel occlusion (where filler is inadvertently injected into a blood vessel) which can lead to tissue ischemia and skin loss, the risk of such events is higher when filler is placed in the nose as compared to elsewhere in the face. Also, of note, there have been reports of patients experiencing blindness after liquid rhinoplasties. This is because the blood vessels that feed the nose and eyes are part of a large and concentrated network of vessels confined to a very small area of the face. Therefore, it is crucial to go to a provider with intimate knowledge of nasal anatomy and who has experience operating and placing filler in this area.
Intraoperative sedation - how awake will I be for a blepharoplasty?
If you choose to be. With any cosmetic procedure of the face, there are varying degrees of anesthesia available to you.
On one end of the anesthesia spectrum, you can elect to have only local anesthesia – meaning numbing medication injected in the area to be operated on. You’re completely awake and totally lucid. This type of anesthesia is common for an upper blepharoplasty.
At the other end of the anesthesia spectrum is general anesthesia – where the patient is completely anesthetized, has a breathing tube in their mouth, has zero awareness of what is happening, and experiences no pain. This type of anesthesia is commonly used for rhinoplasty surgery.
In between local anesthesia and general anesthesia, you have varying degrees of conscious sedation – this can be achieved with oral medications, IV medications, or a combination of both. The ultimate goal for anesthesia during cosmetic surgery is to provide a patient the most comfortable experience while also providing them the safest mode of anesthesia. It’s important to ask your surgeon about which type of anesthesia they recommend for the procedure you’re undergoing and who will be administering the anesthesia medications.
At FACE Leawood, we have a board-certified Anesthesiologist that assists with all procedures in which the patient requests sedation.
Planning for recovery: how am I supposed to sleep after an otoplasty?
Each specific surgeon has their own postoperative protocol for every procedure. But generally, following an otoplasty, you will want to sleep in a position that does not disturb, manipulate, or apply pressure to either ear. Lying on your back with the head slightly elevated is what most patients find to work after a bilateral otoplasty, meaning both ears were operated on. This is especially important during the first 2-3 weeks of healing. Thereafter, most patients find it more comfortable to sleep this way, as the ears can remain sore for a several weeks after surgery.
What is a liquid facelift???
A ‘liquid facelift’ is a term popularized for non-surgical facial rejuvenation in which filler is placed in various aspects of the face in order to achieve a more youthful, refreshed look. There is no specific recipe for where and how much filler is injected – the treatment is individualized to the specific patient, their anatomy, and their overall aesthetic goals.
I am not a big fan of the term. Why? Because fillers don’t actually lift the face. I think the term ‘liquid facelift’ is misleading and confusing for patients.
Only surgery can truly lift things. Fillers add volume. It’s my opinion that as individuals age, the best outcomes often come from the result of surgery, judicious volume replacement by way of filler placement, and dedicated attention to the overlying skin.
What can I eat after buccal fat removal?
Buccal fat sits within the deep space of the cheek. Some patients elect to have a portion of this fat pad removed in order to slim the lower half of the face and to allow to better accentuation of the cheekbones. Buccal fat removal is typically achieved through a small incision within the mouth, on the inside of either cheek, at the level of the bite line (where the upper teeth and lower teeth meet when biting down). Following fat removal, the incisions are closed with several dissolvable stitches.
After surgery, the key is to not traumatize the incisions lines or stitches with anything too chewy or sharp (think no beefy jerky, chips, raw veggies, pretzels). Patients are advised to eat soft foods for the first week, as the incisions heal and as the postoperative swelling begins to resolve. It’s wise to stock up on soft mushy foods before surgery, like applesauce, mashed potatoes, smoothies, soups, yogurt, etc.
Planning for recovery: what can I expect following my rhinoplasty surgery?
A rhinoplasty is performed in order to change the appearance of the nose. This can be done primarily if a patient strictly wants a change in the look of their nose, or secondarily after a trauma. Following rhinoplasty surgery, a patient can expect to experience: swelling, bruising, discomfort, nasal congestion, +/- nasal bleeding/drainage.
The majority of swelling will peak 2-3 days postoperatively and begin to slowly improve. Roughly 70% of swelling will be gone by 2 weeks. Thereafter, residual swelling will continue to improve for the first year (yes, a year!).
Bruising is minimal in some patients and more pronounced in others. If a patient bruises, it’s typically in the cheeks and around the eyes. It usually takes 2-3 weeks for this to totally dissipate.
Discomfort varies highly among patients following rhinoplasty surgery. Some patients only take a couple Tylenol after surgery while others will elect to take prescription pain medication for ~5-7 days.
Nasal congestion after surgery is expected. Just as the outside of the nose swells, so does the inside. And this can be really annoying, particularly at night when the patient is forced to mouth breathe. Be patient and it will improve. It usually takes 2-3 weeks for the majority of the internal swelling to significantly improve.
A small amount of nasal bleeding is common after rhinoplasty surgery. It’s common for patients to go home with a drip pad (or gauze pad) taped under their nose to catch any bleeding the evening of their surgery. If a patient experiences bleeding, it’s typically only a few drops every hour for the first 1-2 days after surgery. Anything more than that warrants a call to their surgeon overnight.
Always consider your neighbor - which procedure is best to address hooded eyes?
It can. The term ‘hooded eye’ refers to excess skin that folds down within the region of the upper eyelid. It is usually more noticeable toward the outer edge of the eye, where the eyebrow tapers towards the temple. People often associate it with aging but it can also be seen in younger individuals, as the result of genetics.
Working down, let’s think about the forehead, eyebrow, and upper eyelid as different but neighboring units. If the forehead and/or eyebrow are sagging, that can result in the appearance of excess skin within the upper eyelid region – whether there’s a true excess or not. If that same patient takes their hand and gently lifts the eyebrow, that will improve the amount of excess eyelid skin.
Now let’s say the forehead and eyebrow are in good position – no sagging – but the upper eyelid skin itself is responsible for the hooding. This would be addressed not with a brow lift, but rather with an upper blepharoplasty (or upper eyelid surgery).
So yes, a brow lift can improve the appearance in a hooded eyelid. But…some patients may benefit more from an upper blepharoplasty. And others may want to consider both a brow lift and an upper blepharoplasty at the same time. These are all critical to discuss with your surgeon preoperatively to ensure you really understand what’s contributing to what and what you can expect improvement in postoperatively.
Does buccal fat removal make you look older?
A poorly executed cosmetic surgery can yield ill results on anyone. Likewise, an incorrectly chosen surgery can yield unacceptable results on a patient. Buccal fat removal should be reserved for patients who have overly full cheeks.
The buccal fat pad sits within the deep layer of the cheek, between the facial muscles and the lining of the mouth. It’s beneath the cheekbone and above the lower jaw bone. Buccal fat removal is a surgery that aims to reduce the size of this fat pad by removing a portion through a small incision in the mouth. Recovery is typically well-tolerated and patients begin to appreciating results after 1-2 months (as swelling improves).
How long does buccal fat removal take to heal?
Healing can be defined in a few different ways.
Acute, or short-term, healing occurs within the first 1-2 weeks after surgery. This is when the majority of swelling is seen and starts to dissipate, any bruising appears and then starts to disappear, and then patients experience the greatest degree of discomfort. Similarly, these first couple weeks are the most crucial in the healing phase – think of the tissues as knitting themselves back together. They require a safe, nourished, clean, and calm environment to do that. It’s important to avoid over manipulation to the area as well as extreme heat and/or stress.
Long-term healing is what happens over the next 8-12 months. And while it may seem crazy to think that tissues are still healing up to a year following a surgery, it’s true. Tissues continue to heal and remodel for months following surgery.
Specific to buccal fat removal, the incisions inside the mouth are typically healed in 2 weeks, any bruising is usually gone in 3 weeks, and the majority of swelling has improved after 3-4 months.
What’s the best way to hide an eyelid (blepharoplasty) scar?
Blepharoplasty refers to eyelid surgery. An individual can undergo an upper blepharoplasty, in which the upper eyelid is addressed, or a lower blepharoplasty, where the lower eyelid is addressed.
During the early healing phase, the incision line is pink and may be a bit raised. This improves over the first few months and eventually yields a tiny, flesh-colored line. The great news is that the eyelid skin is the thinnest skin in the body. In general, it heals excellently and most patients have nearly imperceptible scars once the area is completely healed.
For an upper blepharoplasty, the incision is placed within the natural crease of the eyelid, which camouflages well when the eye is open. For a lower blepharoplasty, the incision is placed either on the skin just beneath the lower eyelashes or on the inside of the lower eyelid and is therefore not visible. Makeup may be used after 2 weeks to help cover pink incision lines.
Let’s talk swelling AFTER a face and neck lift
Typically, the postoperative swelling seen with facelifts and neck lifts will peak about 2-3 days after surgery and begin to slowly improve thereafter. About 70% of the swelling is gone after 2-3 weeks. And the remaining swelling is nearly gone by 6 months.
Every patient swells and recovers a bit differently. Health status, activity level, genetics, and diet can all play a role. It’s best to lay low and minimize physical activity for the first 2 weeks. Once you’re cleared by your surgeon to begin exercising, it’s best to ease back into things so as to prevent significant recurrence in swelling.
It’s advisable to plan for 2 weeks off from social settings and three months off from any big, important events (e.g., weddings) to allow for swelling, bruising, and incision lines to heal.