That is a little bit of a trick question due to the fact that if it is strictly a cosmetic rhinoplasty, the answer would be the age at which the patient stops growing.  In young women, it is typically around the age of 15 and in young men, it is typically at age 17 to 18.  If a child has had a very significant congenital malformation of the nose or has had very significant trauma to the nose with resulting deformity, a minor rhinoplasty may be performed at almost any age, even as young as a toddler.  A more definitive rhinoplasty is usually then performed in that same child once they reach the age where they stop growing.

No Comments »

In most patients, Botox is the best treatment for crow’s feet; however, certain patients have crow’s feet that are due to cheek elevation and not due to the contraction of the muscle around the eye.  Those patients would really not benefit from Botox treatments as Botox is placed in the muscle around the eye to relax it and thus improve those wrinkles in that region.  For patients that are not going to see much benefit from Botox, several alternatives are still available.  Frequently those patients have rather low-set brows and this contributes to the crow’s feet wrinkles and thus endoscopic browlift could significantly improve the crow’s feet area and this would be a very long term solution for the patient.  Others have crow’s feet that would be amenable to treatment with a resurfacing procedure such as an erbium laser resurfacing or ProFractional laser resurfacing.  These types of treatments can be performed in the spa setting, but do have a few days of downtime.  A new technology that is very exciting is the use of ultrasound to treat the tissue around the eyes.  Ultherapy by Ulthera is a device that visualizes the skin and underlying tissue and then places focused ultrasound energy to injure the deeper tissue and cause tissue tightening.  This can not only lift the brow, but also significantly improve the crow’s feet wrinkles and even the wrinkles along the underside of the eye.  Treatments are performed in a single setting.  There is only mild discomfort involved and there is absolutely no downtime.  The results are visible in approximately three months and can be rather outstanding considering the fact that this is a noninvasive, nonablative, no downtime procedure.

No Comments »

There is really no time limit or age at which point one should look at doing another facelift.  It is really a matter of what signs of aging have recurred after the prior facelift.  I have actually seen patients within a year of having a facelift performed who continue to have significant issues that were not corrected by the prior facelift technique.  These techniques are typically the less sophisticated techniques such as minilifts, weekend lifts, lifestyle lifts, or quick lifts.   The technique that I perform of a deep place facelift can correct all of the issues that the patient presents with.  I have also seen patients ten years out from facelifts or even up to 15 or 20 years out from their prior facelift who present for consideration of a revision facelift.  There is a very big advantage that a deep plane facelift has when treating a patient who had undergone a prior facelift.  Due to the fact that the deep plane facelift or extended SMAS facelift goes under the deeper layer of the face, this is an area that has never been treated surgically previously.  This therefore makes it much easier for the surgeon to operate at that level and ultimately the direction of elevation and fixation is much more vertical when compared to a standard facelift approach.  This can actually reverse some of the stigma of a prior facelift if the patient has a “swept” look from a facelift that was performed previously.  I would highly recommend that any patient interested in a revision facelift have a consultation with me in order to go through the options and discuss the advantages of the techniques that I personally perform.

No Comments »

A comprehensive rejuvenation is really what it sounds like.  It is comprehensive in the approach that is taken toward this rejuvenation.  With that said, that means that all areas of the face that are showing signs of aging are treated simultaneously, so that what I call facial harmony is maintained.  Facial harmony means that all areas of the face look similar and thus go together and give a patient a more natural and rejuvenated appearance.  When single areas of the face are treated and other areas are not, facial dysharmony can result, which may not be blatantly apparent to others, but certainly does not give the patient the natural and harmonious effect of a comprehensive approach to rejuvenation.  Most patients that I see that are over the age of around 48 years old would benefit from a comprehensive approach that would involve endoscopic browlift, an upper eyelid lift, lower eyelid lift, deep plane facelift, and erbium laser resurfacing.  This is performed in a single setting in the operating room.  Patients will typically spend the night at the Paragon Surgical Center where a private nurse is on hand overnight with them.  I see the patient the following day and take off a small pressure dressing and then they are allowed to either go to a local hotel or bed and breakfast or if they live nearby, they can then go home for a few days at which point I would then see them back for removal of sutures from their eyelids.  A total of six days after surgery, I remove the facelift incisions and we perform another treatment in the Quintessa Medical Spa to freshen up the skin and approximately 75 percent of patients at that point in time would look good enough to go out and do normal nonsocial activities.

No Comments »

Absolutely, in fact, really the most common and in my opinion best method at providing patients with plumper lips is a nonsurgical procedure involving placement of a filler material of hyaluronic acid into the lips themselves.  This can be performed using Juvéderm or Restylane.  The results typically last around six months and the injection can be surprisingly painless when performed appropriately.  It is very important that the injector be experienced in lip augmentation as improper placement of the filler material can give patients a very artificial appearance and this is described frequently ad “sausage lips” or “duck lips.”  This is mainly due to placement of either too much filler material in the lips themselves or more frequently it is due to placement of the filler material in the corners of the lips that really do not require any augmentation at all.  With that said, if the injector is experienced at lip augmentation, plumper lips can be achieved and give the patient a very natural youthful appearance.

No Comments »