Question: I had eyelid surgery approximately two years ago, now I have small wrinkles under my eyes. Is this normal? I recently moved to Milwaukee and would like to know if you can remedy this and if it would require another surgery.

Answer: It is certainly not unusual for people to have a small amount of wrinkling under their eyes after a blepharoplasty since that is highly dependent on the patient’s skin elasticity as opposed to skin excess.  I would have to evaluate you personally to determine whether or not you do truly have a skin excess or if it is just the inability of the skin to rebound when you squint, but there are options available that would not require you to undergo another surgical procedure.  One would be some sort of laser resurfacing where the skin is treated to improve the collagen in the skin and this will then in turn improve skin texture, tightness, and wrinkle reduction.  For a no downtime option, Ultherapy can actually be used on the lower eyelid skin especially the newer transducer that treats 1.5 mm below the surface.  The results are not as significant as a full laser resurfacing but, considering there is absolutely no downtime involved with it, it certainly is still an option.  If you do have a significant amount of excess skin causing the problem then you may want to consider a simple in office pinch procedure to the lower lids where the excess skin is removed, sutures are placed, and these are removed in three or four days.  As you can see, there are a variety of options depending on your particular problem and tolerance of any downtime and I would, therefore, recommend a consultation with a board-certified facial plastic surgeon.   

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Question: I have a nose that is too wide at the tip. I would like this reduced in size and I would also like the nose shortened. Do you use the open-tip technique with an incision across the columella? Is general anesthesia suggested or required?

Answer: There are a variety of techniques that can be employed to narrow a tip and adjust its projection and depending on your particular anatomy this may or may not be performed through an internal approach versus an external approach.  It really depends on the surgeon’s comfort level, experience, and the patient’s particular anatomy.  For most patients that have a bulbous tip and an overprojected nose I can perform the procedure through an internal approach and, therefore, not need the incision along the columella; however, if a patient has significant asymmetries to the tip or if there is a need for a significant number of cartilage grafts then more than likely I would recommend an external approach.  Ultimately, rhinoplasty is highly customized and, therefore, I would have to evaluate your particular anatomy before I would be able to tell you whether or not I would recommend an internal or an external approach.  Regarding anesthesia, I perform all of my rhinoplasties under general anesthesia as I have just found that it is easier for both the patient and me and with today’s advanced anesthetic techniques the risks are exceptionally low.

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Question: I am an asthmatic. Could a rhinoplasty make my breathing worse?

Answer: A rhinoplasty should not affect your asthma in any way.  In the far majority of cases, I will actually make someone breathe better after a rhinoplasty as opposed to make them breathe worse, but the nasal airway is not going to significantly affect your asthma, which is an inflammatory lung condition.

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Question: I am a 34 year old Jamaican woman with extremely flared nostrils. Can this be fixed with ethnic rhinoplasty?

Answer: There are a variety of techniques available that can be used to reduce flared nostrils during an ethnic rhinoplasty.  I would recommend seeking out a very experienced rhinoplasty surgeon since these can be very complicated procedures with a high likelihood of a revision in inexperienced hands; furthermore, I like to discuss the limitations that certain techniques would have for each individual’s particular anatomy so that they do not have a higher expectation than can be achieved.  I have found that computer-generated imaging is imperative in situations like this so that the patient can see their nose on the computer with the expected postsurgical changes on their face.  This allows for them to have a realistic expectation regarding the appearance of the nose after surgery.

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Question: I recently heard of something called lip sculpting. Is this different from lip augmentation?

Answer: Lip sculpting and lip augmentation are similar, but in lip sculpting we are not necessarily just trying to make the lip look bigger or trying to just augment the lip, but we are actually trying to improve the shape of the lip by placing filler in areas that you would not even consider to call the lip.  For instance, the philtral ridges are the small ridges that go from the nose down to the lip at the top of the Cupid’s bow.  These tend to flatten as we age and by placing an injectable filler in this area to recreate the philtral ridges in combination with recreating a much more significant Cupid’s bow to the upper lip, we can have a very nice rejuvenation and augmentation to the lip without making the lip look overly large.  Essentially, every lip augmentation procedure that I personally perform would be considered a lip sculpting procedure since we are going to customize the placement of the filler to give the patient the best result possible.  

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