I am 45 years old and have a horrible turkey neck. Is this something that a facelift would fix or is there something called a neck lift or some other procedure that just addresses the neck?
Yes, certainly a regular facelift would be a suitable fix for something that is described as a turkey neck. However, there is also a procedure which involves doing what we call a post auricular neck lift which can be done under local anesthesia and involves incisions just behind the ear and in the hair which can also take care of a neck problem. However, if there are significant problems with the muscles underneath the jaw area in the neck, there may be necessity for having an incision to specifically address these muscles. Also, if there is a significant amount of jowl laxity it may be necessary to come in front of the ear and do some pull in that area. But again, to answer your question, a facelift certainly takes care of a turkey neck but there is also something that is more specific called a post auricular neck lift which can sometimes also take care of the problem and can be done under local anesthesia and often in less than an hour.
I have had four nose jobs and am still not happy with my nose. Can it still be fixed? How many nose jobs are just too many?
With each rhinoplasty there is an increased risk of complications and given all the work that you have had done clearly this is a procedure that should be undertaken very, very cautiously, if at all, and definitely by a highly experienced surgeon. It still may be possible to create some moderate degree of improvement, even a significant degree, by relatively limited maneuvers which the experienced surgeon can perform. These limited procedures avoid completely elevating the skin as that is where the complications typically can develop. Furthermore, with any revision procedure, attention must be paid to re-building or re-creating the structural components of the nose so as to achieve a stronger or anatomic result.
Since my rhinoplasty two months ago I am much more swollen on the left side of my nose than the right. How normal is this and should the swelling fade enough so the nose will look more symmetric? How long will this take?
I would say at this point, two months post-op, that the swelling is not so much swelling as it is an asymmetry of the nasal bones of the bridge. You can still treat this area with steroid injections to see if it improves in case there is any scar tissue in the area and obviously if there is not much of an improvement then the only thing that can be done is some surgical correction whereby the fuller nasal bone area can be either re-set and/or rasped or filed down. The other option is to build up the opposite side with something like injections of Radiesse.
Can fillers be used to treat tear troughs and if so, which one is the best?
When applied by a skilled and experienced physician, fillers can be tremendously successful in treating the tear troughs. My preference is to use a hyaluronic acid filler for the tear trough area. Restylane is a great choice but requires a delicate hand and skilled eye to get the best results.
During revision rhinoplasty, how are problems with the nasal tip fixed?
Revision rhinoplasty is, as I have answered before, one of the most complicated procedures in facial plastic surgery. Every good nose begins with a tip so it is essential that proper tip placement, projection, angulation from the face, and lastly shape and design is done first. A variety of techniques can be used for positioning the tip including the addition of cartilage grafts, suturing techniques, sculpting techniques, and even the use of Gore-Tex and other type implants which are used very occasionally. Once the tip is secured in place, and it is essential that the securing not be weak but rather strong, the rest of the nose can be lined up to fit in proportion with this tip. These are the reasons why most revision rhinoplasty surgeons will utilize the external technique so as to assure the most natural and stable results.
I have heard a lot of controversy regarding the external rhinoplasty approach versus what people call the closed rhinoplasty approach. Isn't it true that you can get scarring with the external approach?
There has been an ongoing debate amongst surgeons who do the external or open rhinoplasty versus those that use the closed or endonasal technique. I personally prefer the external approach for a number of reasons, the most important of which is it permits the best visualization of the nasal structures as they will exist after the surgery is completed. Through an incision made in the nostrils and connected up to a tiny gull wing incision on the bottom of the nose, the entire cartilage and bone support of the nose can be visualized and then maneuvers can be done to do sculpting and refining of the nose. Another advantage of the external approach is that it does not involve weakening of the external support of the nose.
I'm a 51-year-old guy and I can't stand the fullness that I have in my neck. What can I do?
Typically, once a male reaches the age of 40 to 45, there is a loss of elasticity of the skin that makes doing isolated liposuction under the chin not a worthwhile technique for it results in nothing other than extra tightened skin. In these cases, a variety of different neck lifts can be performed, the most common is one in which an incision is made primarily in the neck hairline and behind the ears and sometimes extending a bit in front of the earlobe. This allows for the redraping of the skin in a more upward direction, along with the removal of the excess skin and thus a more trim and youthful appearing neck line. These neck lift procedures can be done under either oral sedation with some local anesthesia or under deeper twilight sedation and they have a recovery period most commonly of five to seven days.
I am a Hispanic female and I have heard that Hispanic noses are very different to work on than the typical Caucasian nose. Is this true?
There is tremendous variation even within ethnic groups, let alone between different ethnic groups, regarding structure and appearance of the nose. While a very broad category, Hispanic noses can have somewhat less tip support than Caucasian noses and, as a result, the tip tends to droop a bit and there can also be more flaring of the rest of the tip. A surgeon experienced in Hispanic rhinoplasty can address each of these issues, which can include narrowing the tip, strengthening it with the use of cartilage from the septum or the ear, as well as refining and narrowing the nasal bridge to create a more streamlined and narrow appearance. This part is true artistry in rhinoplasty surgery.
I'm happy overall with the appearance of my nose but feel that my tip is too wide and my nostrils are too wide as well. Is there anything I can do?
Many times in rhinoplasty it is not necessary to work on the entire nose. While a top surgeon with years of experience such as myself will go ahead and advise you as to what areas of the nose need to be worked on so you retain balance and harmony with the rest of the face, it is not always necessary to redo the entire nose. With limited tip work, especially nostril narrowing, there is a procedure called the Weir technique that provides for narrowing of the nostrils with no visible incision as the incisions can be made inside the nostrils. Sometimes additional work needs to be done on the tip such as refining it and perhaps changing its position by rotating it up or having it project further out. These are all things that can be addressed and discussed with your surgeon.
Can you explain what a midface lift is and for whom it is appropriate?
The midface lift is just one variation of a face lift procedure. These face lift variation procedures are becoming more and more popular because they avoid the full amount of surgery required in a total face lift, which basically means it reduces the length of the incision, the time for recovery, and the amount of surgery to the patient. The midface lift essentially addresses two frequent areas of concern to both men and women, which is the loss of fullness in the upper and mid-cheek region due to sagging, as well as the creation of jowls. The incision with the midface lift is through the sideburn and then usually extends into the ear and then wraps around just behind the ear lobe. Through the incision, the deep tissues can be elevated as in a full face lift so that there is a long-lasting result and then the incision is reapproximated. Most of these face lift area procedures are performed under local anesthesia with some oral sedation, rather than full twilight sleep, and recovery is significantly shorter with the midface lift, typically four to five days versus a full eight to ten day with a face lift.