Nose, Art and Surgery

When I reflect on how I was brought down the path of becoming a specialist in facial cosmetic surgery, it reminds me of my true love for artistry.  Since childhood, I have enjoyed not only the appreciation of art (paintings, sculpture, poetry, performance, etc), but I also have an unstoppable drive to create art.  I started with crayons and pencils when I was young, but have since written fiction and poetry, painted in oils, and sculpted in clay.  For decades, I even had a passion for working with wood, but alas, that is now too hazardous to my hands.  The joy of creating something from an amorphous canvas, ball of clay, pile of wood or blank computer screen is hard to articulate, but time does not seem to pass when an artist is at work.

As I pursued my medical career, I continued to work on my art (although sufficient time was often hard to set aside), and only knew that for some reason I enjoyed surgery and procedures that involved working with my hands.  Once I saw my first rhinoplasty (nose job) surgery, however, I was absolutely HOOKED!  The joy I felt watching the combination of surgical skill, medical knowledge and artistic vision left me without a doubt that I wanted to know all there is to know about the artistry of cosmetic and reconstructive surgery.  Because so much of our identity and communication is in the face, I developed a passion for all facial procedures with an unstoppable drive for natural looks with lasting and functional improvement.

My studies, collaboration with many accomplished nasal surgeons, and fellowship with a renown facial cosmetic surgeon have given me the tools to consistently deliver to patients artistic, natural and functional nasal improvement.  Each time I meet a new patient in consultation for rhinoplasty, it is a joy to work with them and develop a vision together as we image the improvement they desire.  The surgery is yet another joy, and an honor that I cherish.  Bringing a change to the face of a patient that they enjoy truly is humbling and brings a level of satisfaction that is impossible to articulate.  I am extremely fortunate to do what I love!

I continue to contribute to my field as well as keep abreast of all that is new in the world of facial cosmetic surgery (especially rhinoplasty - my first love), and I continue to practice art in the more classic forms.  To me, balance of medical science, manual dexterity and artistic vision is the key to achieving improvements that bring smiles to the faces of my patients and give me the greatest personal satisfaction.

The Importance of Volume

"Just because you can lift it does not mean it fell."

In our newest era of facial rejuvenation, this phrase has never been more true.  We have been learning that concepts of facial youth have a lot to do with the location and quantity of facial volume and how this changes over time.  Current research has shown that we can recognize an aging face from a distance (too far to notice wrinkles).  This is because the actual shape of the face has changed from volume differences.

For example, a child's face is very circular.  This is because the developing facial skeleton starts in a more round shape and the fat distribution in the face of a child in the cheeks and neck approximate a circle.  In fact, the face does not begin to take on a more oval shape until the early twenties and does not mature to it's most beautiful, "heart-shpaed" form until the late twenties or even the early thirties.  After this timepoint, volume changes that affect the location and quantity of facial fat as well as changes in bone volume (which contributes to a much lesser degree) begin to change the face in such a way that it can often be identified according to a person's actual age.

Of course, facial volume is not the only factor in facial aging - I like to express the process using the analogy of a three-legged stool.   Facial aging involves changes in skin quality, changes in facial laxity AND changes in facial volume.  The first two processes are dealt with by the use of laser resurfacing and lifting procedures (like a facelift).  The volume issue, however, is often ignored or grossly undertreated.

Most facial aging requires a volume replacement of 30-50cc.  This may sound like a lot if you think about it in terms of Restylane or Juvederm (which are sold in 1-cc increments), but in terms of how much volume this actually is, picture 1/4  to 1/3 of a can of soda.  This volume, which is best replaced by using one's own fat ("autologous" fat), is carefully and strategically placed back into the areas of loss in order to further add harmony and finesse to the process of facial rejuvenation.

Autologous fat is your own living tissue and can be harvested from a number of places on your body without leaving any scars or visible contour changes.  We use the latest technology to purify the harvested fat and maximize the long-term results and consistency.  Early experiences with autologous fat transfer were less predictable, but the latest applications make the results more permanent and easier to control. 

When a patient sees me for facial rejuvenation, a careful examination includes assessment of the three factors of facial aging (skin, laxity and volume) and recommendations depending on the areas affected.  In some cases, autologous fat transfer is all that is needed to achieve a natural result.  In others, a combined approach is necessary.

How can you tell if you might benefit from autologous fat transfer?  Look in the mirror in a well-lit room and ask yourself:  Are my temples a little sunken?  Do I have circles under my eyes?   Are my cheek bones a little angular and not as smooth as they used to be?  Do I have visible "jowls" because of a depression on between my chin and jawline?  Does my face look "heart-shaped" or is it starting to look more square?  Do I have a "tired" look?

If you think the answer to some of these questions is yes, autologous fat transfer may be the best solution to rejuvenate your face naturally.

For personalized analysis and recommendations for facial rejuvenation that include all of the approaches to best achieve a natural result, contact our office to arrange a consultation.  Patients find this visit to be an enjoyable and enlightening experience.

Before and After Photos

If you have spent a little time on my web site, you have probably noticed that there are very few "before and after" photos available for viewing.

This is because I value the comfort and privacy of my patients above my personal marketing efforts. It is important to be clear that I do have a library of patient photos for prospective patients to view. This can be done in the office during a consultation where my patients' private photos are protected from distribution.

The Internet now has a number of automated systems that copy and catalog photos that are up for public display. Once a photo is posted - even for a moment, it is essentially impossible to retrieve it and keep it private.

I want all of my patients to feel comfortable when they choose me, so I strongly believe that photos should be available for review. I also want my patients to rest easily after surgery that their privacy is tightly guarded.

If you would like to view my library of patient photos, call or email to arrange a consultation. Not only will you be able to view my work, you can arrange to speak with a recent patient and have your own results digitally imaged.

Lifting Without Surgery

The "Holy Grail" of facial cosmetic surgery would be a procedure that could lift and tighten the face, neck and brow without a single incision or any visible signs on the skin that something was done.  We desire a procedure that could be done in the office without ANY time off from work ("down-time") and would give real meaningful results.

Over the decades, we have edged closer to this lofty goal with the use of injectable fillers like Restylane and Juvederm, neuromuscular modulators like Botox and Dysport and laser procedures to tighten the skin.  Although these accomplish some of the goals we seek, they all fall short on some level.

So-called "minimally invasive" surgical procedures have also been developed.  These have given shorter recovery times with very nice results (when done properly) but still involve incisions and down time.

In order to stay current with the desires of my patient population, I have continually researched new technology that can bring meaningful improvement without the down time and surgical incisions.  I continually seek something for those with active lives or who still work full-time that does not interrupt their busy schedule.

Last year, I was fortunate to be among only a few doctors selected to begin using a revolutionary technology that is the closest to the "Holy Grail" - the Ulthera System.  This technology uses ultrasonic energy similar to that used to break up kidney stones in lithotrypsy or in ultrasonic dental cleaning devices.  This energy can be focused in a way that it can travel through the outer layers of the skin without causing harm while delivering high amounts of very focused energy to the tissue below.

In fact, studies have now proven that the layer treated with the Ulthera System is actually the same layer I surgically lift for face, neck and brow lifts.  By delivering this energy to that layer, a controlled process of tightening and collagen building takes place.  This leads to a lifting and firming procedure that truly has NO DOWN TIME.

I have seen it for myself in my own patients and family members!  A single treatment is usually all that is necessary to get visible results.  Because of the energy that is delivered below the skin, this procedure does require some medication for pain, but no visible external marks are made.  In fact, my patients can return to work or their daily activities the very next day without restriction or need for concealer of any type.  Actually, my patients can go back to work the same day but for the fact that most of them elect to take a sedative or pain pill before the procedure.

With this, I have seen patients with mild or moderate brow droop, neck sag or cheek jowling get the kind of results that would normally require surgery.  In most cases, I prefer to combine this procedure with Facial Fat Transfer to get an even more dramatic improvement in both facial volume and laxity.  Although Facial Fat Transfer is still a surgery involving a few small incisions, it is still very minimal and gives life-long benefit.

Surgery of all types still has its place for facial rejuvenation.  We are not at the point where technology can replace all surgery.  Still, the Ulthera System eliminates the need for surgery in many patients - even moreso when combined with Facial Fat Transfer.  For those patients who feel it may be too soon, too much or too difficult to undergo surgery, the Ulthera Treatment with or without Facial Fat Transfer offers the most ideal treatment to get results while minimizing (or even eliminating) down-time. 

If you are interested in learning more about the Ulthera System or Facial Fat Transfer, Contact Us to arrange a consultation.  I can go over in more detail the Ulthera Treatment as well as related procedures that may best benefit you.  The treatments can be focused on specific areas of the face, or the best value is in treating the full face and neck.  During your consultation, we will go over what would best meet your needs and what you can expect.

Are all lasers equal?

Laser technology has brought several major advantages to the field of medicine over the past 25 years.  We can treat disease with smaller or no incisions, we can read vital signs instantaneously, and YES, we can improve the cosmetic appearance of the face (among other areas).

Probably not surprisingly, the cosmetic use of lasers has been expanding more rapidly than most physicians' knowledge on the subject.  It is not unusual to attend a plastic surgery conference and hear a surgeon ask a laser salesperson, "So, what does THIS one do?" This type of question is usually followed with a barrage of marketing information that would make even the most focused individuals glaze over.

But really, is there a significant difference between all of the different lasers???

Although I would love to give a simple answer to this question, the reality is that lasers are very complex tools whose performance are dependent not only how they work, but on who is using them.

But WAIT!  Before I dive deeper into an already very deep pool of information, let me break it down more simply:  Lasers have limitations and so do their operators.  As a cosmetic surgeon of the face, I treat lasers as devices similar to any other surgical instrument.  I have a high understanding of the lasers I use and I can tailor their settings and applications to meet the goals of my patients.

The trouble, many times, is that most physicians can't afford to own every laser (they carry heavy price tags that range from $35,000 to $250,000 apiece) and therefore have to make the best with what we have.  This means that many physicians are forced to choose between sending a patient away or trying to accomplish something with the lasers they own that might be beyond what the device or operator can accomplish.

The right thing to do, obviously, is for physicians to tell patients upfront if their devices or expertise cannot safely help them reach their goals.  As a patient, you can ask exactly what device they plan to use and if this method is common to their practice.  Be vigilant, check facts on the internet and even with a second opinion.  Lasers have many advantages, but they are also potentially dangerous and should be treated with solemn respect.

As a last note, be aware that many "fad" lasers exist in the medical spa market.  Sure, laser hair removal is fine, but many new "non-medical" lasers are being employed outside a physician or surgeon's office under the pretense that it will give dramatic results.  The fact is that most of these fad devices are safe but minimally effective.  This is because in order for them to be safe in the hands of the non-physician, these devices cannot reach the depths of skin required to make a real difference.

When it comes to long-term results with laser skin treatment, start by talking with a surgeon or physician and formulate a plan that will help you reach your goals.  Of course, I perform consultations for laser skin treatment, and this includes a complete cosmetic facial assessment with computer imaging.  Contact my office to find out more!