Facial Plastic & Reconstructive Surgery

Rhinoplasty, or septorhinoplasty, is the surgical practice of reshaping the nose. Commonly described as a nose job, the surgery has both functional and cosmetic uses. The importance of the relationship between structure and function cannot be overstated — sculpting a well-shaped nose that does not allow airflow is not a satisfactory outcome for either the patient or the surgeon. Our team of double-boarded facial plastic and reconstructive surgeons also have expertise in otolaryngology (ear, nose, and throat surgery). As such, we place special importance on preserving nasal function while addressing cosmetic concerns.

We work with you to establish realistic and achievable expectations for the aesthetic changes to your nose. Our goal is to improve the nose’s appearance while ensuring it blends in and provides balance to the overall facial aesthetic. Optimal results occur when nasal alterations are harmonious with your baseline features. Cosmetic goals may include reshaping the bridge or tip of the nose, straightening a crooked nose, and changing the size of the nostrils.

Most rhinoplasties take two to five hours, depending on the degree of work that needs to be performed. Surgeries are generally well-tolerated, and patients usually leave the surgery center the same day. The operation can occur in either an ‘open’ or a ‘closed’ fashion, and may sometimes require additional cartilage to be borrowed from the nasal septum, ear, or rib. Your surgeon will review the best approach for you based on the surgical goals.

Revision Rhinoplasty

Revision rhinoplasty describes any rhinoplasty occurring in a patient that already underwent a previous rhinoplasty. Typically, such revision cases are more complex given scarring and removal of tissue that is present in the native nose. Our team has significant expertise in revision rhinoplasty and can utilize a variety of techniques to provide the best possible outcomes for our patients in complex situations. 

Recovery

Recovery from rhinoplasty entails a ‘laying low’ period of approximately two weeks. Most patients only require acetaminophen after about 24 hours, and generally are able to return to their usual activities after approximately one to two weeks.

A facelift, or rhytidectomy, is offered to patients wanting a younger, rejuvenated version of themselves. We seek to ‘turn back the clock’ through a combination of excess fat removal, tightening of facial and neck structures, and smoothening of the skin. A natural look is an essential goal, achieved through intricate knowledge of facial and neck anatomy. Vital structures (including nerves that move the facial muscles) are in the surgical field where the operation takes place. Our extensive experience with facial nerve patients allows us to comfortably and safely operate in this same surgical area to provide the best possible outcome for you.

The operation generally takes around four to six hours depending on the technique chosen. Incisions are hidden within natural creases around the ear and in the hairline, making them inconspicuous after the healing process occurs. Sometimes an additional incision is made in the fold underneath the chin to allow tightening of the central neck. Your surgeon will review potential options with you during your visit, dependent on your anatomy and surgical goals. Patients usually go home the same day as the surgery unless there are other circumstances.

Recovery

The recovery process is typically comprised of a pressure dressing placed around the face and neck for the first 24 hours. Your surgeon usually sees you the day following the surgery to remove this dressing and ensure everything is healing appropriately. After that, application of a snug facial/neck bandage is done for the next one to two weeks.

Blepharoplasty, or eyelid surgery, involves removal or repositioning of excess skin and fat from around the eyes. This can be for the upper eyelid, the lower eyelid, or both. Most patients seeking this intervention perceive an appearance of ‘tired eyes’ due to hooding of the upper eyelids or excessive fullness of the area underneath the eyes. A careful physical exam and history is critical to ensure proper surgical selection and patient satisfaction are achieved. The goal of the surgery is to rejuvenate the face around the eyes. For some patients, this means not only looking refreshed, but also having improved vision due to removal of the physical obstruction from the excess upper eyelid skin.

Upper blepharoplasty involves making a skin incision in the natural crease that forms above the upper lid. Excess skin is removed and any protruding fat is addressed. The incision heals very well and is typically not visible after a few months given the location. Lower blepharoplasty is usually performed with incisions made on the inside of the eyelid. Fat is repositioned or removed depending on patient anatomy. If excessive lower eyelid skin exists, an incision below the eyelashes may be made to remove this.

Eyelid surgery can take place under local or general anesthesia, depending on the type of surgery performed, patient preference, and surgeon judgment. Recovery typically entails placement of antibiotic ointment on the incisions and in the eye for a period of one week.

The forehead and eyebrows naturally descend as we age. This can result in impaired vision and a heavy look for the upper face. Rejuvenation of this area entails a brow lift, for which the goal is to reset the eyebrows and forehead in a higher, more natural position. This subsequently brightens the upper face, reduces (but does not eliminate) wrinkles of the forehead, and sometimes improves vision.

Several different techniques exist for a brow lift, depending on patient goals, anatomy, and surgeon judgment. Your surgeon will review these options with you during your consultation. Some versions of a brow lift can be performed under local anesthesia, while others necessitate general anesthesia.

Recovery

Recovery from a brow lift usually entails a pressure dressing applied to the forehead for the first 24–48 hours. Ointment is applied overlying the incision. The procedure is generally well-tolerated, and patients are discharged from the surgical center on the same day as surgery.

As we age, the distance between the nose and the upper lip naturally increases due to a variety of factors. As such, the youthful proportions of the lips are distorted, causing the skin of the upper lip to look long and the red portion of the lip to look thin. Many patients want to restore the lip to a more youthful and full appearance. While some patients are satisfied with the injection of dermal filler to help increase the volume of the red lip, others prefer a surgical lip lift to achieve a longer lasting solution that also helps to restore the balance between nose to lip distance and the fullness of the lip.

Many different techniques exist for doing a lip lift. These include options for incisions underneath the nose in natural creases, incisions on the underside of your lip, and/or placement of tissue into the lip itself. Your surgeon will determine the best choice for you.

Isolated lip lifts can be performed under local anesthesia and are generally tolerated very well. You’ll go home the same day as the surgery and follow up closely with your surgeon to ensure you are healing well.

As we age, changes to our facial skin, soft tissues, and fat results in loss of facial volume in specific areas. Fat transfers can sometimes be performed to address this volume loss. Fat transfer adds your own fat cells to help restore the natural fullness, curves, and shape of your face.

Fat transfer involves the removal of fat (typically from the abdomen or thigh) using a liposuction technique. The fat is then isolated and injected into areas of the face that have lost volume. This procedure can be performed alone or in combination with other facial rejuvenation procedures (such as a facelift). The result of fat transfer is similar to what is achieved with dermal filler, but more permanent.

Our team of facial plastic surgeons can discuss if fat transfer is a good option for you. The procedure is typically performed in the operating room and patients go home the same day. There is minimal downtime from this procedure.

Otoplasty, or ear pinning, is the surgical procedure of correcting protruding ears. The most common causes of the problem are underdevelopment of ear cartilage of the top half of the ear and excessive presence of cartilage in the bowl of the ear. While otoplasty can be performed at any age, we often recommend doing so around the age of six for children. This is because the ears are almost fully grown at this age, and therefore the psychological distress brought about by school-age peers can be minimized.

The surgical procedure takes approximately two hours for both ears. For children, the procedure is done under general anesthesia. Local anesthesia is an option for some adults. Incisions are made on the backside of the ear, adjacent to where the ear meets the skull. Sutures are placed to strengthen and shape the cartilage in necessary areas, and any excess cartilage is removed. The goal is to make the two ears as symmetric as possible in a more natural position. Patients are discharged home the same day, and hearing is not affected.

Recovery

Recovery entails wearing a dressing or a headband over the ears for the following few weeks following the surgery. Your surgeon will follow you closely following the operation to ensure you are healing appropriately.

The buccal fat pad is a natural collection of fat that is present on the inside of both cheeks and contributes to the volume of the midface. For some patients that have excessively round or full cheeks, removal of the buccal fat pad can lead to an improved appearance. Some caution should be employed with regards to removal of the buccal fat in youthful patients, given the natural volume loss that tends to occur with aging in all individuals.

The procedure involves a small incision made on the inner aspect of the cheek. The buccal fat pad is identified and removed from the surrounding tissue. The incision is then closed with absorbable sutures. The procedure can be performed under local or general anesthesia, depending on patient and surgeon preference. There is minimal downtime from the procedure.

Our team of facial plastic experts will review your overall facial features and surgical goals with you to determine whether you would benefit from buccal fat pad removal.

Hairline lowering surgery, or forehead reduction, is performed for patients that wish to reduce the distance between their eyebrows and their hairline. The goal of the surgery is to create a more balanced facial proportion. Your surgeon will perform a comprehensive evaluation of your facial features and review your surgical goals to determine if you are an optimal candidate for this procedure.

Hairline lowering surgery consists of an incision made in a ‘trichophytic’ fashion just at the edge of the hairline to allow for hair regrowth and subsequent camouflage of the incision. The tissues of the scalp are then elevated and the scalp is advanced forward. Excessive non-hair bearing skin of the forehead is removed and the scalp is laid down in its new position.

The procedure is typically performed in an outpatient setting. It can be done either under local or general anesthesia. Our facial plastic surgery team will review options with you and determine an individualized treatment plan during your consultation.

Facial skin cancer can be alarming for patients given the cosmetic and functional issues that can arise following removal. We work closely with our dermatology colleagues to create a reconstructive plan for your following removal of your cancer. The goal of these reconstructions is to preserve as much function as possible while optimizing the aesthetic result. Our facial reconstructive surgery team will review reconstructive options with you during your consultation visit to achieve your goals and ensure the best possible outcome to maintain form and function.

We work closely with our head and neck cancer surgeons and perform complex reconstructions of the face, nose, tongue, jaw, neck, and throat following tumor removal. These reconstructions often involve borrowing tissue from the surrounding tissues or from distant sites to help rebuild and reconstruct the involved structures in order to restore both form and function. Some of these operations require microvascular reconstruction, where tissue (including skin, muscle, bone, and/or fascia along with the blood vessels to these tissues) is taken from another part of the body and connected to blood vessels in the head or neck to replace missing tissue. We work in close conjunction with our head and neck cancer colleagues in establishing a surgical plan and creating as smooth a recovery as possible.

Incomplete development of the auricle, or external ear, can result in self-consciousness, bullying, and mental health issues for our pediatric population. Surgical reconstruction of the ear involves creation of a new framework through a meticulous surgery performed over several hours. Usually, the surgery is performed around the age of six or seven. A second stage of the surgery is often necessary several months later. Our facial reconstructive surgery team works closely with other subspecialists to obtain a holistic picture for our patients and walk them and their families through the process of building a new ear.

Other ear deformities can occur from trauma (e.g. cauliflower ear) or earlobe piercings. Our group of experts will review potential options for helping improve the appearance of the ear depending on the cause and timing of the problem.

Infants born with cleft lip and/or cleft palates can struggle with important developmental milestones in addition to the accompanying physical deformity. Our facial plastic and reconstructive surgeons work in close conjunction with other important providers for such children, including pediatric otolaryngologists, speech and language pathologists, nutritionists, and dentists. We will review a comprehensive plan and timeline for your baby and go over the surgical process and expected recovery with you during your consultation visit.

Facial trauma can have significant effects on both appearance and function. Our team of facial plastic and reconstructive surgeons has extensive experience managing patients with complicated facial fractures and trauma from a variety of different causes. We also understand the importance of managing such problems in a timely fashion. We will review your case with you and use our experience to determine the best management plan for you depending on the timing, location, and severity of fractures. Throughout the process we will work to ensure the best possible functional and aesthetic outcome for you as you recover from the traumatic incident.

Suboptimal wound healing can result in a scar that catches the eye, based on the location, thickness, or quality of the reformed tissue. Our team of facial plastic surgeons is trained in the various methods available to make scars less noticeable. Options include removing the scar and bringing the skin back together, repositioning the scar in a more favorable orientation, or resurfacing the scar using a variety of different techniques to help it blend in. Our specialists can help develop an individualized plan for you.

Keloids are the result of irregular, excessive scarring that occurs following damage to the skin, such as from an incision or a piercing. Left untreated, keloids can continue to enlarge and eventually result in significant disfigurement and potential functional problems. Management is dependent on the size, location, duration of presence, and previous treatment of the keloid. Injection with steroids is often a first step in management, while removal of the keloid can be performed as well depending on presenting factors. Keloid recurrence following removal is a significant possibility, therefore close follow up for continued monitoring is necessary if removal is performed.

Neuromodulators work by preventing muscle contraction. In extremely dilute, low doses (such as when given as Botox or Dysport), they are very effective at preventing or reducing facial wrinkles by relaxing the underlying muscles that contribute to their formation. While often aimed at reducing the wrinkles of the forehead, the skin between the eyebrows, and the ‘crow’s feet’ around the eyes, there are many more nuanced uses of this modality that our facial plastic surgeons can employ for you.

Dermal fillers, such as Juvederm and Restylane, are comprised of hyaluronic acid, a substance that naturally exists in your body. These injectable gels aim to improve the fullness in volume-deficient areas of the face and lips. While prioritizing your goals, our facial plastic surgeons can determine the best treatment option to highlight your facial features. Dermal fillers have consistently been shown to be a safe office-based procedure with results typically lasting six months to one year.

Skin resurfacing can be achieved through the use of laser treatments. We employ a state-of-the-art carbon dioxide (CO₂) laser which precisely targets the areas of treatment. Such resurfacing techniques allow for improvement in skin appearance due to a number of factors, including aging, smoking, acne, and sun damage. Scar appearance can also be improved with resurfacing techniques. The procedure is performed under local anesthesia, with healing times dependent on the condition treated and intensity of treatment.

Platelets are a crucial component of an individual’s blood that help promote clot formation and tissue healing through secretion of a variety of growth factors. Platelet-rich plasma (PRP) therapy involves extraction of a vial of a patient’s blood, centrifugation of the blood to separate it into its component parts, and isolation of the platelets and plasma to create the PRP. In such a way, a patient’s own blood components are then injected into targeted areas for enhanced platelet and growth factor healing effects. This modality is particularly useful for early stage hair loss, and has been effective for facial rejuvenation purposes as well.

Neuromodulators, such as Botox

Botox can be very beneficial for patients suffering from synkinesis and tight, hypertonic muscles months after the initial occurrence of facial paralysis. Relaxing the overactive muscles through the targeted use of Botox will allow for increased facial symmetry and decreased facial tightness. Targeted use on the healthy side can improve symmetry as well. As with Botox use for cosmetic purposes, injections are performed in clinic with minimal downtime. This is typically a first line treatment for management of synkinetic facial paralysis.

Fillers

The benefits of using fillers as volumizers for patients with facial paralysis have recently begun to come to light. This low-risk, reversible modality can help patients improve their oral competence (i.e. keeping food and liquids in their mouth) as well as improve facial symmetry through targeted injections around the mouth, midface, eyes, and nose. Injections are performed in clinic, and have been shown to improve the self-confidence of patients with facial paralysis about their appearance.

Physical Therapy

Targeted physical therapy for facial muscles is an important and often overlooked portion of the rehabilitation process for patients with facial paralysis and sykinesis. Our dedicated speech and language pathologists have specific training for facial retraining in patients with facial nerve disorders. Through their guidance, improvements can be achieved in facial movements that will improve symmetry, decrease synkinesis, improve function, and relieve tightness.

Selective Myectomy or Neurectomy

For patients with synkinesis following recovery from a facial nerve insult (e.g. Bell’s palsy), selective cutting of the overactive muscles (myectomy) or nerves (neurectomy) can help improve symptoms. These surgical options are usually pursued in an effort to make the desired results of Botox treatments more permanent. Care must be taken to ensure the procedure is not overdone, resulting in a potential loss of function. Our team has significant experience performing these delicate procedures and can help decide the best path forward for you.

Eye and Brow Reanimation

One of the most important aspects of facial paralysis management is ensuring the affected eye is protected. As the muscle that controls eye closure is innervated by the facial nerve, patients with facial paralysis often cannot close their eye adequately. In addition to burning and excessive tearing, this can lead to overexposure of the cornea and ultimately vision loss. Management often includes placement of a small, low profile weight in the upper eyelid to help with eye closure along with tightening of the lower eyelid. At times, the brow on the affected side is also raised to a more natural position to address vision loss that can accompany its hooding. These procedures can often be performed with minimal downtime and significantly improve quality of life.

Static Facial Suspension

In patients with flaccid facial paralysis without expectation of recovery, a static suspension sling can be used to help lift and position the facial tissues into a more symmetric position at rest. The sling helps to lift the corner of the mouth, restore the nasolabial fold (laugh line), and more appropriately position the nostril. The aim is to help improve facial symmetry, help prevent spilling of liquids from the mouth, biting of the lips, and improve speech and nasal breathing. The most common material used for this is tissue called the fascia lata, which is a tough sheet of tissue found just underneath the skin in the outer thigh. The fascia lata is harvested through two 3-cm horizontal incisions on the outer thigh. There is no long-term effect on thigh function afterwards.

Nerve Transfer

Depending on the cause, timing, and expectation of facial recovery, management of facial paralysis sometimes includes nerve transfers. This surgery involves ‘borrowing’ another nerve that innervates muscles (such as tongue or chewing muscles) and connecting it to the facial nerve. After enough time to allow for nerve regrowth and with facial training exercises, patients can learn how to effectively reuse areas of their face through different movements.

Gracilis Free Flap

Patients with longstanding facial paralysis sometimes require functional muscle to be transferred to the face in order to restore their smile. This surgery involves attaining a small muscle on the inner portion of the thigh called the gracilis muscle, along with the associated artery, vein, and nerve that supplies the muscle. There is no functional effect on the thigh due to removal of this muscle. The gracilis muscle is then connected to an artery and vein in the face using microvascular surgery. Often, the gracilis is innervated by the nerve to masseter, a chewing muscle, to allow for mouth movement with biting down. Alternatively, we sometimes employ a cross facial nerve graft to connect a facial nerve branch from the opposite side of the face to power the gracilis. This allows for a spontaneous smile and laugh to be achieved. Our specialized facial plastic and reconstructive surgeons will review the best option for you during your consultation.