What is a safe age to consider nose surgery?

This all depends on the particular patient.

If a patient’s face is still growing, it is possible that a rhinoplasty could interfere with the growth and create asymmetry. Once fully grown, a rhinoplasty can be safely performed without this risk. A good rule of thumb for women is 12 months after onset of menstruation, and for a man is after 12 months has gone by without an increase in shoe size.

The other part of this question relates to the psychological development of the patient. Nose surgery can be a stress inducing event, and requires significant emotional maturity to thrive throughout the healing process. This readiness can be determined by discussing the surgery and the expected post-operative course. A mature patient will be realistic about the outcome and ask appropriate questions.

I had a nose job when I was a teenager, and now, 15 years later, my nose looks pinched and I cannot breath. Can you help me?

Some rhinoplasty techniques used in the past were excellent at creating narrowing of the nose during the initial post operative period, but, unfortunately, as the nose healed and the swelling subsided, the nose became too narrow and the inside became pinched and obstructed. Typically, this pinching and nasal obstruction gets worse over time. The goals of any revision rhinoplasty would be to strengthen the supportive structure of your nose and try to restore normal function. Of course, this would depend on the exact nature of your obstruction and would require a complete physical exam.

I heard about a facelift that is done in the office with only numbing medicine. How does that work?

Like many surgeries, not all face-lifts are the same. Certain techniques are best done with the patient deeply sedated, or under general anesthesia. In the right patient, however, a wonderful , long lasting result can be achieved without using these techniques and possibly can be done using only mild sedation and numbing medicine. This will depend on the anatomy and desires of the particular patient, and can be discussed during a facelift consult.

My upper eyelids look like saggy flaps hanging down to my eyelashes. Can this be improved?

Of course. As discussed in the Eyelid Surgery section, this problem is worsened as the brow sags with advancing age. Some improvement can be expected from use of Botox to elevate the brow, and bring some of the skin upward, off the eyelid. If this does not provide sufficient improvement, some of the skin can be removed. This procedure can be performed in the office using only numbing medicine in the skin, or in the Surgery Center, with the help of an anesthesiologist if more sedation is needed.

My son has protruding ears and I took him to a surgeon that proposed shaving the cartilage to reshape the ears. Do you use this technique?

Some surgeons use the shaving technique and can get excellent results, but I believe there is a risk of creating visible step-offs as the edges of the shaved or incised cartilage protrudes into the skin. I prefer to bend the cartilage with permanent sutures (stitches) buried under the skin. In my hands this creates a more natural contour.

Some physicians charge Botox by the area and some charge by the unit. What is the difference?

With Botox, the more units you use, the more effect you will have on a particular patient. Therefore, for a more subtle result, less Botox can be used and it will cost less. A more dramatic result may require more Botox and will cost more. I believe the best results can be attained by customizing the approach for every patient and finding the appropriate amount to get the desired results. By charging by the unit, the patient will only pay for the effect requested.

How long does Juvederm and Restylane last?

This depends on the patient and the area injected. The results can last up to a year, and some recent studies have shown that when the area is retreated at 4 ½ months, the effects can be still be seen at 18 months.

I have been diagnosed with a cancer on my lip and am scheduled to have it removed using the Moh’s technique. When should I see a plastic surgeon for the reconstruction?

Your dermatologist may be perfectly skilled at reconstructing the defect. Discuss this with your doctor to see if a plastic surgeon’s input could be beneficial. If possible, visit the plastic surgeon before the tumor is removed so your lip can be examined and photos can be taken. Frequently, the reconstruction can be done the same day, or the next day.

How long does it take to recover from a chemical peel?

That depends on the type of peel. We have a superficial peel that we can do in the office without any anesthesia. It causes the skin to peel for about two to two and a half days. We like to time it so that the peeling occurs over the weekend and no time off from work will be needed. This peel is very effective at tightening the skin and evening out some of the skin discolorations.