Facelift specialist, Beverly Hills plastic surgeon Dr. Donald B. Yoo, discusses Deep Plane Facelift surgery including facelift recovery, and facelift expectations. Rhytidectomy Before and After photos and patient reviews are shown.
Before and After Deep Plane Facelift Surgery
Before and After Deep Plane Facelift Surgery (Rhytidectomy)
Rhinoplasty specialist, Dr. Donald B. Yoo, discusses non surgical rhinoplasty (nose job) using facial fillers (Restylane®, Juvederm Voluma®). Advantages/disadvantages, risks, and what to expect during the procedure are explained. Before + after pictures, and patient reviews are included.
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BOTOX® expert, Beverly Hills plastic surgeon Dr. Donald B. Yoo, discusses BOTOX® for masseter reduction. Also known as jaw reduction with BOTOX®, or the V-line procedure, Before + After photos and patient reviews are shown.
Botox for masseter reduction (jaw reduction) performed to taper and slim the face.
Before + After non-surgical rhinoplasty for softening and straightening profile and dorsal hump.
Most commonly the puffiness under the eyes is a result of a forward outpouching (pseudoherniation) of the fat that surrounds your eye. Normally this fat is contained around the eye (where it’s hidden) by a thin structure called the orbital septum. It acts very much like a sheet holding the fat back. As we age, this septum becomes thinner and weakens, allowing the fat to “pooch” forward.
In addition to the bags, with aging and gravitational changes, the volume of your cheeks and midface is being reduced and pulled downward. This downward descent of the midface structures leaves a deficiency or hollowing under the eyes, resulting in a “tear trough” (nasojugal groove).
A lower eyelid surgery called lower blepharoplasty with fat repositioning is available to help combat these issues. Lower blepharoplasty is performed through a hidden incision on the inner surface of your eyelid. Through this incision the fat that is “pooching” is mobilized and moved to an area where it is useful – the tear trough, where there is volume deficiency. This serves to move fat away from an area of excess and fill the area of deficit, smoothing the contour between the lower eyelid and the cheek.
Before and after lower blepharoplasty with fat repositioning.
Some bruising and swelling is expected after surgery, but most patients are out and about in 10-14 days. Pain and discomfort is generally mild after surgery.
Since it is located in the center of the face, the nose plays a crucial role in facial proportions. An unbalanced nose can distort the perception of balance for the entire face, even when the other facial features are aesthetically pleasing. Though it plays less of a role than the nose, the chin also plays an important part in determining facial harmony, especially from the profile view.
From the profile, a small chin gives the illusion that the nose is large and over-projected (pushed too far from the face) since the chin is “set back” relative to the nose. A small chin can also cause the nose to appear too “long”. There are 2 potential solutions for this during rhinoplasty surgery. One is to account for the appearance of the nose in relation to the small chin, by reducing the size of the nose to match the chin. For mild microgenia (small chin), this is a viable option. For more significant chin disproportion, the more ideal option is to address the nose and chin, to harmonize the entire face. Especially from the profile, this combination of procedures can deliver dramatic results.
When performed conservatively by an experienced surgeon, chin augmentation looks completely natural and undetectable besides a small incision hidden below the chin.
Nonsurgical rhinoplasty is performed by using a dermal filler to augment or “build up” the nose. Since volume and height can only be added, it can not actually remove a dorsal hump (bump on the bridge of your nose), but depending on how it is injected it can lessen the appearance of the hump.
The area of the bridge above the hump, connecting to the forehead, is referred to as the “radix”. Sometimes this area is too low, causing the hump to look even larger than it really is. When the area is augmented (built up and made higher), the result is a straighter profile and the appearance that the hump has been removed. This does result in an overall taller and more projected nose, so it works best for patients with a deep, or low radix.
Rhinoplasty, or a “nose job” as it is more commonly known, is one of the most frequently performed cosmetic surgery procedures today. If you are considering undergoing rhinoplasty it is important to consider all aspects of the procedure, including what you can expect during your immediate recovery period so you can make an informed decision.
In general, after rhinoplasty you can expect to experience some throbbing pain and headaches. Most patients who have undergone rhinoplasty only require a couple of days of a narcotic for pain relief. After that, most report that over-the-counter pain relievers such as Tylenol are more than sufficient to relieve their discomfort. The majority of patients are pleasantly surprised how the level of discomfort is less than expected. Most bruising and swelling will resolve within 7-10 days after surgery, and the majority of patients will take 10-14 days off from work or school.
The most uncomfortable aspect of the recovery is probably not being able to breathe through your nose during the first week after surgery. This is due to swelling from the surgery itself, and sometimes from small silicone splints that Dr. Yoo places inside the nose to aid the healing process. Nose blowing should be avoided for the first two weeks, and instead nasal saline irrigation and sprays should be used to help keep the inside of the nose moist and clean. As the swelling resolves, your breathing will be dramatically improved compared to before surgery.
Dr. Yoo sees patients the day after surgery, then one week after surgery. At the one week post-op visit, the cast and sutures are removed and a light, nude colored tape is applied. Light cardio exercise may resume 2 weeks after surgery, and full workouts may resume 4 weeks after surgery.
About 3-6 months after your surgery the vast majority of the swelling (60-80%) will have resolved, though your nose may still feel a bit numb. Healing will continue for a full year after surgery, and up to two years after revision surgery. Many patients enjoy seeing the subtle changes their noses undergo during the healing process as they reach their final aesthetic result.
Common goals in Asian rhinoplasty include augmenting the dorsum (building the bridge), projecting and refining the tip (making the tip smaller and taller), and narrowing the nose. A variety of different techniques have been described to augment the dorsum, including using synthetic materials such as silicone or Gore-tex, and using autologous materials (from your own body) such as rib cartilage and diced cartilage wrapped in fascia (DCF).
Figure. 1
Silicone nasal implants have become a popular choice for dorsal augmentation because they are pre-formed in a variety of different shapes and sizes and are easy to place, thus greatly reducing operating time and complexity. Immediate results are also quite good, especially in patients with thicker skin such as Asians. Although Asian rhinoplasty with silastic implants is quicker and easier than surgery with autologous grafts (your own tissue), it does come with a number of downsides. Silicone implants never become incorporated into your nose and always remains as a foreign body. Thus, there is always a risk of migration, infection and extrusion. Even if an implant has been safely in place for ten years, there is still a chance for the implant to move out of position, or even thin out the skin to the point of poking through the skin (see Figure 1).
Dorsal augmentation with autologous grafts is a more technically challenging and far more time consuming surgery, but the results are natural, safer and permanent. Beverly Hills facial plastic surgeon Dr. Donald Yoo specializes in Asian rhinoplasty using autologous grafts because it provides the best possible aesthetic and functional outcomes. He is amongst a small, elite group of surgeons worldwide with extensive experience in using rib cartilage for Asian rhinoplasty. Instead of using a pre-formed silicone implant, harvested rib cartilage is finely diced and wrapped in fascia harvested from a hidden incision in the hairline (see Figure 2). This implant is custom tailored to provide the precise augmentation and bridge shape desired.
Figure. 2 Removed silicone implant. Below: Custom-made diced-cartilage fascia (DCF) implant.
Unlike the silicone implants, diced-cartilage fascia (DCF) implants become fully incorporated into your nose so that it simply becomes a part of you. In addition, the DCF provides a very natural, aesthetically pleasing contour, unlike the very sharp and artificial edges of silicone implants. The result is a more beautiful you.
Before and After augmentation Asian rhinoplasty with DCF (diced cartilage fascia) and rib cartilage harvest.
Every surgery leaves scars, but the goal with any type of aesthetic surgery is to minimize the appearance of scars as much as possible. The best way to minimize scarring is to avoid creating an unsightly scar to begin with. Meticulous technique is essential, as it will provide the best chance of a scar to heal well. Paramount to a successful closure is avoiding tension along the incision line, perfect approximation and careful eversion of skin edges. Skin edges tend to pull apart as wounds heal and contract and if there is any tension on the wound a wide, unsightly scar results.
Proper technique is always important but most critical when an incision cannot be hidden and is in a highly visible place, such as with a male facelift patient who has experienced hair loss. There are also instances where we can hide scars. For example, with a chin implant, the implant is typically placed through an incision through a natural skin wrinkle or skin crease located beneath the chin. That way the resultant scar “hides” within this crease. Hiding certain facelift scars is possible as well, as some incisions can be placed along the hairline and behind the ears.
Aside from good surgical technique to minimize the appearance of scars, proper wound care is important as scars mature. Keeping the incision area clean while healing is important as well, along with avoiding any strenuous exercise that may create tension in the incision area. Sun protection with sunscreen of SPF 30 or higher is vital, as sun exposure will result in hyperpigmentation (darkening of the scar). Close follow-up is important because even if you care for a wound perfectly, a scar may still form. Scar formation can be modulated during the healing period using injections of a dilute steroid and 5-fluourouracil, as well as with laser treatments (pulsed-dye laser, fractional resurfacing laser).
Overall, there are many measures that can be taken both during and after surgery to minimize the appearance of scarring and leave the patient with a fantastic result.
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