Posted on February 1st, 2012
Q: I Have a Big Nose And Hollow Eyes – What Do I Do?
A: Hollow Eyes and Large Nose
It certainly is possible to address both situations simultaneously. It does depend on the details but a reduction in the size of the nose can be combined with mid-face/lower eyelid filling. I would suggest that you not use injectable fat but rather a Tear-Trough implant for the hollowness. This implant is not subject to the unpredictability of fat survival and does not require a separate surgical site for harvest. It also is far more likely that your hollowness is skeletal, not soft tissue. The implant directly addresses skeletal deficiency since it looks and behaves as though it were bone once in position.
Doing the procedures separately could potentially make for more accuracy because of greater ease in deciding how much to do at each location. But with a surgeon experienced in both procedures, this should only be a minor consideration.
The extra skin will not be a problem. It will contract over the new nose.
Posted on January 27th, 2012
Q: I’ve wanted to have my nose done for a long time,not just because of how it looks. I believe that the inner workings of my nose are behind my issues – constant, painful headaches/migraine. I’d rate them 9-10/10 on the pain scale, usually in the front of my head, around the sinuses -Mouthbreathing!My dentist/hygienist always say my mouthbreathing causes shifting of teeth/dry gums,which have caused many problems I smashed my nose pretty good a few times when I was younger, not sure if I broke it
A: Rhinoplasty and Migraines
The septum (which is the partition starting at the nostrils and going all the way to the throat) can have a spur (a spiked out section) that is so large that it completely crosses the air passage part of your nose, embedding itself into the sidewall. The result of this may be severe and persistent headaches. This is far from being the most common cause of headaches, however, it is common enough to consider. This type of headache may get worse with conditions that cause swelling in your nose like colds and allergies. A proper exam of your nose in the office can rule it out immediately if no spur is present. If a spur is present and pressing against the sidewall, the possibility exists that it is the source of your headaches. If numbing the inside of your nose alleviates the headache, it is highly likely that it is the cause. However, if the headache doesn’t go away with numbing, that doesn’t rule-out the spur as the culprit. Surgical removal of the spur would be the only true way to rule it out as the cause. The headache would be immediately “cured” by surgical removal of the spur if indeed it were the culprit. I have “cured” about a dozen patients of these headaches in my career. Curiously, several of those patients never reported the headache issue prior to surgery, had no expectation of the surgery fixing the headaches, and were surprised afterward when they no longer had headaches.
A septoplasty would potentially improve the airway if an obstructive deviation or spur were present. Not all spurs and deviations result in airway obstruction. A turbinate reduction is also a very good way to improve the airway and often times is more important than the septoplasty. Turbinates are outcroppings from the sidewall of the inside of your nose and have a large capacity to swell and shrink. They are the primary cause of obstruction that comes and goes with such things as colds, allergies, and position (laying down vs being upright, even laying on the left vs right). A turbinate reduction will not stop them from fluctuating, but at any given degree of swelling, they will be smaller than they would otherwise have been.
Rhinoplasty is a surgery that alters the appearance of your nose. Typically a rhinoplasty alone would have no affect on your breathing. I say “typically” because there are situations where it could improve or worsen the airway.
Posted on January 9th, 2012
What is the best option for tightening the jawline for the very beginning of jowls? I am only 43 and have been told that I am not ready for any type of Facelift; however, I don’t like the appearance of my lower face.
I have tried Thermage twice and it has not produced the effect I had hoped for. Thank you
A: 40 year old with early jowls
At 40 years old and a touch of jowls, I would suggest camouflage techniques such as Radiesse. This often works well, is safe, and does not hinder your ability to do other procedures in the future. It does not surprise me that you are dissatisfied with Thermage, I don’t believe I have ever met a patient who was. I would encourage you to avoid all of the various machines that claim to provide a facelift without surgery, patients rarely see the promised changes, or even any change at all for that matter. At your age I encourage you to be conservative.
Posted on January 4th, 2012
My parenthesis are noticeable and definitely age me, how much of a reduction can I expect by having this procedure done?
A: Juvederm is a Great Solution
Juvederm as well as Restylane are excellent products for filling smile creases like yours or even ones that are much worse. The hyaluronic acid that makes up Juvederm is a natural skin component and is very safe. It is a simple 5 minute procedure and you can expect at least 6 months of results, but often times improvements last well over a year. In fact, new studies have shown that filling wrinkles with hyaluronic acid causes collagen remodeling which doesn’t just camouflage the wrinkle, but rather, actually fixes it. I have seen this many many times on patients who I see regularly for years as we repeat their Botox but continue to be pleased with the Juvederm result. Most patients need one syringe of product per smile line, but mild cases can use a single syringe and more severe ones need three. You should expect some mild bruising for a few days after the treatment that typically will cover with makeup.
Posted on December 12th, 2011
I have my two somewhat oversized earlobes and im wondering how much would a procedure to just cut the earloes to make them small would cost.. i had in mind it would be inexpensive since it is only earlobe reduction .. would there be any permanent scars? How long does it take to heal or until i can take the bandages off? thank you very much
A: Earlobe Reduction Surgery
Earlobe reduction surgery is a regular part of my practice. There are different approaches depending on what type of earlobe you have, past piercings, and what it is you would like to end up with. Cost is usually around $1000 for both earlobes. While it is possible to have issues with poor scarring, this is quite unusual in the earlobe. If you have piercings in your ears and they didn’t form unsightly scars or create pigment problems, probably earlobe reduction won’t either.
Posted on November 30th, 2011
Considering the fragility and the sensitivity of the skin area, is Botox a recommended option?
A: Botox in the Lips
Treating “smokers” lines in the lips is best done with a multi-modality approach. Botox alone is not likely to give you a satisfactory result. I suggest as a primary treatment using injectable fillers (Restylane) and then adding very small amounts of Botox as an adjunct. Treating creases in the lips should be left to someone who has a great deal of skill and experience as you will likely be unsatisfied otherwise.
To be effective, Botox in the lip needs to be done in much smaller amounts and at a much shorter interval than other areas. For example, you might treat the upper lip with a total of 5 units every 6 weeks. Fillers on the other hand typically only need to be repeated in this area once per year or maybe less, especially if you maintain your Botox.
When you ask “is it safe”, the answer is certainly yes. There would not be any permanent harm as a result of a poorly done treatment. You could end up over treated which would certainly be annoying, embarrassing, and challenging, but it would wear off. It is best to err on the side of under treatment. Returning after one week for a little more is better than having to wait a month to get control of your lip back!
Posted on November 21st, 2011
Q: Which Treatment is More Cost Effective: Dysport or Botox?
I don’t just want to know which one is cheapest, I also want to know which is the better buy, based on results and need for repeat treatments.
A: Dysport vs. Botox Cost
There is no universal answer to this question. However, I think you will find on average that you can get the same result for less money using Dysport. In my office it will cost you about 10% less, not including any rebates. But, just like buying anything, it will depend on who you are buying it from. Dysport is currently offering rebates of $50 per treatment , which will make it more cost effective virtually everywhere.
Web reference: http://www.dr-apo.com/lunchtime-procedures/
Posted on November 15th, 2011
*Asked on RealSelf
Q: After Three Laser Facials, Still See Fine Lines Around my Mouth
I have had a problem with some fine lines on my lower face, I have had a serious of three laser facials one month apart. My last was in November. The dematologist said it would take about 12 months to see the final results, however, that is a long time to be stuck with lines that I don’t like. What else can I do? I am only 33. Yes I use strong sunscreen everyday.
A: Superficial Laser Treatments Won’t fix Lines
Wrinkles are a property of the dermis. Any type of peel that you would be doing as a series is almost certainly not getting into your dermis at all. A peel such as that is taking off the top part of the epidermis, which grows back, then you peel it again, it grows back, and so on. As you can see, the only thing this type of peel affects is the epidermis over and over, but the wrinkle is in the dermis.
You need a single aggressive peel to address wrinkles. At age 33, you could consider a fractionated deep peel such as Matrix, DOT, Fraxel Repair or others that use a CO2 laser and go well into the dermis. While this isn’t as effective as a regular deep peel, the healing will be far less and 33 year old wrinkles should respond nicely. The non-ablative treatments such as Fraxel do even less than a superficial peel in that they usually affect neither complexion or wrinkles.
Web reference: http://www.dr-apo.com/surgical-procedures/laser-skin/
Posted on October 24th, 2011
About a year ago I underwent a septoplasty to correct a severely deviated septum that resulted from a broken nose when I was younger. My surgeon removed what must of been sizeable bone spur that was obstructing the nasal passage which definitely helped with my breathing. Unfortunately, it did little to correct the aesthetic appearance of my nose. The septum is still very deviated midway up the nose so it has maintained its crooked appearance. This is due to the septum pushing out against the nostril while the other “droops”. Furthermore, my right nasal bone is caved in slightly due to the break adding to the appearance of crookedness/curve. When I consulted a plastic surgeon a bit later about the possibility of a septoplasty revision he said it would not be worth it considering a lot of cartilage was removed. This would make it hard to re-anchor/attach the septum and would also increase the risk of perforation. What can i do to fix this asymmetry? Is a rhinoplasty still possible? And what can be done about the crushed right nasal bone? I have considered fillers to even out the appearance of the curve and create symmetry. Though i’d want permanent results, Is this a better option? Thanks in advance!
A: Rhinoplasty After Septoplasty Is Very Possible
It is absolutely possible to do a rhinoplasty after having had a septoplasty. It is probably true that you have a higher risk of having a septal perforation occur but this risk is still very small in the hands of a qualified surgeon. Ideally you would have had your rhinoplasty and septoplasty done together at your first surgery, but we can’t go back in time and change that so there is no reason to fret over it now.
It is important that you find someone who really enjoys doing rhinoplasty, is skilled at both external and internal nasal surgery, and makes this a significant part of their practice. This won’t be an easy surgery and the surgeon needs to have the patience to stand there for whatever amount of time it takes to disassemble your nose and reassemble it as straight, strong, and functional as possible.
Posted on October 17th, 2011
Look at my picture, can you see my eyelid is drooping…I would like this raised,can this be done with a injection of Botox ?. I don’t want to have a eyelid lift. Where would you inject and how many units do I need ?
A: Lifting with Botox
Botulinum products (Botox, Dysport, Xeomin) can be used to create a subtle brow lift and thus a subtle eyelid lift. Treating the muscles that pull downward on the brow will relax them and allow for a slight shift upward for some people. This affect is not consistent from one person to the next. It typically produces only a subtle lift but I have seen some people get significant lifts. One should be careful not to produce “joker” eyebrows doing this as it is very unnatural and I see many injectors do this somehow thinking it looks good.
The two main muscles that pull down on the eyebrows are the outside portion of the orbicularis occuli muscle (crows feet area) and the corrugator muscle (between the eyebrows). Treating the frontalis (forehead) muscle can help shape the result.
In the end, however, you really are better off having an eyelid lift if that is the main effect you are trying to achieve. Using Botox exclusively for this purpose is a very inefficient use of your time and money.
