Face

Eyelid Surgery (Blepharoplasty)

The skin of both the upper and lower eyelids can loosen and sag with time. An eyelid lift, or blepharoplasty, can correct this. During the procedure, your physician surgically removes excess skin and in some cases fat and muscle from both the upper and/or lower eyelids to redefine the shape of the eye.

Blepharoplasty can give your eyes a more youthful look and can correct droopy eyelids, a condition called ptosis. You may want a blepharoplasty procedure for cosmetic reasons or to be able to see better. This often depends on what part of the eyelid has the excess skin:

  • Upper eyelids: Excess skin in the upper eyelids can result in a tired appearance or can result in difficulty seeing the top portion of your field of vision. Sometimes, blepharoplasty surgery for the upper eyelid is for cosmetic reasons, while in other cases the surgery is medically necessary to allow you to see better.

  • Lower eyelids: Blepharoplasty in the lower eyelid is usually a cosmetic procedure to improve the shape, contour and appearance of loose skin, bulging fat and irregular shape.

​Am I a candidate for eyelid surgery?

Candidates for eyelid surgery are men and women who are:

  • Physically healthy

  • Psychologically stable

  • Realistic in their expectations

Some medical conditions make eyelid surgery more risky, including:

  • Dry eyes

  • Thyroid problems

  • High blood pressure

  • Cardiovascular disease

  • Conditions requiring blood thinners

  • Previous eye surgery

  • Diabetes

  • Detached retina

  • Glaucoma

If you have any of these conditions, talk to your doctor to find out if blepharoplasty is appropriate for you.

Blepharoplasty complications

There may be other side effects and complications from the procedure. We work with you to minimize these complications and manage any discomfort you may experience. Learn more about eyelid surgery complications.

Possible complications associated with eyelid surgery may include, but are not limited to, the following:

  • Temporary vision problems - double or blurred vision may occur after undergoing eyelid surgery. This typically lasts for just a few days following the surgery.
  • Eye closure problems - some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent.
  • Swelling or asymmetry changes - temporary swelling and a slight imbalance of one eye in relation to the other may occur during the healing or scarring process.
  • Acne - after the stitches are removed, tiny whiteheads may appear. The surgeon can remove the whiteheads with a very fine needle.
  • Ectropion - this extremely rare complication is the pulling down of the lower lids. Further surgery may be required in order to correct this symptom.

 

While every patient’s experience is different, here is a general guide to eyelid surgery:

Where will my surgery be performed?

We will decide with you where to perform the surgery. Location options include:

  • Surgeon's office-based surgical facility

  • Outpatient surgery center

  • Hospital operating room

In the office-based location this will be performed with local anesthesia only and no sedation.  The other facilities can include being sedated or under general anesthesia depending on the patient’s needs.

  • The procedure can last from 30 minutes to several hours depending on what is required for correction of the underlying issues. After the procedure, you may experience short-term side effects including:

  • Eyelids may feel tight

  • Eyelids may feel sore

Recovery

You should expect to have significant bruising (black eyes) for 1-2 weeks and some swelling following surgery. The swelling can persist for several months in some instances.  In most cases, you can expect to be able to go back to work within a few days. Some patient’s may have dry eyes during the recovery process and it is suggested you use some eye drops to help with these symptoms for several weeks following surgery.

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Upper Eyelid Demo
Lower Eyelid Demo

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Botox

The muscles around the eyes can create wrinkles and cause the brows to droop. By relaxing these muscles, Botox® can help replace a furrowed brow with a refreshed look. Botox® not only effectively reduces wrinkles, it can provide many of the benefits of a surgical brow lift without the recovery time. It is used to soften dynamic wrinkles--the wrinkles produced by facial movement. Static wrinkles, from smoking or sun exposure, are best treated with fillers, lasers or surgery.

Generally treatments can be administered in an office setting. Anesthesia is rarely needed, but an ice pack may be used.

You will see the results within three to five days. While results vary, benefits last about three to four months.

 

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Botox

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Obagi Medical Skin Care

For more information about Obagi Medical, visit their website at www.obagi.com or call the office at 319.393.1902.

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Nose Surgery (Rhinoplasty)

Each year across the United States, half a million women and men seek consultations with facial plastic surgeons to improve the appearance and function of their noses. Some people are unhappy with the noses they were born with and some are unhappy with the way aging has changed their nose. For others, an injury may have distorted the nose or the goal may be improved breathing.

Rhinoplasty literally means shaping the nose. The goal is to improve both the form – making it harmonize better with other facial features--and function of your nose. Skin type, ethnic background, and age are important factors to be considered.

A unique ‘structural approach’ is used to reshape the nose, giving your face a balanced look, as well as making your nose stronger and more functional. In more common approaches to rhinoplasty, tissue removal is emphasized, which actually weakens your nose.

During the pre-surgical consultation, your nose, both externally and internally, will be examined and evaluated. The surgeon will explain how the nasal structures can be reshaped to improve both the form and function of your nose. For some patients, reshaping the chin at the same time may enhance the desired results.

If you're considering rhinoplasty, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.

The Best Candidates for Rhinoplasty

Rhinoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you're physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate.

Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth defects or breathing problems.

Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they've completed their growth spurt-around 14 or 15 for girls, a bit later for boys. It's important to consider teenagers' social and emotional adjustment, too, and to make sure it's what they, and not their parents, really want.

All Surgery Carries Some Uncertainty and Risk

When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon's instructions both before and after surgery.

After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface; these are usually minor but may be permanent. Other possible risks specific to rhinoplasty include but are not limited to:

  • Difficulty breathing through your nose
  • Permanent numbness in and around your nose
  • The possibility of an uneven-looking nose
  • Pain, discoloration or swelling that may persist
  • Scarring
  • A hole in the septum (septal perforation)

In about one case out of ten, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.

Planning Your Surgery

Good communication between you and your physician is essential. In your initial consultation, the surgeon will ask what you'd like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He or she will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.

Your surgeon will also explain the techniques to be used, the facility where the surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don't cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered.

Be sure to tell your surgeon if you've had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you're taking any medications, vitamins, or recreational drugs; and if you smoke.

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing For Your Surgery

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Where Your Surgery Will Be Performed

Rhinoplasty may be performed in an outpatient surgery center or a hospital. It's usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.

Types of Anesthesia

Rhinoplasty is performed under general anesthesia, so you will be sleeping for the entire procedure.

The Surgery

Rhinoplasty may be done inside your nose or through a small external cut (incision) at the base of your nose, between your nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.

Your surgeon can change the shape of your nasal bones or cartilage in several ways, depending on how much needs to be removed or added, your nose's structure, and available materials. For small changes, the surgeon may use cartilage taken from deeper inside your nose or from your ear. For larger changes, the surgeon can use cartilage from your rib, implants or bone from other parts of your body. After these changes are made, the surgeon places the nose's skin and tissue back and closes the incisions with sutures.

If the wall between the two sides of the nose (septum) is bent or crooked (deviated), the surgeon can also correct it to improve breathing.

After the surgery, you'll be in a recovery room, where the staff monitors your return to wakefulness. Most patient’s are able to go home the same day.

After Your Surgery

After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery.

In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It's usually in place for about one week.

Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a "drip pad" — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don't place the drip pad tight against your nose.

To further lower the chances of bleeding and swelling, your doctor may ask that you follow precautions for several weeks after surgery. Your doctor may ask you to:

  • Avoid strenuous activities such as aerobics and jogging.
  • Take baths instead of showers while you have bandages on your nose.
  • Not blow your nose.
  • Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site.
  • Avoid extreme facial expressions, such as smiling or laughing.
  • Brush your teeth gently to limit movement of your upper lip.
  • Wear clothes that fasten in the front. Don't pull clothing, such as shirts or sweaters, over your head.

In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.

Use SPF 30 or greater sunscreen when you're outside, especially on your nose. Too much sun may cause permanent irregular discoloration of the skin of your nose.

Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don't put anything such as ice or cold packs on your nose after surgery.

Your nose changes throughout your life whether you have surgery or not. For this reason, it's difficult to say when you have obtained your "final result." However, most of the swelling is gone within a year.

Getting Back to Normal

Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you're entirely up to speed.

Your surgeon will give you more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics.

You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they'll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed.

Your surgeon will schedule frequent follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can't do, don't hesitate to call your doctor.

Your New Look

In the days following surgery, when your face is bruised and swollen, it's easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it's quite normal and understandable.

Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you'll no longer look as if you've just had surgery.

Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.

In the meantime, you might experience some unexpected reactions from family and friends. They may say they don't see a major difference in your nose. Or they may act resentful, especially if you've changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you've met your goals, then your surgery is a success.

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Nose Surgery (Rhinoplasty)

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Rhytidectomy (Facelift)

As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds and fat deposits appear around the neck.

Rhytidectomy has become a highly desired facial plastic surgical procedure in the U.S. While called a face lift, it actually involves only the lower third of your face. A face lift cannot stop aging; however, it can improve the visible signs of aging by tightening underlying tissue, and re-draping the skin of the face and neck as well as oftentimes replacing or repositioning the adipose tissue that has atrophied.

At your initial visit, your surgeon will examine the structure of your face and skin texture, color, and elasticity. Individual risks will also be discussed, especially those related to medical situations such as high blood pressure, a tendency to scar, smoking, and any deficiency in blood clotting.

The Best Candidates for a Face Lift

The best candidate for a face lift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but face lifts can be done successfully on people in their seventies or eighties as well.

A face lift can make you look younger and fresher, and it may enhance your self- confidence in the process. But it can't give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

If you are currently smoking you will not be offered surgery until you are able to quit for at least 6 weeks prior.

All Surgery Carries Some Uncertainty and Risk

When a face lift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers.

You can reduce your risks by closely following your surgeon's advice both before and after surgery.

Planning Your Surgery

Face lifts are very individualized procedures. In your initial consultation the surgeon will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery.

Your surgeon should check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

If you decide to have a face lift, your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Where Your Surgery Will Be Performed

A face lift may be performed in an outpatient surgery center, or a hospital. It's usually done on an outpatient basis, but some patient’s may need to spend the night in the hospital. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may also require a short inpatient stay. Our surgeons perform most face lifts under general anesthesia.

 

The Surgery

A face lift usually takes several hours-or somewhat longer if you're having more than one procedure done. For extensive procedures, some surgeons may schedule two separate sessions.

Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on your facial structure and your surgeon's technique.

Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.

In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle layer, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.

Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.

After Your Surgery

There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by your surgeon. (Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months.

You should keep your head elevated as much as possible for a couple of days after surgery in order to keep the swelling down.

If you've had a drainage tube inserted, it will be removed one or two days after surgery. Bandages are usually removed after one to five days. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you'll be looking normal.

Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.

Getting Back to Normal

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first.

Your surgeon will give more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity, including sex and heavy housework, for at least two weeks (walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for several months. Above all, get plenty of rest and allow your body to spend its energy on healing.

At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff and you'll probably be self-conscious about your scars. Some bruising may persist for two or three weeks, and you may tire easily. It's not surprising that some patients are disappointed and depressed at first.

By the third week, you'll look and feel much better. Most patients are back at work about ten days to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.

Your New Look

The chances are excellent that you'll be happy with your face lift-especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places-behind the neck and ears-where areas of beard- growing skin have been repositioned.

You'll have some scars from your face lift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be scarcely visible.

Having a face lift doesn't stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one face lift are lasting; years later, you'll continue to look better than if you'd never had a face lift at all.

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Face Lift (Rhytidectomy)

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