In Debbie’s case and in every case I strive to create a more attractive, youthful look while avoiding the telltale signs of cosmetic facial surgery. In the upper eyelids, I curve the planned skin excision up and out at the lateral aspect of the eye to avoid hooding and to create a more attractive upsweep and tightening of the crow’s feet area. In the lower lids, I take care not to make any changes that will lower the lid margin so that too much “white” of the eye is showing. If the lower lid is too lax, it needs to be suspended and supported in a natural fashion.
In face and neck lifting, many surgeons take the incision in front of the ear straight up into the temporal area. The effect of this is that, when the face is lifted and rotated, the sideburn or pre-auricular tuft of hair is rotated up and one is left without hair in front of the ear which is very unnatural looking. I take care to place the incision just inside the hairline so as not to move the tuft of hair. Likewise, instead of continuing downward and placing the incision on top of the tragal cartilage in front of the ear (which is easier to close) I place it well inside the tragus and take the time to carefully fold the skin over during closure so that there is NO SCAR in front of or on the tragus. The earlobe must be undisturbed as well so as not to create a “pixie-ear” deformity with the earlobe stuck to the side of the cheek.
Perhaps the most egregious example of “done” cosmetic surgery is rhinoplasty and revision rhinoplasty. Rhinoplasty is perhaps the most difficult cosmetic surgery we perform. I strive to create a natural look, to maintain the position of the alar rims (nostrils) and create tip refinement without a pinched or “done” look, without over-rotating the tip. The bridge of the nose should be strong without a hump or convexity but without too much concavity that makes the nose more “operated” in appearance. The ideal proportion on profile is straight with a “break” or depression just above the tip and a beautiful tip-defining point and “double-break” of the columella below. I will post more thoughts on nasal surgery coming up.
Debbie looks radically different as her before and after photos will attest. These are early 4-week postop photos and we will post more as time passes. Debbie has told me her neck now looks like it did in high school! Although there is not much I would like to re-create from high school, the contour of the neck and face would be welcome!
