The size and shape of the nose may be the most defining characteristic of the face. Every year, hundreds of thousands of people throughout the United States elect to improve the appearance and/or function of their nose through nasal surgery or rhinoplasty. Some people would like to improve the size of shape of the nose; others wish to repair damage caused by an injury, and some would simply like to breathe more easily. Rhinoplasty is designed to improve imperfections in the nose, whether they are "inherited," present from birth, or as a result of trauma. The operation is performed to repair asymmetries, to make certain nasal features more delicate, or to create a nose that is more harmonious with the rest of the face.
Since the nose provides a focal point of balance for other facial characteristics, it cannot be viewed alone. It is sometimes advisable to create a stronger chin (mentoplasty) to correct what appears to be an excessively large nose, or to create the impression of a shortened nasal tip.
Rhinoplasty can be combined with the surgical repair of the nasal septum (septoplasty). The septum is the structure that sits in the middle of the nose separating one side from the other. Often, twists and deflections may be present which obstruct breathing. A septoplasty improves or eliminates this problem.
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Rhytidectomy and rhytidoplasty are the medical terms used to describe the operation designed to remove wrinkles and decrease sagging that occurs on the face and neck with aging. This type of facial plastic surgery has become the third-most desired cosmetic surgical procedure in both men and women. This procedure is frequently performed along with a browlift and eyelid surgery to achieve effective facial rejuvenation.
The facelift operation includes incisions that are carefully placed in natural skin creases behind the "tragus" of the ear and behind the hairline so that they are extremely difficult to detect. A "short-scar" technique, or "S-lift," approach may be used if appropriate.
The most important tightening takes place in the tissue under the skin rather than in the skin itself. The skin is then "redraped" to fit a more streamlined framework. This type of lift avoids the obvious "wind tunnel" look by minimizing tension of the skin to create the most natural-looking results possible. The improvement will last 5-15 years. You should realize, however, that you will look much better at any given age than you would have without the operation. So, in essence, the changes are permanent!
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This relatively new procedure allows Dr. Macdonald to address subtle but significant signs of aging, such as pronounced nasolabial folds (between the side of the nose and the corners of the mouth) and hollowness in the mid-face/cheek areas. These natural changes are produced by the combination of gravity and a loss of elasticity in the skin and soft tissue.
The "48-hour facelift" is performed through an incision that is less than 2 inches long above the hairline of the temple. Elevation of the mid-face/cheek area is achieved with the help of an endoscope. Threadlike sutures are used to suspend the soft tissue in this area back to its normal, more youthful position. This technique allows the nasolabial fold to be softened or eliminated. High "cheekbones" of youth are restored and the lateral eyebrows and mid-face are lifted. Since the small scars are so well hidden above the hairline and there is minimal post-operative bruising, many patients go back to work in 5-7 days. A full recovery can be expected in one to two weeks.
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In our culture, the eyes are usually the primary focus of attention. Droopy upper eyelids can make you look tired and older and can also impair your vision. In the lower lid area, puffiness or "bags" under the eyes may produce a worn and tired-looking appearance. The solution is quite simple!
Blepharoplasty removes the excess fat, muscle and skin from upper and/or lower eyelids. The results can include a very natural, refreshed appearance, with a younger-looking, firmer eye area. Dark circles can be eliminated. Those around you will usually think you look healthy and very well-rested without ever knowing that you have had a surgical correction.
The incision in the upper lid is hidden in a natural skin crease. For those patients who wish to create a new upper eyelid crease or change the existing one, Dr. Macdonald also performs "double-eyelid" surgery. Dr. Macdonald generally makes the lower eyelid incision on the inner surface of the eyelid so that there are no visible scars at all in this region. This is referred to as the "trans-conjunctival" approach. Laser resurfacing or brow recontouring may be considered along with eyelid surgery.
Recovery time is extremely rapid. If bruising occurs, it generally lasts no longer than 3-5 days. There are generally no visible incisions, scars or stitches in the lower lid. Stitches in the upper lid are well hidden by the natural upper lid skin crease until they are removed within the first week.
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Otoplasty may be performed to correct prominent "outset" or misshapen ears. This is often done during childhood but is also occasionally addressed later in life. Surgery begins with an incision just behind the ear, in the natural fold where the ear is joined to the head. Dr. Macdonald will remove the necessary amounts of cartilage and skin required to bring the shape and position of the ear into natural proportion with the head. In some cases, the ear is "pinned" back with permanent sutures to secure the cartilage. Soft dressings and/or a headband are then worn for 7-10 days to hold the ear in its new position during the initial healing period. A sports-type headband is worn while sleeping for 4-8 weeks post-operatively. The risks are minimal and the scar is hidden in the natural crease behind the ear.
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The brow and forehead areas often show the first signs of aging as the skin begins to lose its elasticity. Sun, wind, habitual facial expressions and the pull of gravity produce frown lines, wrinkling across the forehead, and an increasing heaviness of the eyebrows. Even people in their 30s may look older than their years because the forehead and brow areas appear tired, angry, or had a sad expression which does not reflect how they actually feel.
By addressing the upper portion of the face, the brow lift provides subtle but effective facial rejuvenation. It may be considered along with a traditional facelift, or the more conservative mid-face/cheek lift, and eyelid surgery for a more comprehensive approach to facial rejuvenation.
A brow lift repositions the eyebrows upward to a more aesthetic and youthful position, and decreases the lines between the eyebrows and above the nose. In addition, a brow lift can reduce the amount of wrinkles across the forehead and change the height of the forehead. Endoscopic technique allows small incisions to be placed behind the hairline to hide any scars. Dr. Macdonald uses this technique (called the endoscopic or "limited-incision" brow lift) when appropriate.
The brow lift is frequently performed in conjunction with BOTOX® Cosmetic, eyelid surgery and/or management of mid- or lower facial contour.
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A chin implant or bone-reshaping adds strength and definition to the jawline. This is very important in facial symmetry and proportion. Chin augmentation is often particularly effective when done in conjunction with other procedures (e.g. rhinoplasty, neck liposuction or facelift).
The time required to perform a chin implant usually ranges from one to one-and-a-half hours. Local anesthesia with sedation is most commonly used. General anesthesia is very rarely recommended. A small incision is placed inside the mouth or just under the chin area. Dr. Macdonald selects the proper size and shape of the implant from those considered the most likely choices, with the patient's input during the pre-operative planning consultation, and inserts it into a pocket over the jawbone. Usually the chin is taped after surgery to minimize the swelling and to help prevent any early shifting of the implant. If an intra-oral incision is made, the sutures will dissolve; otherwise, they will be removed in 5-7 days.
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Loss of fullness in the cheek/mid-face area may give a flattened or sunken look to the face. This may occur following an injury or simply as the mid-face loses bone and soft-tissue volume. Alternatively, loss of proportion here may also be due to excessive fullness in the soft tissue of the lower mid-face and cheeks. Reestablishing proportion in this area can create more natural-looking, youthful-looking and balanced facial features. Subtle changes created with care, artistry and finesse can have a wonderfully positive impact.
Cheek recontouring may be achieved through a mid-face/cheek lift to readjust the position of your own natural tissue. Cheek implants, placed next to your natural cheekbones, may be more appropriate. Occasionally, an injectable tissue filler (e.g. Restylane, Cymetra, Bioform or fat) may be all that is required.
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Liposuction surgery was originally developed in France and has become increasingly popular in the United States since 1982. The surgery involves removal of fat deposits underneath the skin in certain areas such as the cheeks, neck, abdomen, flanks, back, upper arms, lateral thighs ("saddle bags"), inner thighs, knees and buttocks to make sculpted improvements in contour. Liposuction surgery is now one of the most frequently performed cosmetic surgery procedures elected by both women and men. Results have been excellent in the overwhelming majority of cases.
The operative procedure involves making tiny incisions (approx. 1/4 inch in width) so that a narrow, hollow suction tube may be passed beneath the skin. Dr. Macdonald uses the tumescent technique to minimize any blood loss or post-operative bruising associated with this procedure. In this way, the sculpting can be performed safely while allowing for the quickest recovery possible. Dr. Macdonald may also use ultrasound to assist with the liposuction (ultrasonic-assisted liposuction, or UAL) or power-assisted reciprocating cannula in appropriate cases involving areas where the fat is intimately intermixed with firm fibrous tissue (e.g. male breasts or following trauma or previous surgery).
While some physicians perform "mega liposuction," in the interests of patient safety Dr. Macdonald has placed limits on the volume of fat that he will remove during any one operation. Most patients will be able to have all of their areas of concern addressed with a single procedure. However, Dr. Macdonald does not perform liposuction on patients who are seeking to achieve general, overall weight loss. The most appropriate patients (men and women who will be happiest with their results) are those who have one or more regionally localized fat deposits. Most commonly these deposits occur in the abdomen, inner or outer thighs, flanks or upper arms in women and in the abdomen or flanks ("love handles") in men. Other areas that may be addressed include the knees, back, calves or ankles.
Once the fat has been removed, the goal is to keep it off. With this in mind, Dr. Macdonald prefers to perform liposuction on patients who are at their most stable weight, with a diet and exercise regimen which they can easily maintain. To help liposuction patients achieve a comfortable, healthy post-operative lifestyle, they are offered a complimentary consultation with Michelle Kupick, R.D., a local nutritionist and registered dietician.
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