What can I eat after buccal fat removal?
Buccal fat sits within the deep space of the cheek. Some patients elect to have a portion of this fat pad removed in order to slim the lower half of the face and to allow to better accentuation of the cheekbones. Buccal fat removal is typically achieved through a small incision within the mouth, on the inside of either cheek, at the level of the bite line (where the upper teeth and lower teeth meet when biting down). Following fat removal, the incisions are closed with several dissolvable stitches.
After surgery, the key is to not traumatize the incisions lines or stitches with anything too chewy or sharp (think no beefy jerky, chips, raw veggies, pretzels). Patients are advised to eat soft foods for the first week, as the incisions heal and as the postoperative swelling begins to resolve. It’s wise to stock up on soft mushy foods before surgery, like applesauce, mashed potatoes, smoothies, soups, yogurt, etc.
Planning for recovery: what can I expect following my rhinoplasty surgery?
A rhinoplasty is performed in order to change the appearance of the nose. This can be done primarily if a patient strictly wants a change in the look of their nose, or secondarily after a trauma. Following rhinoplasty surgery, a patient can expect to experience: swelling, bruising, discomfort, nasal congestion, +/- nasal bleeding/drainage.
The majority of swelling will peak 2-3 days postoperatively and begin to slowly improve. Roughly 70% of swelling will be gone by 2 weeks. Thereafter, residual swelling will continue to improve for the first year (yes, a year!).
Bruising is minimal in some patients and more pronounced in others. If a patient bruises, it’s typically in the cheeks and around the eyes. It usually takes 2-3 weeks for this to totally dissipate.
Discomfort varies highly among patients following rhinoplasty surgery. Some patients only take a couple Tylenol after surgery while others will elect to take prescription pain medication for ~5-7 days.
Nasal congestion after surgery is expected. Just as the outside of the nose swells, so does the inside. And this can be really annoying, particularly at night when the patient is forced to mouth breathe. Be patient and it will improve. It usually takes 2-3 weeks for the majority of the internal swelling to significantly improve.
A small amount of nasal bleeding is common after rhinoplasty surgery. It’s common for patients to go home with a drip pad (or gauze pad) taped under their nose to catch any bleeding the evening of their surgery. If a patient experiences bleeding, it’s typically only a few drops every hour for the first 1-2 days after surgery. Anything more than that warrants a call to their surgeon overnight.
Always consider your neighbor - which procedure is best to address hooded eyes?
It can. The term ‘hooded eye’ refers to excess skin that folds down within the region of the upper eyelid. It is usually more noticeable toward the outer edge of the eye, where the eyebrow tapers towards the temple. People often associate it with aging but it can also be seen in younger individuals, as the result of genetics.
Working down, let’s think about the forehead, eyebrow, and upper eyelid as different but neighboring units. If the forehead and/or eyebrow are sagging, that can result in the appearance of excess skin within the upper eyelid region – whether there’s a true excess or not. If that same patient takes their hand and gently lifts the eyebrow, that will improve the amount of excess eyelid skin.
Now let’s say the forehead and eyebrow are in good position – no sagging – but the upper eyelid skin itself is responsible for the hooding. This would be addressed not with a brow lift, but rather with an upper blepharoplasty (or upper eyelid surgery).
So yes, a brow lift can improve the appearance in a hooded eyelid. But…some patients may benefit more from an upper blepharoplasty. And others may want to consider both a brow lift and an upper blepharoplasty at the same time. These are all critical to discuss with your surgeon preoperatively to ensure you really understand what’s contributing to what and what you can expect improvement in postoperatively.
Does buccal fat removal make you look older?
A poorly executed cosmetic surgery can yield ill results on anyone. Likewise, an incorrectly chosen surgery can yield unacceptable results on a patient. Buccal fat removal should be reserved for patients who have overly full cheeks.
The buccal fat pad sits within the deep layer of the cheek, between the facial muscles and the lining of the mouth. It’s beneath the cheekbone and above the lower jaw bone. Buccal fat removal is a surgery that aims to reduce the size of this fat pad by removing a portion through a small incision in the mouth. Recovery is typically well-tolerated and patients begin to appreciating results after 1-2 months (as swelling improves).
How long does buccal fat removal take to heal?
Healing can be defined in a few different ways.
Acute, or short-term, healing occurs within the first 1-2 weeks after surgery. This is when the majority of swelling is seen and starts to dissipate, any bruising appears and then starts to disappear, and then patients experience the greatest degree of discomfort. Similarly, these first couple weeks are the most crucial in the healing phase – think of the tissues as knitting themselves back together. They require a safe, nourished, clean, and calm environment to do that. It’s important to avoid over manipulation to the area as well as extreme heat and/or stress.
Long-term healing is what happens over the next 8-12 months. And while it may seem crazy to think that tissues are still healing up to a year following a surgery, it’s true. Tissues continue to heal and remodel for months following surgery.
Specific to buccal fat removal, the incisions inside the mouth are typically healed in 2 weeks, any bruising is usually gone in 3 weeks, and the majority of swelling has improved after 3-4 months.
What’s the best way to hide an eyelid (blepharoplasty) scar?
Blepharoplasty refers to eyelid surgery. An individual can undergo an upper blepharoplasty, in which the upper eyelid is addressed, or a lower blepharoplasty, where the lower eyelid is addressed.
During the early healing phase, the incision line is pink and may be a bit raised. This improves over the first few months and eventually yields a tiny, flesh-colored line. The great news is that the eyelid skin is the thinnest skin in the body. In general, it heals excellently and most patients have nearly imperceptible scars once the area is completely healed.
For an upper blepharoplasty, the incision is placed within the natural crease of the eyelid, which camouflages well when the eye is open. For a lower blepharoplasty, the incision is placed either on the skin just beneath the lower eyelashes or on the inside of the lower eyelid and is therefore not visible. Makeup may be used after 2 weeks to help cover pink incision lines.
Let’s talk swelling AFTER a face and neck lift
Typically, the postoperative swelling seen with facelifts and neck lifts will peak about 2-3 days after surgery and begin to slowly improve thereafter. About 70% of the swelling is gone after 2-3 weeks. And the remaining swelling is nearly gone by 6 months.
Every patient swells and recovers a bit differently. Health status, activity level, genetics, and diet can all play a role. It’s best to lay low and minimize physical activity for the first 2 weeks. Once you’re cleared by your surgeon to begin exercising, it’s best to ease back into things so as to prevent significant recurrence in swelling.
It’s advisable to plan for 2 weeks off from social settings and three months off from any big, important events (e.g., weddings) to allow for swelling, bruising, and incision lines to heal.
How many facelifts can one person have?
There are no limits on the number of ‘good’ facelifts a patient can have. And by good, I mean they were performed with a technique that maintained respect for the tissue and its blood supply.
It is common for patients who undergo a facelift in their 40s-50s to undergo a revision facelift 15-20 years later. Remember, a facelift will turn back the clock a few years but it does not halt aging. Time, gravity, and Mother Nature are still there. You will continue to age, you will continue to lose collagen, and things will continue to sag with the pull of gravity. Moreover, the quality of the skin decreases as we age, giving less of a cushion to the structures underneath.
As a community of face experts however, we have generally found that patients undergoing facelifts at a younger age tend to look better overall, heal more favorably, and their results last longer.
Will my otoplasty last forever?
Unlike facelifts, otoplasties and rhinoplasties tend to last ‘forever.’ I put ‘forever’ in quotes because the surgery has to be done well to achieve long-lasting results.
The cartilaginous structure of the ear and nose are more rigid and don’t give way to the natural processes of aging and gravity like our cheeks and necks do.
An otoplasty surgery is one in which the outer ear is reshaped or resized in order to achieve a more natural look. While each otoplasty surgery is a bit different, a common goal is to make the ears sits closer to the head (or not stick out quite as much). The techniques used to set the ears back are intended to last forever with no anticipation of revision surgery later on.
Threadlifting: what is it?
Thread lifting involves placing a suture under the skin, within the soft issue, pulling in a desired direction, and suspending the tissues in a more “lifted” position.
The issues with thread lifting are numerous:
No tissue is dissected, or released. Most surgeons will agree that it’s the physical separation of superficial tissues from deep structures that is key to providing long-lasting rejuvenating results.
No tissue is removed. There’s often bunching at the distal lift point, just as you’d expect if you pulled one edge of a duvet taught over a bed. Over time, the “lifted area” tends to settle back into its original, pre-procedural position.
Effects are short lived. It’s rare to see long-term (e.g., >6 month) before and after photos demonstrating meaningful results. That’s often because the tissue has relaxed back into its original position.
Indwelling threads can lead to infection, bunching, and extrusion (where your body begins to reject the thread and push it out, towards the skin surface).
I do not perform threadlifts and caution patients from this procedure when with other providers.
I want a browlift and want to avoid surgery…what are my options?
Neurotoxins (Botox, Dysport, etc.) are a great option to achieve a bit of brow elevation without surgery. The key to understanding the answer to this question is understanding that there are different muscles around the eyebrows and eyelids that pull the brows in different directions.
The main forehead muscle, the frontalis, lifts the brows up. The main eyelid muscle, the orbicularis oculi, pulls the brows down. And in the middle of the brows, in a region we all the glabella, there are a group of muscles, the procerus and corrugators, that pulls the brows down and towards each other.
The key to a non-surgical, or chemical, brow lift is appropriate dosing and injection of neurotoxin into each of these areas. Think of it like a scale – if you want to raise the brows, you’ll need to dose one are a bit higher than the other.
The other important thing to note about neurotoxins is that they don’t last forever. While there are some differences in duration between the different brands, patients will generally start to notice the medication wearing off in 3-4 months. So just like getting your nails done or hair dyed, it requires regular maintenance to achieve an ongoing look.
Rhinoplasty - low long does the surgery take?
The answer is highly variable. It varies based on the patient’s anatomy, their aesthetic goals, and the experience and techniques used by their surgeon. At its shortest, a rhinoplasty may take an hour. At its longest, it may take up to 8 hours.
The length of the surgery is good to know as a patient, but isn’t everything. Let’s dive a bit deeper…a very straightforward, primary rhinoplasty in a patient who simply wants a small tweak in the hands of an experienced surgeon may only take an hour. While a more complex, revision rhinoplasty (meaning they’ve had one before) who is desiring a bigger change and requires multiple grafts may take multiple hours. Both patients will likely end up with great results.
Prior to undergoing any procedure, I encourage patients to ask their surgeon about the length of the procedure, the type of anesthesia that will be used, the person who will be administering the anesthesia, and the facility used during the procedure.
How long will a neck lift last?
The contents of the neck are numerous – you have skin, superficial fat, deep fat, muscles, and submandibular glands within the neck. During a neck lift, one or more of these layers is addressed.
I heard a mentor once describe the neck similar to a grassy hill. If you’re excavating the hill and the dirt beneath is completely leveled, it won’t ever ‘grow back.’ The overlying grass will weather as time progresses, but the hill will remain flat.
The same is true for a neck lift. If the surgeon appropriately addresses (or ‘levels’) each layer of the neck during a neck lift, results will last with age. The overlying skin ages and loses elasticity, which is inevitable, but the underlying structures with remain contoured.
What is ‘mentoplasty’ surgery?
Mentoplasty refers to cosmetic surgery of the chin and surrounding area. Commonly, chin augmentation is performed to give patients a stronger chin. Less commonly, an overly large chin can be made smaller.
There are different approaches to augmenting the chin, both surgical and nonsurgical. If a patient elects for surgical chin augmentation, a permanent implant is placed just over the bone. This can be achieved through a small incision beneath the chin, or less commonly, through a small incision in the mouth. The main benefit of a chin implant is its permanence. Whereas if a patient elects for non-surgical chin augmentation with filler, repeat treatments are required over time.
Tell me more about lower blepharoplasty…
The term blepharoplasty refers to cosmetic surgery of the eyelid. A lower blepharoplasty is commonly performed to address the ‘bags’ of the lower eyelids.
Think of a youthful face. The lower eyelid-to-cheek junction is smooth. There’s no obvious demarcation between the two regions. As we age, the skin thins, we lose collagen, tissue begins to sag, and the lid-cheek junction becomes more obvious. The ‘bags’ are composed of protruding fat. This fat can be either removed or repositioned during lower eyelid surgery to smooth that lid-cheek junction.
Incision placement for lower blepharoplasty is either on the skin, just beneath the lower lash line or on the inside of the lower eyelid. The decision on where to place the incision is a point of discussion preoperatively, based on the patient’s anatomy, their goals, and the surgeon’s preference.
Acute recovery time is about 1 week, where it’s advised to reduce your activity level, swelling and bruising occur, and we ask for no makeup and/or contact use. More long-term healing is appreciated over 3-4 months, where the last little bit of swelling abates and you’re better able to appreciate your final results.
How long after an otoplasty can I exercise?
The body heals all wounds. Whether it’s a surgical wound or a non-surgical wound. But to heal most optimally, a relaxed and non-stressed environment is ideal.
What does that mean after a cosmetic surgery? It means performing diligent wound care – keeping things clean and appropriately moistened to allow the body to heal the incision site. It means eating well and providing the body appropriate nutrition. And it also means laying low and not vigorously exercising for the first 2-3 weeks. Exercise, while great for our overall health, can stress healing wounds by increasing our bodies’ blood pressure and temperature beyond that ‘relaxed state’ that’s required for optimal healing.
Does buccal fat removal help with jowls?
A facelift, neck lift, and/or buccal fat removal can all help address jowls. The term “jowling” refers to a sagging area of skin, fat, and other facial tissues that descends with age and is most noticeable along the jawline, on either side of the chin. Some individuals are more predisposed to developing jowls based on genetics and lifestyle factors.
To treat the jowls, some will advocate for filler in adjacent regions to help camouflage the area of concern. The gold standard, or best treatment, for jowling, however is surgery. The exact procedure and extent of that surgery is dictated by the patient’s anatomy, age, goals, and tolerance for downtime.
How long does a facelift last?
This is one of the most common questions I receive. And the answer is a bit more nuanced that you may expect. A few points:
A facelift, or any facial rejuvenation procedure, sets the clock back but it does not stop time. After a facelift, you will continue to age.
Every patient ages differently. And this is often related to your overall health, genetics, hormonal status, sun exposure, stress level, etc. It’s impossible for a surgeon to predict how you personally will age.
Patients undergo facelifts at different ages and different stages of their life. One on end of the spectrum, a patient may have a facelift in their 40s, wanting to ‘stay ahead’ of the aging process and pursing surgery at the first small sign of jowl formation and neck sagging. On the other end of the spectrum, a patient may wait until their late 60s. The amount of collagen and elasticity in the younger patient is higher, thus their results are likely to hold up better over the following 15-20 years.
If you are considering a facelift, it is important to understand that your facelift will never be “undone” or “fall.” You simply continue to age. And aging changes tend to accelerate the older we get.
How long does a browlift last?
A browlift raises the skin and soft tissues of the forehead and brow. Like any cosmetic procedure, it will turn back the clock but it won’t stop the clock. You will continue to age.
And age-related changes of the face occur differently for different individuals. So, there’s no defined answer to this question. It really depends upon how the patient continues to age. Patients who age more rapidly may have a handful of years before they begin to notice brow dropping while patients that age more slowly may never notice recurrent drooping of their brows long-term.
The best way to maintain your surgical browlift results is to continue to get neurotoxin (Botox, Dysport) injections in the crows feet and glabella areas after a surgical browlift. The key here is recognizing that the while a surgical browlift is good at surgically placing the brow at an elevated position, the long term, repetitive, and continual down pull is happening as a result of the nearby muscles. The strength of this pull-down action can be softened with Botox, Dysport, etc., yielding a better long term result for an elevated brow position.
Dressing after surgery: how long should I wear compression after my neck lift?
While every surgeon is different in their surgical technique, they also vary in their postoperative care protocols. I personally do not advocate for routine use of compression dressings after a neck lift.
Compression dressings apply firm and constant pressure to the skin and its underlying blood supply. This blood supply has already been disrupted by the surgery itself. For tissues to heal well after surgery, adequate blood supply is critical. For this reason, I do not have patients apply compression dressings routinely after surgery.
Prior to the routine use of drains after surgery, it was very common for surgeons to tightly wrap patients with compression dressings after facelifts and neck lifts. This was to help prevent fluid accumulation under the skin. With the placement of drains, however, the need for compressive wrappings is simply not there. Drains help evacuate the postoperative fluid that accumulates after surgery and the lack of compressive dressing allows for the best blood flow to skin during those first few days (arguably the most important) after surgery.