Face Gallery

A 5-year follow-up on a woman of color in her mid to late 20s who had a rhinoplasty through an open approach.  The tip is refined, the hump is reduced and the tip is elevated slightly.

A woman in her later 50s with a partial split and drooping of her left earlobe.  Her diamond earrings fall out.  She remembers her daughter tugging on her left ear as an infant while breastfeeding.

She is shown before and again, 3 months after earlobe lift and split repair and then re-piercing in the office.  Her right ear was not involved.

A woman in her late 20s who has been bothered by prominent ears her entire life.  She is shown before and again, just 6 weeks after correction in the operating room.

She still has some mild redness of the ears at 6 weeks, which should now fade and resolve over the next month.  Scars are at their reddest and thickest at 6 weeks and then will fade and improve over the next 2 years.  At 6 weeks, the incisions just inside the conchal rim are already starting to fade.  During surgery, I first est back her deep concha by excision of a crescent of cartilage through an anterior approach.  Then I rasped her antehelical fold with the Dingman otoabrader, as taught to me by Dr.Reed Dingman at the University of Michigan during my plastic surgery residency, to break the “spring” of the cartilage and allow it to bend with less force.  Then, “Mustarde” sutures were placed to recreate the antithetical fold and give it a gentle curve. At this point, her ear lobes will still be prominent and were set back by dividing a ligament called the “intertragicohelcine ligament” and then pexing the helical tail to the concha with a suture as described by Dr. Richard Webster, along with a “fishtail” excision of skin behind the earlobe, without interfering with her ear piercing holes.    She loves the natural appearing contour of her ears after surgery.  She told me that the wind recently blew her hair up, and ordinarily, she would have been quite anxious that her formerly prominent ears would show, but she found that she was no longer bothered because of the now normal and beautiful contour.

A man in his late 70s with a basal cell carcinoma of his left ear.  He also has typical drooping of the earlobe that occurs as patients age.  His original photo before the biopsy is shown.  The next photo is in our office before surgery, showing the drooping of his earlobe.  The next two photos were taken immediately after his Mohs surgery by the Mohs surgeon.  The next photo is one week after surgery, showing the correction with a flap taking extra from the drooping earlobe and moving it up along the helical rim to correct the defect.  The final photo is at 6 weeks and shows a beautiful contour of the ear as well as a correction of the large skin cancer defect.

Scars typically get thicker and redder for 6 weeks and then begin to fade.  One benefit of being in the late 70s is that the scars fade, and the skin does not “heal as vigorously” as when we are younger.  So, at 6 weeks, he already passed “the little girl test.”  He does not have a deformity that little girls or boys might notice and comment on to their parents.

A woman in her early to mid-20s with a partial split of her right ear and a complete split of her left ear.  She did sleep with her earrings in place.  She is shown before and again, 3 months after bilateral split ear repair.  Scars typically will become thicker and redder for 6 weeks and then fade and improve over the next 2 years.

An Indian woman in her late 50s who had split earlobes repaired in India 6 months before but still did not like the appearance of her ears.  On examination, she has a drooping of her earlobes and some redness from her piercings c/w a probable nickel allergy.  The drooping gives her earlobes an aged appearance. She is shown before and again 3 months after a bilateral earlobe lift performed in the office under local anesthesia.  Scars typically get thicker and redder for 6 weeks and then start to fade and improve over the next 2 years.  At 3 months, her scars still have some redness, but she has an excellent contour now.  She will continue to use topical silicone to help the scars mature and avoid UV exposure to decrease the risk of darkening the scars. In my experience, patients would like a beautiful earlobe, not simply a repair of a split.  If the earlobe has significantly drooping I usually recommend an earlobe lift be performed at the time of the split repair.

A man in his early 70s shown immediately after moh excision of a basal cell carcinoma of his left ala, and then 16 years after 3-stage reconstruction with nasolabial pedicle flap and ear cartilage graft to replace the entire aesthetic subunit of the ala.  He continues to have a natural contour and results 16 years later.

A woman in her mid-50s with a partial split of her right ear.  She has a history of redness which may represent a nickel allergy.  She is shown before and again, 3 months after split repair with a small lift.  A beautiful shape of the earlobe is seen after surgery.

An Asian woman in her late 20s who has had gauges since she was 15.  She removed them 6 years ago and found that the gauged appearance no longer matches the professional appearance she maintains for her job.  She needs to wear small plugs to camouflage them during meetings.  She would also like to be able to wear normal earrings when she gets married.

She is shown before, immediately after, and again, 3 months after an “L” plasty repair that also removed a second piercing on each ear.

A woman of color in her early 60s is bothered by the aged appearance of her face and lower eyelids.  She is shown before and again, 4 weeks after a trans-conjunctival lower lid blepharoplasty combined with fat grafting of the face.  She has a little thickening of one of the puncture sites just lateral to the right ala of the nose and we will have her start topical silicone.

In addition to having a prominent lower eyelid fat pad which was removed with the surgery through the inside of the eyelid (“trans-conjunctival”), she has some of the typical volume loss of aging which was replaced around the eyes and the cheeks with the fat grafting.

The Vitality fat processing system from Sientra was used to process her fat before grafting.  This uses a proprietary system to wash the fat, and remove oil and impurities and has been shown to increase the viability of the fat cells and the long-term take of the fat over other methods.  At one month it is too early to assess the survival of her fat grafting but she has minimal inflammation at this time.