A woman in her early 80’s with a basal cell carcinoma of her left ala. The ala can be a challenging area to reconstruct and typically requires several stages. She had a first stage with a nasolabial pedicle flap and ear cartilage graft. She returned to have this divided 4 weeks later. A second stage to better refine the flap contour was performed 9 months later. She is shown before, just after Moh’s excision and again, 5 months after her final procedure.
A woman in her mid 70’s s/p moh’s excision of a squamous cell carcinoma (SCCA) of the lower lip. The lower lip is prone to more sun exposure and when a patient develops a scca in this area they typically have “actinic cheilitis” which is sun damage of the rest of the pink portion (vermillion) of the lower lip that is prone to develop more skin cancers. It is usually a good idea to remove the entire remaining sun damaged vermillion and advance the lip forward- called a “lip shave” or “vermillionectomy”. That was done here and her lip is shown 11 months after surgery-the scar Is nearly imperceptible even with a close up view and the lip has normal function and motion, but the vermillion that has been brought forward from inside the lip has not had chronic sun exposure and is not therefore prone to develop another scca.
A woman in her early 70’s with a cleft of her right ear where her earrings tore through and age related drooping of both ears. She is shown before and again, 3 months after a bilateral earlobe lift incorporating a repair of her cleft. With a lift, the earlobe is swung back and forth across an imaginary midpoint to precisely mark a wedge of excess earlobe to be excised, “lifting” the earlobe. She is thrilled with the more useful. Her earlobe tear was most likely from sleeping with her earrings in. After re-piercing she will wear a Bandaid at night for the first 3-4 weeks and then get in the habit of removing the earrings when sleeping. Most patients tend to sleep more on one side than the other, and the earring post gets pushed back and forth catching on the pillow an can slowly cut through the earlobe like a wire cutting through cheese.
A woman in her early 40’s with a cleft of her right ear. She had initially had this repaired with good result and re-pierced at 3 months. She did not however remove her earrings at night while sleeping and re-tore the same earlobe 2 months later. Repairing the earlobe does not make it any stronger than it was initially. It is good to repair problems and even better to prevent new problems. People tend to sleep more on one side than another and the force of the pillow constantly moving across the earring can cause the post to slowly cut through the earlobe, like a wire cutting through a cheese. So she returned to have this repaired again. She is shown now 3 months after this second repair and again, just after re-piercing in the office. She now plans to protect her ear during the initial 3-4 week healing period after re-piercing with a Bandaid at night while sleeping ( the earring is kept in for the first 3-4 weeks while sleeping to allow the new piercing to become lined with new skin cells) and then after this time to start removing her earrings completely when sleeping.
A 90 yo woman with a large defect of her upper lip after Moh’s excision of a squamous cell carcinoma. She is shown just after Mohs surgery and again, 6 weeks after repair with a paranasal advancement flap.
A woman in her late 50’s who is bothered by drooping of her eyebrows and an aged appearance of her eyes. She has prominent “tear trough” deformities and under eye “bags”.
She is shown before and again, 4 ½ months after an open brow lift, upper lid blepharoplasty and lower eyelid blepharoplasty with fat pad transposition into the tear trough area. She holds her left brow slightly lower before and after her surgery. She is thrilled with the more youthful but still natural appearance after surgery.
A Hispanic woman in her middle 20’s who feels that her nose is “too big” for her face and does not like a dorsal “bump”. She feels that her nostrils are too big and the tip is drooping and too flat. She has had a septoplasty elsewhere in the past.
She is shown just 6 weeks after an open rhinoplasty with reduction of the dorsal hump and nondestructive tip rhinoplasty, combined with an anatomic chin implant placed through a submental incision. The tip will continue to soften and improve in definition as swelling resolves over the next 3 years. Already she has a more elegant and refined profile.
A woman in her mid 20’s with a partial cleft of her right earlobe and an almost complete cleft of her left earlobe. Her earrings no longer sit properly in the ears, the backs pull through. She is shown before and again, 3 months after repair in the office under local anesthesia and again, just after re-piercing.
A woman in her early 60’s who is bothered by an aged appearance of her upper eyelids. She is shown before and again, 2 months after bilateral upper eyelid blepharoplasty combined with a lateral browpexy under local anesthesia in the office. She has also had Botox and Restylane for treatment of her frown line.