Face Gallery

A woman in her early 30’s with bilateral gauges.  She has had gauges since her mid-teens and was gauged up to as large as an inch.  This no longer fits her lifestyle and she wanted to have them repaired and to be able to wear normal earrings again.  She is shown before and again, 5 ½ months after Z-Plasty repair and again, just after re-piercing in the office

Photos are shown before surgery with the gauges in, with the gauges out, and with the z-plasty marked and injected with local anesthetic.

A woman in her early 60s who had a rhinoplasty more than 40 years ago.  She has developed some settling of the mid-dorsum and a palpable septal cartilage bump in the “open roof” area between the reduced nasal bones.  We could consider returning to the operating room to rasp down the bump and add some additional tissue such as a temporalis fascial graft.  But we elected to try the much simpler option of augmenting the area with 0.6 cc of Restylane.  At two weeks she has an excellent result.  This can typically last for 2 years or longer in this area and is relatively easy to repeat as necessary.

A woman in her mid-30s with a bilateral partial split of her ears.  She did sleep with her earrings in place and also has a nickel allergy.

She is shown before and again, 3 months after repair.  Her earlobes have a prettier shape now and the splits have been repaired.  She is going to avoid nickel and sleeping with her earrings in place to decrease the chance of a recurrence.

A woman in her early 40s with bilateral drooping of her earlobes and stretching of the holes left more than her right.  This makes it difficult to wear studs, which are falling out.  She has a history of sleeping with her earrings in, but also most likely has a nickel allergy.

She is shown before and again, 3 months after a bilateral earlobe lift with split repair.

A bilateral ear lobe lift in a man of color. He is in his mid-50s and felt that his earlobes were droopy and gave him an aged appearance. His earlobes were indeed longer than ideal with the right side intertragal notch to a free border of 26 mm and attache to a free border of 14 mm.  The left ear was 28 mm from the intertribal notch to the free border and attached to the free border of 13 mm.  In studies of ear aesthetics, multiple independent observers have determined that the ideal attached to a free border is 10 mm or less and preferably 5 mm or less.  He is shown before and again, 11 months after surgery in the office under local anesthesia.  Slightly asymmetric wedges were removed from each earlobe to correct his asymmetry and drooping.  We had him use Topical silicone for several months after the earlobe incisions had healed and avoided exposure to the sun.

A 7-year follow-up on a patient with an extremely severe nasal obstruction with total blockage of the right nose and near total blockage of the left nose, with a right angle bend of his septum.

An extracorporeal septoplasty was performed at the age of 17.  In this case, the septum is completely removed/ reshaped on the back operating table, stabilized with a resorbing plate, and placed back into position, stabilizing with sutures and drilling holes through the nasal bones.  The nasal dorsum tends to “settle” a few millimeters so it is often best to leave it a little prominent so that when it settles it is in the right position.  In his case, we were fortunate and obtained an excellent result with a straight nose, correction of his dorsal hump, and clear nasal passages.

A woman in her mid-50s is shown before and again, 5 ½ months after upper eyelid blepharoplasty combined with brow-pexy.

Discussion:

As patients age, the face loses volume and the brows descend.  When there is lateral brow descent and “hooding”, a blepharoplasty alone will not correct the problem.  A brow lift can be done to pull up the forehead and gives good results when combined with upper eyelid blepharoplasty.  However, not all patients want this much surgery.  A brow-pexy is an in-between solution, that does not raise the eyebrows but “pexes” or fixes them with sutures in the area of the orbital rim so that they do not drop further when a patient sits up.

A woman in her later 60s with a partial split of her right ear and drooping of both ears.  She is shown before and again 4 months after bilateral earlobe lift/repair.

A woman in her early to mid-20s with a complete split of her right earlobe for the past 3 years.  She had a partial split from sleeping with her earrings in, and then caught it on a towel and tore it completely.  It was “repaired” elsewhere but didn’t stay together.

She is shown before and again, 3 months after repair.  It is important to excise the healed edges of a split at the time of the repair and doesn’t sound like this was done. She is thrilled to be able to have her ear re-pierced and wear earrings again.

A woman in her early 30’s with gauges.  She needs to have this corrected so that she can become a police officer.  She is shown before and again, 6 weeks after “z plasty of Borneo” correction.