A woman in her mid 20’s who was bothered by the appearance of her nose as well as having difficulty breathing. On examination she was noted to have a weak chin as well. Whenever someone is considering rhinoplasty we are taught to always look at the chin. If it falls behind a line that connects the lips, it is usually”weak” or too small, and a chin implant or advancement of the chin can dramatically improve the results. She is shown before and again, just 6 weeks after an open rhinoplasty along with placement of a medium chin implant. It is better to under correct the chin slightly rather than having it appear too “strong” or masculine in appearance. She is already thrilled with her new look. The tip will typically continue to appear more refined over the next 3 years as the swelling diminishes. We also corrected deviation of the septum and vestibular stenosis at the same time- her breathing was obstructed by deviation of her septum but also collapsed inside at the “nasal valve”area when she inhaled- the area that is improved with BreathRite type strips. We corrected this with “spreader grafts”,a strip of her septal cartilage that sits up high on the inside along the top edge of the septum and prevents the collapse. Her breathing is corrected now, and she is very happy to have a beautiful and refined look to her nose and face.
A professional in her mid 30’s who is bothered by a crooked nose, dorsal hump, difficulty breathing. On examination she was noted to have significant deviation of the septum as well as vestibular stenosis. Vestibular stenosis is the collapse of the nose when someone breathes in that takes place at the “nasal valve” area and is often temporarily improved with “Breath rite” strips. She was also noted on exam to have a “weak chin”. The chin falls behind an imaginary line that touches the upper and lower lips. She is shown before and again,4 months after an open rhinoplasty with correction of the vestibular stenosis by placing “spreader grafts”, a match stick shaped piece of the septal cartilage. She also had a medium chin implant placed. She is thrilled with her early improvement, and no longer has obstruction of her breathing. Her husband notes that she no longer snores at night. The nasal tip will continue to gain refinement over the next 2 1/2 years. The slight pinkness of her nose is a sunburn from the weekend.
The same patient is now shown in her mid-50’s. Her upper face has held up well following her brow lift and blepharoplasties from 10 years before. She has some slight “weakness” of the chin and elected to have a small chin implant placed at the same time. She is shown before and again, 5 months after a short scar MACS face lift combined with a chin implant and micro fat grafting. Facial aging is mainly due to volume loss as we age. Although lifting the tissues improves the appearance, filling the tissues at the time of lifting gives a more natural appearance. When a patient has a second facelift they are at risk for descent of the skin at the sides of the mouth, sometimes called “jokers’ lines” and it is important to support this area with additional volume at the time of surgery. She also had Sharp needle intradermal fat grafting (SNIF) (link here for the utube video)as described by Dr’s Zeltzer, Tonnard and Verpaele in 2012 to improve the deep line between her lower lip and chin. She did not require further surgery to her eyes, brow and mid face at this time. In addition to improving her facial balance and making her nose appear smaller, the chin implant also improves the appearance of the neck after surgery.
A woman in her late 40’s complained of her nose being “too large”. Her nose has excellent aesthetics however, and after analysis it became clear that her chin is too small (“hypogenia”). She is shown before and again 6 weeks after chin augmentation with a solid silicone implant placed through an incision under her chin. Although no surgery was performed on her nose, it appears proportionally smaller and in better balance with her face in the after photograph.
A woman is shown before and again 7 months after facelift combined with a chin implant. When a patient with a “weak chin” is requesting a facelift or a rhinoplasty, a chin implant is typically recommended at the same time to improve the subsequent facial balance and results.
A woman in her early 70’s who was unhappy with the aged appearance of her face is shown before and again, 1 year following a facelift with chin implant and dermabrasion to her upper lip. When the chin is “weak” and falls behind an imaginary line that is dropped down from the front of the upper and lower lips, a chin implant can improve the results, as seen here.
A woman in her early 60’s with obstruction of her vision from brow ptosis and eyelid skin hanging down. She is shown before and again, 6 week after an endoscopic brow lift and bilateral upper eyelid blepharoplasty. She has a refreshed look after surgery.
A woman in her mid to late 60’s who is bothered by an aged appearance. She is shown before and again, 5 months after an endoscopic brow lift, upper eyelid blepharoplasty, fat grafting to the cheeks and lips, Facelift with lateral Smasectomy and peri-oral dermabrasion. Her results will be limited somewhat because of decreased skin elasticity- the “fabric” that we are working with. Nonetheless, she has a dramatic and natural appearing improvement at 5 months. Skin quality is somewhat better with the fat grafting. The dermabrasion is a tried and true technique that can give improvement of the lines around the mouth but with less risk of bleaching that can be seen with laser or deep chemical peels.