The implants are made of a solid but soft silicone rubber that cannot be felt under the skin.  The implant never moves and does not ever need to be replaced. Unlike breast implants that are made of liquid silicone inside a shell, there is no liquid in a chin implant therefore there is no risk of leakage of silicone. There are many different shapes and sizes of implants and it is up to the surgeon to know which style and size will look best for a given person.  Everyone is different and therefore the implant that an individual receives must be carefully planned and thought out.  Often the implant must be customized to fit the patient’s exact anatomy. I do an equal amount of chin implants on both men and women, both young and old.  The procedure takes about 30 to 40 minutes and can be done under local anesthesia in the office.  Chin augmentation is one of the most powerful techniques we have in our arsenal to improve one’s appearance and something that has been extremely beneficial for my patients over the years.

I have had a lot of experience with fat grafting over the last 10 years and I have seen everything including fat lasting 10 years on some people and 6 months on other people.  After thousands of my own patients and thorough discussions with many of my colleagues who I consider to be honest and at the top of the field.  I have some strong opinions about the fat grafting craze. Our discussions have involved the topic of where we have been and where we are headed.

Fat grafting has been around for 40 years but it gained a lot of press and PR in the early 2000′s when the Plastic surgery reality shows hit the airwaves.  It was a time when the economy was strong and there were doctors from all different specialties delving into the plastic surgery world the way pick axe salesman flooded the market at the time of the gold rush.  It is well known that most of the doctors who advertise plastic surgery aggressively are not plastic surgeons at all.  They are usually dermatologists and other Non Plastic surgeons who call themselves “cosmetic surgeons”.  Fat grafting is a very safe procedure to do under local anesthesia and it does not require a scalpel.  As a result of this fact, most of the “cosmetic surgeons” offer and advertise this procedure.  As the plastic surgery boom occurred in the early 2000′s there was aggressive marketing and advertising by the cosmetic surgeons and they most often were advertising fat grafting.  This created a buzz throughout the community and therefore most patients had heard of it and thought it would be the best option for themselves without knowing much about it.  Now that the dust has settled and millions of patients have had fat grafting there is much less excitement about the procedure.

The reality is that the longevity of fat grafting is unpredictable.  Some people will have long lasting results and others will not despite using the same technique and using the same amount of fat.  There are certain things that are essential to do as the surgeon to make sure the fat has the best chance of surviving including low pressure harvesting and micro droplet technique injections. Still, the unpredictable nature remains.  There are certain areas of the face where fat tends to survive like the tear trough. Areas where the fat tends to absorb quickly would be the lips.  It is important to see a surgeon who you trust and who has a lot of experience with fat injections to get an honest idea of what to expect from the procedure.  Fat grafting is still my favorite option for a few very select set of issues a patient may have but I use it much less frequently than I used to as patients often opt for more predictable and more permanent procedures.

Revision rhinoplasty requires experience, talent and skill to perform well and it can be one of the most rewarding procedures for both patient and surgeon when done correctly.

These photos are 3 weeks after surgery.  She still has some swelling and minor bruising that is easily covered with makeup.  This is a perfect example of a dramatic change that doesn’t change who a person is, this change simply enhances or restores a person’s appearance back to what it was when they were younger.

He has a tell tale sign of a bad facelift called a “Pixie Ear” which is where the earlobe is stretched towards the angle of the jaw and this deforms the appearance of the ear and looks very unnatural.  The reason that people will develop Pixie ears is because there is too much tension on the skin.  This is a common problem associated with the older style facelifts that don’t tighten the SMAS layer which is the deeper muscle layer under the skin.  I was able to significantly improve his neck and jawline as well as correct his Pixie ears with a revision “deep plane” facelift that placed all the tension on the deeper layers such that there was no tension on the skin layer upon completion of the surgery.

The keys to micro liposculpture of the face are to be extremely judicious and precise when it comes to removing fat from the face and the use of very small cannulas is very helpful in limiting the problems that can readily occur if caution is not exercised.

The correction of this problem will depend on each person’s particular anatomical findings.  Treatment options include fillers, fat injections, midface lifting and cheek implants.  All of these options have their place and all can be very effective if they are done on the right person.

H.P.  is a 56 year old man who was unhappy with the aged appearance of his upper and lower eyelids and wished to have upper and lower blepharoplasty to rejuvenate his eyelids.  He also wanted a very subtle, natural and masculine appearance.    He had an upper blepharoplasty and lower blepharoplasty with fat repositioning which is lower eyelid rejuvenation where the fat of the lower lids is preserved to prevent hollowness but repositioned to eliminate the baggy appearance.   He was back to work 5 days after his surgery and had no discomfort after the surgery.  This a very good representation of the expected results with male upper and lower blepharoplasty.