Eyelid Surgery (Blepharoplasty)

Last week Melissa and I arrived in Hollywood, Florida for the 10th International Symposium of Facial Plastic Surgery. This meeting is held every 2 years, alternating between a site abroad and a site in the U.S. Two years ago it was in Cartagena, Columbia. This year, Florida. I really had no idea where Hollywood was before I arrived. As it turns out, it is a funky little strip of beach between Ft. Lauderdale and Miami. The hotel was surprisingly comfortable, right on the beach, and the town had an active though small stip of fun nightlife. Of course I was there to work, but enjoyed the pool and beach with many colleagues who have become friends over the years.

On Tuesday, the day before the meeting started, I had the Spring Board of Directors Meeting of the American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS). Plane trouble caused me to arrive late, but I still managed to get there for the last 6 hours of the meeting. We had a great session, confirming plans for the mentorship program I helped put together for young facial plastic surgeons among other things.

On Friday I ran a 2-hour panel on Functional Rhinoplasty. The panel members were an international group including Dan Becker, Stephen Park and Rick Davis from the U.S. and Fausto Lopez-Ulloa from Mexico, Sameer Ali Bafaqeeh from Saudi Arabia and Holger Gasner from Germany. Each panel member spoke about what they have changed in their practice of functional rhinoplasty in the last 10 years of their practice. We then debated how to care for certain severe functional cases.

Later on Friday I participated in a panel on Revision Rhinoplasty, along with Steve Pearlman, Wayne Larabee and Geoff Tobias. Then on Saturday I had the distinct pleasure of giving a talk on cartilage grafting in rhinoplasty with Dr. Charles East from London, England. The best part of the meeting was being able to exchange ideas and see what others are doing with rhinoplasty around the world.

I also made plans to do live surgery workshops in Bogota, Columbia next fall right after doing the same in Lima, Peru. Finally, I had a meeting regarding further organizational details for the AAFPRS semi-annual Rhinoplasty course next year in Chicago. All in all, a very productive meeting in a really enjoyable location.

Q: 6 months ago I had a scar revision for a scar on lower eyelid. The tissue connecting the lower and upper eyelids on the outer corner of my eye stretched too much as a result of the poorly performed surgery resulting in a pulled down lower eyelid. I now need someone who can lift up my lower eyelid AND at the same time remove the scar (4-5mm wide, 2cm long) from my lower eyelid. Is this something that can be done?

A: For a long, moderately thick eyelid scar, the trick is to repair the problem while NOT increasing tension on the eyelid. Sometimes a midface lift is needed to lift the whole cheek up underneath the eyelid to insure there is enough support for any repair. At other times large dissections of the eyelid and surrounding tissues are enough. There is no quick fix for this complex problem. You are correct to assume that not every surgeon can tackle such a complex problem.
Minas Constantinides, M.D.

When did all the craze begin that mini facelifts are so sought after? There are very few Manhattan women who will benefit from a mini facelift. If you only have a little jowling and minimal neck laxity, then maybe this is for you. But remember that the facial plastic surgeon is extremely handicapped by the mini facelift incisions and the limited dissection. Yes you will be back at work looking pretty good in a week. One year later you will probably be back to where you were before facial plastic surgery. But one more week healing time is all a full facelift typically requires, and it gives a much better and longer lasting facelift. Why spend all that money for just one week less of recovery and only one year of good facelift results? This procedure is becoming more and more recognized as what it is…an oversold procedure designed to make you believe that you are getting more than you are. I don’t believe it works for anyone over 45 years old, and it never works well in men. Beware of this Trojan horse.

Minas Constantinides, M.D.

Jowls after a facelift will always come back. The type of facelift you have will determine when. Jowls are the fat of the jaw line that sags as the SMAS layer sags over time. How that layer is lifted will be more or less successful in correcting the problem.

No one is doing a skin-only facelift anymore. Many surgeons do some version of a SMAS-lift; others (like me) do some version of a sub-SMAS or deep plane lift. In order to correct jowls, the lifting along the jawline has to lift the SMAS effectively at the jowl. This is best accomplished by lifting beneath the jowl. In my hands, I can do this best using a deep plane facelift approach.

Regardless of how well the lift is performed, as you age the jowl will return. The only question is, “When?” With deep plane facelifts, usually the jowls are improved for so long that a revision lift is not needed for over 8 to 10 years.

The pixie nose was once the most sought-after nose to have. In the 1960’s, many models had pixie noses. The rhinoplasties performed then, with the scooped bridge and turned-up tip, were designed to create the pixie nose. Today, we think of a higher bridge and less-upturned tip as more esthetically ideal, but the pixie nose look is not dead. Many of my patients from South America still want that look since there it is still popular in some areas. What matters most is: does your nose matches your face? A shorter, upturned nose may work beautifully with a small face, but less well in a face with larger cheek bones or a stronger jaw line. If your nose bothers you, a consultation with photo-imaging will help you decide if changing it will make you look better.
Improving a pixie nose typically calls for raising the bridge and lengthening the tip. Both these maneuvers are challenging, with nasal lengthening one of the most difficult maneuvers in rhinoplasty. I would recommend you select a surgeon with experience in this technique. Ask to see before and afters of patients with noses like yours. Assess whether he is an occasional rhinopalsty surgeon, or an experienced one. Talk to his other rhinoplasty patients. Trust your instincts on this and you are sure to have a good outcome.

Our entire office would like to extend our warmest wishes for the best 2010 possible to all our readers. We look forward to celebrating your successes and helping you with your challenges in the year to come.

For a video clip of the story as aired today on WABC, see: http://abclocal.go.com/wabc/video?id=6936962

In a recent article on Medscape.com, Dr. James Wells, MD, Past President of the American Society of Plastic Surgeons, continued the negative campaign disparaging every doctor other than general plastic surgeons who perform plastic surgery. He particularly disparaged the American Board of Cosmetic Surgery, and every other Board not a member of the ABMS. In this list would also be the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).

What Dr. Wells did not point out is that the ABFPRS is the ONLY non-ABMS Board that has been recognized by the courts in 4 states as being ABMS-equivalent. Why would the courts have had to get involved in all of this? Because for years general plastic surgeons such as Dr. Wells have tried, to no avail, to restrict the practice of plastic surgery to themselves. They have sued members of the ABFPRS to try to stop them from calling themselves Board-Certified Facial Plastic Surgeons.

Every time this designation was challenged, it was defeated. In fact, in Georgia the plastic surgeons were forced to pay a large settlement to the American Academy of Facial Plastic and Reconstructive Surgery, which then helped to found the ABFPRS. Did Dr. Wells mention any of this in his interview?

For years general plastic surgeons have spent hundreds of thousands of dollars trying to persuade the public that they are the only ones “qualified” to perform plastic surgery. Facial plastic surgeons, on the other hand, have had 4 years of specialty training on surgery in the head and neck area (this is after 1-2 years of general surgery), 1 additional year of specialty training in facial plastic surgery exclusively, and have passed 2 Board exams: the American Board of Otolaryngology (an ABMS Board) and the ABFPRS. The ABFPRS exam is a rigorous oral and written exam, but it is not enough to pass it. After passing, the applicant must submit a case list of 100 facial plastic surgery cases in a 2-year period. If the list is accepted, only then will he be given Board-certification by the ABFPRS and be able to call himself Board-certified in Facial Plastic Surgery.

Unlike the ABPS, the ABFPRS allows general plastic surgeons to be certified by it. Isn’t it time to stop quibbling over who is better trained and which Board can certify a surgeon? Isn’t it time to unite our efforts and learn from one another. Fortunately, people like Dr. Wells are becoming a diminishing minority. Younger generations, myself included, have fought for inclusivity rather than exclusivity. In combined meetings, we have been able to share our ideas, experiences and philosophies so everyone benefits. This is much more constructive than the divisive finger-pointing that Dr. Wells advocates. In the end, the best results are achieved by the surgeon who is an expert in his field through training and experience. Which Board certifies the surgeon is a small matter as long as the surgeon is ethical, thoughtful and skilled. Most of us understand this. As do most patients.
Minas Constantinides, M.D.

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