Eyelid Surgery (Blepharoplasty)

Susie, don’t take your surgeon’s reluctance to perfrom a facelift that you want personally. Most surgeons like certain techniques because either they are easier to perform (MACS lift much easier technically than deeper lift) or they are not familiar with a requested technique. Most surgeons would simply tell you their reasons for preferring one technique over another (for example, maybe you need less of a lift for now, so he is recommending something less invasive). However, a combination of reluctance and an abrupt manner probably mean that he just isn’t the surgeon for you, whatever the reason.

As for deep plane lifts, they are ideal for producing a great result in experienced hands, as long as the indications are there for them. They are far superior in my opinion to more superficial lifts, but take longer to perform and to heal from. You have to ask yourself if you can tolerate a week of more swelling for what will ultimately be a longer-lasting and more effective lift in the appropriate patient.

Minas Constantinides, MD
Manhattan, NY

Monday this week was a perfect facial plastic surgery day. It began with my doing a deep plane face and neck lift in my accredited office based surgery center. The patient was a beautiful fair skinned woman with early jowls, submental excess, and midface ptosis. This was a patient that many of my plastic surgery colleagues might have done a limited surgery. However, I strongly feel that that might look good for a year, but then the face would start to look funny. The deep plane lift is such a great and versatile procedure. Because it raises the whole face back to where it belongs, it works well in mild aging problems and in severe ones. She will look 10 years better, never overdone, just like herself.

After that 4 hours of surgery, I hustled up to Day Surgery at NYU Langone Medical Center. There, I performed a revision rhinoplasty for a wonderful woman who just did not get the result she wanted one year ago from another surgeon. Not only did she not like how her nose looked, but she could not breathe from either side of her nose. I managed to get through all her scar and effectively improve her nasal appearance. For her breathing, she needed internal nasal valve improvement, so I used a combination of spreader grafts and upper lateral cartilage splay sutures. Her tip volume was reduced, but because of her scarred skin I was worried that her skin would not be able to contract down to the new framework that I built. So, I removed some of her skin to pull it down tighter over the framework. All the reconstruction was done using septal cartilage grafts, with no need for ear or rib. It was a fantastic 4 hour effort.

I ended the day by repairing a fractured zygomatic arch in a young man who was mugged last week outside a club in Manhattan. In addition to the depressed cheek bone, he couldn’t easily open his mouth or move his jaw to the affected side. Fortunately, a relatively easy reduction could be accomplished by simply making an incision in the temporal hair, following the temporalis muscle under the arch, and popping the arch up. The bone fragments locked up beautifully, avoiding a larger and more complicated operation. This approach, called a Gilles repair, doesn’t always work perfectly, but his fracture was the perfect type for this.

This was a day that allowed me to apply all my skills in facial plastic surgery: Cosmetic, functional airway, and reconstructive. After 9 hours of actual surgery, I felt invigorated and happy I could do such great work that would help my patients with their concerns, giving them increased self-confidence and better function.

June was another great month.  On the clinical side, I performed a number of great surgeries, including one surgery that lasted 8 hours!  It included a deep plane facelift, blepharoplasties, forehead lift, rhinoplasty, chin implant, and fat transfer from the abdomen to the face.  The patient has done wonderfully, and two weeks after surgery was able to fly to Australia looking and feeling great!  Another June facelift/forehead lift patient at two weeks after surgery is going on vacation looking fantastic.  One of my facelifts from May came back looking absolutely wonderful, at least 10 years younger.  She, too, is thrilled.

Rhinoplasties dominated the June schedule, with many successful surgeries of both primary and revision rhinoplasties.

Academically, I was in charge of the Dept. of Otolaryngology’s annual graduation research day.  I invited Dr. Ted Cook from Portland, OR, to be our visiting professor, and ran a panel with Dr. Cook, Dr. Nicolas Tabbal, Dr. Norman Pastorek, Dr. Philip Miller, and Dr. Anil Shah.  The day was a huge success with a very high caliber of talks given.  I presented 3 research papers that will be also presented at the Annual Fall National Meeting of the American Academy of Facial Plastic Surgery.  All in all, a very good month.

I just saw the patient who had her facelift yesterday.  She looks absolutely fantastic.  Swollen, of course, but minimal bruising and already she can see the amazing contour her face and neck will have.  She is very happy so far.