Eyelid Surgery (Blepharoplasty)

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.