Palm Beach Plastic & Cosmetic Surgery
Detailed procedures made simple
BOTOX® Cosmetic, and its newly FDA approved competitor Dysport®, both work wonderfully well to temporarily reduce lines around, between and above the eyes (forehead). The consistent safety record of BOTOX® Cosmetic has been demonstrated over the past 30 years, and Dysport®'s FDA studies have shown similar results. Dysport® may have further slight advantage in both activation time and possible duration of treatment. These products may also be useful to treat excess sweating underarms, hands and or feet. There is no product allergy testing required, however not advised during pregnancy or patients with neuro-muscular disorders.
Fillers (JUVÉDERM® Injectable Gel, Restylane®, Perlane®)
These sugar based FDA approved injectables also have consistent safety track record, and don't require allergy testing. They are indicated for reducing deep lines around the mouth, and can further enhance fullness and contour of lips, cheeks, under eye hollows, and nasal irregularities. They are also temporary (manufacturer notes 6-12 months), and further compliment facial surgeries although will not replace them.
As with the mini-lift procedures, most eyelid procedures can safely be performed in the office with local anesthesia (numbing solution injections) only, although our adjoining hospital outpatient surgery unit is also available. Options exist for lower eyelid improvement depending on what bothers the patient - fatty bulges, skin excess, wrinkles, discoloration or combinations. Skin lasers and fillers can also be combined with lower eyelid lifts to further enhance lid appearance. Upper lid procedures will also improve excess eyelid skin and fat, however should also be evaluated along with the brow as either or both can contribute to the appearance of upper eyelid aging. An additional procedure through the upper eyelid incision (“canthopexy”) can also be performed to further improve the aging lower eyelid drooping appearance.
Usually the mini-brow procedure is most effective to improve lateral brow droop, and can be safely done in the office with local anesthesia (numbing solution injections). On occasions a full brow lift is necessary to reduce the skin droop between the eyebrows and is done in our adjoining hospital outpatient surgery unit. Additional BOTOX® Cosmetic/Dysport® will further improve the horizontal forehead lines. A full brow lift also can be combined with a full and/or mini-facelift to further improve overall facial appearance.
Not everyone wants, desires or needs a "full" facelift procedure. The mini-facelift series are options currently available to improve those areas (neck, jowl, cheek, brow) in the office with local anesthesia (numbing solution injections) only. Because the minis are limited in scope, there is limited bruising swelling and rapid recovery. [See Mini vs Full Facelift]
However, for those who have a greater degree of skin sagging, fat excess, and/or extensive neck muscle bands, the full facelift is safely performed under anesthesia in our adjoining hospital outpatient facility. Eyelid lifts, forehead lift, nose and ear reshaping can also be performed during the full facelift while under anesthesia. For those desiring more than in-office local injection type anesthesia, the mini-facelift series can also be done in our adjoining hospital outpatient facility.
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Excessive neck skin, fat and/or muscle bands can be improved though an incision made under the chin. However, we have found the best neck results are achieved in combination with either the mini-facelift and or full facelift procedures which further improves the horizontal neck skin sagging. Occasionally when only fat without excess loose neck skin is present, mini-liposuction alone can often be effective to improve neck contour.
Otoplasty, commonly known as ear reshaping, usually is done for older children (after age 6 when most ear growth has occurred) and for teens with protruding ear(s). It can also be done for older patients often in combination with other facial rejuvenation procedures. The incision is placed behind the ear, and can be performed in the office using local anesthesia (numbing solution injections). If ear malposition is found at birth, often a custom made ear reshaping device can be utilized avoiding surgery altogether! Congenital (birth defect) ear loss/deformity is a different issue that may also include loss of hearing and/or other face/body issues. Reconstructive surgery for these congenital ear deformities usually are performed at an earlier age, in multiple stages.
Cosmetic Rhinoplasty procedures, commonly known as nose reshaping, usually are considered for “mature” teenagers (usually after age 16 when most nasal growth has occurred), but for older patients often in combination with other facial procedures. Minor irregularities of shape, position and indentations can often be improved with injections of filling agents like Restylane® and JUVÉDERM® Injectable Gel®, although temporary. Cosmetic nasal reshaping will address issues of nasal “bump” and/or nasal tip or both, as determined during consultation. Additional refinements may also include the use of cartilage grafts usually taken from inside the nose or occasionally the ear. Nasal breathing problems created by a nasal (deviated) septum obstruction can also be improved during cosmetic Rhinoplasty procedures.
Nose Cancer Reconstruction
The art of reconstructive Plastic Surgery is especially important when considering facial reconstruction-especially the nose, the most prominent facial feature! As with breast reconstruction, the goal of nasal reconstruction is to provide as normal an appearance as possible. Oftentimes a “direct” closure is possible by undermining local skin to fill the gap. However, for larger areas of reconstruction, the use of either skin graft and/or “skin flaps” are considered to best provide similar skin repair to what was removed. Sometimes, it may take several procedures (which can be performed in the office with local anesthesia numbing solution only) to accomplish the finished reconstructive result.
Cleft Lip Repair
Congenital cleft lip/cleft palate are due to a variety of causes, and fortunately the treatment for same has become very much standardized after significant contributions from different medical specialties. This condition (much like burn wound treatment) is best treated with a “team approach” of multi-specialists, as associated speech, dental, hearing and psychological issues can be associated. In addition to the original cleft lip repair (which may be one or both sides, as well as being incomplete or complete), consideration is also given to treatment of associated nasal deformities.
*** Our adjoining hospital outpatient surgery unit is also available for those patients desiring additional anesthesia***