Solutions for the Nose Job
Cosmetic Rhinoplasty

Leesburg | Loudoun | Ashburn | Virginia

One of the most common concerns seen in our office for consultation is dark circles under the eyes.  The reasons for dark circles under the eyes are multi-factorial and include:

  • Loss of volume in the upper cheek eyelid junction which is no longer able to camouflage the underlying orbital bone
  • Increased sun exposure of the lower eyelids as the lower eyelid sits on a shelf on the upper cheek
  • Stretch of the lower eyelid skin as the cheek falls with age causes the lower eyelid skin to wrinkle and darken
Given these findings, the treatment strategy to addressing the dark circles of the lower eyelid are:
  • Add volume to the upper cheek eyelid junction with fillers or fat transfer
  • Forever Young BBL to bleach the dark abnormal pigment of the eyelid skin
  • Surgical removal of excess lower eyelid skin if necessary.

The dark circles under the lower eyelids are the result of many concurrent reasons.  

Nasal Tip

  • A wide nasal tip, also called a boxy nasal tip, is a commonly requested concern for patients.  The shape and size of the nasal tip is created by paired nasal cartilages that are individually wide and separated from each other.  The outline of your tip cartilage can often be better visualized by pushing the tip upward while looking at the tip cartilage in the mirror.  

  • The treatment strategy is to narrow the front to back width of a wide tip cartilage in addition to joining the left and right nasal cartilages in the midline.  

Nasal Hump

  • The nasal hump is commonly seen more commonly in certain ethnicities including patients from the middle east and around the mediterranean.  Some patients refer to their features as a Roman Nose.  

  • The nasal hump is composed of a tall nasal bone that is contiguous with a tall nasal cartilage.

  • The treatment strategy is to file down the bone and cartilage with a special filing instrument or chisel.  Filing down the nasal hump will sometimes result in a flat top surface to the nose, particularly if the hump is particularly tall.  Imagine taking off the top of a triangle.  If the top surface looks overly flat, the nasal bones are broken at the base of the triangle and pushed inwards to close the gap at the top.

Wide Nasal Bones

  • Wide nasal bones are addressed by breaking the nose and pushing the bony side walls inward.  Imagine pushing the sides of a triangle towards the midline of the triangle.

Wide Nostrils

  • Wide nostrils are commonly seen in certain ethnicities including asians and patients of color.   

  • The treatment strategy is to perform a “wier excision” that can decrease the circumference of the nostril.  Imagine the nostril as a circle where the base of the circle is located where the nostril joins the cheek.  A wier excision will remove a small wedge of the nostril at the base followed by closing up the smaller circle.  The scar is hidden in the crease between the nostril and cheek.

Flat Nasal profile

  • Flat nasal profile is the opposite of a nasal hump.  This finding is commonly seen in certain ethnicities including asians and patients of color.  

  • The treatment strategy is to build up the nasal profile using facial fillers, cartilage grafts, or implants.  Adding facial fillers are the easiest option and an option that we perform daily because it does not require surgery.  

  • Voluma, juvederm, or radiesse are common facial fillers.  These are injected in the office in a 10 minute procedure with no downtime

  • Patients having surgery for other cosmetic concerns will often opt for septal cartilage grafts or implants created for this purpose.

The principle goal is to perform the procedure in a way that appears natural.

The goals of the upper eyelid surgery are to reduce the factors that contribute to their appearance of fullness and heaviness.  These include:

  • The removal of any extra eyelid skin
  • The conservative removal of any fat growth and herniation
  • Raise the forehead or temple if a drooping brow contributes to hooding of the lateral upper eyelid

Facelift or Mini-Facelift – for lower facial droop and jowling

Forehead lift- for brow droop 

Lower eyelid surgery- for dark circles, extra skin, or fat bags

Fat transfer or Facial fillers-  for facial volume

Forever Young BBL – For dark skin pigment, sun spots, age spots

Profractional Laser Peel – For fine lines and textural changes of the skin

Micropeel – For fine lines and textural changes of the skin

Botox

The appearance of looking “startled” after upper eyelid surgery are due to poor assessment, judgement, and technique on the part of your surgeon.  The most common reason is over-elevation of the brow if a browlift is performed at the same time as the upper eyelid surgery.  This is particularly true in men ( Think Kenny Rogers ) given that men actually look better and more distinguished with slightly low brows.  

The first step therefore is to find a talented plastic surgeon with a good understanding of facial aesthetics ( not your eye doctor or dermatologist ).  Second, avoid over-elevation of the brows if a forehead lift is needed at the same time.  

More often than not, upper eyelid surgery is performed without general anesthesia if it is performed as the only procedure.  

The procedure is most commonly performed under local awake anesthesia.  A long acting ( 6 hours ) is injected directly into the eyelid.  Most patients are also given a valium-type drug to help them relax.  

  • The best plastic surgeon near you should have the following qualifications
  • In practice for at least 3 years
  • Performs at least 1 upper eyelid surgery per week
  • Is a board certified plastic surgeon ( as opposed to a ENT, optholmolagist, or dermatologist )
  • Look at reviews in google

Complications of upper eyelid surgery are fortunately rare.  The most worrisome complications are the removal of too much upper eyelid skin ( lagopthalmos ) and blindness.  I thankfully have never seen either of these in my own practice.  And short of journal reports, I have never known of any patient to have experienced blindness.

The more common and realistic complications include:

  • residual hooding ( extra skin ) in the lateral eyelid.  This is usually due to the contribution of a heavy forehead and brow.  My patients are always told of this possibility if they have preexisting lateral brow droop and they are not having a brow lift.
  • residual fat protrusion of the medial eyelid near the nose.  The medial fat compartment is deeper and situated near the medial eyelid muscles.  Conservative rather excessive removal of the fat in this compartment is often prudent to avoid complications of muscle involvement.
  • Milia and small cysts along the suture line.  This complication is unfortunately very common.  They resemble pimples and are easily removed in 3 to 6 months and usually without extra charges.  

Upper eyelid scars are hidden in the normal existing upper eyelid crease.  This natural crease provides excellent camouflage for the scar.  The scar is red at first but easily hidden with make-up for first 3-6 months.  After about 3 months, the scar will begin to whiten and lighten.

The recovery from upper eyelid surgery is mostly cosmetic as opposed to functional.  That is, most patients are capable of work from a pain and discomfort standpoint in 2-3 days.  But because of the visibility of bruising most patients will not return to work for 7-10 days.  

Patients can work from home nearly immediately.  

Bruising will take up to 2 weeks to resolve.

Bruising of the upper eyelid is almost always present.  The bruising will show as a dark blue in the first week and as a yellow green in the second week after surgery.  Make-up can be used to cover up any bruising once the sutures are removed in 7 to 10 days.  

Candidates for upper eyelid surgery will complain of the following:

  • Upper eyelids feel and appear heavy particularly at the end of a day
  • The eyelids appear to close off the appearance of the eyes

For my patients:

  • First follow up visit is usually 1 to 2 days after surgery.  Out of town patients and some patients who are more comfortable can skip this appointment and replace it with a text image of your eyes from home.
  • Ice the eyes for the first 2-3 days to reduce bruising and swelling
  • Avoid any physical activities for 3-7 days to reduce bruising and swelling
  • Suture removal appointment in 7-10 days

Upper eyelid blepharoplasty is the medical term for upper eyelid surgery

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