SURGICAL PROCEDURES

Rhinoplasty (Nose reshaping)

Rhinoplasty is one of the most common facial cosmetic procedures. The nose is the centerpiece of the face, so deformities are often quite noticeable to those requesting treatment. Nose surgery can be done to improve both form and function, but they often go hand in hand. For example, deviations in the septum (the partition between the two sides of the nose) can often create a crooked tip or base of the nose. Dr. Saxon has particular expertise in rhinoplasty, and having a background in Otolaryngology (Ear, Nose, and Throat Surgery) allows her to refine the nose while maintaining the structure to keep you breathing normally after your surgery.  No matter what parts of your nose you would like to change, Dr. Saxon aims to create a natural appearance to help your nose blend in with the rest of your face without a “done” look.What are common reasons why patients get a rhinoplasty?

  • Dorsal hump – a bump on top of the nose
  • Flat dorsum – the top of the nose is too flat
  • Bulbous tip – the tip of the nose is too wide
  • Crooked nose – either congenital or from a broken nose in the past
  • Overprojected tip – The tip of the nose comes out too far from the face
  • Wide nostrils – the bottom of the nose is too wide making the entire nose look larger
  • Breathing issues

What is recovery like after rhinoplasty?

Rhinoplasty is a day surgery, meaning patients go home after a brief recovery in the post anesthesia care unit. Dr. Saxon utilizes nerve blocks with long-acting anesthetics which helps patients stay comfortable both the day of surgery and beyond. Although pain medication is given, most patients only take them for a day or two and transition to Tylenol or ibuprofen. Most describe their nose as being sore but not unbearable. A cast is placed on the nose for a week, and congestion lasts several days to several weeks after surgery. For the most part, Dr. Saxon does not use packing material inside the nose which makes recovery much more tolerable. We usually recommend that patients take one week off of work following surgery, but many feel well enough to do some work from home if need be.

Facelift

As you age you undergo several predictable changes including loss of fat in the face and loss of skin elastisticity. There are many ways to maintain a youthful appearance in the early stages of aging such as botox and filler and use of skin products. At some point, most reach a point of diminishing returns in the use of more conservative treatments as they do not have as more product is needed without as dramatic of effect. Facelift is a good procedure for those with loose and excess skin of the face and neck. There are various techniques for performing a facelift, and Dr. Saxon will tailor the technique to your individual anatomy and needs. Neck liposuction and tightening of a muscle in the neck called the platysma is often done at the same time as a facelift to create an ideal angle between the chin and neck.

What is recovery like after a facelift?

Immediately after a facelift, patients will have a compressive dressing around the head. This comes off the following day, and a more comfortable wrap is placed. You will have swelling and bruising that often extends down onto the chest from gravity. Incisions are placed in a crease around the ear and scalp. These incisions are kept clean by you or a caretaker after surgery. Sutures and surgical clips are removed one week after surgery, and at the same time you will start using a light chin strap to keep compression on the chin. Swelling can continue for several weeks after surgery. Most have numbness on the neck and around the ear temporarily for 2-3 months as well. It is normal to feel minor lumps and bumps during the healing process which smooth out over time. Sunscreen is very important even up to a year after surgery to avoid pigmentation issues along the incision lines.

Neck Liposuction

Liposuction of the neck is often done in conjunction with a facelift; however, there are many circumstances where liposuction alone with give a nice contour to the neckline and remove excess fat from under the chin. There are many options to removing fat from under the chin now including Kybella and Coolsculpting. Although there is no downtime with these options it often takes 2-3 treatments to see the desired results. Neck liposuction is a great option for those not wanting to wait months to see results and can be done under local anesthesia in the office.

What is recovery like after neck liposuction?

Neck liposuction can be done through small incisions hidden around the ears. These are closed with sutures that may need to come out one week after surgery. A compressive dressing is placed around the chin and is kept on at all times for one week except to shower and clean the incisions. Swelling and bruising are present for at least one week and can extend for several weeks. A high-collared shirt or scarf can be placed around the neck during this recovery period.

Blepharoplasty (Eyelid Surgery)

Surgery of the eyelids to remove excess skin and protruding fat is a very popular procedure which opens up the eyes to create a more relaxed, rested and youthful appearance. As one ages, there are several changes that occur to the upper face. The brows descend, fine lines start to emerge around the eyes and forehead, and the eyes begin to be hidden amongst extra skin and puffiness. This is not just a problem with advanced age, however. Dr. Saxon often sees patients in their 30s and 40s who simply have a very small amount of excess skin of the upper and/or lower eyelids that causes smudging after makeup is applied which can be very annoying. As one ages further there is even more excess skin and potentially some protrusion of pockets of fat around the eye socket. Gone are the days of removing all of this fat as it actually ages the face. Now, only a smaller amount is actually removed or repositioned to reverse the consequences of time. Many eyelid procedures can be done in the office under local anesthesia.

Dr. Saxon will perform a comprehensive exam during your consultation to address all of your concerns and use a technique tailored to your specific needs.

What is recovery like after blepharoplasty?

After blepharoplasty there will be an incision within the crease of the upper or lower eyelid that is closed with sutures. Many times Dr. Saxon uses sutures that dissolve. For those with darker skin you may have sutures that do not dissolve and need to be removed 3-4 days after surgery. Swelling and bruising peak 1-2 days after surgery. Instructions are given to apply ice to the eyes and keep the head elevated to minimize this. Many experience temporary dry eye and need to use artificial tears for several weeks. If dry eye was already present before the procedure it will likely worsen for a brief period of time. Once swelling has subsided many go about their daily routine while wearing sunglasses in public. The incisions around the eyes tend to heal almost undetectably.

Brow Lift

A brow lift can remarkably change the entire face with minimal recovery. As one ages the eyebrows descend and sag closing off the eyes to light. Sometimes this sagging can even limit peripheral vision. It is often done in conjunction with a blepharoplasty to rejuvenate the upper third of the face. There are a variety of techniques for achieving a brow lift:

  • Endoscopic brow lift – This is by far the most common technique. With this method, small incisions are made in the scalp to gain access to the soft tissue of the forehead. A tiny camera called an endoscope is introduced through these incisions so that all vital structures such as nerves and blood vessels are kept safe. To use this technique an optimal hairline must be present.
  • Pretrichial brow lift – This technique is used in those with a high hairline because it lowers the hairline at the same time it raises the eyebrows. The incision (called a trichophytic incision) is beveled so that hair actually grows through it after 2-6 months camouflaging the incision.
  • Coronal brow lift – A coronal brow lift involves an incision about 4 centimeters behind the hairline. It is often utilized for those with a recessed hairline to hide the incision.

When considering a brow lift, Dr. Saxon will perform a comprehensive exam of the eyes, forehead, and hairline to tailor the surgical technique to your specific needs.

What is recovery like after brow lift?

Recovery after a brow lift is generally quite straight forward. A compressive dressing on the forehead is placed for one week and can be removed to wash the hair and clean incisions. In the case of an endoscopic brow lift, there are only small incisions present. With other techniques, the incisions are much longer and can be kept clean by keeping the hair clean and removing any scabs. There is bruising and swelling that is worse around the eyes and cheeks from gravity pulling it down. The scalp is often numb for weeks to months and resolves over time. Most people take a week off of work to give time for bruising to subside, but patients feel well enough to do work from home throughout most of the recovery period.

Scalp Advancement (Hairline Lowering)

A high hairline can be a problem for both men and women often being the key factor in determining a hairstyle. Advancing the scalp forward may eliminate the need for hair grafting and is often more natural in appearance. This procedure involves making an incision (called a trichophytic incision) right at the hairline. A trichophytic incision is beveled so that hair can actually grow through it over time camouflaging the incision. The scalp is brought forward into the desired position and often rounded off at the edges. This creates a natural hairline and slightly raises to eyebrows. For men, the hairline may continue to recede, so they will want to ensure that hair loss is stable before undergoing this procedure. In this circumstance there is still a risk of needing hair grafting in the future should hair loss continue albeit fewer grafts. In women, estrogen usually prevents the hairline from changing drastically and undergoing this procedure at any time is generally safe.

What is recovery like after scalp advancement?

Scalp advancement has a fairly short recovery time. Immediately after surgery, a compressive wrap is placed around the forehead. It can be removed daily for hair washing and cleaning incisions. There is mild swelling and bruising which descends with gravity down around the eyes and cheeks. The forehead tends to be numb temporarily which minimizes pain. Any clips and sutures are removed one week after surgery, and local wound care will continue for one week further after that. Sunscreen and scar creams are recommended after that time. Hair starts to grow through the incision 2-6 months after surgery.

Otoplasty (Ear Reshaping)

The most common reason to have surgery on the external ear is simply for ears being too big and prominent. This is often because the cartilage that forms the ear does not have a ridge called the antihelical fold. There are many techniques to setting the ears back, but one involves recreating this fold with permanent sutures. An incision is made behind the ear to place sutures, remove any cartilage needed, and score cartilage to encourage it to maintain its shape. Dr. Saxon has in-depth knowledge of the intricacies of the shape of the ear since she has special expertise in microtia reconstruction. She uses her knowledge of form and function to give a natural result.

What is recovery like after otoplasty?

Immediately after surgery a compressive dressing is placed over the ears to keep them in position until swelling subsides. This will be taken down the day after surgery and replaced with a more comfortable one. The incisions behind the ears are typically closed with dissolving sutures, so there is no need to have them removed. Swelling and bruising typically subsides one week after surgery. At that time the compressive dressing is removed, and patients are asked to wear a headband over the top part of their ears for added support for an additional 2 weeks.

Earlobe Repair

Years of wearing heavy earrings can take a toll on the ear lobes by widening the piercing. It can be easily solved by closing the hole and repiercing the ear lobe in a slightly different location. As we age, the ear lobe elongates and loses volume. The ear lobe itself can be reduced in size by removing a portion and reattaching it within a hidden skin crease. Many patients even find it helpful to augment the volume of the ear lobe with a hyaluronic acid filler making it possible once again support the weight of jewelry.

Other reasons to repair the ear lobes include trauma with complete division of the ear lobe or repair of gauged ear lobes. All of these procedures can be done easily in clinic.

What is recovery like after earlobe repair?

Recovery from this procedure is really quite simple. You will have sutures both in front of and behind the ear lobe that will need to be removed 1 week after surgery. Tylenol and ibuprofen are usually all that are needed for pain, and there is really minimal swelling and bruising. Generally, no time off from work is required. Piercing can be done one month after the ear lobe repair and is included in the cost of the procedure.

Cheek Augmentation

The face is composed of multiple distinct fat pads which descend and shrink with age. If this weren’t enough, the bone of the face actually gets smaller as well. The result is the appearance of the face being deflated. Fullness in the cheeks or malar area improves the appearance of the entire face. Not only does augmenting the cheeks bounce light off the eyes but also diminishes folds in the lower face creating more balance.

For this reason, cheek augmentation has become widely popular in recent years with the ease of hyaluronic acid fillers like Voluma which works great in this location. The downside of fillers is that they eventually need to be repeated. For those who want a more permanent solution a cheek implant is the way to go. Small incisions are made on the inside of the mouth, and a silicone implant is placed. Silicone implants are soft and feel natural. Because a tight pocket is made no plates or screws are necessary to keep it in place. There is a wide variety of shapes and sizes that are considered during a comprehensive evaluation, so one will be chosen specifically for your face shape.

What is recovery like after cheek augmentation?

There is minimal downtime after a cheek augmentation. The procedure can be done in the clinic under local anesthesia, and so even go right back to work. You will have some residual numbness for up to 6 hours after your procedure much like you would feel after having a dental procedure. Dissolving sutures are used to close the incision, and instructions are given to use a special mouthwash to keep the mouth clean. No dressings are placed, and there is little to no visible bruising since the implants are placed directly onto the bone of the cheek. Since work is done in and around the nerves in the cheek, some degree of residual numbness can persist for 2-6 weeks.

Buccal Fat Pad Excision

If you find yourself contouring your face with makeup daily to camouflage your “chipmunk cheeks” you may be a good candidate for a buccal fat pad excision. This is a quick 45 minute procedure in the office under local anesthesia to accentuate the cheek bones and downplay fullness in the lower part of the face. The overall goal it to transition a round face into an oval or inverted triangular shape. It can be paired with botox in the masseter muscle (the muscle attached to the jaw) or fillers around the cheek bones to give even more of a dramatic change.

The procedure itself involves making a small 1 centimeter incision inside the mouth. The fat pad is just inside this incision and comes out in one piece. A small portion of tissue at the base of the fat pad is left in place to prevent scarring and a hollow appearance.

What is recovery like after buccal fat pad excision?

The incisions inside the mouth are closed with dissolving sutures. Instructions will be given to wash the mouth out with a special mouthwash, and routine dental care can be resumed as soon as tolerated. A soft diet is recommended for the first day or two to prevent biting the inside of the cheek while swelling is present. Mild swelling occurs which is improved with a compressive wrap. Bruising is generally not visible since the fat pad is deep within the cheek. Swelling gradually goes down over 1-2 weeks revealing your postoperative result.

Fat Transfer to the Face

The face loses volume with age and can be replaced with a multitude of materials to create a more youthful appearance. A growing trend in both facial and body cosmetic surgery is in using your own fat to replace what was lost. Many like this option simply because they do not like foreign materials in their body. Other advantages include that it is permanent and there has been some evidence to support the presence of stem cells within the harvested fat to improve the appearance of the skin.

An optimal result using the fat transfer technique usually involves repeating the procedure to an average of 3 times since some of the cells do not survive with each treatment. The good thing is that once this is done it is absolutely permanent.

The fat cells are harvested using a small liposuction cannula and taken from the abdomen, thighs, or buttocks. For facial injection only a small amount is harvested, about 3 tablespoons, so no change in contour of the donor areas is seen.

What is recovery like after fat transfer to the face?

The small incisions are closed with dissolving sutures and a special glue. There is very little down time after this procedure. Mild swelling and bruising may be seen, but this is minimal since blunt cannulas are used instead of sharp instruments. After a week, the glue can be rubbed off by using any ointment like Vaseline, and routine skin care may resume. No pain medication beyond Tylenol or ibuprofen is needed since this procedure is very well-tolerated.

Chin Augmentation

Patients with a small, retracted chin have usually been bothered by it their entire life. For the most part, it is unrelated to how well the teeth fit together and is called microgenia. Other terms you may have heard are micrognathia and retrognathia. Micrognathia means that the jaw is small and an overbite is present, and retrognathia means that the jaw is normal is size but set back also creating and overbite. In both of the latter cases, oral surgery is a better option so that the teeth are brought back into normal position. In the case of microgenia, augmenting the chin is a viable option since no work needs to be done on the teeth.

A small chin can be repaired using multiple techniques with the most common being placement of a silicone implant. Incisions are made inside the mouth to place the implant at the bottom edge of the jaw. Because the pocket made is just big enough to fit the implant, plates and screws are generally not needed. Another option for chin augmentation is by making cuts in the bone to slide it forward. This technique is more invasive and often not necessary since modern implants are well-tolerated, have fewer risks, and has a much quicker recovery. A wide variety of shapes and sizes are available, and they can even be custom designed if needed.

What is recovery like after chin augmentation?

The incision in the mouth is closed with dissolving sutures. While healing, instructions are given to use a special mouthwash to keep bacteria from collecting in the crevices of the mouth. Brushing the teeth is allowed at any point as soon as it is comfortable. A compressive dressing is also placed around the chin and jaw for added support. This is kept on at all times during the first week and then only while at home the following week. It is normal to have some numbness on the chin, and it usually improves within 2-6 weeks. Rarely, a pocket of fluid or blood can accumulate alongside the implant. If this happens it can cause excess pain and swelling for a longer period of time. The fluid should be drained in the office immediately if this occurs.

Lip Lift

Many people are deterred from undergoing lip augmentation because they have at some point seen someone who has had too much filler placed. As one ages, the upper lip elongates and hangs over the upper teeth. A more youthful upper lip is one that is full but short exposing the upper teeth when the mouth is open. If you look at any fashion magazine you can see examples of this as models often pose with their mouths open.

A lip lift is a procedure that can be done with or without lip augmentation and appears more natural than simply adding volume alone. It involves making an incision in the crease at the base of your nose and removing some of the skin of the upper lip. You can think of it as a facelift for your mouth!

What is recovery like after a lip lift?

After a lip lift there are sutures at the base of the nose hidden within the skin crease. These are removed one week after the procedure. These are kept clean and moist with ointment to prevent any scabs from forming. Mild swelling and numbness occurs, but bruising generally is minimal. The incision can appear tight and slightly pink for several weeks to months which all improves over time. Instructions are given to keep sunscreen on the incision at all times to prevent long-term pigmentation of the scar. A few days after the sutures are removed patients are free to wear makeup over the incision.

Mandible Contouring (Jaw Reshaping)

Mandible contouring, also known as V-line or K-Pop surgery, has been extremely popular in Asian countries for years before emerging as a trend in the U.S. The term “K-Pop” surgery came from its popularity in Korea as it exemplifies the jawline of many prominent Korean pop stars. The jaw can be wide in the back near the angle, in the front near the chin, or both. Some have widening the back of the jaw from enlargement of the masseter muscle which can be addressed with botox performed every 3-4 months to shrink the muscle. It is often the case that the actual bone structure of the jaw is wide leaving surgery as the best option.

To perform mandible contouring, incisions are made inside the mouth to gain access to the bone. A special instrument similar to a powered nail file is used through those incisions to precisely sculpt the bone. This technique is less aggressive than making cuts in the bone but with fewer complications. Nevertheless, the results are dramatic! Mandible contouring is just as much an art as it is a science. The right eye to determine the ideal degree of narrowing and shape of the jaw is essential when considering who to perform your surgery.

What is recovery like after mandible contouring?

The incisions in the mouth are closed with dissolving sutures. While healing, instructions are given to use a special mouthwash to keep bacteria from collecting in the crevices of the mouth. You will be able to brush your teeth as soon as you are comfortable. There is considerable swelling after this procedure mostly from enlargement of the masseter muscle along the edge of the jaw. For this reason, final results aren’t realized for at least 3 months and can continue to improve afterwards. A compressive dressing to give support to the chin and jaw is kept on at all times for one week and while at home afterwards for an additional 1-2 weeks.

Adam’s Apple Reduction (Tracheal Shave)

The thyroid cartilage, otherwise known as the Adam’s Apple, varies in size between individuals. It is usually more prominent in men since testosterone enlarges and changes the shape of the cartilage. Some women, however, have a prominent Adam’s Apple as well. Shaving down this prominence gained popularity in the transgender community, but is now a popular procedure in the general public.

The most important reason to go to an experienced surgeon for this procedure is the risk of permanently changing the voice if done incorrectly. The vocal cords insert within this cartilage at varying levels. Finding this insertion site is the most important part of this procedure so that the voice is preserved. Dr. Saxon is very comfortable doing this since she has a background in Otolaryngology which includes voice surgery.

During the procedure, the Adam’s Apple is exposed, and a camera is used to visualize the vocal cords as the same time. A needle is then placed through the cartilage to precisely locate the insertion site of the vocal cords. All of the cartilage above this level can then be removed. This ensures that the bump on the neck is taken down as much as safely possible without affecting the vocal cords.

What is recovery like after Adam’s apple reduction?

The incision in the neck is closed with dissolving sutures and a special glue. The only limitation afterwards is avoiding lifting heavy objects for two weeks. Most feel well enough to go on walk and do light exercise. Your voice may be raspy for about one week from the breathing tube placed during the procedure which is normal. If you are coming from out of town it is required to stay near the hospital for 24 hours because of the very rare possibility of a collection of blood around your voicebox within that time period.

Brow Bone Reduction

The upper third of the face has the most dramatic effect on attractiveness and femininity. The goal of brow bone reduction is to sculpt the bone over the eyes to allow light to accentuate the upper face. It is most often a combination procedure with work on the bone, brow lift, and lowering the hairline. Dr. Saxon performs this procedure most often in gender confirmation procedures in the transition from male to female facial features. With these procedures in the media more often the last few years it is now requested from the general population more and more every day.

The key to creating the best result with this procedure is addressing the frontal sinus. This sinus is a pocket of air of varying size beginning at the top of the nose and extends up in the forehead. The majority of individuals require more than just shaving down the bone. To create a smooth contour between the forehead down to the nose requires entering into the sinus and setting the bone back. Dr. Saxon’s intimate knowledge of the sinuses and performance of hundreds of these cases makes her one of the few experts in this procedure. She continues to be board certified in Otolaryngology Head and Neck Surgery and can address any sinus pathology if encountered at the time. Once an ideal contour is achieved, the bone is set into position with titanium plates and screws.

What is recovery like after brow bone reduction?

The incision will be closed with a combination of sutures and clips that will need to be removed after one week. A compressive dressing is worn on the forehead during that time and can be removed for showering and cleaning the incision. There can be significant swelling and bruising which will extend down around the eyes with gravity. It is not uncommon for the eyes to be completely swollen shut for the first 24 hours, so a friend, family member, or caretaker will be needed to help you for the first few days. Swelling quickly diminishes, and pain begins to improve at that time. The scalp and forehead can be numb for several months and is expected. If the incision is made in the hairline, hair starts to grow after 2-6 months.

Mole Removal

Dr. Saxon removes moles on the face of varying sizes to minimize scaring. Many times, the skin can be closed using a circular closure resulting in a round dot instead of a straight line. This tricks the eye to thinking you have a blemish instead of a scar.

Of course safety is of utmost importance. If there are any features worrisome of a mole transitioning to a skin cancer it will be sent to a board certified pathologist for evaluation.

What features of moles should make you suspicious of cancer? Remember your ABCs!!

  • Asymmetry: cancerous lesions are not typically round
  • Border: Look for the edges of the mole to see if they are blurry or uneven which is a sign of an abnormal mole
  • Color: Normal moles are uniform in color. Abnormal moles may have more than one color or very dark in appearance.
  • Diameter: A mole greater than ¼ inch is considered abnormal
  • Evolving: If the mole is changing over time in any of the above features it is considered abnormal.
Scar Revision

Scars on the face can come in all shapes and sizes. Because of this there are a number of techniques to address scars. A comprehensive evaluation and plan can be tailored specifically to your needs. Some procedures commonly offered include:

  • Scar excision and geometric broken line closure to make the scar thinner and break up any straight lines to the trick the eye from noticing the scar
  • Local tissue rearrangement to reorient the scar
  • Subscision to lift up a depressed scar
  • Dermabrasion to smooth out uneven contours
  • Microneedling to promote collagen growth around scars

For the most part, more than one of these techniques is needed to create the best result. A treatment plan will be made at the time of your consultation.