Encinitas Doctors

Sagging Skin After Weight-loss at 21. Is a Facelift my Only Option? (photo)

I’m 21 and I’ve been overweight most of my life. I’ve recently dropped 55 lbs over the course of a year. (180, now 125 at 5’2”) I’ve noticed sagging or loose skin and I’m definitely concerned about my face. The sagging became noticeable when my face started slimming about 5 months ago. Should I lose more and my face will firm? Should I look into a facelift or are there other non-surgical ways? Does my skin just need more time and/or a specific care regimen? Facial exercises? Glycolic Peels?

You are to be sincerely congratulated and commended for losing the extra weight, and hopefully, you'll be able to keep it off.  A smile will instantly lift your face, which is why so many surgeons post photos of their post surgical facelift patients smiling.  I don't see sagging in your face or neck at all.  Your upper lid marginal reflex distance is lower than normal, and you have about 1 mm scleral show beneath your corneoscleral limbus and lower eyelid-cheek junction is clearly demarcated, with lower eyelid contour irregularities.  Your canthal tilt is beautiful.  The corners of your lips turn up nicely, and only if the nasal labial furrows bother you would I treat them with filler.

The treatment I would recommend depends on which of your features bothers you, what your budget is, available recovery time, and risk tolerance.  Also, how strongly you feel about a permanent (or very long lasting) result is germane.  Specifically, what exactly is the distasteful "sagging" you reference?

Steve Laverson, MD

San Diego Plastic Surgeon

Is It Ok for Post Op Review to Be Done by Another Surgeon?

I live out of province from where i'm traveling to have my rhinoplasty done (24 hour drive). Is it a big deal to have the surgery, drive home, and have another surgeon in my home town do my post op (take off cast, make sure everything's ok)? Gets very expensive otherwise.

My advice:  Be sure the surgeon in your hometown agrees in advance.  If that surgeon does rhinoplasty but you are going elsewhere, which is certainly your right, it's a real slap in the face to your hometown surgeon to do the post surgical care from someone else's operation.  What if there's a problem?  Your hometown surgeon, in general, having not performed the procedure, will likely not be inclined to manage such a situation with the same enthusiasm had he or she been your surgeon from the start.  Even if he or she is a Saint, your hometown surgeon will not know exactly what was done, and this handicaps the post surgical care. 

The surgeon you're traveling to should want to follow you closely enough to be the one who removes the splint and sees the result anyway.  Definitely follow your operating surgeon's advice, if nothing else.

I ask my out of town rhinoplasty patients to stay for at least a week near my office on relaxing vacation.

Just my opinion.

Steve Laverson, MD

San Diego Plastic Surgeon

Will I Grow into my Nose? Nose is Bigger then All my Features (photo)

My family has pretty big noses, but the difference is for them, it works with there facial features. I'm 17 and my nose isn't bumpy, it's straight. The problem is it's very WIDE at the bottom and I don't think it goes with my features. My lips are small, my eyes are small, and im not a large kid. I don't understand why my nose is so unproportional. I want to be a actor someday and I don't think ill get to if my nose looks so bad. I feel if my nose was smaller i'd look good. Help? :(

Narrowing the base of your nose is a straightforward office procedure, so if you believe the base at the bottom of the nostrils is too wide, you may have this gently narrowed without committing to full rhinoplasty.  Be aware however that narrowing the base may make the tip appear larger because the tip to base relationship changes after narrowing just the base.  If your tip is small, it will work out,  If the tip needs to be made smaller, this can be tried first with injectables, and if unsuccessful, formal tip rhinoplasty or rhinoplasty to include the top of your nose as well, depending on the changes you desire.

Steve Laverson, MD

San Diego Plastic Surgeon