Detroit Doctors

Is it Encouraged to Bring Photos of Noses I Like to a Consultation for Rhinoplasty?

Hi, I am going for a primary consultation for rhinoplasty. Is it frowned upon to bring photos of noses I like to a consult? Obviously, it is not going to look exactly like another persons nose, but does it help a surgeon as a guideline?

Part of a successful consultation process in rhinoplasty is establishing a good rapport and building effective communication tools. This is why "morphing" or digitally enhancing existing photographs has become so popular. Patients do no have the same vocabulary as surgeons do when it comes to describing the nose. We  (plastic surgeons) talk in terms of angles and proportions, however our patients just intuitively know what aesthetic they prefer. In fact the most popular answer to my question of what changes my patients want is, "I know I just do not want my nose to look like Michael Jackson's".  One way of bypassing this potential for confusion is to bring pictures from the popular media to understand exactly what our patients likes and dislikes are. From there a surgical plan can be developed to tailor specific changes to fit each individuals' nose.  Open communication and honesty are the backbones of a successful outcome. Good Luck!

Giancarlo Zuliani, MD

Detroit Facial Plastic Surgeon

Lateral Brow Lift for 22 Year Old Woman?

I am 22 years old, and I have noticed for the past few years that the end part of my brows droop down. This gives a somewhat sad expression. I really want to correct this, and have tried botox before. I didn't get great results, and I am not sure why that is. I noticed when I tie my hair up in a ponytail, my brows look lifted and much better. It also compliments my eyes more. Is a lateral brow lift the only option here? I would like to try the least invasive thing that I can.

Although 22 years old is quite young to "need" a browlift, there are some people who inherit a very low brow, especially laterally. A properly executed lateral brow lift accomplishes a significant and aesthetically pleasing appearance to the lateral brow and eyelid area. This technique involves an incision behind the hairline, above the ear on each side of the temple. An endoscopic dissection is performed to avoid nerve damage. The release is carried all the way down to the eyebrow and then the tissue (superficial temporal fascia) is tightened for a long lasting result. Less invasive browlifting techniques that involve suspension sutures, fixation sutures, or do not dissect to the brow seem to have minimal results, in my opinion. 

Evan Black, MD

Detroit Oculoplastic Surgeon

Can a Browlift Stretch the Forehead Skin to Minimize Acne Scarring Not Helped by Prior Laser Treatments and Dermabrasion??

I am 45 with no sun damage to my skin, however I have bad acne scars on my forehead. I have had dermabrasion when I was 25, followed by two CO2 laser treatments, and 4 Fraxel laser treatments. I have also had Deep FX. None of these worked for my forehead acne and in fact I do believe over time simply modified the scars by softening the sharp edges, while making my skin look the texture of cottage cheese in that it is severely dimpled all over from the various lasers.

Brow and forehead lifting can improve the facial appearance in appropriate patients by elevating the sub-brow fat, decreasing forehead lines and the lines in between the brows, and reducing "crows feet." The surface of the skin and the deeper layers of the skin that are affected by acne scarring do not typically improve with this type of lift. A variety of laser and non-ablative (non-laser) treatments are available to improve acne scarring.

Evan Black, MD

Detroit Oculoplastic Surgeon