Avron Lipschitz, MD

lines around the lips or smokers lines otherwise referred to as life lines are caused by a combination of loss of skin elasticity, sun damage and the mobile skin and soft tissue around the lips. This is one of the most frequently requested areas of treatment in a plastic surgery office. Interestingly surgery is not the answer here although we treat these frequently lines during facelifts and other cosmetic surgery of the face. The 2 options are a resurfacing or fractionated laser which works well with varying amounts of down time and recovery versus injectable fillers which have no down time but don't last as long as a laser. The brand of laser can vary from a C02 laser to erbium laser and filler may include Belotro, Retylane or Juvederm.

In general grafts can be removed, modified or trimmed. It would be important to evaluate you in person to see the area of concern. Sometimes a surgical simulation tool using Vectra technology can facilitate communication.

It is possible to reverse a dorsal hump reduction but may I suggest augmenting the dorsum with filler before embarking on surgery. This allows you to recreate the hump but is reversible. Like trying on a pair of shoes before committing to buying them. 

Your photos do not show a low brow but an in person exam is required to fully evaluate your concerns.  The 3 main techniques for brow lifting include endoscopic brow lift, mini or subcutaneous brow lift and coronal brow lift. The incisions differ and the technical instrumentation is different for each procedure. The "least invasive" technique is a mini brow lift with small incisions along the lateral temple. It also tends to produce the most natural result lifting the brow only a small distance. The coronal brow lift is a large full scal incision across the top of the head, allowing for a powerful lift but associated with a large scar and more risk of hair loss. The endo brow used an endoscope visualization instrument and more extensive undermining. Another component in brow lifting is the anchoring technique. Endotine devices versus suture technique. Finally the advent if botox has changed brow lifting over the years allowing smoothing of forehead wrinkles and some brow elevation without surgery. With so many choices each technique must be tailored for each patient. Always consult a board certified plastic surgeon familiar with brow lift techniques. 

Recovery after facelift is an important aspect of care. All patients need help for the first 24 - 48 hours after surgery. Nothing complicated but an adult care giver will be required for driving, making sure dressings are intact and for basic chores and activities of daily living around the house. All patients will come in for a check up on post op day 1 and dressings are removed. By day 2 -3 most patients are caring for themselves.Sutures are removed day 7 and light duty exercise is resumed this advances progressively for 4 weeks until full activity is resumed.

The area you have highlighted is ala contour irregularity caused by either a cartilage graft, lower lateral cartilage buckling or lower lateral cartilage transection. It is a technical adjustment that must be made and can be done as a revision case. Start by discussing the problem with your surgeon. If you need a second opinion discuss this with a rhinoplasty surgeon who is familiar with revision work.

The healing time for rhinoplasty is 1 year. Initial healing occures after 1 month. After 6 months the shape has evolved and after 1 year it is complete. If you are not satisfied with your results at 2 years an evaluation should be sought.

You are correct to do your research before choosing your rhinoplasty doctor. First check the surgeon's credentials. The doctor should be board certified in plastic surgery or facial plastic surgery. Second the doctor should have experience with rhinoplasty surgery and finally meeting with the doctor you should have a good connection with him/her.

The photos demonstrate a c shaped nasal deviation to the right and a bulbous tip. The photos are not complete and you will require an in-person examination and formal photos before final determination of the correct surgery for you. The surgeon is correct that "changing the shape of the nose" is not covered by insurance. You would be best served by a rhinoplasty at the time of your septoplasty.

There is a long list of causes for hair loss. Post surgery several factors can cause hair loss, trauma to the scalp during surgery and reaction to drugs like general anesthetic agents are included on the list. Medical and surgical stress can also cause hair loss. Unfortunately it is hard to predict which one of these may cause hair loss in any one individual. As a plastic surgeon performing facelifts there are several technical maneuvers to avoid hair loss including minimizing trauma to hair follicles and ensuring good blood supply to the hair. It would be unusual to see local anesthesia cause hair loss.