Emily Hrisomalos, MD

Thank you for your question and photo which shows your concern very well. This early on in the healing process, some lumpiness and irregularity is completely normal and is almost the "norm". Even in a "mini" facelift, there is significant dissection under the facial tissues and this does take some time to heal. In general, by 2-3 months after surgery, most irregularities and "lumps" resolve and at that point if these concerns still exist, you and your surgeon can discuss possible interventions. Early on in the healing process, massage can be very helpful in facilitating healing and tissue remodeling. Make sure to confirm with your surgeon that he/she is okay with you starting to perform massage before commencing. Best wishes for your continued recovery!

Thank you for your question and the photo you provided. Even though 2 months seems like quite a while, in the grand scheme of post-surgical healing it is actually very early and your nose will continue to become more refined over many months. In general, the healing process continues for up to a year, sometimes even longer. A couple of millimeters can make a big difference when evaluating nostril symmetry, so it is imperative to ensure that all swelling has resolved prior to intervention or final assessment of whether or not there is a problem. I sincerely hope that once the healing process is complete you are happy with your final result. Congratulations on getting this surgery for yourself- the hardest part of it all is waiting!

Thank you for your question and the photos you provided and sincere congratulations on beginning your journey. There are multiple ways to embark in facial feminization and I think you will certainly be pleased with the changes you experience after HRT, however when starting this later in life, there are certain features that will not change dramatically without additional intervention. In the upper face, reducing the prominence of your brow, perhaps with the addition of brow elevation would certainly be feminizing and some have cited this area as the most recognizable "masculine" or "feminine" aspect of the face as a whole. Progressing to the middle third of the face, re-shaping the nose with a rhinoplasty also often also produces a dramatic change in the overall facial appearance. In the lower face, I would recommend reducing the size of the jaw and shaving down the adam's apple. Schedule a face-to-face consultation with a surgeon who specializes in these procedures to discuss your overall goals, desires, and the how to optimally proceed.

Thank you very much for your question and the excellent photos you provided. The surgeries you have had have given you a very feminine jawline and forehead which many people continuously strive for and I think was an excellent place to start. I think you would gain the most additional feminization from a rhinoplasty to alter the contour of the nasal bridge and dorsum as well as lifting the tip which are classically feminine features. If you wanted to stick to one surgery, that is the one I would recommend. I believe this would change your overall facial proportions and midfacial appearance, eliminating the need for a LeFort or other craniofacial procedure. Shaving down the Adams apple, which could be done at the same time, would also be a significant improvement and eliminate this "tell" in the neck that can be an obviously masculine feature. Be sure to schedule a consultation with a surgeon who specializes in these procedures for a face-to-face evaluation and discussion of your personal desires- best wishes in achieving your goals!

Thank you for your question- it is a great one that many patients have and there are many conflicting opinions on this. What is most important is that you schedule a consultation with a board certified specialist in nasal surgery. After discussion of what you hope to achieve and thorough examination he or she will be able to discuss the pros and cons of nonsurgical rhinoplasty versus closed or open rhinoplasty with you. There are certainly benefits to each, and each carries risk with it. Fortunately, the possible complications of these procedures, though they can be devastating, are extremely rare when performed meticulously and on the right patient. Much of your decision will rely on how much downtime you have for recovery and what degree of change you are hoping for. Also important to keep in mind is that using filler will almost certainly require repeated injections as these products (hyaluronic acid fillers) do not last indefinitely. In any case, either option can work wonderfully for the right patient. Best wishes in achieving the results you are looking for!

Thank you for this question and the photos you provided. Rhinoplasty is one of the most challenging surgeries to perform as a surgeon and to go through as a patient. This is largely because of the many factors that contribute to proper healing and stable structure. When the cast initially comes off, there is expectedly still a great deal of swelling which tends to obscure the underlying nasal structure. Once this swelling begins to resolve the true underlying shape of the nose becomes evident. What can confound this, is the presence of thick skin or scar tissue which can heal in unpredictable ways and lead to a suboptimal appearance or an appearance different than what was created in surgery. Other confounding factors include "memory"" of the cartilage which can be manipulated and sutured in the desired configuration, and ultimately end up "reverting" to its original appearance. Taking photos throughout the process can help clarify what is going on as does continued follow-up with your surgeon. Ultimately, allow for a full year to pass after surgery before evaluating the outcome and certainly before allowing any intervention. Hopefully this will continue to evolve and refine and be consistent with your original expectations!

I am so sorry to hear you are experiencing this after going through surgery a second time. The good news is, it is ultimately very early in the healing process and this is certainly within the realm of normal healing in the early post-operative period. The final appearance of incisions can take many months, (6-12 months in some areas) to become evident and it is far too early to make any conclusions at this point. The delicate skin of the upper eyelid tends to heal remarkably well and is very forgiving. Give this time and continue to follow-up with your surgeon. Eventually, she or he may recommend gentle massage of the area to soften and flatten the scars. Waiting can certainly be the hardest part after surgery. Best wishes for an optimal recovery!

Thank you for your question and photos. There is absolutely no reason to intervene just because inferior scleral show is present. This is within the spectrum of normal. If this is something that significantly bothers you or there is a concern that the lower eyelid may be weak and this could increase over time, then correction with a canthoplasty or canthopexy would be appropriate in order to potentially shorten and tighten the lower eyelid and tack it up to the outer corner of the orbital rim. Certainly a face to face consultation with a facial plastic surgeon, oculoplastic surgeon, or plastic surgeon would make this more clear and the various options could be discussed with you in detail.

Thank you for this question and well-taken photos that show your concerns. It appears that you have a shadowing mostly of the medial aspect of the lower eyelids. This is often called a "tear trough" and can be very easily treated with filler in a short office procedure by a specifically trained practitioner. This would improve the appearance from the front as well as from the side and efface or "fill in" that dark shadowing. Given your age and the ease of treating this non-surgically, I would recommend that at this time based on what you have presented. With age, other issues may arise in this area which would be better treated with surgery. I wish you the best of luck in seeking out this treatment!

Thank you for your inquiry on this topic. The periorbital region is frequently one of the first to show signs of aging. What I can see based on the photos you posted is that you have started to exhibit fat pseudoherniation, which is the term used for when the connective tissues weaken with age allowing the orbital fat to herniate out and lead to the appearance of "bags". The good thing is that this can easily be treated with eyelid surgery called blepharoplasty which either removes or repositions this fat to smooth out the under-eye contour. If you wish to avoid surgery or prefer to try something less invasive up-front, fillers can be used in the office to camouflage the dark and depressed area underneath the bags. This often yields very nice results, but as mentioned is more of a camouflage of the problem rather than "fixing" what has caused it. Both are great options depending on how aggressive you would like to be. Consult with a facial plastic surgeon, plastic surgeon, or oculoplastic surgeon for a thorough evaluation and discussion of these options to find out what works best for you!