Rhinoplasty

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Rhinoplasty to sculpt the rounded nasal tip with reduction of the nasal alae would help bring the attention toward your eyes. Pyriform aperture augmentation would also be helpful. This can be done permanently with a graft during the rhinoplasty or temporarily with filler. This will help your upper lip on profile view become more vertical with less backward slant. It appears that there may be upper eyelid droop (called ptosis). It is hard to tell with photos alone. Seeing an Oculoplastic surgeon who can repair eyelid ptosis would allow a definitive diagnosis. If you have ptosis then correction will make you appear more awake and brighten the eyes. In the meantime, you could try Upneeq (generic oxymetazoline) eye drops to see if it is helpful.

I was wondering what procedures do you think I'd benefit from in order to get an overall more ballanced/harmonious and attractive appereance. I am open to hearing both non surgical and surgical options. Thank you.

What procedures should I get done to achieve a more balanced, attractive face? (Photo)

The upper eyelid surgery is often used to create a crease or to remove extra skin. Some surgeons will also suspend brow tissue (using a "browpexy"). The edge of your brow that is further from your nose (lateral brow) appears to either have swelling or prominent tissue (sometimes this is due to the lacrimal gland and other times due to the brow fat pad). It is reasonable to use massage 3 times a day for about 1-2 minutes using something to help your fingers glide on the skin (such as Vitamin E oil or lotion). Start by the corner of the eye that is close to the nose and use a motion going upward + backward. If this does not help after 3 weeks, then it is reasonable to look into getting a browpexy. 
One article on this is: The Brow Fat Pad Suspension Suture: Safety Profile and Clinical Observations by Dr. Eftekhari et al. published in the journal Ophthalmic Plastic Reconstructive Surgery in 2016.

I got upper eyelid surgery done in July in Vietnam and was advised that the swelling and puffiness will reduce and the full results will show by the 6 month mark. I am currently 6 months post-op but they are still puffy, is there something that went wrong with my procedure? Is it my skin? Will I need revision?

6 months post-op, still puffy. Will I need a revision? (Photo)

Some people get nice results after having 3 sessions of radiofrequency microneedling. It can help with the puffiness, however the deep grooves between the lower eyelid and the cheek and along the cheek (palpebromalar and malar grooves) may persist. One of the most common and effective treatments to treat the grooves is fat grafting (requires harvesting fat). Another option is two to three sessions of platelet rich fibrin injection (requires a blood draw).
If the radiofrequency microneedling does not achieve the degree of improvement wanted, then a blepharoplasty surgery can address the fat pads under the eyes.

Im a 55 year old male who is having lower blepharoplasty in 2 months for my under eye bags, but i also have these malar/festoons below that are also red and very pronounced. Can these be treated non surgically and how?

55, male, can malar/festoons be treated nonsurgically and how? (Photos)

Yes, a rhinoplasty would be able to sculpt your nose to the desired shape. There are ways to refine both the bridge of the nose and the tip of the nose.

I have a very round nose from the front with a very straight nose from the side. Would a Cindy Kimberly nose be possible on me?

Would a Cindy Kimberly nose be possible for my nose type? (Pohto)

I recommend a combination of platelet rich fibrin which has your body's own growth factors to help with rejuvenation (this requires a blood draw). Also Radiofrequency microneedling or laser would be helpful to improve the skin quality. An alternative to platelet rich fibrin is nanofat, which has your body's own stem cells. This requires a procedure to harvest fat. Platelet rich fibrin and nanofat are not filler and do not increase volume directly. They help your body make its own collagen. 
Of note, some people feel that firming creams are helpful, but they are not as reliable as the other options listed earlier.

2019 I went to a cosmetic nurse, suffering with under eye bags due to lack of sleep, stress, the doctor placed Perfectha deep into my under eye area, immediately after experienced horrific swelling, kept in touch with nurse who kept suggesting ice, massage and antihistamines, then hospitalized for orbital cellulitis, continued to experience flare ups when tired so had it dissolved, this area is now hollow and aged, what can I do to fix this? It is incredibly upsetting

What can I do to correct hollow, aged under eyes caused by previous filler? (photo)

It appears that the cartilage called the conchal bowl is large. This is one common reason for people to have prominent ears and can be addressed with a surgery called an otoplasty.

Is the point of cartilage on the ear Darwin tubercle? What is causing my ears to be prominent?

What could be causing my prominent ears? (photo)

This is considered mild cheek laxity and is not related to sun exposure. Causes currently thought to contribute to this include gravity, gradual loss of bone over time, and genetics. A treatment that has shown great results in many people is a series of radiofrequency microneedling such as Profound RF. Usually people get 3 sessions. Some people decide to get a midface lift which gives nice results, however it requires more downtime.

I’m a 31-year-old female who has spent a significant amount of time driving with unprotected sun exposure, mostly on the left side of my face through the window. My upper and lower left cheek is visibly more saggy and deflated looking than the right side, which remains a bit fuller. I’ve been wearing daily sunscreen for about 3 years now since discovering how important it is to prevent skin aging. I’m wondering what treatments or procedures would most effectively address these issues. Thanks!

What procedure or treatment would be most effective for addressing my sagging cheeks? (Photo)

One option that has not been tried is injection with kenalog (a steroid) and/or 5 fluorouracil (a different anti-scar medication). Another option which is frequently used to improve scars is treatment with laser. Sometimes these are used in combination (topical steroid massaged into the skin just after the laser).

I am a 42 year old woman. At 12 I got a hideous sebaceous infection on my nose which left me with a scar + a bump. When I was 23 I had a plastic surgeon try and fix it - he only left me with more of a bump and an additional scar. At 32 I had some filler put above the scar which smoothed out the area somewhat but that didn’t last long. I repeated it twice before seeing another specialist who 2 yrs ago told me a threadlift would solve my woes. Now I am left with a bulbuous tip, still a scar + bump

How to fix my nose once and for all? (Photo)

Botox (or any other botulinum neurotoxin) can allow puffiness under the eye to push forward. This is because the muscle (orbicularis oculi) which normally holds it back is now relaxed. When the neurotoxin wears off, it should improve. There is nothing wrong with allowing the Botox wear off. If filler is redone while the Botox is active, then less filler will likely be used, and the look of the under-eye area may change once the Botox does wear off.

I’ve had slight malar bags for years successfully camouflaged with cheek filler for 2 years. I had top up filler Oct (same practitioner) then end of Nov I had Botox to crows feet and slightly under eye for the first time. Malar bags are now swollen. Reputable qualified physician who did the treatments has said to dissolve filler and refill. I’m concerned however that Botox has contributed to the problem and wondering would it be best to wait until this has worn off just incase?

Botox or Filler or both? Malar Bags (Photo)

Everyone has asymmetric facial bones. People tend to notice the differences around the eyes more than the differences in the cheeks, jaws, etc. In your case, the left brow is lower because the bone (superior orbital rim) is a bit lower on that side. If you strongly wanted to pursue a method to make the illusion of even brows, you can use brow color or microblading. For a permanent method, a direct brow lift would be the only way to even out the brows, however it would leave a thin scar just above the brow. Most people do not want a scar there and choose not to have the procedure. Other brow lifts with hidden incisions do not correct asymmetry well.

I've always had asymmetrical eyelids, but lately, I've become more self-conscious about it. It feels like I have a lazy eye, even though it doesn't significantly affect my vision. I've noticed that the drooping eyelid doesn't open at the same speed as the other one, but this only happens occasionally. I’m a 29 year old female.

Why are my eyelids two different shapes? (Photo)

J. Renee Booth, MD

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Earlobe Repair

Otolaryngologists (also called ENTs) specialize in head, neck, and throat surgery, making them qualified to perform functional rhinoplasties and other facial surgeries. Those who have also done a facial plastic fellowship can perform cosmetic facial surgeries.

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Ryan A. Stanton, MD

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Dilip D. Madnani, MD, FACS

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J. Renee Booth, MD

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