..Before & After Cosmetic: Face

Temporal Brow Lift

This lovely young woman initially asked me to do an upper lid blepharoplasty to remove the redundant skin on her upper lids. After careful study, I determined that what she really needed was a brow lift. This would solve the upper lid problem without leaving a scar around her eyes and raise the ptotic (sagging) lateral brows. Please compare carefully the brows in the before and after pictures. Can you see how the lateral halves have been raised just the right amount so that she looks alert but not surprised? And look at those upper lids.. They look so natural. The incision for this procedure is behind the hairline in the scalp so there is no visible scar. What a great cosmetic surgery operation; dramatic , natural results with no scarring… Did you notice that she is actually three years older in the after picture even though she looks much younger ?

Trans-conjunctival Lower Lid Blepharoplasty

This young gentleman did not require skin excision so I performed his lower lid blepharoplasty through his conjunctivae. He’s still a little swollen from the lidocaine I injected as this picture was taken only minutes after we finished the procedure.

Augmentation Rhinoplasty

Note: The brown skin in the post-op picture at right is due to the betadyne prep that has not been washed from her face. The post-op photo was taken four to five minutes after we finished the procedure. In the pre-op picture you can see that her nose is bowed to her left (the viewer’s right) like a closed parentheses ‘’)’’. Post-operatively, it is straight. This case demonstrates the considerable improvement that can be achieved with only tiny adjustments. When it comes to cosmetic surgery, doing too much can sometimes be more harmful than not doing anything. As in drawing, where unskilled artists tend to exaggerate the size and angles of facial features, most plastic surgeons tend to overcorrect deformities, leading to an ‘’operated on’’, sometimes even bizarre, non-human appearance as in the celebrity lip augmentations and pulled face lifts that have surfaced in the media of late.

Augmentation Rhinoplasty

This adorable young woman received an augmentation rhinoplasty elsewhere. Unfortunately, the implant was not placed in the center of her face. Furthermore, it does not look very real, instead resembling a pencil under her skin. It was a fairly simple matter of removing the old implant and putting a new one in its place. Despite the swelling, as this picture was taken only minutes after we finished the procedure, you can see that the new implant looks more like a real nose and it is in the center of her face where it belongs.

Zygomatic Augmentation

 This slide depicts a zygomatic or cheek augmentation done on a young Khmer woman on whom I had previously done a nose augmentation. Here are the pre and post-op pictures side by side. You can see the zygomatic augmentation easily from these ¾ views. This has given her face a slightly more angular look . It has placed more emphasis on the middle third of her face and away from the lower third which was slightly dominant pre-operatively. As beautiful as this young woman was before surgery, she is even more so now. The difference ‘’in person’’ is striking. Incidentally, she called me from home on the evening of her surgery to complain that I hadn’t done enough. I disagree. I feel that I created just the right angle from her lashes to the widest part of her cheekbones and then down to her mouth and chin. There is a tendency in plastic surgery to keep adding more (look at what untalented doctors have done to lip augmentation!) when both patient and doctor see some improvement. The surgeon should never augment beyond what is ideal.
Please note also the above A/P photo. Her cheekbones look great from this angle too. Also, observe the nose. It blends in perfectly with her face and enhances her beauty in a most natural way. There is not the slightest hint that she has had a ‘’nose job’’. The mistake most doctors make here is in overly-narrowing the graft at the nasal bridge, giving the appearance of a pencil sitting under the skin. I keep it wide in this region so it blends in seamlessly with the area leading down to the medial canthi of her eyes.

Augmentation Rhinoplasty and alar reduction

This Khmer lady was unhappy with the turned up appearance of her nose, the flat nasal bridge and the large size of her nostrils; an oft-encountered triumvirate here in Cambodia. She requested a nose augmentation and narrowing of her alar base. I used to discourage the latter of these procedures on the basis that the scars left were excessive after the aggressive alar base (and nostril) reduction procedure I learned in Brasil. But thanks to a new procedure compliments of Dr. Rod Rohrich of the Southwestern Medical Center in Dallas, I am able to get a good result with minimal resection and scarring. This lady is pictured less than 2 minutes after completing the operation so there is some swelling present from the lidocaine I injected. The two procedures took about an hour to complete and were performed under local anesthesia only. These patients frequently report that they return to work the same day (which of course I discourage); proving once again that women are tougher than men. These simple procedures, if performed precisely, can markedly improve one’s overall appearance as you can see here.

Male Neck Lift

This gentleman looks much younger than his stated age, even in the pre-op picture. Nevertheless, he hated the excess skin on his neck and the lax platysma muscle. He received a male neck lift where we go in anteriorly to tighten the muscle before removing excess skin and closing with a Z-plasty (to prevent tenting). This has become a very popular procedure and is second only to liposuction among our male patients.

Male Neck Lift and Neck Liposuction

This is the same procedure in a 50 year old who had lost his jaw line. It has been included here to demonstrate the importance of the hyoid bone in the final result. I did some liposuction on this patient as well which helped to bring out the all-important jaw line and we got a good result even though his hyoid is fairly low.

Male Neck Lift and Neck Liposuction

 A final male neck lift to make two points. First, to demonstrate the dramatic results that can be achieved with extensive liposuction. The secret here is to treat the entire neck and lower face from above the mandible to the clavicles, ear to ear. Second, to show the scar that results from this procedure. In the A/P photo at far right top row, it is there 

in the center of his neck. Look closely and you will see the arms of the ‘’Z’’. This man is very clean shaven making the scar visible yet, to me, the improved contour of his neck  far outweighs having a scar.  In a man who is less clean shaven, the scar is even less visible.


Short Scar Face Lift

This lovely woman came from Australia recently. As you can see, I performed a face lift on her. We used an S-Lift this time. It is one of the many short scar techniques available (other common ones being the MACS Lift and Dr. Baker’s Short Scar Facelift). We sometimes combine this with an under the chin procedure but this patient didn’t need it at this time. Notice the improved jaw line and neck contour and the movement of jowl fat into the hollow below her cheekbone, resulting in an appearance approximately 15 years younger than her stated age of 43. A little bruising remains on her chin as I needed to be aggressive in the jowl area and fully release the mandibular ligament in this patient.__________________________________________________________________________Pictured below is a face lift and upper and lower blepharoplasty I did recently. This lady was such a joy to get to know as we discussed what she wanted and whetheror not I could achieve it for her:carol Face and neck and eyes straight onCarol face lift profile



Left: Pre-op, Right: One week post-op, Below: about eight years later!! carol Face and neck and eyes straight oncarol Borowski



You can see on the A/P set that I moved her jowl fat up to the malar (cheekbone) region where

it ‘belongs. Also note how I tightened the lower lid on her globe (by resecting a little and sewing the end to her orbtal rim at the lateral canthus) to avoid the sagging that we see in older people.. Look at the lower lids in the one week post-op picture and compare them to the lower lids in the pre-op picture. What a great improvement! Its very easy to see how much tighter her lower lid looks in the post op picture. All patients report to me that it feels much better too. We don’t charge extra to do this because we don’t want the extra fee to cause some one not to do it when we think they should. If they need it, they will get it… Finally, you can see that I did a lot of work on her neck. She had a lot of excess skin in the jowl and neck areas and the proper treatment of this woman required full excision without, of course, giving her a ”pulled” or ”operated on” appearance. I think I removed about 20 years from her look.. What do you think?


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