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Steven M. Denenberg, M.D.
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The paired jowls interfere with the contour of the jaw line as it moves from the chin up to the ears.  In the after picture, that contour is more triangular; in the before, the jowls make burbles in the smooth line of the jaw.  Note that her melolabial folds did not improve with the face lift, as they typically do not.

Her lower eyelids sit in a low position as a complication of lower eyelid surgery that was performed elsewhere.  The eyelid surgery tutorial's chapter on lower eyelid surgery contains a discussion on what can happen to the eyelids when the eyelid operation isn't performed with judgment and care.


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"...you will not find a more knowledgable,
caring, and personable physician. "
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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: Do I Seem Like a Good Candidate for a Second Revision Rhinoplasty (And Possible Otoplasty)?
I had two rhinoplasties (and otoplasties) performed by the same plastic surgeon. I would like to look prettier and more feminine (with character). I'm thin and tall, and my facial features look too harsh. I think that my nostrils have retracted and my nose is too wide for my face (no real philtrum either), and my ear lobes seem too big. I would only want to go through surgery if my previous surgeries can be improved upon (it's expensive).
(Questioner submitted photos)

Dr. Denenberg's answer: Feminine often means a smaller nose, even with character
Hi. In my opinion, after two previous rhinoplasties, it's very difficult to make only tiny changes in the nose. You could benefit from another rhinoplasty if the goal is to make a more substantial change. See my "Web reference" link for the morphs I made to your photos. The primary change I made was to raise the tip of your nose. Then I took down the small hump to match the new position of the tip.

An otoplasty is usually performed to make the ears less noticeable from the front, and yours do not stick out, so I wouldn't have any more otoplasties. An earlobe reduction is a fairly safe and predictable change that could be performed, according to your preferences.

The good news for you is that, in expert hands, raising the tip of the nose and taking down a remaining hump are two of the most predictable changes that can be made, even in a revision rhinoplasty. It involves complicated work on the tip, so you must be certain to look at your doctor's other revision rhinoplasty patients, where the nose was shortened, to see that he was able to accomplish for someone else the same thing that you want for yourself. That's your only good way of evaluating a plastic surgeon.

Link to this question on RealSelf.com