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Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.
eyelid surgery
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If my plan is to perform both a brow lift and upper eyelid surgery, I like to do the brow lift first, and then work on the upper eyelids about six weeks later.  It's a small hassle for the patient, but I think it gives better results.

When performing the upper eyelid surgery, I like to take off enough skin that the patient can't quite get her eyelids closed for a couple days after surgery.  By the end of the week, the lids are closing fine.  That way, I am convinced that I removed all of the skin that I could safely remove.

If I'm elevating the brows during the same operation, it's not safe to be that aggressive with the skin excision on the upper lids.  I have to skimp on the lid excision, and the result isn't quite as good.

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Questioner: Is This Abnormal Procedure for a Revision Rhinoplasty?
So, after many phone calls, I finally was able to get in contact with the surgeon that had done my previous rhinoplasty. I spoke with the secretary and she said he could get me in for a revision, but I never got to speak with the surgeon over the phone and not once was I asked what I wanted to change. Is this normal? (I have not seen him in person yet as he is 23 hours away) Also, do you think it's possible to reduce the cartilage at the tip without doing anything to the nasal bridge or dorsum?
(Questioner submitted photos)

Dr. Denenberg's answer: Your surgeon may not have the skill to fix your problem
The change your nose requires -- bringing the tip of your nose back toward your face and elevating the tip -- involved complicated work on the tip cartilages. See my "Web reference" link for a morph of the changes that I would recommend. It's apparent that that work was not done in the first operation. So we don't know yet whether your surgeon can accomplish the changes you want now.

Unless you saw before and after photos of your surgeon's work, showing excellent results in those kind of changes to the tip, you don't know whether he can do it. The fact that he offered you a revision without knowing what your nose looks like now, and without knowing what changes you want, frankly, is a bad sign.

Many plastic surgeons reflexly recommend that patients return to their original doctor for revision surgery. Instead, I recommend re-evaluating your original doctor. If you think you did good research in selecting him in the first place, if you saw lots of good before and after photos of noses with similarities to yours, and if your results just somehow fell short of what you and he wanted, then you might be fine to have him perform the revision, depending on how reasonable you think his evaluation of your current nose is. On the other hand, if you suspect that you didn't do good research on him originally, and you didn't see lots of befores and afters, and it's not that your rhinoplasty fell a little short but it went entirely off track, then it would be dangerous for you to have him perform the revision. He might not have a chance to fix the problems, you could look worse, and it would make it even much harder again for another surgeon to fix things later. Go slowly.

Link to this question on RealSelf.com

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