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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: Shall I consider a revision? Wide & asymmetrical nose by the front and tip is sticking out. 6 months Rhinoplasty post-op.
I got Closed Rhinoplasty 6 months ago because my nose was huge, with a big dorsal hump and a deviated septum. When the cast was removed, I liked my nose very much by the side because it looked straight and small. However as the swelling was going down, the bone became smaller and my tip started to stick out so much. I think my tip now looks much bigger than right after removing the cast. Is that swelling? Do you think that my nose can improve with time or shall I consider a revision?
(Questioner submitted photos)

Dr. Denenberg's answer: I don't think the tip problem is swelling
I think the problem is that the tip was too projecting, given the position of the bridge, and when the cast came off, there was so much swelling on the bridge that we couldn't see the problem. Now that the bridge swelling has gone down, we see how prominent the tip is.

I don't consider this a polly beak. A polly beak is where the there is unwanted fullness above the tip, and if that fullness weren't present, the tip would look about right. in your case, if that fullness about the tip goes down, your nose would look even longer, which would pose a new problem. Also, a polly beak is usually scar or cartilage *above* the tip cartilages, but the fullness we see there could very well be the tip cartilages themselves.

Seems to me, you need a revision, where advanced work would be done on the tip, to deproject it, and especially to elevate it upwards. In expert hands, these can be fairly predictable changes to make, even in a revision, but all plastic surgeons would not possess the skill to accomplish the changes. So you need to be sure to see before and after photos before you launch into an operation like that.

Link to this question on RealSelf.com

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