Austin Texas Board Certified Plastic Surgeon


Happiness and Plastic and Cosmetic Surgery

I wanted to be a Plastic Surgeon at a very young age, 12 years old. At the young age, I was enthralled with the opportunity plastic surgeons had to help improve the lives of their patients by enhancing their appearance.  Thus Plastic Surgery, and Cosmetic Surgery in particular, holds special meaning for me.  It is a medical discipline that is focused as much on the how people feel as the way they look.  I see the goal of Cosmetic Surgery as not just to modify the outside of one’s nose, face, or body but to generate happiness.  That is a bold statement, but I believe it is true.  Why else would people part with their hard-earned money, embark on an endeavor infused with inherent uncertainty, and take time out of their busy lives for the necessary recovery.  Happiness is what patients seek.  I have learned this, I respect this, and it is what guides my every action, every thought, and every decision when I take care of my patients.  It is important to note that I don’t believe that Cosmetic Surgery alone can create happiness.  In order to benefit from the changes Cosmetic Surgery can provide, a patient has to have the capacity to be happy, to be content.  Fortunately almost all patients do have that capability.  One of my biggest responsibilities as a Plastic Surgeon, as a doctor, is to hear and understand a patient’s goals, aspiration, and motivations and match those with an explanation of anticipated result outcomes, patient experience, and anticipated positive emotional impact.  When during a consultation, I am able to “look inside” a patients head to “see” what they are expecting and let a patient “peak inside” my head to “see” what I believe I can deliver; happiness is ultimately the result.  I call it the “Cosmetic Surgery Consultation Mind Meld.”  Understanding one another creates beneficial expectations and perceptions – and that is everything.  Hope to see you soon.

The Unlift – Beyond the Facelift

My practice is in Austin, Texas. Much of the cosmetic surgery I do is in the face and neck.  Facelift and necklifts are one of my favorite procedures to do because of the significant impact is has on the life of the patient.  A quite clarification is required: in my opinion almost all facelifts should treat the neck and almost all patients who say they want a necklift really need a facelift too.  That is to say there are very few people who have had aging changes in their neck only.  I have not seen a patient who has had a neck with sagging skin worthy of a neck lift that did not also have jowls and sagging cheeks too.  The face and neck age at the same rate.  Anatomically and surgically the face and neck are the same structure – the important layers of one are contiguous with the same ones in the other.  And addressing one is best done when addressing the other at the same time.

I see both women and men for facelifts. The majority however are women.  Women come to see me in their 40s, 50s, 60s, and 70s.  While there are some difference between those at the polar extremes (40s and 70s) the goals and the desires are generally the same.  Women desire surgery that will make them look younger and less tired.  They want to avoid surgery that will make them pulled, stretched, like they had surgery, and not like themselves.  Additionally, patients considering facelift have concerns about the nature of the surgery.  They are apprehensive and think of it as a big operation that takes a long time and creates a lot of swelling, bruising, and pain and has a protracted recovery.  Much of this sentiment is created by things they have seen on the television, been exposed to on the internet, and heard from friends or family.

It might seem obvious but it is still important to point out that not all facelifts are the same just as not all cars are the same. Different makes of cars have different features.  So too do different techniques for facelifts as do similar techniques in the hands of different surgeons.  And frankly, one can reasonably argue that some are qualitatively better.  In my opinion, those facelifts that are high quality are characterized by little bruising and swelling, minimal pain, and short recovery time.  Additionally they do not create a lasting pulled or stretched look, do not distort normal facial features, do not create a look that betrays the fact that the person had a facelift, and does not change the core identity appearance of the face.  By observation and report from others, they are the very different from the clichéd concept of what a facelift is, what result it creates, and the nature of the experience associated with it.  I aim to provide this enhanced form of facelift and because there are true distinctions from the typical I refer to it as the “Unlift.”  Its the next step, its beyond the facelift.

More about this in future posts.

The link between nausea and bruising in rhinoplasty

Bruising occurs when blood seeps out of the blood vessels and gets trapped in the body’s soft tissues. This occurs as a normal occurrence in surgery and some continues to weep out in the first day or more of recovery.  When you are nauseated and retch or vomit you create a temporary increase in pressure in the blood vessels, especially in the head and face.  This results in pushing more blood out of the blood vessels into the surrounding muscles, fat, and skin thus resulting in more bruising.  So by limiting nausea we can reduce bruising.  Here are some ways to accomplish nausea reduction in which patients participate.

  • Emend – An Rx taken before surgery
  • Zofran – An RX taken after surgery, pair it if needed with the pain medication. See below.
  • Avoid eating a lot of solid food the day of surgery after the surgery. I suggest sticking to clears and crackers, dry toast.  Heavy food in the stomach can worsen nausea.
  • Avoid excess pain medication – This is a delicate balance because pain can raise the blood pressure too.
  • Take pain medication with some food – Again there is a delicate balance here because while crackers and toast are mild, too much can lead to nausea. May also need to take the nausea medications at similar times to reduce narcotic associated nausea.
  • Avoid swallowing blood – sometimes there is a small amount of oozing that drips back to the back of the throat. While it might seem impolite or untidy it is best to spit this out into a piece of tissue or into a cup. Blood in the stomach can cause nausea.

Rhinoplasty Top Ten Frequently Asked Recovery Questions

The Top Ten FAQ’s After Rhinoplasty (Week #1)

The following information with help provide some basic information about the rhinoplasty recovery process.

  1. When do I start my medications?

Start the antibiotic the evening of the operation

Start the Steroid the evening of the operation. Take the last day single dose that night.  Then the next day start with day #1 of the taper.

  1. How long do I sleep in a head elevated position?

3 days

  1. How long will I have sinus pressure?

For one week. It will end when the internal splints are removed.

  1. When should I start light activity such as walking?

The day of the operation if you are comfortable, but certainly the next day.

  1. When do I start nasal saline spray and antibiotic ointment?

The day of the operation

Spray the nasal saline in each nostril 4 times daily.

Place some bacitracin antibiotic ointment just in the inner rim of the nostrils twice daily with a cotton swab

  1. Is it normal to have some bleeding?
  2. When can I shower?

The day after surgery, but the splint must be kept dry. It is best not to attempt to wash your hair or face in the shower.  Also it is good to use lukewarm water.  Hot water can cause sweating.  That and the steam can make the splint detach from the nose.

  1. How long do I need to have someone around to help?

At least 24 hours. But you might not feel well enough to drive for a full 7 days.

  1. If I have bruising under my eyes how long will it be present?

7-10 days generally

Arnica Montana and Bromelain can help make it go abate faster

  1. What do I do if I have a concern or need to have a question answered?

Call the office. During business hours you can speak to someone in our staff.  After hours the recording will give directions on how to have me contacted.

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