Patient Questions

Hootan Zandifar is an Expert Contributor on FindaTopDoc. Here are some of their recent answers to patient questions.

Plastic Surgeon
Hootan Zandifar, MD

Under eye bags can easily be removed through a blepharoplasty procedure. To do this a small incision is made inside the eyelid where it is completely hidden. The fat area around the eye is then exposed and any excess fat is removed. Occasionally this procedure is coupled with removal of extra skin around the eye. The results are great and the recovery is very quick.

Septoplasty is generally not too painful. There is some discomfort that’s associated with her and patients can sometimes experience pain in the upper teeth which is typically related to referred pain from the nasal floor. However, the most common complaint after a septoplasty is that the nose feels stuffy and there is pressure in the nasal area and the sinuses. The recovery from this is typically about one week and after that patients generally feel fine and can resume most normal activities.

The length of a scar revision surgery really depends on the extent of the scar that’s being revised as well as its location. Simple scar revision surgery can take no more than 30 minutes. However certain scores require a lot more time. This could be because they are longer or are in areas of your body that pose certain challenges for your surgeon to achieve great results.

This is a great question. Botox is one of the most used beauty products out there. It is generally very safe and has very few side effects. However, patients can experience certain side effects. Some of the side effects include headaches, bruising and discomfort at the site of the injection. Most of these side effects resolve in a few days to a few weeks. If you have an allergic reaction to Botox you may have more extensive side effects. However allergic reaction to Botox is relatively rare.

Eye lif surgery or blepharoplasty can last a lifetime. Once you remove the excessive skin and fat, you have results that last forever. However, as you continue to age you end up getting more sagging of the skin and herniation of the fat which then may necessitate a repeat minor surgery in the future. Most patients don’t find any need for the second procedure and those who do won’t need it for at least a decade or two.

Great question. The truth is most plastic surgery lasts a lifetime. What that means is when we do “eye bag surgery” or what we usually refer to as lower lid blepharoplasty with fat removal, we remove bulging fat from under the eyes and sometimes reposition it in a location that fills in grooves around the eyes (this is called fat pad repositioning). We then remove extra skin from the lower eyelids. As the result of this surgery the bags are gone. However, what we can’t do is to stop you from aging. What that means is that you will continue to age, your skin will increase in laxity and more fat from around your eye will bulge through in time. Now this can be anywhere from 10 to 20 years later and usually is not to the same degree as how it was initially. That’s why I say the results last a lifetime.

The best way to recover from an eyelid surgery (blepharoplasty) is to listen to the instructions your surgeon has given you. But in general, these instructions would include resting your eyes, not rubbing or scrubbing your eyelids, not lifting anything heavy and not doing any strenuous activities. I recommend that my patients sleep with their heads elevated so that there is less swelling and bruising. I usually have them put a washcloth that has been dipped in ice bath over their eyes for the first 2 days. I have them avoid taking any medication that would cause increased bleeding and bruising (Such as ibuprofen, garlic, vitamin E,...). Finally, I usually have them take arnica a few days before until a week after surgery. When they do this, most of my patients are able to return to normal function 7 days after surgery.

The short answer is yes. There is a procedure called buccal fat reduction that can decrease the fat over your cheeks. This is usually done through a small incision inside your mouth. However, this can only address the fat over your lower cheek basically around the mouth. To address extra fat or tissue over the rest of your cheeks a facelift procedure is usually needed. Through a facelift incision we can remove extra fat, re-suspend the muscles and remove extra skin. This leads to an over all great improvement of the cheek area.

Great question. The detailed answers depends on the type of facelift that you are having. Is it a deep plane facelift or a short skin flap lift? Will there be a neck component or not? All of these factors can change the recovery time by a week or so. But in general, I tell patients that the recovery for a facelift is usually about 7-10 days. After that you can put on makeup and go out to do your day to day stuff. If you are preparing for a major event such as a wedding or a party then I would usually recommend giving yourself 4-6 weeks of recovery time. By then your new face appears healthy, fresh and perfect for showing off.

This is a very important question. Often times I see patients that had nose jobs and now have difficulty breathing through their nose. The truth is that if done by a competent surgeon, a nose job not only improves the appearance of the nose but also improves its function. Meaning, after a nose job you should typically breath better than before. At the very lease you should not breath worse. In patients who need it, I usually combine a septoplasty procedure (to correct a deviated septum) with my nose jobs to improve the breathing of the nose. I sometimes find it necessary to address other functional aspects of the nose as well such as enlarged turbinates (turbinate hypertrophy) or collapsed nasal valve. I can then address each of these issues during the nose job (rhinoplasty) procedure. You need to find a surgeon who is very comfortable with all aspects of nasal function and form so that you have a great result bot cosmetically and functionally.

Thank you for your question. It is a really good question that comes up frequently. The short answer is as many as you would need. But that statement needs some clarifications. Generally, most patients do not need a facelift until they are in their 50s or 60s. Before that we can manage many of the wrinkles and excessive skins with non-surgical procedures such as lasers, fillers and so on. But once the skin has become too saggy then the only solution is to have the excess skin removed and the muscle layer of the face supported. That's what a facelift would do. Typically when you have a facelift (if done appropriately) you can expect to look somewhere between 10-15 years younger. So now if you are 60 then you may look like you are 50. These results age with you but the benefit lasts forever. meaning that when you turn 70 you look like you are 60 and so on. Because of this most patients don't need a follow up full facelift. What we can do for them is to do a mini-facelift or a limited facelift in the future as the skin laxity returns. This is typically done only once or twice more and most patients don't even need nor want to have a second procedure because they are so happy with the results that they have. I hope that answers your question.

One of the most common complaints I get from my patients after doing a facelift on them is that they feel like now their hands give their age away. It’s really a difficult area to treat because there isn’t really many options available to address the aging of the hand. That being said there are a few options available that give great results and help to make your hands appear younger. First, you can use a filler such as Radiesse to give some volume back to the hands. One of the changes of aging is that the skin of the hand becomes thinner and the fat in the tissues begins to thin out. A filler can improve both of these issues and help to improve the appearance of your hands. Second, you can do resurfacing of the hands. These can be done with light peels or lasers. Resurfacing helps to remove the age spots that appear on the hands and it can help to thicken the skin. Both of these changes help to improve the appearance of your hands.

Thank you for your question. This is a very good question that comes up often. To understand what a mini facelift is we have to first explain what a full facelift is. A full facelift involves incisions generally around the ears and in the hairline as well as incisions under the chin. The skin is elevated over the face and the neck and it allows us to re-suspend the sagging muscles and remove extra skin. The incisions heal beautifully in natural creases of the face and you have a younger more rejuvenated look. A mini-facelift in many instances involves incisions that aren’t quite as long as a full facelift and the elevation of the skin usually isn’t quite as extensive. Therefore, a mini facelift has a shorter recovery time but also has a less dramatic results. Generally when you are younger than 60 having a mini facelift is a great option because you don’t need as much skin removed and your recovery is much faster. Also, when you have surgery earlier, you enjoy the benefits longer.

Great question, Cheek implants are a really good option for those patients who do not have a prominent cheek bone. There are a few ways that you can put cheek implants in. One way to do it is through a small incision in the upper gum line. This lets us get access to the cheek bones and be able to place the implant where we want to. It also allows us to find and preserve the nerve that gives sensation to the cheek and upper teeth. A second way that a cheek implant can be placed is through a lower eyelid blepharoplasty incision known as a transconjunctival incision. This is a less commonly done approach. The appropriate approach can be decided with you and your facial plastic surgeon.

This is a great question. What exactly is a Liquid Facelift. This is a term that I have seen being used more and more these days. To better explain it lets first explain what is a facelift. A facelift is generally a surgical procedure that uses incision artistically hidden around the ears and hairlines to reduce sagging of the skin and improve the jawline, neckline and the cheek area. The results of a facelift last a lifetime. The recovery can be around 1-2 weeks and there is a fair amount of down time associated with it. A liquid facelift on the other hand is when fillers are used to correct the wrinkles of the face. It has limitations to the amount of correction that can be done but as you would expect, it usually does not have a very long downtime. A liquid facelift is typically ideal for people who have less sagging of the skin and more hollowness. Both options are great and I would advise you to speak to a facial plastic surgeon to finds the ideal solutions for you.

Thank you for your questions. Facial wrinkles around the mouth and eyes are a very common complaint in my practice. You should know that there are many ways to treat the wrinkles of the face (also called Rhytids). First let's address the wrinkles around the eyes. To improve the appearance of these wrinkles, you can use products that weaken the movement of the muscles. These products include Botox, Dysport and Xeomin. They work wonderfully to decrease the wrinkles around the eyes and forehead and can also help to prevent new wrinkles from appearing. Sometimes the wrinkles around the eyes are cause by excessive skin. In this case you can have blepharoplasty or an eyelid lift. This procedure can be done with twilight anesthesia and achieves wonderful results with a quick recovery period. Another treatment for the wrinkles around the eye can be the use of resurfacing treatments such as lasers and chemical peels. As for the wrinkles around the mouth, they can be treated with lasers and chemical peels as well. However, you can also use fillers to fill the wrinkles and decrease their appearances. These fillers could be products such as Jeuvederm, Restylane or Belotero.

Hi, sorry about your fall. Because the cuts from trauma generally have some crush injury to the tissues, they tend to leave more of a scar than surgical cuts. For this reason, it is best to see a plastic surgeon to evaluate your scar and see if there is anything that can be done to decrease the appearance of the scar. The good news is that there are lots of non-surgical options to improve the appearance of the scar. Your plastic surgeon can give you topical treatments to improve its appearance or use of lasers and resurfacing procedures. When all else fails, you can always resect and re suture the scar.

Great question. Botox (or Dysport or Xeomine) is a product that weakens the strength of muscles. So we can use it to treat what we call kinetic wrinkles or wrinkles that are caused by muscles that move. A great example is the muscles that move your forehead and eyebrows. These can cause wrinkles between your eyebrows (labella) or the wrinkles of the forehead. When we use Botox in this area, it can decrease the appearance of aging. In your sister's case, if she does have sagging skin she may need either a filler or surgery to remove excessive skin. I recommend seeing a plastic surgeon to better evaluate what her needs are.

To better answer this question it would be great to know what procedure it is that you are having. There are several treatments for re-contouring your jaw. For example, the jaw can be re-contoured with use of fillers. Fillers can help to make the jaw line more straight. Common risks of fillers are bruising and swelling. However, there can be some serious risk if injection is done improperly. The jaw can also be countered using liposuction or other types of treatments that remove or dissolve fat. This also can lead to bruising and swelling. Again if done improperly you can have some serious side effects. Finally, the jaw can be re-contoured using a facelifting or a neck lifting procedure. This procedure should be performed by a trained facial plastic surgeon and leads to great results when done properly.

Thank you for your thoughtful questions. The truth is that any surgical procedure can be uncomfortable and there is no exception with nose surgery or Rhinoplasty (also referred to as a nose job). This can be due to many things such as pressure, congestion, difficulty breathing through the nose and yes pain. However, most patients are able to easily tolerate the pain and discomfort associated with rhinoplasty, by taking some oral pain meds. Most patients need only a few days of pain meds and then they find that simple Tylenol will suffice. As far as recovery for rhinoplasty it usually takes 1-2 weeks for most of the immediate swelling to subside. However, for about 6 weeks we don't want you to wear glasses or put pressure on your new nose. This way you can ensure that all the tissues fuse in their proper location and there is no shifting of the bones. Also, your nose can be mildly swollen for up to a year. No, this doesn't mean you look swollen but you feel like your nose is still firm or numb. Time will take care of these feelings and you will love your new nose.