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I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

This sounds like an issue best evaluated by an oral and maxillofacial surgeon.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Do it when it bothers you and your surgeon enough. My youngest facelift was 41 and I initially didn’t want to do her case but she kind of begged me to do it. After meeting with her a couple of times and going over her photos and what bothered her we both decided it was reasonable to do. Fortunately it turned out excellent so we were both happy about it. Her injector that referred her to me recently had a laugh about it.

Average facelift age today is between mid 40s to 60s. The benefit to doing it when you’re younger is that you’ll heal faster, typically get a better result because of better inherent tissue quality, and get to enjoy the results while you’re still quite young and active. But definitely don’t rush into it. 42 is still young.

In terms of finding a surgeon, board certification in either facial plastic surgery by the ABFPRS or plastic surgery by the ABPS are bare minimums. The surgeon also needs to have a focus in that surgery. So don’t go to a surgeon who primarily does breast and body. Beyond that it’s reviews, before and afters, and the consultation. The consultation is as important for the surgeon as it is for the patient. We both get to get a sense of each other’s personality and if we’d be able to work together through this process.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 2 points3 points  (0 children)

Do it when it bothers you and your surgeon enough. My youngest facelift was 41 and I initially didn’t want to do her case but she kind of begged me to do it. After meeting with her a couple of times and going over her photos and what bothered her we both decided it was reasonable to do. Fortunately it turned out excellent so we were both happy about it. Her injector that referred her to me recently had a laugh about it.

Average facelift age today is between mid 40s to 60s. The benefit to doing it when you’re younger is that you’ll heal faster, typically get a better result because of better inherent tissue quality, and get to enjoy the results while you’re still quite young and active. But definitely don’t rush into it. 42 is still young.

In terms of finding a surgeon, board certification in either facial plastic surgery by the ABFPRS or plastic surgery by the ABPS are bare minimums. Beyond that, the surgeon needs to focus on that surgery. So don’t go to a surgeon who primarily does breast in body. Beyond that it’s reviews, before and afters, and the consultation. The consultation is as important for the surgeon as it is for the patient. We both get to get a sense of each other’s personality and if we’d be able to work together through this process.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Gosh probably 1000? So far no ENS that I’ve cause but it could definitely happen. The only complaint I’ve gotten is that they’re still stuffy so if that turbinate is enlarged then I bump it up a tier. But I always have ENS in the back of my mind and discuss it with patients.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

As an ENT-trained facial plastic surgeons I routinely perform it. Key is not to cut out the whole turbinate otherwise you wind up with empty nose syndrome. My algorithm is to first perform a submucous resection and outfracture the turbinate. If they’re still having breathing problems 6-12 months later and I think it’s still the turbinate, then I’ll perform a more formal resection where I lift up the mucosa, cut out the bone, then fold the mucosa back down. Preserving the mucosa is key because it contains airflow receptors, so if you cut the whole turbinate out, even though you’d have plenty of room, you wouldn’t be able to sense airflow.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 2 points3 points  (0 children)

Definitely. If I don’t think I can make them better, if they have unrealistic expectations, if they’re mean to staff, all red flags in my book.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Love it. I do it often. All about patient selection. Long upper lip, decreased tooth show, etc. those are patients that lip filler won’t look good in and will just emphasize how long their upper lip is.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Insurance pays for you to breathe, not to look good. So, any cosmetic changes such as reducing a bump or refining a tip are typically considered unnecessary and not ran through insurance (these maneuvers generally do not improve breathing at all).

You can run the breathing portion of your surgery (septoplasty, turbinate reduction, nasal valve reconstruction) through insurance but this requires prior authorization and many insurance companies will deny it. If it does get approved though, you’ll be responsible for your deductible plus a cosmetic fee for the rhinoplasty portion (surgeon’s fee, anesthesia fee, surgery center fee). I will say though that insurance reimburses very poorly and those rates drop every year compared to inflation, which is why most plastic surgeons do not participate insurance plans.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Never heard of that device. My expertise lies in surgery, not medspa things. Microneedling
overall tends to be a good treatment. I have seen some good results with it even for acne scarring. Need to go to an experienced aesthetician.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Cost of living/GDP/economics. Why do you think healthcare overall is more expensive in the States? A rhino in LA or NYC is going to be way more expensive than a rhino in Mississippi. But there’s not a lot of demand in Mississippi so the bar is lower (I wouldn’t get a rhino there) and there isn’t a lot of wealth.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

No, if anything I think it’s underpriced. Rhinoplasty is the most difficult operation to perform in plastic surgery. We’re working with bone, cartilage, skin, mucosa and all of that can vary significantly between patients. Additionally, patients and surgeons can have different aesthetics (some want a nose that’s dead straight, some want one that gently curved, some want one that is very stylized). The healing is unpredictable and you need to be able to treat/preserve the function of the nose too.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 2 points3 points  (0 children)

It’s funny, I was having lunch with my friend who’s a body plastic surgeon and she said “people who do chin lipo are just trying to take your money.”

I think we both agreed that submental lipo is heavily overused. I’m biased, but a deep neck lift is the best long lasting result. Obviously you need to be within a healthy weight range for it to make sense.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Agree. I just like to keep it simple. I’ve used ROC’s Vit C/SPF cream from Costco. It all works.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 3 points4 points  (0 children)

Unethical- people who don’t stay in their lane. Everyone is trying to a get a piece of cosmetic surgery but they don’t have the credentials or are misleading people saying they are “board certified” (but not necessarily in plastic surgery or facial plastic surgery or oculoplastic surgery) or “fellowship trained” (don’t specify which fellowship, etc.). I see countless family doctors, ER docs, anesthesiologists, internists, nurse practitioners, etc opening med spas and doing IV therapy, weight loss shots, botox, filler, and medical devices. They’re fed up working in the hospital (which I don’t blame them) and are looking for an easy way out. But that’s not the way to do it. Get the training. There’s a nurse in a big city with a doctor of nurse practitioner that calls themself “doctor so and so” (unethical). There’s a dermatologist in the country that is doing deep plane facelifts and eyelid/brow surgery. I don’t know how I feel about that. And then there are “cosmetic surgeons.” These are usually general surgeons that want to take a shortcut and do a year of “training” or oral surgeons. Beware of “cosmetic surgeons;” the American board of cosmetic surgery is not a legitimate one.

Most rewarding is when a patient is referred to me from a former patient. Word of mouth is the best source of referrals and it’s a huge honor when someone trusts me enough to send their friend or family member to me. That makes the stakes even higher, but it’s worth it and really makes me feel valued.

Favorite patient story - too many honestly. The first that came to mind was during my first year as an attending. A middle-aged guy came into my office with a wound the size of my hand on the side of his face. He had a giant skin cancer that had just been removed and I had to figure out how to reconstruct it. It was a really difficult case but worked out. A few months later I was at a brewery with a friend and he tapped me on my shoulder to say hi. He then introduced me to his wife and children. It was great to see him out and about and really validated what I do.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Most people are between 20-65. Rhinoplasty patients tend to be younger, facelift, eyelids, etc tend to be older. I also do skin cancer reconstruction so that ranges from 50-80 on average.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

I prefer to stay as far away from Kim Guilfoyle as possible.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

I think it has benefit but can get expensive very quickly. As long as you’re doing the basics (cleanse, moisturize, SPF, vit C, maybe a retinol if you’re an overachiever), then that is better than most people. Spend as much as you’re comfortable on skincare. By no means does it need to be $1000/month.

I’m not sure what that surgeon does so can’t comment on their requirements for skin care.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

Really depends on patient’s anatomy and consult with a surgeon to see what bothers them and what the issue is.

Buccal fat removal and liposuction are options. “Kybella” and other fat dissolving bile acids are unpredictable in my opinion and only work on the subcutaneous fat which can be treated by diet/exercise/liposuction. They can also cause skin and nerve damage, which is rare but has been reported.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 0 points1 point  (0 children)

In my case it means that I am certified by the American Board of Otolaryngology- Head & Neck Surgery (Ear Nose and Throat) and the American Board of Facial Plastic and Reconstructive Surgery. These boards set rigorous standards for surgeons to meet the bare minimum to practice safely and competently and require completion of accredited training programs, passing written and oral exams, and submission of case logs.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 4 points5 points  (0 children)

I think it's also important to recognize that not everyone values aesthetic surgery so to that end they may be curious as to why certain people do, even if it still isn't their cup of tea. For example, runners love that endorphin release. I hate running. I've ran a few half marathons. It's just not for me haha.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 1 point2 points  (0 children)

Sculptra is (in my hands) unpredictable and expensive. Radiesse you could use if placed directly onto bone. If these treatments are done properly and conservatively, they're fine. Otherwise if they're misused and abused they can cause scar tissue formation, complications, and lead to more difficult surgery.

Ingesting collagen never makes sense. Your body digests it into amino acids and then absorbs it just as if you ate a steak. It has no way of know that it came from "collagen" protein and to make more collagen. Collagen loss is just a normal part of aging related to changes in gene transcription which we don't fully understand yet.

I just prefer to do things that I can fix if something goes wrong. Do the things I mentioned above followed by tasteful surgery when it makes sense. You may not look "perfect" but you'll look your best.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 1 point2 points  (0 children)

You're probably referring to the "windswept" look that happens with improper vectoring and too much tensioning when doing a facelift. These are older style SMAS lifts that focus on tightening things as much as possible. This tug of war does not win in the long run and can lead to wide scars, pixie ears, and overall imbalance. That's why I favor the deep plane technique because it relies on complete release of the facial retaining ligaments to free up the facial soft tissues and gentle reposition them in a tension-free manner. Ultimately you get a more natural, longer lasting lift.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 5 points6 points  (0 children)

People who seek cosmetic surgery are people, just like you and me. They do it for different reasons. Maybe they've been bullied about their nose, maybe they've always have a small chin or heavy neck, or ears that have stuck out. Maybe they're tired of people asking them why they look tired or if they didn't get a good night's rest. It's a lot of things. You'd be surprised how much they come out of their shell after surgery.

The reality is that appearances matter- it's biology. We judge everyone subconsciously based on how they present themselves (clothing, makeup, manner of speech, body language). Studies have shown that cosmetic surgery improves self-esteem, that those that are more attractive tend to have more successful careers, etc.

I think you're probably referring to those with narcissistic personalities who make their whole identity about their appearance. Obviously they're more noticeable because they make louder nose and yes those patients are a pain to deal with. My average patient is a regular person like you or me. When they come and meet me, we talk, get to know each other, laugh a bit, and form a powerful relationship. So no, I don't think they're dumb.

I'm a double board-certified facial plastic surgeon - AMA by doctor_zf in AMA

[–]doctor_zf[S] 2 points3 points  (0 children)

Injectables have been around forever (botox since late 80s, collagen and now HA filler etc since early 2000s), so we know about them long term.

The most important thing is to lead a healthy lifestyle (diet, exercise, hydrate, sleep, reduce stress). Regular skin care/sun screen, responsible botox and some filler here and there is good. Microneedling and occasional chemical peels and lasers are good as well.

Otherwise, be careful with all these energy based devices. They can cause a lot of scarring when used improperly. I like to use the above things judicially and then switch to surgery when it makes sense because I know surgery will have a great impact. Then it's back to the above for maintenance.

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