Health Features

Health: Put Your Best Face Forward

The first impression you make on others is, of necessity, based on your face. And while beauty is only skin deep, if you are unhappy with a facial feature, it’s good to know that options abound for reshaping, redoing or reinvigorating that feature. The changes might be subtle, but their impact on your self-esteem can be great.

[eyes]
The eyes are the first features to show age through dark circles, corner wrinkles or puffy bags. The good news: They’re also the easiest to fix with minimally invasive solutions.

baby steps
Aging eyes not only can make you appear older than you are, but they also can suggest emotions or characteristics that are not really there, such as hostility, disinterest, fatigue and grouchiness, according to Dr. Joe Muccini of MidAmerica Skin, Health & Vitality Center.

Some of the main causes of tired-looking eyes are age, lack of sleep, allergies and genetics, according to Dr. Richard Moore, medical director for The Lifestyle Center. “As we age, the skin gets thinner and consequently the blood vessels and pigment underneath start to show through more,” Moore explains. “There’s also a loss of volume—so you can get a puffy look around the eye, a recessed volume below that, and then there’s the cheek. It’s that loss of volume between those two planes that makes eyes look older and tired.” Additionally, squinting, focusing and sleeping on your side can lead to wrinkles around the eyes.

Most people start noticing subtle changes in their 30s. But that doesn’t mean you should wait until then to fight the signs of aging. Prevention is always the best bet, Moore says. “There are preventive things you can do at a young age: avoid significant sun exposure, use eye creams with an antioxidant, stay well hydrated and get regular rest at night. And maintain a healthy weight; fluctuation in weight has an effect on skin,” he says.

past prevention
If you’re past the point of prevention, don’t panic. There are plenty of effective, nonsurgical options. “ Skin tightening and smoothing treatments like radiofrequency (e.g. Pelleve) or microneedling (e.g. SkinPen) can help,” Muccini says. “Ultrasound treatments (like Ultherapy) also can benefit the eyes. Moore also recommends Botox to relax wrinkles, particularly crow’s feet, and the Venus Legacy, a nonsurgical skin tightening tool that uses magnetic energy, to also decrease dark circles. You may need multiple treatments to achieve your desired outcome because less aggressive treatment options tend to have less staying power than surgical options.

“We all continue to age,” notes Muccini. “Nothing stops the passage of time and human aging, but we can push back the overt signs of aging. But nothing lasts forever—not face-lifts, not surgery.” Most doctors offer free consultations for new clients to discuss what is bothering them and the treatment options available. Keep in mind that eyes need to be evaluated in the larger context of the face, as well as the overall skin condition and past history of treatments, Muccini says.

[prominent ear correction]
Yes, some ears stick out enough to actually require correction. If not exactly ‘required,’ correction might just be highly desirable—and that’s OK, if it’s going to make a child feel much better about himself. Experts say the relatively straightforward procedure is most commonly performed on children between 4 to 14 years of age.

what’s the problem
Otoplasty or ‘ear pinning’ is designed to reposition and reshape prominent ears. For those patients who are born with the problem, restoring the ear to a normal position can avoid teasing and the psychological trauma that goes with it, says Dr. Gregory Branham, a Washington University facial plastic surgeon.

According to Dr. Christina Plikaitis, a SLUCare plastic surgeon, ears may stick out because the shell part of the ear (conchal bowl) is abnormally deep, which pushes the ear out and/or the fold of the ear (antithetical fold) is underdeveloped and does not bend back enough. Most patients have a little bit of both going on, she says.

Prominent ears are fairly common, but many people do not realize they’re treatable. Others simply cannot afford the operation, which can range between $2,000 and $5,000.

timing is everything
“The ideal time is before the child starts first grade, so that teasing can be avoided. It occurs equally among boys and girls, although slightly more boys than girls have otoplasty at an earlier age, presumably because girls can hide their ears with longer hair,” Branham says.

Elective surgery for young children may seem shocking, but Plikaitis says by 5 or 6 years old, the ear is generally grown and the cartilage is strong enough to support sutures. “It’s not a good idea to force the procedure on kids if they’re not interested, because it will be harder to get them to comply with recovery,” she says. “What I like to do in my consultations is talk about what the surgery is, as well as the recovery, and then let them really think about it and decide if/when it’s right for them. I’ll show them before and after pictures and create digital pictures of what they’ll look like afterward, too.”

“We see adult patients who have the procedure, often because their parents could not afford it when they were young,” Branham says.

what to expect
Following the surgery, a bulky dressing is applied to the ears to protect them and keep them in place as they are healing, Branham says. After a few days, a terry cloth headband is worn over the ears to protect them from getting bumped or being jostled during sleep and an antibiotic ointment is applied to the incisions for one week. The ears are tender to touch for the first week and will remain sensitive for several weeks if they are bumped.

Patients will see a difference almost immediately. “Once the dressing is removed, you should be able to appreciate the difference in how close the ear lies to the head. However, there is typically swelling and bruising that must resolve so that the ears can take their final shape,” Branham notes. Incisions are typically made behind the ear so the scars are inconspicuous. Because surgery is done on the outside of the ear, there is no risk to the patient’s hearing.

Patients and their parents generally are very happy with the outcomes. “Ear deformities draw unwanted attention and teasing. I had one girl stop participating in basketball because she wouldn’t wear her hair up! This is a relatively simple procedure. Patients do well, heal quickly and are usually really happy because this has bothered them for a long time,” Plikaitis says.

[noses: second surgeries]
About 10 percent of rhinoplasty patients return for additional revisions—from small tweaks to major changes. Why?

artistic touch required
Rhinoplasty is commonly regarded as the most difficult cosmetic surgery. “ There are many hard-to-control variables, such as skin thickness, cartilage strength, bone thickness, anatomic variation and healing rates,” says Dr. Brock Ridenour, a facial plastic surgeon. And because each and every maneuver performed during a rhinoplasty operation has an effect on the entire nose, this surgery requires both careful planning and ‘on the fly’ adjustments.

It’s no wonder, then, that a relatively high percentage of rhinoplasty patients seek revisions or secondary rhinoplasties, says Dr. L. Mike Nayak, a facial plastic surgeon. Nayak says there are four main reasons for patients to seek a secondary rhinoplasty. “ One is communication—was it understood what you wanted? Two is the unpredictability of the surgery—everyone knows what you want, but it just didn’t turn out that way. Three, you got what you wanted, but it has changed over time. Four, you have changed and what once looked good on you no longer fits. Notice, I didn’t say ‘bad result.’ The definition of a bad result is that the patient doesn’t like it. It’s very subjective,” he says.

“A small percentage of dissatisfied patients suffer from body dysmorphic disorder (BDD), a body-image problem characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance,” adds Ridenour. “They’re best treated with the help of a mental health professional.”

are you a candidate?
“Scarring of the nasal skin is the main limitation when planning secondary procedures,” says Ridenour. “ Revision is almost always possible if the nasal skin is healthy and has adequate circulation.”

But solely being unhappy with your nose does not make you a candidate for rhinoplasty, points out Nayak. He notes that expectations must be realistic, in terms of what is achievable with each particular patient.

Scar tissue that develops around the nose after the original procedure and limitations imposed by changes in blood supply, skin thickness, and anatomy can make a second nose job complicated, Ridenour warns. “Another challenge is that there often is a shortage of available materials (cartilage) for reconstruction, requiring the surgeon to borrow cartilage from the ear or a rib.”

Patients frequently experience more swelling after secondary rhinoplasty, and it takes longer to see the final outcome. Ridenour recommends working with the original surgeon, if possible. “If you wish to change doctors, find a surgeon with experience in revision rhinoplasty who has successfully treated many of these problems,” he adds.

avoiding do-overs
Rhinoplasty surgery is a true art, so it’s important to find a surgeon whose aesthetic judgment matches your taste. Careful planning and communication will minimize the potential for postoperative dissatisfaction, Nayak says.

Nayak says he uses 3-D imaging to “show what I see in my head as reasonable, achievable and in good taste.” It’s a communication tool: “You say you want it a little bit smaller—but what does that mean?”

Recommended