Frequently Asked Questions about Plastic Surgery

Eyelid Surgery and Laser Together Can Address Bagginess AND Crow's Feet

Q. Dear Dr. Lowe, I'm in my late thirties, and I don't think I'm ready for a facelift yet, but my eyes are tired looking and I have crow's feet. When I mentioned to a friend that I was thinking about having eyelid surgery, she said I needed laser surgery. Would that be enough?

A. Your friend is partially correct. Let me explain the difference between eyelid surgery and laser surgery. Excess, baggy eyelid skin or fat in the eyelids is causing the puffiness under your eyes. To remove this, you would need eyelid surgery, medically termed, a blepharoplasty. Since bagging of the eyes can develop at an earlier age than heavy wrinkles, a blepharoplasty is often performed 10 years before a facelift is needed. In this very common procedure, the excess skin and fat of the eyelids are removed at the fold of the upper lid and just below the lower lash lines, or from the inside of the lower eyelids. To remove fine lines and wrinkles around the eyes (the crow's feet you're referring to), more and more plastic surgeons are offering laser skin rejuvenation surgery. Laser light, a product of CO2 laser, has become the skin resurfacing tool of choice for Board Certified Plastic Surgeons. The advantages are that there's no bleeding and it provides the plastic surgeon precise control over the exfoliation process. It gently removes the damaged surface layer of dead cells, working much like an artist's brush, smoothing fine facial lines.

Many men and women have been pleased with this combination because it addresses their two biggest concerns: baggy eyes and crow's feet. The cost of eyelid and laser surgery combined ranges between $3,500 to $5,000 in the Annapolis area.

Dr. L

Computer imaging helps to provide a Doctor/Patient agreement on nose surgery goals

Q. Dear Dr. Strawberry, My nose has always bothered me - it's a little too large, meaning too high with a hump. I have thought about plastic surgery, but I am afraid of looking vastly different afterwards. I still want to look like me. Do plastic surgeons each do "nose jobs" a certain way? And how much do they cost?

A. "Nose job" is quite simply, popular slang for a rhinoplasty, which is the surgical procedure for correcting imperfections of—or simply reshaping—the nose. The most common reasons for which rhinoplasties are performed are to reduce the overall size, to reshape a bulbous tip, to remove a hump on the bridge or to improve a poor angle between the nose and the upper lip. Working through an incision inside the nose, the nasal bones comprising the bridge are modified to produce a narrower bridge. When a large hump is removed, the base of the nose might need to be proportionately narrowed. Your concern about your desired result is justified. Good communication with your surgeon is critical. I find a computer imaging session has improved the communication with my patients, thereby improving their satisfaction with their result. I meet with the patient first to discuss their goals, then one of our patient counselors photographs the nose and face and does the computer imaging per my instructions. Then we review a computer-imaged result together to be sure that the patient understands the surgical goals and how they are to be achieved. The average cost for a rhinoplasty, including surgeon's fee, anesthesia and the operating room is $4,000 to $5,000 in the Annapolis area.

Dr. S

Computer Imaging Proves Helpful and Popular with All Facial Procedures.

Q. Dear Dr. Buhrer, Friends of mine have talked about how surgeons use "computer imaging" to envision plastic surgery results. Do you offer computer imaging? Is this the best way for me to learn about which procedures would improve my look?

A. Yes, we offer computer imaging and have found it to be of great value to our patients. We are continually amazed at how computer imaging dramatically improves a patient's ability to visualize all the possibilities and improves the doctor-patient communication. We use the most advanced imaging system available, Mirror Image, with state-of-the-art tools and digital cameras. I am particularly proud of how our patient counselors and nurses use computer imaging to explain what is possible and what is not. As surgeons, all of us review the "alteration" result on the computer with the patient to discuss what can be achieved realistically and how we would approach it surgically. Let me describe a few examples of how computer imaging has helped patients to understand what can be accomplished:

Facelift: A side view of a facelift, before-and-after shows many patients how dramatically the neck can be improved as part of the lower portion of the facelift.

Eyelid surgery: In many cases, we need to discuss upper versus lower eyelid surgery or even a brow lift to treat the upper eye region around the eyebrow. Each are different and the morphed image allows the patient to see the possible result from each approach.

Laser: Many patients are not sure what a facelift can do and when laser is required for the removal of fine lines. The actual process of doing the computer imaging shows our patients which areas can be improved and with which surgical tool. I personally like the laser tool which shows the percentage of wrinkles likely to be removed.

Nose Surgery, chin augmentation, facial contouring, and even liposuction: Using the before and after images, the difference is quite clear.

Dr. B

Q. Dear Dr. Laughlin, My daughter is 16 and has very large breasts which cause her neck, back and shoulder pain as well as embarrassment, and prevent her from participating in school athletics. I am concerned about her and would like to plan breast reduction surgery during her holiday vacation. Please explain the surgery for me. Is it covered by insurance?

A. I share your concern for your daughter. Breast reduction mammaplasty is an excellent solution for such young women. Many school-age young women schedule this type of surgery with a Board Certified Plastic Surgeon during the holiday break. The procedure is performed, under a general anesthesia, in an ambulatory surgical center. The surgeon makes horizontal and vertical incisions that resemble a key hole pattern, following the contour of the breast. Through the incisions, the surgeon excises tissue, fat and skin from the sides of the breasts. Nipple, areola and underlying tissue are then relocated upward and the breasts recontoured. Following surgery, and perhaps after an overnight stay, the patient goes home with incisions covered in light dressings. Sutures are removed within one to two weeks. Full physical activity can be resumed within four to six weeks.

The cost is covered by most medical insurance companies in the Annapolis area. Amount of coverage varies with each company and usually depends on weight and size of the breasts, proof of discomfort and pain and the estimated grams of tissue to be removed. A plastic surgeon's staff, with a good deal of experience with this procedure, can handle all of the paperwork and submit appropriate information to get a positive determination. Most people have satisfied their insurance deductible by this time and benefit by having surgery.

Dr. L