Rhinoplasty surgery is incredibly common. In fact, it is one of the most common cosmetic procedures performed every year. Patients’ motivations for undergoing a rhinoplasty are as varied as the patients themselves, but there are some common goals among them.

Often, patients are simply interested in having a nose that is in better balance with their other features. Rhinoplasty can correct both a nose that is too large or too small. An overly large nose can be corrected by removing some of the cartilage within the nose. If the nose is too small, implants or grafts can be added to increase its overall size.

Sometimes, the shape is more at issue. Commonly, a patient may be unhappy with a hump or convex shape to the bridge of the nose. This is easily corrected by filing down the cartilage and bone, thus reducing the hump and resulting in a flatter nose. The same process is used for patients unhappy with a bump or uneven shape left by an old break.

Other aspects of nasal shape can be changed as well. Some patients feel that the base of their nose is too wide. This can be adjusted through the removal of excess tissue and repositioning the nostrils. The tip of the nose may be at issue as well. A tip that is droopy or too long can be corrected by removing underlying cartilage. Conversely, a tip that is too flat or a nose that is too short can be extended through the addition of cartilage grafts.

Whatever aspects of your nose you desire to change, it is important to discuss everything with your surgeon to be sure you have realistic expectations for what rhinoplasty can achieve. Your surgeon can evaluate your particular situation to recommend the best course for treatment.

If you’re interested in learning more about how rhinoplasty can benefit you, contact facial plastic surgeon Dr. Sheldon Kabaker of Oakland, California, at (510) 451-1116.

Question: Hi Dr. Kabaker – I’m leaning toward doing this procedure. Before I do, I have some more questions.

I’d like to understand better how much hair (1/4 inch? 1/2 inch?) is removed from the back of my head. I guess what I don’t fully appreciate is that this hair will grow back and hide the scar. Does that happen in every case?

Will I feel physical sensation at the surgery site for months, years after the procedure?

Is there a chance that the site would not heal properly, or that it could reopen?

I’d appreciate 3 references I could contact by telephone or email.

Answer: We remove a certain amount of hair from an area of the scalp that does grow bald in the patient’s lifetime. We do not create more hair, we simply move existing non-balding fringe hair to balding recipient areas. We have to leave enough hair so that the donor area looks normal with usual hair styles such as the one you wear. The transplanted hair grows in the recipient area and does not grow back where it was taken from. This is the basic concept of hair transplantation.

If I were to do 2500 grafts I would need to take about 25-30 square centimeters of donor scalp. Therefore the strip of donor scalp could be 1.3cm in height and about 20cm in length. That would leave a suture line and eventual scar that would measure about 20 cm from side to side that is immediately covered by the surrounding hair. This becomes a scar which is similarly hidden forever. Alternatively one could have 1500 small drill holes (FUE) of a shaved area of the scalp that eventually gives tiny white scars that , like the linear scar, only shows if you shave your head. I do not use this second harvesting technique as I feel the quality of the grafts and the subsequent result of good growing hair is lessened. Also the total cost is more. There is a $400,000 robot machine made by Artas which can do this FUE (follicular unit extraction) harvesting work. I am not buying one. I feel that the artistry in this work is in the creation of the recipient sites , the proper selection and sizing of the best quality grafts, and the placing of them in the recipient sites. There is no robot that does this yet, however some marketing schemes seem to imply that there are such devices. I sure wish there was such a machine .

You should feel no more residual discomfort, early and late, than a dental procedure .

I leave sutures in for two weeks to prevent an accidental opening of the donor area. At times I have removed them in one week. A strong blow to the back of the head could open up the donor incision. The donor area, like any repaired body incision, is not strong for about 6 weeks.

I no longer will ask prior patients to be called by prospective patients. I have exhausted my favorite and most vocally articulate patients’ respect for privacy. I do not do discounted hair transplant surgery in exchange for such impositions. Maybe I should.

Four months is plenty of time to heal and there might be about a half inch of growth from the transplants. The sooner you start the sooner your result.

Many people will find that others’ impressions of them may be connected to the appearance of their chin. A strong and defined jawline is generally associated with a strong and confident personality, and patients therefore are often interested in achieving more definition in this area. Due to the prevalence of action heroes with strong, square jaws, chin augmentation is a particularly popular cosmetic procedure for men.

Augmentation of the chin can be achieved in a variety of ways. Some surgeons will begin with temporary non-invasive treatments such as fillers before moving on to a more permanent solution. I do not do this.  Permanent alteration of the shape of the jawline can be achieved though the insertion of an implant and if it is unsatisfactory, It can easily be removed.

Genioplasty, or mandibular advancement, is a procedure that involves sliding the lower jaw forward. Incisions are made inside the mouth, and the surgeon cuts the jawbone in a way that allows it to be slid forward. Due to the bone involvement, healing from a genioplasty can be more significant that an implant, but in some cases this procedure is better suited to the needs of the patient. This should be done by a surgeon with skills and experience in maxillofacial surgery.

In other cases, such as wanting to create a wider jaw, implants may be more appropriate. Inserting an implant is relatively simple and quick. Having had vast experience with alternative incisions, I place all my chin implants from a small incision beneath the chin.  The implant is then placed directly against the bone. A variety of implant materials are available, and what is best for you will depend on your needs and your surgeon’s preferences. Materials include silicone, Goretex, Med-por, and Mersilene mesh, with silicone being the most common and my preference. Occasionally, some surgeons may choose to use a piece of your own bone, which may be harvested from a rib or the pelvis. I feel this is unnecessary and more prone to complications. Why has a second operative site?

If you are interested in exploring what a chin augmentation could do for you, contact facial plastic surgeon Dr. Sheldon Kabaker of Oakland, California, at (510) 451-1116.

Lines around the mouth and sagging cheeks are common complaints patients have regarding their aging faces. These areas of the midface are affected mostly by the fat of the cheek sagging over time. This enhances the appearance of under-eye dark areas and diminishes the definition of the cheekbones. These areas are often not well resolved with a traditional facelift. A midface lift can resolve these problems and also may reduce the appearance of smile lines and lift the corners of the mouth for a more youthful appearance.

For the most comprehensive result, two sets of incisions are made. These are at the bottom of the cheek inside the mouth, and behind the hairline near the temple. Through these incisions, your surgeon can separate the tissues from the bone, lift them, and secure them in place with absorbable fasteners. This lifts the fat pads back towards the top of the cheekbone, lifting away the folds around the nose and mouth and redefining the cheekbones.

A less invasive operation can be performed in which the surgeon makes an incision below the lower eyelid to lift the fat pad. This version has the benefit of being less invasive and therefore requiring less recovery time, but also does not achieve the same level of result as it does not lift the skin and other tissues. Some surgeons perform this operation by making the incision inside the lower eyelid, eliminating the external scar.

The midface lift is a procedure that is often combined with others. Commonly, patients may undergo a lower eyelid operation along with the midface lift as the under-eye area is associated with sagging cheeks. Sometimes, the aging seen in the midface may be due in part to insufficient underlying structures, and in these cases, patients may benefit from including a cheek implant with the midface lift.

If you are interested in whether a midface lift may be right for you, contact facial plastic surgeon Dr. Sheldon Kabaker of Oakland, California, at (510) 451-1116.

Question: Do you offer this operation in any other state or country?

Answer: The vast majority of my hairline lowering patients are from far away, but need to spend as little as 2 nights in the area. I do not work outside my private clinic in Oakland , California (across the bay from San Francisco). I need to have the familiarity of my surroundings and the help of my experienced staff to do this operation effectively. I am presently not licensed in any other state or country.

It is quite common for people to feel self conscious about the appearance of their ears. Imperfect ears, such as ones that are too large or too protruding, can become an issue in childhood, and if not corrected may bother a person for their whole life. Ear surgery, or otoplasty, is relatively simple and can even be performed on children. This simple procedure can correct these problems and save a patient from feeling self-conscious and insecure about the appearance of their ears.

The most common type of ear surgery is ear pinning, which corrects protruding ears. In this procedure, the surgeon makes an incision behind the ear where the scar will be hidden in the natural crease. From this access, the surgeon will remove a sliver of cartilage to bring the ear in closer to the head. He may also trim the remaining cartilage to improve the overall shape of the ear. Permanent internal sutures may be used to create natural folds that may have been missing in the ear, and temporary sutures will be used externally until the ear is healed.

Otoplasty can correct ears that are too large, protruding ears, or deformities caused by birth defects or injuries. It is most commonly performed on children and teens, but patients may also be adults who have been bothered by their ears for a long time or who have had ear surgery in the past and are unhappy with it.

As with any surgery, it is important that patients be in generally good health and have reasonable expectations for the outcome of the surgery. When the patient is a child, the surgeon will want to be sure the patient has a reasonable understanding of what is happening and does not seem upset by the idea of undergoing surgery.

If you are interested in whether otoplasty may be right for you or your child, contact renowned facial plastic surgeon Dr. Sheldon Kabaker of Oakland, California, at (510) 451-1116.

Although surgeons always work hard to achieve optimal results for their patients, there are, unfortunately, times when perfection is not reached. Sometimes, a patient is simply unhappy with the look of the nose after a rhinoplasty. In more serious cases, the way the nose has healed may result in breathing problems. These issues can be corrected with a secondary rhinoplasty surgery, also known as revision rhinoplasty.

Post-recovery problems with the nose are often out of the surgeon’s control. The tissues of the nose can take up to 18 months to heal, and the way in which they heal and restructure themselves over this time cannot always be controlled. This healing process can result in a nose that does not look exactly as intended. As a result of this, rhinoplasty is a very commonly repeated procedure, with as much as 10-20% of rhinoplasty patients undergoing a second operation.

Aspects of the nose’s appearance that patients may not be satisfied with are incredibly varied. They ould include surgery not going far enough and ending up with a nose that is short of reaching the original goals. Opposite this, the rhinoplasty may have gone too far and removed too much of the nose. Some patients find that their nose simply looks unnatural and too obviously operated on.

Sometimes, patients may experience more serious complications related to their breathing. The removal of cartilage during the initial procedure may weaken the nasal valve system and cause changes to occur during healing. Problems may be experienced because this system controls the amount of air passing through the nose. Obstruction may also be caused if the septum does not heal straight.

Before undergoing a repeat procedure for cosmetic reasons, it is important to be sure it is something you truly want. Surgery is always a risk and should be undertaken with caution. If you are interested in a revision rhinoplasty, contact facial plastic surgeon Dr. Sheldon Kabaker of Oakland, California to schedule a revision rhinoplasty consultation (510) 451-1116.

Facial expressions play an important role in interpersonal relations. When people feel that the way their face has aged makes them appear worried, tired or, worse, angry, this can have an impact on work and social life. These appearances are often influenced by the eyebrows and forehead, and may be treated with a brow lift.

The eyebrows are attached to the underlying skeletal structure, and are supported above by the skin and musculature of the forehead. Of course, gravity and time affect these structures just as they do the rest of our bodies. As the tissues weaken over time, the brows can become heavy and begin to sag. As we subconsciously try to correct this sag, we overuse the muscles of the forehead and develop wrinkles.

An endoscopic procedure is the most recently available type of procedure. This is marketed as a less invasive procedure. Four to five small incisions are made along the hairline, through which the surgeon accesses the tissue and muscle to reposition them, aided by tiny cameras. There is little risk of forehead and scalp temporary numbness, the scars are well hidden, and healing time is manageable due to the small incisions.

The greatest effect can be achieved through a coronal lift. In this technique, an incision crosses the top of the head from ear to ear, and a sliver of skin is removed, allowing for the lifting of the brow. However, this technique does come with some risk of side effects. It can result in a raised hairline along with the brows, and the significant incision can take time to heal fully. Temporary forehead numbness can also be a side effect of this procedure. Often a sign cant amount of scalp hair is removed and the hairline is raised. If you have a low hairline and thick hair, this approach is very good.

The incision can also be placed along the hairline. This version of the procedure gives similar results, with the benefit of not raising the hairline. The scar is generally well hidden by the hairline. And, the hairline can even be lowered. This my preferred approach for women.

Dr. Sheldon Kabaker is a renowned facial plastic surgeon located in Oakland, California. If you are interested in whether one of these procedures may be right for you, contact Dr. Kabaker’s office to schedule a consultation: (510) 451-1116.

Due to the visibility of our faces, and the fact that it shows more signs of aging than other areas, there is a lot of focus on different types of facelifts. A traditional facelift is a time proven procedure and, as such, it has predictable outcomes. Some people, either because they can’t afford the money or time involved in such a procedure, or because they simply want a quicker result, are turning to newer, less invasive options.

Traditional facelift procedures involve incisions along the hairline from the temples to around and behind the ears. Through these incisions, your facial plastic surgeon can access the layers of muscle or connective tissue underneath the skin, lift them, and secure them in a more youthful position, along with the outer layer of skin. This ensures a complete and natural result.

One of the newer, less invasive facelift procedures is known as the thread lift. A thread lift is performed by inserting barbed threads under the skin with a needle. The barbs on the threads allow the surgeon to use the threads to lift the skin, requiring minimal incisions, and producing minimal scarring. Patients generally resume full activity within a week, and side effects are limited as are the results. A version of this technique used to lift the cheek pads has proven to be effective.

However, due to the nature of this non-invasive procedure, the corrective potential of a thread lift is limited. This type of procedure is unable to affect the changes in the distribution of facial tissues that happens as we age. It does not remove any of the excess sagging skin, so this remains on the face and is visible after the procedure. A recent study found that while initially some improvement in appearance was achieved, the result disappeared by around a year post-procedure. The physicians involved felt that the initially apparent results were probably attributable to inflammation.

Patients who are interested in a natural, lasting result should consider investing the time and expense in a facelift. In the long run, it will be more cost effective. If you are interested in whether a facelift is right for you, contact Dr. Sheldon Kabaker of Oakland, CA, today to schedule a private consultation:(510) 451-1116.

Question: I was told by another surgeon that follicular unit grafts can be done at the same session as the hairline lowering/forehead reduction. Do you do this? And how much is the additional cost

Answer: I will only do grafts at the same time as a hairline lowering if they are needed in front of the temple hair. This can contribute to narrowing of the forehead. A maximum of about 600 can be done with this concept. The grafts are taken adjacent to the hairline advancement incision ends which are in the temporal areas. No additional scars are thus created.

I am opposed to harvesting grafts from the back of the head in the same operation for 2 reasons. The first one being that an incision in the back of the scalp along with one in the front could cut off critical blood supply to the scalp (a terrible complication I once have consulted). The second is that I am concerned as where to put a large number of grafts. I would expect poor survival and compromise to the circulation to the front of the hairline scar if they are densely packed in the front. I have no problem with doing traditional follicular unit transplant grafts 7-9 months after the hairline lowering has healed in order to get further lowering, to reshape the front hairline or to hide a visible scar then the hair is very thin. To do the 600 grafts along with the hairline lowering would add approximately $ 2500 to the hairline lowering charges.