San Diego Facial Plastic Surgery

There are various websites popping up that review physicians. Some of these sites are reputable, meaning: you may contact the owners, you may reply to erroneous posts, and defamatory comments are excluded. Other sites are hosted by third parties who do not divulge the owner's name, allow anonymous postings, and tolerate (and even encourage) defamation-in other words: disreputable sites. These sites tend to cater to angry individuals with personal "gripes," and can be dangerous sources of disinformation.


Some of these "gripers" are rhinoplasty patients, for the some of the following reasons:

Rhinoplasty is a very complex surgery, and the surgeon must have good aesthetic taste as well as the skills to obtain the desired cosmetic result. But this is not enough: the surgeon must also consider the functional issue of breathing. The final result should be a nose that works as good as or better than before surgery. Juggling these factors and also conveying realistic, safe goals to a patient and their family (who have their own ideas of perfection) is what makes this surgery so challenging.

Any plastic surgeon who performs hundreds or thousands of particular procedure will eventually have a complication. What separates experienced, skilled surgeons from the others is that these surgeons will generally have minor complications, and will know how to effectively and efficiently treat them.

Unfortunately, in some cases a patient may react to even a minor complication in a way that makes it impossible for the surgeon to help them, or to correct the flaw.

An example of this is a rhinoplasty patient who comes to a four week or 3 month postop appointment and demands a revision. The surgeon, on exam, may agree there is an imperfection or even a functional problem. However, the surgeon cannot make a final decision on the extent of intervention required because the nose is still healing and changing from surgery. He must ask the patient to allow for reassessment at the next visit in one to three months. The patient, meanwhile, perceives this as a "denial of the problem" and immediately consults with another plastic surgeon to get their opinion. This other surgeon has no problem declaring to the patient that not only do they need a revision-but they need a MAJOR revision and it will cost twice as much or even three times as much as the original surgery. The patient then spends more than the original surgery fee in order to correct a problem that either would possibly have improved with time or only required a touch up at minimal to no cost. This can be a disastrous outcome for the patient and a frustrating one for the original doctor. There are certain ethical considerations with regard to the second surgeon but that is whole separate matter.

My advice to all patients is to thoroughly read their preoperative literature and understand that noses can take up to one year to fully "settle down" after surgery. During this time it is important to be patient and follow instructions. Remember, if you choose a board certified, experienced, and reputable facial plastic surgeon, they will stand behind their work and do what they can to make you happy-but doctors must follow certain unwritten rules and protocols. One of these rules involves allowing the nose to settle down before planning additional surgery.

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The practice will be undergoing an expansion in the next months. We are adding approximately 800sf to accomodate the growing medical spa, as well as add additonal exam rooms and a private recovery room. Our surgical patients will have a private entrance and exit for the days following their procedure. We hope to keep the disturbance minimal and do not anticipate any sheduling changes. Thank you for your patience!

For many patients considering facelift surgery or mini facelift at our San Diego office, one of their chief concerns is the recovery period or downtime. By using twilight sedation and performing the procedure in a precise and custom-tailored fashion, we generally limit recovery to one to two weeks. This may vary of course if additional procedures such as eyelid lift or laser resurfacing and fat grafting are added- but even so, most patients fall within that range for facelift recovery.

On the first night after having a facelift at our La Jolla Center, patients often choose to have a professional nursing assistant stay with them. This can be at their own home if they live close by, or at the adjacent Sheraton Hotel. Other patients who have a comfortable or experienced family member or friend and had a relatively short procedure may choose to have this person stay with them instead.

Facelift sutures are removed between 5-7 days after surgery, and at this point swelling and bruising are becoming minimal. Makeup can usually be applied, and patients will start to resume some of their activities.

The important thing to keep in mind with any surgical procedure is that recovery times are estimates- everyone is different, and it is important to feel relaxed during this period, and to be able to take one or two extra days if needed.

Labels: branded facelifts, facelift recovery, facelift san diego, mini facelift

In our San Diego plastic surgery practice we see a lot of patients who are interested in eyelid rejuvenation or blepharoplasty. Often, they are not sure what exactly they don't like about their eyes- only that they look "tired" or "aged."

It is the job of the facial plastic surgeon to make an accurate diagnosis and to also explain to the patient what they see as as the problem and what can be done to correct it.

In the past- plastic surgeons would address most lower eyelids the same way: removal of fat-as well as skin and occasionally muscle, to try to "smooth out" the lower lid area.
Unfortunately, not all eyelids respond well to "removal" of tissue, and in some cases this will create an artificial appearing "hollow" look around the eye.

In many cases, it is helpful to address the groove beneath the lower eyelids: this is called the nasojugal crease. It is formed due to thinning of the skin over the boney orbital rim, and leads to an aged appearance with a resulting shadow over the area.

The nasojugal crease can be addressed with fat grafting, fat repositioning, a midface lift, or with implants.

Fat repositioning can often be the most straightforward approach-as we are able to use tissue that is already there, avoiding liposuction or additional surgery. The fat that is herniated or bulging below the lower eyelashes is manipulated into a new position over the boney orbital rim, and often secured with sutures. The loose skin and muscle layers are then redraped over this, and excess skin and muscle may be removed.

Labels: eyelid lift, fat repositioning, san diego eyelid lift

Finesse Rhinoplasty describes rhinoplasty performed to correct minor imperfections in an otherwise "decent" nose: a small hump, a slightly wide tip, etc. If you think you are a "finesse rhinoplasty" patient there are a few points to consider.

Making an already "good" nose into a "perfect" nose requires a great deal of experience and skill on the part of the surgeon, as well as attention to detail. Computer imaging is very important in these cases so that you and your surgeon agree on what the goal is- and that it can be accomplished. Indeed- no one can promise you a "perfect" nose-and perhaps there is no such thing. The actual goal is to make the nose "better" or "near perfect" - and to do so without compromising function or long term beauty.

Endonasal or "closed" rhinoplasty can be the preferred approach for patients like this; it allows access to the bridge without compromising supporting structures of the tip of the nose, and thus minimizing the amount of surgery needed for an otherwise attractive part of the nose. Often, finesse rhinoplasty will be combined with a chin implant or neck liposuction in order to create an ideal profile.

As in any cosmetic surgery, both patient and surgeon should weigh risk versus benefit. Patients should examine rhinoplasty before/ after photos of patients with similar noses treated by their surgeon to get an idea of the results they may obtain.

Labels: ethnic rhinoplasty, finesse rhinoplasty, rhinoplasty, rhinoplasty before and after

Botox and Dysport have now been competing head to head on the market for several months, and our San Diego patients have reported good results with the new botox competitor. In our practice, we have found that it takes approximately 3 units of Dysport to every 1 unit of Botox to achieve comparable results. Since there are 300 units in a bottle of dysport and 100 units in a bottle of botox, ounce for ounce they are pretty much the same.

For patients it is important to understand that $4/unit for Dysport is the same as $12/unit for botox- simply multiply by 3 to get the equivalent value.


Overall, having two competing products that both work means lower prices and that is what we have seen. Patients should keep their eyes peeled for specials on either product at our San Diego Face medical spa.


Several of my patients who reported that their botox has not been lasting as long as when they first starting using it have switched to dysport, to see if they can get more "bang for the buck." We will keep you posted on these results...

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Active FX and Total FX are two of our most popular San Diego skin rejuvenation procedures. The reasons for this are that these procedures are quick, involve minimal downtime (generally one week at the most) and are effective. Patients achieve often dramatic improvement in wrinkles, loose skin around the cheeks, eyes, and jowls, and acne scars. Despite these great results, it is important for patients to understand that great looking skin requires maintenance. If bad habits resume after your laser skin resurfacing treatment, the brown spots, wrinkles, and crepey skin will also return.

Most of our patients pre-treat their skin with retinol and hydroquinone based products as recommended by our aestheticians. Medical grade products have a higher concentration than regularly found in the drug store, and act to inhibit hyperpigmentation (dark spots) and also allow a deeper, more effective penetration of the laser.

In addition to pre-treatment, we recommend avoiding direct sun exposure and using a high quality sunscreen with UV-a and UV-b protection.

Approximately one to two weeks following Active FX, patients are generally ready to resume their skin care, which at this time can be re-tailored to their current skin condition. The goal at this point is to maintain the result of the laser treatment, and also to build upon that with even more improvement over time. Having a great team of aestheticians and an aesthetic RN allows us partner with our patients for long term great looking skin!

Labels: active fx, laser resurfacing san diego, laser skin resurfacing, medical spa, skin care after laser