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Facial Surgery Palo Alto


A facelift refers to the correction of the neck, jowls, cheeks, nasolabial folds and the malar/eyelid junction areas. The procedure is designed to reverse the effects of aging caused by gravity, fat loss and sun damage. This is achieved by addressing the skin, fat and muscle in such a way that results in a more youthful, healthy, natural and non- surgical appearance. My surgical technique has evolved over the years. The modern standard facelift is bidirectional. The skin is moved back and underlying connective tissues are shifted upward.

Learn more about facelift surgery.


There are many different procedures designed to improve the appearance of the eyelids and the orbital area around the eyes. A list of improvements might include; giving the upper eyelids a more open look, altering somewhat the native ethnicity of the eyelid when requested, or diminishing the puffiness, lining or hollowness of the lower eyelids. Eyelid surgery may involve either lid or both upper and lower lids. With time, upper eyelids become saggy with excess lax skin, redundant or lax muscle and excess fat. Hooding or heaviness of the upper eyelid occurs on a congenital basis or is acquired with age. This heaviness often results in a tired or sleepy appearance. Cosmetic improvement is not the only reason to consider an upper blepharoplasty. Function can also be a factor. Vision can be compromised when the upper lid droops (ptosis) and partially covers the pupil.

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Brow Lift

In conjunction with a facelift, often included is forehead surgery (forehead / frown procedure) to elevate drooping brows, to give an open, alert upper eyelid, and to soften frown lines. Advances in forehead surgery include the use of mini incision endoscopic surgery, employment of “detection defying” hairline technique, and improved versions of the coronal technique. Because each approach has merit, the important issue is to match each patient with the technique that is best for him / her. A hairline incision approach works well if the patient has a high forehead with receding hair.

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Rhinoplasty or Nose Reshaping

Rhinoplasty is the term given for the cosmetic surgical correction of the nose. The goal of cosmetic nasal surgery is to establish a pleasing profile with facial harmony. Attention is drawn away from the nose, not to it. Females usually attain their full facial growth potential around 14 to 15 years. Males are usually candidates for nasal surgery from 15 to 16 years and sometimes older.

There are two different approaches to performing nasal surgery. One is a closed method that is reserved for minor corrections, such as shaving down dorsal humps or narrowing nasal tips. The incision can be made inside the nose. For more challenging corrections, the surgeon may prefer to use the open technique to give more visibility to the surgeon. The open method has a small incision at the base of the nose that is well camouflaged.

Noses differ a great deal and individual assessment is very important. Some changes may include: straightening a crooked nose, making a very large nose smaller, increasing certain dimensions of a nose perceived as too small, shaving down a dorsal hump, building a stronger bridge, getting a better tip projection, making a tip narrower or shaped better, or making the nostril flares smaller. On occasion, narrowing wide nasal bones might even be indicated. The surgeon must listen very carefully to the patient’s desires and assess his/her candidacy and realistic expectations. Candidacy depends on anatomical facts plus the patient’s desires. A careful discussion with photography is informative and necessary. The end result should be very natural and non-surgical in appearance.

Function or airways must always be considered. Natural breathing is critical of course to everyone. Airway problems are often corrected simultaneously with a rhinoplasty procedure. A beautiful nose that doesn’t breathe very well is not a successful endpoint. So it’s all about aesthetics and function. Breathing difficulties that developed by nature or trauma can be improved by correcting the airway obstructions or deformities. The latter correction is often referred to as a septoplasty. Other medically necessary corrections can involve turbinate reductions or outfractures, which we often group into the septoplasty category. Rhinoplasties are not usually covered by insurance. Septoplasties can involve insurance participation.

Probably 99% of the time, the patient’s desires and what is possible and appropriate are in good accord. Occasionally however, a patient may have unrealistic expectations, so careful discussion is important. This is particularly critical regarding nasal surgery. I rarely use computer imaging to suggest a result. This only indicates what a computer can do and may be way off a realistic surgical endpoint. I’d rather use photographs taken of the patient to review together and discuss what changes are possible and desirable. The patient is then given the opportunity to review work that I have already performed on similar noses. One of the wonders of practice in the San Francisco Bay Area is the delightful diversity of our patients. I have done nasal surgery on patients with worldwide heritage (Asian, European, Middle Eastern, African, East Asian Indian, Native American and Hispanic). All do well and merit very individual attention.

A rhinoplasty can be done with conscious sedation or asleep. Although I.V. sedation is a possibility, it is always nice to be asleep for both comfort and total safety. An M.D. anesthesiologist enhances safety and comfort.

We make every effort to assure comfort and gentleness. Surgery is usually done on an “out patient” basis where the patient returns home to recuperate. There is no nasal packing unless extensive airway work was performed. A small splint may be applied for 48 hours or so to protect the nose. Patients return to work, school or play in 4-7 days. Full recovery takes 6-12 months or longer depending on the procedure. Most patients look fine in 10 days, but resolution of swelling takes longer. Sutures are usually the dissolving type, but occasionally some need to be removed.

Learn more about rhinoplasty.

Cosmetic Surgery of the Lips

Lip and Mouth concerns may be congenitally based or an age acquired problem. If lips are excessively large or asymmetric, they can be reduced or adjusted. If lips are thin and deficient, they can be made fuller. Lip enhancement can be accomplished with fat transplantation which can be of long term or semi permanent durability.

Learn more about cosmetic lip surgery.

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