Description:

Description:

Technique: Open Revision Rhinoplasty with Costal Cartilage Grafts
Graft Types: Bilateral Spreader, Columellar Strut, Bilateral Alar Rim, Dorsal Onlay
Graft Source: Costal (Rib) Cartilage

Patient Story

This patient is a retired woman currently living in Georgetown, Texas who was referred to Dr. Weinfeld by another Plastic Surgeon in Round Rock for consideration for Revision Rhinoplasty. This patient suffered significant nasal trauma with a severe nasal fracture (broken nose) in her late teen years. This event had a significant negative impact on her breathing and on the appearance of her nose. In here early twenties she underwent a rhinoplasty which she states worsened her nose leaving her with very small nostrils that are difficult to pass air through, a very short nose, and an over rotated tip. She desired a revision rhinoplasty to improve the appearance and function of her nose. This was a very emotional issue for her and in particular she stated that she wanted her nose to have the appearance that it did prior to the injury and the first rhinoplasty. In particular she wanted a slight convexity to the dorsum (i.e. a slight hump) which was consistent with the character of her nose as she remembered it. She underwent the complex revision rhinoplasty using rib cartilage some of which was fashioned into a dorsal onlay graft which was essential in the process of restoring dorsal contour and nasal length. She has been very happy with the transformation in the appearance of her nose and its function. She is now considering having Dr. Weinfeld perform a facelift.

Description:

Description:

Improvement Focus: Excess upper eyelid skin, cheek decent with jowls, obtuse angle between face and neck with loose skin.

Technique: Cervicofacial Rhytidectomy (Face Lift, Neck Lift), Sub SMAS Dissection / Flap, Platysmaplasty, Upper Lid Blepharoplasty

Patient Story:

This patient is a woman in her early seventies from the Hutto / Round Rock area outside of Austin, Texas.  She was referred to Dr. Weinfeld by and Austin Dermatologist.  The patient has been very happy with her results and was surprised and pleased by the fact that the discomfort was significantly less than she expected.  She only required prescribed medications for discomfort for one day.

Description:

About 7 months following rhinoplasty and chin augmentation with implant.
Notice how on the front view the chin implant provides more support for the lower lip and her mouth. Rhinoplasty surgery (nose job) is often combined with other procedures to improve overall facial balance. These additional procedures include chin augmentation (chin implant), chin reduction (genioplasty), eyelid surgery (blepharoplasty), fat grafting, brow-lift, neck liposuction, and buccal fat reduction.

Description:

Chin augmentation with porous, polyethylene, implant, and submental liposuction

Description:

Early follow-up (2 months) from endoscopic brow lift, upper lid blepharoplasty, lower lid blepharoplasty, and fat grafting. Great combination of procedures for this woman in her early thirties who wants to look more awake and “slow down” the aging process.

The brow lift was what is best described and Turbo Powered Endoscopic Brow Lift. Why turbo powered? First endoscopic brow lifts are performed through small incisions made in the scalp and an endoscope, which is a thin surgical camera, is inserted beneath the skin in order to dissect it down to the brows so that they can be freed and repositioned at a higher location. Most endoscopic brow lifts are done through three such incisions. However the “Turbo Powered” version involves two additional small incisions further off to the side in the scalp part of the temple. When you add these two additional incisions it allows you to dissect further down on the face down to the cheekbones and allows you to reposition and elevate the skin surrounding the lateral portion of the eyelid and Peri orbital region. By doing so you’re able to elevate additional tissues in the temple region and even the upper cheep turning a routine brow lift into what is better described as an upper facelift. This was paired with a very minimal upper lid blepharoplasty to remove any residual excess skin in the upper eyelid to give a really smooth look to the upper eyelids and reduce lateral hooding. It’s important to keep in mind with any upper lid blepharoplasty that there needs to be some residual skin left behind in order to prevent an issue where the eyelids wont close. A transconjunctival lower lid blepharoplasty is where the incision to address the lower eyelids performed on the inside of the lower eyelid. This allows you to liberate and reposition the fat pad in the lower eyelid to drape it over the bone and blend the lid cheek junction. This can help reduce the tear trough and create a smooth transition from the lower eyelid to the upper cheek that mimics the anatomy seen in much younger people. When we look at these photos we must bear in mind that lower eyelid procedures often have a longer recovery time as it relates to swelling. For that reason her lower eyelids do you look somewhat puffy but it is a good demonstration of a reduced tear trough. Fat grafting was performed in the upper cheek to further reduce the tear trough and to further blend the lead cheek junction.

Description:

Description:

Improvement Focus: Dorsal Hump / Bump, Tip Shape, Uneven Dorsal Aesthetic Lines

Technique: Open Rhinoplasty

Graft Types: Bilateral Spreader, Columellar Strut, Sub-Domal, Bilateral Alar Rim

Graft Source: Septal Cartilage

Patient Story: This patient had injured his nose playing soccer. He wanted cosmetic improvements to his nose and also needed to breathe more efficiently through his nose. He underwent surgery where both issues were addressed.

Description:

Liposuction and T-Z plasty in 65 year old man

Description:

Description:

Special Note: Cleft Rhinoplasty
Technique:
Stage 1 – Iliac Crest Bone Graft to Pyriform Aperture and Skin Graft to lining of Left Ala (nostril)
Grafts – Pyriform Aperture, Alar Lining
Source – Iliac Crest
Stage 2 – Revision Rhinoplasty with Costal (Rib) Graft
Graft Types – Bilateral Spreader, Columellar Strut , Lower Lateral Crus Batten, Bilateral Alar Rim
Graft Source – Costal Cartilage (Rib)

Patient Story

This patient is a mid-Forties school teacher from Austin Texas who was referred to Dr. Weinfeld by an ENT colleague who refers Dr. Weinfeld patients with complex nasal breathing problems and rhinoplasty challenges. She had difficulty breasting due to collapse of the left side of her nose and septal deviation and desired improvement in the appearance. Her case was complex due to the face that she had a nasal deformity related to her past history of cleft lip and had a prior rhinoplasty by another Plastic Surgeon. Owing to his experience in advanced pediatric and adolescent cleft nose surgery at Dell Children’s Medical Center, Dr. Weinfeld felt that the best a way to achieve the patient’s goals would involve a two stage approach. In the first stage an iliac crest bone graft placed at the left side of the pyriform aperture was used to support the left ala bringing it more forward and a skin graft was placed in the left ala lining to help release the scarred and contracted tissues. In the second stage the patient’s rib own cartilage was used in an open revision rhinoplasty to rebuild the structure of the nose improving the function and appearance. Of special note to restore more normal contours to the cleft (left) side a lower lateral crus batten graft constructed from rib cartilage was used to strengthen the native cartilage that was abnormal due to the cleft and damaged due to the prior rhinoplasty. She has been very happy with her results.

Description:

Description:

Improvement Focus:  Excess upper eyelid skin, lower eyelid bags, cheek decent with jowls, obtuse angle between face and neck with loose skin.

Technique: Cervicofacial Rhytidectomy (Face Lift, Neck Lift), Sub SMAS Dissection and Flap, Platysmaplasty, Upper and Lower Lid Blepharoplasty

Patient Story:

This patient is a woman in her late fifties who is the wife of a senior hospital administrator in Austin, Texas.  She was interested in comprehensive cosmetic facial rejuvenation.  Following her consultation with Plastic Surgeon Dr. Weinfeld, she felt the best approach for her was two-stage process.  First she underwent an upper and lower blepharoplasty.  The lower blepharoplasty was performed with a subciliary approach permitting septal reset and blending of lid cheek junction.  This advanced approach provides more than just lower lid smoothing.  It permits elevation of the upper cheek, softening of the nasojugal crease, and a decreased vertical dimension of the lower eyelid – all features associated with youth and attractiveness.  Following three months she underwent and facelift and necklift.  In the majority of patients, but especially in patients with full faces and necks, Dr. Weinfeld choices to use direct sculpting of the lower face and neck fat instead of using liposuction which can be less  precise.  The powerful effect of direct sculpting can be seen in her post-operative photos.

Description:

Description:

Technique: Open Rhinoplasty

Graft Types: Bilateral Spreader, Columellar Strut, Sub-Domal, Bilateral Alar Rim

Graft Source: Septal and Costal Cartilage

Patient Story: This patient suffered trauma to her nose and had previously undergone a septoplasty by another surgeon to help improve her breathing. She came to see Dr. Weinfeld due to his experience in complex rhinoplasties in patients have previously undergone septoplasties.