Q&A With Dr. Core

First question is:

“I have a number of friends who have had eyelid surgery that looks very unnatural. How has eyelid surgery changed over the years?”

There have been two major changes in eyelid surgery over the past 10-15 years. The first one is preservation of fat in both upper and lower eyelid region. Both techniques previously involved a removal of fat pads, both in the upper lids and lower lids which often left patients with a hollowed out and rather bizarre appearance. Some well-know celebrities went through this procedure and, in fact, when performed on younger patients, it actually makes them appear older. If one will simply look at the eyes of some of the young women in popular magazines such as Vogue or Glamour, and take a close look at the eyelid area, you will see that there is still fullness and fatty tissue in both the upper and lower lids, especially in the upper lids. The difference between this fat and the fat in the aging lid is that this fat has good support and structure and this brings us to the second change in eyelid surgery over the last 10-15 years and that is the concept of support. Previous eyelid techniques involved excision and removal of “excess skin”. In actuality while excess skin can be present in some patients, most of the time the skin is not excess, it is just relaxed and unsupported and in addition has photo aged in such that it has fine lines and wrinkles. The modern technique for making eyelids look more youthful is to provide more support, both for the underlying fatty tissue as well as the overlying skin. The main component that provides this support is fascia and muscle. Unfortunately, fascia in the eyelid areas also is attenuated that operations to try to support this layer has not been very successful. On the other hand, muscle support techniques have been successful and actually were reported as early as 1972 by Dr. Ulrich Hinderer. While other people have advocated various forms of muscle support over the years, they have never became very popular with plastic surgeons probably because they were poorly understood and the techniques for providing muscle support were not very sophisticated. Dr. Core has over the past ten years developed his own technique for muscle support, which can be varied depending on the needs of the patients and is applicable mostly in  lower eyelid surgery. In upper lid surgery the more natural appearance comes from the formation of a proper crease in the upper lid with fat preservation. In the lower lid, the best results come from fat preservation, possible fat redistributation, as well as a support of the muscular sling over the lower eyelid. The overlying skin is then treated either with simple tightening (if true redundancy is present) or with resurfacing if the problem is fine lines and wrinkles. Second question is:

“I underwent a rhinoplasty several years ago and when I breathe the sides of my nose collapse making it difficult for me to breathe in forcibly. What can be done to correct this?”

This unfortunately is an all too common condition with older style rhinoplasties wherein the lower lateral cartilages were over resected. This was a very popular style rhinoplasty in the 60’s and 70’s and in some cases even into the 80’s, depending on the age and level of experience of the surgeon. Rhinoplasty styles have changed over the last ten years where more cartilage is preserved and left intact for structural support. However, in your case the lower lateral cartilages have been over resected and therefore can no longer support the airways especially during forceful inspiration. However, the good news is that this can be corrected without major surgery. In many cases a small portion of cartilage can be taken from the septum and used as an internal graft putting incisions inside the nose which helps support the lower outer sides of the nose. Recovery from this procedure is very rapid and there are no splints or packing necessary.