Facial Sculpting, Plastic Surgery New York NY

On this page: Putting Your Best Face Forward | Reflection & Realism | Top 5 Cosmetic Surgical Procedures for 2009

Putting Your Best Face Forward

We believe that it is natural to want to look your best. It is our goal at Laser & Cosmetic Surgery Specialists, PC to help our patients feel revitalized and more confident through our specialized services. This is why people who consult with Dr. Rubinstein receive individualized recommendations and care that are based on their needs, goals, and lifestyles. Their sense of wellbeing and their desire to project a specific image to the world are of utmost concern to him, and to everyone who works at the Center. Countless patients have already benefited from his expert touch.

Dr. Rubinstein's specialty is facial plastic surgery, hence his patients often have a number of options available to them with regards to improving the different areas of the face. In many situations, should it be in the patient's best interest, less invasive procedures can be done with very dramatic results. In any case, because of our central Hudson Valley location, our Center is an ideal place for surgery and spa services that provides a relaxing recovery setting away from busy Manhattan.

Our Manhattan plastic surgery services include rhinoplasty, otoplasty, blepharoplasty, facial implants, smart liposuction, endoscopic plastic surgery, brow & forehead lifts, face lifts, various laser procedures and more. Certified by the American Board of Facial Plastic Surgery in New York, Dr. Rubinstein should be your New York City plastic surgery solution.

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Reflection and Realism Ensure Benefits Beyond the Obvious

The number one reason people seek cosmetic surgery is to increase their self-confidence. They want to feel better about themselves; whether this means rejuvenation techniques or improving a physical feature they have not been happy with for years. With the proper motivations and realistic expectations, patients reap additional benefits at home, at the office, with family, and with friends.

Reflection

Before you schedule your consultation appointment, take the time to consider the real reasons you are seeking a change. Why do you want this procedure? Make sure you can articulate your answer; this will probably be the first question your facial plastic surgeon asks you in your initial meeting. Healthy reason may include the desire to look as young as you feel or to increase your self-confidence. Unhealthy reasons, such as trying to achieve the same face as someone in Hollywood or to please your spouse, are inappropriate motivations for surgery. Cosmetic surgery is not a cure-all. It will not help you overcome personal difficulty or secure you a better job. Motivation for having a procedure will vary from one person to another; however, your physician will ensure that you are having surgery for the right reasons and with the right attitude before recommending any procedure.

Realistically, facial plastic surgery will not provide perfection. In fact, if you choose a minimally invasive technique, the results will be subtle, with little or no disruption to your normal activities. Conversely, if you decide to have cosmetic surgery, your recovery will depend on the extent of the procedure with an average of two weeks. Then, you still may need additional time for the swelling to go down before you see the desired results. It is important to remember that upon waking up in the recovery room, it will not instantly be a new you.

Facial plastic surgery does have noticeable and sometimes dramatic benefits; however, you should expect realistic results. It will increase your self-esteem and self-image. This will in turn affect how you come across to people—confident and self-assured—and the impressions you make. Because you feel more confident, you may decide to take on new tasks at work or become more adventurous in social situations. The side benefits to your inner strength will spill into all areas of your life.

Share with your close family and friends why you want a treatment or to undergo facial plastic surgery and what you expect will be the outcome. Be prepared to discuss this with your facial plastic surgeon as you take the next step in boosting your self-confidence.

click here for top 5 minimally invasive procedures

Top 5 cosmetic surgical procedures for 2009 ASPS survey

1. Breast Augmentation (289,000)

    a. Down 6 % vs. 2008;  up 36 % vs. 2000
    b. Rarely covered by insurance

2. Nose Reshaping –Rhinoplasty (256,000)
    a. Down 6 % vs. 2008 and down 34 % vs. 2000
    b. The surgery involves reshaping the nasal tip and or bridge of the nose.
      i. The surgical approach can be open (small external incision) or closed (all incisions inside the nose).
      ii. Surgery time about 1 to 3 hours depending on the complexity of the problem.
     iii. Downtime averages 1 week, but most patients benefit up to 2 weeks off from work or school..
    iv. Surgery is most commonly performed in one's late teens and 20's and can have a significant impact on one's attractiveness by creating a more balanced facial profile and appearance enhancing self esteem and provide a competitive edge in today's job market.
    c. Cost: Average cost $ 4216.  Cost varies by complexity of the surgery.  Revision surgery, i.e. correcting other surgeon's errors often costs a lot more than the original surgery.  Rarely covered by insurance.  If part of the surgery has to be performed to address issues with breathing, that portion can sometimes be covered by insurance.
    d. Surgical risks
     i. Over operated nose.  i.e. Michael Jackson.  Patients have the biggest fear that they will look unnatural.  This stems from how the surgery was taught and performed in the 1960's through the 1980's.  Too much of the normal supporting cartilage in the nasal tip and bony bridge was removed in an effort to create a more sculpted nose.  The results looked good for about 6 to 12 months but as the forces of skin contracture set in, there was little support, nose would collapse inward, leaving an operated on, unnatural appearance with blockage in breathing.  This would often require revision surgery to repair the defect.  Today, the technique has evolved to one where less is more- less cartilage is removed and the refinement is achieved by reshaping the cartilage and bone rather than removing it.  This approach is more difficult to master and is often not utilized by plastic surgeons who still resort to the older reductive techniques due to their ease and speed of performance. I always tell my patients it's easier to get it right the first time than have to go in and correct someone else's mistakes.
    ii. Nasal blockage.  This can occur most commonly by either missing underlying blockage in the nose such as from a deviated septum.  The other reason- doing too much surgery is a more difficult problem to correct and often requires multiple surgeries.  There has been a trend for nasal reshaping surgery to be performed for these two reasons by plastic surgeons that are dual certified- in both Otolaryngology (ENT) and Facial plastic surgery.  Their unique backgrounds in both fields gives them the added advantage in being able to make the person look better and breath better.
    iii. Bleeding.  A little bleeding is normal.  Hemorrhage is a rare complication.  It is for this reason that patients often hear about the dreaded nasal packing (tampons) that have to be placed inside the nose and removed a few days post operatively.  Newer plastic surgery techniques, especially have allowed some rhinoplasty surgeons to perform less traumatic surgery and create far less bruising, bleeding and swelling- and no need for packing!
    e. Alternatives to surgery.
    i. Injectable nose job (rhinoplasty).  More patients are opting for treating imperfections with filler injections.  Results can last on average 1 year.  The main advantage is that there is no downtime, minimal risk, and minimal cost.  This is most commonly done to make further improvements on already operated noses that would benefit from minor touch ups where blockage to breathing is not an issue.  Results can be quite dramatic.
    ii. This trend has been fueled in part by the economic environment. 

3. Eye lid surgery (Blepharoplasty) – 203,000
    a. Trends: down 8 % vs. 2008; down 38 % vs. 2009
     i. Due to poor economy.
     ii. As well as alternatives to surgery such as filler injections and laser treatments.
    iii. Despite this downward trend, eye lid surgery is still by far the most common rejuvenation procedure- far greater than face lifts,  brow lifts and neck lifts.  The eye lid skin is very delicate and tends to age the fastest.  The eyes are also the most visible and corrected tired puffy eyes often has a far greater impact than a sagging neck.   The trend has been to address changes to facial aging as they become visible rather than waiting to address all the changes at once i.e. eye lift surgeries in our 40's rather than waiting for our 50's and 60's when a face lift is also often needed.
    b. Surgical technique & recovery.
     i. Older method of the lower eye lids involve external skin incisions to remove excess skin and fat, which can leave a visible scar as well as complications in healing.  Sometimes this is the best approach inaging of the eye lids. i
    ii. New methods involve treating lower lid puffiness by removing excess fat from the lower lids via a “transconjunctival approach”- making a small incision behind the eye lid in the mucous membranes without a skin incision.  This is often a stitch less approach.  Excess skin is not excised, but rather smoothed out with lasers.  There is less risk and recovery is often quicker.
    iii. The trend today is to do less, as it is now believed that much of the aging changes to our eyelids are not caused by excess skin of the upper and lower eye lids or excess fat, but rather too lit volume around the perceived excess that traditionally was removed.  When all the “excessive” skin and fat was removed, it often left an overly sculpted, hollow appearance which is not youthful.  These days fillers and or fat can be injected around the eye lid bags rather than removing them.  By lifting droopy eye brows, the relative excess skin in the upper lids doesn't have to be removed or not as much has to be removed.  This can often be accomplished with Botox and filler injections obviating the need for surgery.  It turns out less is more in restoring more youthful eye lids.  It is often not easy to convince patients that adding volume to their face will rejuvenate them.  I find that having patients bring in photos of themselves in their youth helps illustrate how they had full facial features in youth and how they have gradually lost facial volume over time.
    iv. Results can last on average 10 years or more.
    c. Cost.  Average $ 2809
     i. Cost depends on whether just the upper or lower eye lids are being treated, or both. If fat or fillers are injected at the time of surgery for a more balanced approach, the cost will be greater- but well worth the added expense.
     ii. Revision surgery often costs more.
    d. Complications
     i. Dry eyes: removal of too much skin can result in the inability to close the eye lid resulting in dry eyes.
    ii. Eye lid malposition:  The lower eye lids can end up being bowed downwards after surgery.  This is more commonly seen when external lower eye lid incisions are made to remove excess skin creating a weakening in the lid.  Removing excess lower lid skin can also cause this problem.
   iii. Visible scars: these can be avoided by using meticulous plastic surgery techniques as well as avoiding external incisions when possible.
    iv. Hollowness: when too much upper eye lid skin is removed, an overly sculpted cadaveric look can result.  This is no longer considered youthful.  This can also happen with excess fat removal of the lower eye lids.  A better approach is to add volume where needed and remove only the true excess in fat.
    e. Alternatives to surgery- big reason for decline in surgical eye lifts.
    i. Injectable eye lifts using fillers and Botox injections
   ii. Laser resurfacing
  iii. Radiofrequency resurfacing

4. Liposuction Surgery – 198,000 performed 2009
    a. Trends: down 19% vs. 2008; down 44 % vs. 2000
     i. Due to economy
    ii. As well as non surgical methods to remove excess fat such as radiofrequency treatments to melt fat i.e. Thermage, ultrasound therapy, and mesotherapy.
    b. Advances in techniques
     i. The tumescent technique, where water is injected into the areas to be suctioned, has resulted in increased safety, less pain, less bruising, and shorter recovery time without the need for anesthesia.
     ii. Laser assisted liposuction is the newest trend.  One of the drawbacks to liposuction in older patients over 40 was what to do with the excess skin that didn't contract after fat was removed leaving sagging in the overlying skin.  Using laser to remove the fat has been shown to tight the skin addressing this problem in the appropriate patients.i
    iii. Despite these advances, liposuction may still need to be combined with face lifts, neck lifts, and body lifts such as tummy tucks where too much redundant skin is left behind and laser or other non surgical modalities will not suffice to tighten and shrink the excess skin.
    iv. Results can last for years but are not permanent as weight gain will result in volume in gain in areas of residual normal fat.
    c. Cost: average $ 2769.  The areas suctioned the higher the cost.
    d. Complications
    i. The most common complication is uneven fat removal.  Touch up surgery can easily correct this.
   ii. A more serious complication is when too much fat is removed.  This may have to be corrected by injecting fat back into those areas- called fat transfer.
  iii. Anesthesia complications/cardiac complications are very uncommon, especially with the advent of tumescent liposuction as well as limiting the total volume of fat removed in one treatment session to safe levels.

5. Tummy Tuck (115,000 2009)
    a. Trends: down 5 % for 2009 vs. 2008 but up 84% since 2000
     i. The recent downturn due to economy.
    ii. Overall trend is up as more women turn to surgery to get back into pre pregnancy shape.  The “mommy makeovers” are increasingly popular.
    b. Cost: ave $ 4936
    c. Risks: visible scars, poorly placed incisions, failure to address muscle weakness.
    d. Alternatives: non surgical skin tightening with radio waves i.e. Thermage and laser assisted liposuction.

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