Surgery & Treatment FAQs

Rhinoplasty

After rhinoplasty surgery, you will likely want to take about a week off of work or school. While you may not be in a lot of pain, it is better to have time off from stressful activities or anything that would require you to be present in person. You can expect to have anywhere from one to three days of pain that can require narcotic medication. Towards the end of the week, you will notice more stuffiness and nasal congestion, possibly some facial pressure. At one week, the tape, cast, and stitches (if present) will come out. Bruising at this point is on its way out and has started to transition from purple to green to yellow, and is easy to cover with makeup. Total bruising usually lasts from 7 to 10 days in most patients. Swelling at the end of one week is manageable, and you will likely be presentable depending on who you’re out with. We recommend two weeks before lunch with friends and 3 to 4 weeks for a more demanding social situation in which all eyes are on you. This could mean a dinner party or an event where you’re giving a speech or are the guest of honor. Swelling will continue to decrease and will be approximately 80% resolved by six months. All of this can vary based on the patient, the thickness of the skin, and what procedure was exactly performed. If you have the luxury of working remotely, this may help with logistics during the post-op period.

Tip Stitch® Rhinoplasty

The Tip Stitch® Rhinoplasty is a minimally invasive rhinoplasty that’s performed under local anesthesia with very little downtime. Patients are awake during the whole procedure, which lasts approximately one hour or less. Patients go home immediately after the procedure with their nose taped. There is little pain medication requirement, as this is a focused or limited surgery. Patients often do well with just Tylenol and Advil. Patients experience almost no breathing issues, and the swelling is not nearly as dramatic as a full surgery. Patients typically return to work the next day and can return to their social life immediately. There are no sutures that need to be removed, and the result is subtle but visible immediately.

Facelift

A facelift procedure typically has one week of downtime where you will want to lay low and avoid any significant social interaction. During this week, you will look swollen and bruised; however, you may not be terribly uncomfortable. Most of the discomfort is in the first one to two days and manageable with pain medication. At one week, all of the stitches are removed, and there is some residual bruising and swelling, which will fade out by roughly 2 weeks in most patients. By approximately 3 to 4 weeks, you can expect to look quite presentable, and some of the residual swelling in the skin may even enhance the appearance of fine lines and wrinkles that were there before.

Blepharoplasty

Eye surgery can be broken down into upper versus lower eyelids. The upper eyelid excess skin can be removed in a local procedure, awake in the office, in approximately one hour. Patients can go home immediately after, and sutures come out at one week. Typically, there’s some bruising that lasts about one week that can easily be covered with sunglasses. Patients should not experience excessive pain and generally do well with just Tylenol.

If lower eyelid surgery is added, then some form of sedation or general anesthesia may be required. This means that you will need an escort to take you home. However, the recovery is not much more involved than an upper eye surgery and generally has the same bruising with a little more swelling of the lower lids. Patients do well with wearing sunglasses the first week after surgery.

Brow lift

In my practice, I perform endoscopic brow lift surgeries, which I think is the most natural approach to elevating and stabilizing the brow. This surgery is typically performed with twilight sedation or general anesthesia and can be combined with other procedures. Patients typically require some pain medication for 2 to 3 days and will experience some bruising and swelling around their eyelids, most of which resolves in 7 to 10 days.

Buccal fat reduction

Buccal fat reduction can be performed with general anesthesia or completely awake with numbing injections in the office. The procedure typically takes about 45 minutes, and patients go home after. There are no stitches that need to come out, only dissolvable stitches inside the mouth. There can be some swelling and soreness of the cheek, which often is unnoticeable as fat has already been removed from the area. Patients are typically instructed to have soft foods for approximately 3 to 5 days. Because the swelling replaces the space that the fat was removed from, the results sometimes take two months to be fully visible. It is important to know that selecting the right patient for this is important to avoid over-slimming the face as the patient ages. In the right patient, this is a very nice procedure to contour the cheek and slim out the jawline.

Submental liposuction

This procedure is performed either awake with numbing injections or with sedation or general anesthesia depending on patient preference. Extra fat that’s located just underneath the skin is removed using a suction cannula. After the procedure, the patient’s face is wrapped for 24 hours to ensure compression and prevent fluid accumulation. After 24 hours, we recommend patients wear a face bra as much as possible over the course of the next week and into two weeks at night. Pain is usually tolerated with light narcotics for the first day or two, and often patients will only take Tylenol. The results are noticeable immediately; however, some of it gets obscured with swelling in the first week. You can expect the neck to be bruised for 7 to 10 days. Patients usually do well with wearing a shawl or scarf to cover. Unlike larger surgeries, patients will not feel immobilized and are free to do most of their daily activities. Patients may return to light exercise at one week and to heavy lifting after three weeks.

Chin implant

Chin implant may be performed under local anesthesia or twilight sedation or general anesthesia depending on patient preference. I typically use silicone implants for this procedure. I usually do an external approach, meaning there’s a small scar underneath the chin which is hardly visible. The procedure takes a little over an hour, and the patients go home the same day. The chin is taped in place for approximately one week to prevent any movement of the implant and to limit swelling in the area. Patients may feel a sore chin and possibly some numbness and tingling in the area. Usually this resolves after one week and patients return to a normal social life at that time. The swelling will continue to dissipate over the course of the next two months, and the result will continue to get slimmer.

Endoscopic mid-face lift

An endoscopic midface lift is typically performed under twilight or general anesthesia for maximal patient comfort. This technique allows a cheek lift through limited incisions in the scalp hidden behind the hairline. Additional small incisions may be placed inside the mouth for further release of the cheek, allowing for maximal results. Because of the small incisions, there are limited sutures to be removed, making this a nice choice for younger patients who are not quite ready for a full facelift surgery with all of the incisions. Pain is typically controlled with some narcotic medication for one to three days. Obvious swelling and bruising of the cheeks and around the eyes typically resolves at the 7 to 10 day mark.

The cost of rhinoplasty depends on what needs to be performed. A lot of patients don’t know that rhinoplasty is a spectrum and that sometimes only certain parts of the nose may be addressed without interfering with normal and natural anatomy in other parts. Typically in our office, rhinoplasty is in the range of $20 to $40,000, all depending on the level of complexity, time required in anesthesia, and if it is a revision. Tip Stitch® Rhinoplasty is less than half of a rhinoplasty fee.

We have a $250 consultation fee, which is meant for in-person visits. This fee includes approximately 45 minutes with the doctor where we review all of your goals and needs. If appropriate, we will also take photographs and manipulate the images on the computer to show you what certain changes may look like on your own face. It’s best to use your own face for these, as sometimes goal images of celebrities may not align with what is possible for you. This fee also applies to any services that are ultimately booked.

We do offer virtual meet and greet sessions for people out of town who may be interested in understanding whether they are a good fit for the practice before making the commitment of coming in person. Virtual sessions are limited and are not a good replacement for an in-person consultation; however, this is often a good start for many people. We do charge the same $250 consultation fee; however, this will also include an in-person visit in the future should you come.

My office offers a range of surgical and non-surgical options for facial treatments. This includes aging face surgery, such as facelift, eyelid surgery known as blepharoplasty, endoscopic midface lifts, necklift, lip lift surgery, buccal fat reduction, and submental liposuction.

Of course, we also provide rhinoplasty, whether it is open, closed, preservation, or minimally invasive such as the Tip Stitch® Rhinoplasty.

Non-surgically, we offer neurotoxin such as Botox and Dysport, hyaluronic acid fillers such as Restylane and Juvederm, and calcium-based fillers such as Radiesse. Platelet-rich plasma injections for rejuvenation of skin tone and texture. AquaGold treatment for micro-injection of Botox into the dermal layer.

If you have medical health insurance, this can sometimes offset the cost of anything that is medically related to your surgery. Our office is out of network, but can assist you with most major insurance carriers should you have a medical necessity.

During surgical consultation, we take a set of standardized surgical photos with proper lighting, which we then input into the computer and use digital imaging software to show you what the changes you’re seeking might look like on your face. I find this to be extremely useful for understanding what patients may or may not want. Patients also find that it helps them solidify what is actually bothering them. I call these photos morphed photos and use them intraop to guide me in getting as close to what the patient wants as possible. Of course, these photos are limited and are not an exact representation or guarantee of what the result may be. However, I find that they are much more useful than standardized photos of other people or even celebrities that patients often bring in. Referring to the photos during surgery is also a helpful reminder of our conversations in consultation.

The changes that occur during surgery are often long lasting or permanent. This does not mean that they occur in a vacuum. Anytime you perform surgery anywhere on the body, there is some healing and scar tissue that forms internally, which can continue to change over the course of many years. It is very important to use sound surgical techniques to prevent any shifting or changing that is unwanted over that time. It is my philosophy to maintain as much of your natural, healthy anatomy as possible to prevent any unwanted changes and to maintain the spirit of your nose or face. As we age, our face continues to age regardless of whatever surgery has been performed. This means that surrounding structures may look different or lose support over time, which can ultimately affect the way your face looks. A certain amount of maintenance may be required, especially in aging face surgery, to preserve the result and maximize its longevity. Often this is in the form of non-invasive or minimally invasive techniques that can be performed in an office setting.

Surgical results are technically immediate. What obscures the final result initially is some swelling and bruising. Often patients require some time to see the final result of the procedure they had. This, of course, changes depending on what was performed. If a nose is being made smaller or a face is being made tighter, these results are often seen right away. Finer or smaller changes may only become apparent after some of the swelling has settled down after one to three months. It’s important to talk to your surgeon to help guide you through what to expect during the postoperative period. Most surgeries have reasonable downtime, which allows you to return back to your social or work life quicker than you may expect.

It’s often surprising how other people in your life may not notice that you made a change. I find this especially true with rhinoplasty. Of course, it all depends on the procedure and the amount of change that is made. I find that younger patients have a better tolerance for change when it comes to changing the shape of their nose. Patients beyond their 20s may feel more attached to the way they look and may not want a very dramatic change. When it comes to a rhinoplasty, we do have some level of control over how much of a change will be made. Smaller finesse, like changes to the shape of the nose, are often better tolerated with older patients who may not be terribly unhappy with the way their nose currently looks.

For aging face patients seeking facelifts, I recommend considering surgery before major skin sagging occurs. There are a few reasons for this advice. One, it is less of a drastic change all at once when you do the surgery slightly earlier. You’re also younger, so healing may be a little easier, and you get to enjoy the results at a possibly more meaningful time. You also leave room for maintenance treatments, which can prolong the results over time. And finally, if timed properly, there may be the opportunity to have a touchup procedure in the future to renew the result.

In order to schedule surgery, you need to know what times would work best for you as far as taking time off of work or school. Our office requires at least one preoperative visit where we specifically go over what to expect before and after surgery. Logistically, to hold the surgical date, we require a deposit. It is also very important.

Surgery requiring anesthesia has some recommendations before going in. Patients are required to have a medical clearance from their primary care doctor. Patients will also need some bloodwork and, depending on the surgery and age of the patient, some additional testing such as a chest x-ray.

Surgeries performed under local anesthesia do not have as many requirements and often are performed safely without medical clearance. This also makes it a lot easier to schedule surgery, as there isn’t as much coordination necessary.

We recommend patients stay in town approximately one week after surgery requiring anesthesia. Of course, this all is dependent on the type and extent of surgery that you have. Smaller procedures that are performed under local anesthesia may have less strict requirements. One of the other considerations is to avoid flying in an airplane for approximately one week, as the dry recirculated air can cause some bleeding in an unpleasant environment.

After surgery and general anesthesia, a patient is required to have an escort take them home. This could be a friend or family member who can stay with you for at least the first 24 hours after surgery should you have any emergencies. If you don’t have anyone, arrangements can be made to find a nurse or an aide. For some surgeries, it is recommended to have a nurse with you at least for the first one to two days to optimize your recovery.

Our office maintains a list of local hotels that patients may elect to stay at. This is especially applicable to out-of-town patients or even patients who may not want to stay at home during their recovery. One of the hotels is the Mark Hotel on the Upper East Side, which does extend a discount to our patients. The hotels are usually located near the office and also near Lenox Hill Hospital, which allows an added level of safety if there are any problems.

Sometimes patients do better at their own home or staying with friends or family. We do have nurses that are available to come with you wherever you stay, whether that’s at a hotel or a friend or family member’s home. This added help can make recovery easier and less stressful for family members in the immediate postop period.

Immediately after surgery, we typically see patients at one week for evaluation of healing and suture removal. Some surgeries require closer follow up. Facelift surgeries we will see the next morning to do a dressing change. Sometimes with rhinoplasty surgery requiring ear cartilage graft, we will remove a bolster from the ear approximately day two or three. While we don’t routinely use nasal splints, these can be removed after a few days if a patient does not feel comfortable with them.

After the first postop visit, the relationship does not stop. We keep close contact with our patients for the first year after surgery. Typically, this means visits at one month, three months, six months, and one year postop. However, these are the minimum, and additional visits are often scheduled to address any patient concerns or simply to help guide patients through the healing process.

In general, we recommend waiting one week before resuming light exercise. This means an elliptical machine or exercise bike on a low setting in order to get the heart rate up. We also recommend waiting 2 to 3 weeks postop before doing any underwater activities or more stressful strenuous lifting, including activities such as Pilates and yoga. For facial surgeries, we often encourage walking and movement as early as the day of surgery. Of course, it’s recommended to have assistance in case you feel lightheaded and uneasy on your feet. We like for patients to move, as it helps prevent blood clotting and other postoperative complications. As healing progresses and patients move onto light exercise, we find that cardio exercise helps mobilize lymphatic drainage and help with some of the swelling.

This is a very common question we get. Planning before a wedding really depends on what the surgery is. For non-surgical treatments such as Botox or fillers, we recommend approximately six weeks before the big day. This allows for possible touchups or corrections of any issues should there be any. It’s also encouraged for patients to have a trial session as early as six months before the injections, to ensure they are exactly what they want.

For a rhinoplasty surgery, I would recommend anywhere from at least 2 to 3 months before a wedding. There is, of course, some variation in this recommendation based on how extensive the surgery is and the natural anatomy of the patient. Patients with thicker skin often require more time for the swelling to subside and for the skin to shrink-wrap around the nasal framework.

The results of injectable treatments in general are reversible. If we use hyaluronic acid fillers, then we can dissolve them with an enzyme that melts the product into water. This can sometimes be targeted with an ultrasound for maximum precision. The effects of neuromodulators such as Botox or Dysport eventually wear off after three months and do not cause long-term changes.

When it comes to surgery, the result is a little bit more final. That being said, there is the possibility of having revision surgery in the future. Unfortunately, this is a reality of any rhinoplasty surgery. There is a small percentage of patients who may not be happy with the final result and will seek additional changes. Most of the time, this is a small tweak that can be addressed with some injections or even a minimal surgery. If the results are unsatisfactory after one year, then a revision surgery may be possible. This all depends on each patient situation.

In aging face surgery, typically skin and fat is draped or removed, and getting your face back to exactly what it was may not be possible. This is why we recommend good communication with our patients over the course of multiple consultations. It is also important to have a good surgical plan prior to going into surgery.

With regards to the Tip Stitch® Rhinoplasty, because of the limited nature of the procedure, it may be possible to release some of the results in the early postoperative period should you not like the change. Additionally, if revision surgery is required, the extent of scarring is minimal because of the limited extent of surgery.

If you have difficulty with breathing through your nose, it is best to discuss this prior to surgery so that we can identify what is causing it and target it during the surgery. In general, nasal breathing does not have to be affected when making changes to the nasal shape. Of course, if you’re having a rhinoplasty, the best time to address your nasal breathing would be during surgery. Often times we use cartilage from the nose to make changes to the external shape. This could potentially improve breathing if there was some physical obstruction caused by the cartilage. During rhinoplasty surgery, I like to restore a lot of the natural anatomy to prevent any loss of support or potential difficulties in breathing in the future. Very early rhinoplasties were more reductive in nature and involved cutting a lot of the support structures of the nose without much restoration. While they may look beautiful early on, long-term this could result in some collapse and obstruction.

After a rhinoplasty surgery, you can expect some bruising and swelling. The most obnoxious bruising and swelling typically resolves after 7 to 10 days, after which most patients feel very comfortable going out to lunch with friends and resuming some of their less stressful social activities. The swelling continues to go down for approximately one year.

For the Tip Stitch® Rhinoplasty, bruising and swelling is extremely limited. Most patients do not have any bruising. While there is some swelling, it contributes to the projection of the nose in the immediate post-op period and may enhance the appearance of the result. The downtime of this procedure is extremely low, with most patients returning to work as early as the next day. Compared to a traditional rhinoplasty, this is a very limited approach that will not be as noticeable in the post-op period.

We typically recommend wearing tape on the nose for the first week after surgery. This is typically placed by us at the end of surgery and does not need to be touched or manipulated. Sometimes with thicker skin patients, we will recommend taping the nose for longer; however, that’s not a guarantee or a hard requirement.

After a rhinoplasty, we typically cover the nose with tape and a cast, which is all removed at one week. Patients will wear some gauze under their nose to catch any bleeding, but that is more to protect clothing. It’s best to keep the tape on the nose dry so that the cast does not fall off earlier than intended. Other than that, there really is no dressing for the nose. Patients are encouraged to use their nose the first day to two days after surgery to minimize bruising.

For Tip Stitch® Rhinoplasty, we replace tape at the end of the procedure, which we encourage patients to keep on for up to a week if possible. Given this procedure is more limited than a traditional rhinoplasty, we do have some leeway for removing and replacing the tape to attend work or social events. We also recommend taping at night for an additional one to two weeks to help maintain the result as it heals.

For facelift surgeries, we wrap the face in a cotton wrap the first night. This then gets replaced by a face bra the next day. We encourage patients to wear a face bra for the first week as much as possible, and up to an additional two weeks at night. Patients find that the gentle compression is actually more comfortable than wearing nothing. We like to maintain some gentle pressure to help ensure the skin heals down without any fluid accumulation.

Surgeries requiring anesthesia are typically booked approximately two months in advance. This allows us to have a comfortable amount of time for obtaining a medical clearance and, if necessary, an insurance prior authorization.

We do have a certified operating room on site in our office, which allows for very flexible and comfortable scheduling options.

It is essential to plan, in time, the sequence of surgeries or procedures to get the most out of them. With regards to aging face surgery, I recommend starting with a surgical option if you are an appropriate candidate before progressing to some maintenance therapies such as energy-based devices. This creates a larger correction upfront, which can then be enhanced or maintained with less invasive procedures as time goes on. If somebody starts with energy-based treatments for skin tightening, they often spend a lot of time, energy, and money on a less robust result and ultimately progress to surgery anyway. In surgery after these treatments, the skin can be more scarred, and the surgery can be more challenging, almost as if it were a revision surgery. For this reason, it often makes sense to perform the larger change first and to save resources for maintenance as time goes on.

Another consideration is time under anesthesia. It’s best to discuss with your surgeon how much surgery is safe and appropriate to undergo at one time given your medical history. Also, it may be best to stage surgeries so that they don’t take unreasonably long to perform together.

We are not open on weekends aside from special circumstances or emergencies. We do our best to accommodate patients as much as possible and their busy schedules. We do offer early evening appointments to help with patients who may be at work during business hours.