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Ask Dr. Stella

Below are questions various readers have sent in to Seattle facial plastic surgery specialist Dr. Stella Desyatnikova. To ask your own question, please contact us.

Rhinoplasty Questions

Q: Hello Dr. Stella,
I have been having breathing problems for some time and I also would like the bump taken off my nose. I am nervous to have this procedure done and was wondering what I should be looking for when choosing a surgeon. I also wonder if it is possible to know what my nose may look like after surgery. Thank you,

– Cathy, Redmond, WA

A: Dear Cathy,
Taking the bump off somebody's nose is usually not as easy as it sounds. The first step in your quest will be to have a consultation. Facial plastic surgeons are uniquely trained and qualified to perform cosmetic nasal surgery while preserving and improving nasal breathing. At your nose surgery ("nose job") consult in Seattle, we usually take photos for computer imaging. It is an important part of your communication with the surgeon as it enables you to see what the change might do for your look and allows the surgeon to ensure that your expectations are realistic.

– Dr. Stella

Q: Hello Dr. Stella,
I had a rhinoplasty about 3 years ago. I didn't do my homework and ended up with a bad result. I would like to have a revision, but not sure whether it is possible and scared it could turn out even worse. Please advise.

– Amy, Fife, WA

A: Dear Amy,
Rhinoplasty is one of the most complex operations performed by facial plastic surgeons. There is an art and science to it, and some surgeons are better at it than others. Choosing the right surgeon for the secondary procedure is even more important than for the original one. We see many patients who had a less than adequate or satisfactory surgery done elsewhere, and we usually go through an extensive evaluation process with the patient to ensure we can deliver the results that will make them happy. While it is difficult to discuss your case without seeing you, in most cases we can greatly improve the results of the previous bad surgery. I would encourage you to have a consultation to discuss your particular concerns.

– Dr. Stella

Q: Dear Dr. Stella,
I had a Rhinoplasty a few years ago, but have recently noticed that one side of my nose is sunken in and the tip is crooked. What is the reason for this change, and how is it fixed?

– Robert, Seattle, WA

A: Dear Robert,
The healing process after rhinoplasty takes a long time, sometimes years. Even though most of the change is usually noticed in the first couple of months, some residual swelling usually stays for a while, sometimes for a year or longer. During healing, a layer of scar tissue develops under the skin and continues to shrink for many years after. This process may uncover the imperfections of the original operation, or it may just shift the tissues around a bit to cause the change. To fix it, you might need a revision surgery. Sometimes, however, a simple injection nonsurgical rhinoplasty can fix your nose and give you the result you are looking for.

– Dr. Stella

Injectable Fillers Questions

Q: Dear Dr. Stella,
I just turned 50, am newly divorced and I am anxious to get out in the dating scene again. I don't expect to look 30 again but I feel that I always look tired and the skin on my face is drooping. I am overwhelmed by all of the latest products and procedures claiming to "take years off my appearance." Where do I begin if I just want to look more refreshed? I am not opposed to surgery either.

– Mary T., Issaquah, WA

A: Dear Mary,
As you know, 50s are the new 30s. The good news is there are indeed many options, products and procedures that can make you look better, younger, and refreshed. Well applied BOTOX® and Restylane® injections can dramatically improve your appearance. Small surgical procedures, such as a mini facelift or eyelid rejuvenation for the appropriate patient can be done in the office under local anesthesia and produce remarkable results. Make sure your physician is experienced and skilled to address all of your concerns and to perform the procedure. Good luck on the dating scene!

– Dr. Stella

Q: Good Afternoon Dr. Stella,
I saw your advertisements in Seattle Magazine, as well as your e-mail address inviting questions. Here is my question: I am a guy who stays in pretty good shape, eats right, gets plenty of sleep etc...But, there seems to be nothing I can do about my eyes. They appear puffy with dark circles around them. I constantly look "tired" even though I'm not. It makes me look older than I am, and is somewhat frustrating. I've tried various creams and products that promise to improve the look of tired and puffy eyes, but nothing works. Is there a minimally invasive procedure that would help? If so, any idea of the approximate cost and "down time?"

– Lee S., Seattle, WA

A: Dear Lee,
I see many patients with similar concerns. It certainly depends on the patient. Occasionally BOTOX or Restylane injections can make a dramatic difference. At other times, eyelid surgery is the way to go. The costs will vary from a couple hundred dollars to several thousand dollars, and the downtime will vary from none for BOTOX injection to 1 to 2 weeks for surgery. I would encourage you to come over for a personal consultation, so that I could assess your particular case and make a more precise recommendation.

– Dr. Stella

Q: Dear Dr. Stella,
I have always had thin lips but dream of my lips looking like Angelina Jolie's. When I search for lip fillers, there seem to be so many on the market that it is overwhelming. What product is going to give me the most natural results? Is the procedure painful?

– Kristie, Yelm, WA

A: Dear Kristie,
There are many products to plump your pout, and by far, the best option to achieve full lips is a filler injection. Hyaluronic acid fillers such as Restylane or JUVÉDERM® will give you the best natural looking, luscious lips. We usually use the numbing blocks, so the procedure is essentially pain-free and we have many happy patients to vouch for this. The results are immediate. The size is important, but so are the shape and overall facial balance, so it is important to see an experienced medical professional. To identify if you are a candidate for filler injection or to learn more, you can call our office to set up a consultation, so that we can better address your concerns.

– Dr. Stella

Q: Dear Dr. Stella,
I had BOTOX done several times and I love it. I would also like to get Restylane injections. Is it possible to use them both?

– Ella, Bellevue, WA

A: Dear Ella,
The beauty of the many treatments available to us today is that we can use them in combination to achieve wonderful results. We routinely combine BOTOX and Restylane, other fillers, and photofacial treatments to achieve the optimal results for each patient. For some patients combined therapy is used as a so-called "liquid lift", and the results are quite dramatic. It allows our patients to achieve great improvement with minimal downtime. Our treatments are individualized, so we can further discuss your particular concerns at your consultation.

– Dr. Stella

Q: Dear Dr. Stella,
I have never tried any of the fillers and would like to try some. I am confused whether to try Restylane or JUVÉDERM. What is the difference?

– Monica, Bellevue, WA

A: Dear Monica,
As a first step in your quest, I would encourage you to see a beauty expert who can offer you a variety of options. Once we determine that you need a filler injection, then we can determine which one is the best for you. As far as the difference between Restylane and JUVÉDERM, I like to tell my patients it is almost the same as Pepsi and Coke. They are similar products with slight differences.

– Dr. Stella

Q: Hello Dr. Stella,
I am 36 and I am getting pretty deep lines between my eyebrows, and around my nose and mouth. Is there anything that can be done about these lines? How long is the downtime and how long before I see the results?

– Jennifer, Bellevue, WA

A: Dear Jennifer,
In this day and age nobody should worry about getting deep lines on the face! Considering how young you are, I am confident we can help you improve these areas dramatically. Usually a combination treatment with BOTOX, Restylane or JUVÉDERM injections will offer you the best results. I would encourage you to come in for a consultation to discuss your options. You can usually schedule consultation and treatment the same day if you prefer. After that it takes several days to see the results from a BOTOX treatment and possibly a day or two for the redness from a filler injection to subside. In about a week your lines will be a thing of the past!

– Dr. Stella

Q: Dear Dr. Stella,
Is there a procedure to help with the deep lines below the corners of my mouth that run down to my chin? They make me look sad and a bit angry.

– Ann, Wedgewood, WA

A: Dear Ann,
This is a fairly common problem, and usually these develop due to several factors: genetics, volume loss in the lower part of the face over time, and certain facial muscle overactivity. There is not much we can do to change the genetics, but we are able to do precise facial sculpting by adjusting the muscles with BOTOX, and plumping up the lost volume with Restylane or JUVÉDERM fillers. In some patients, a mini facelift would be beneficial for tightening and improving the lower face.

– Dr. Stella

Q: Dear Dr. Stella,
What is the difference between RADIESSE®, Sculptra®, Artefill and Restylane? I want filler in my lips and around my mouth, but I'm not sure where to use which product.

– Emily, Madrona, WA

A: Dear Emily,
With so many fillers on the market and many more coming out, how do you make sense of them all? Hopefully your doctor is watching out for your interests and can inform you of the risks and benefits of the multiple options and help you make an educated decision. For the uninitiated, here are some brief basics.

Fillers can be temporary and permanent. Temporary fillers are usually made of hyaluronic acid (HA), collagen or calcium composites. Among temporary fillers, Restylane and JUVÉDERM remain our favorite, with a long history of use around the world, excellent safety record, reasonable cost, and the beautiful natural results we are able to achieve. Several newer HA versions might be cheaper, but they haven't been extensively tested, and their quality, longevity, and safety are questionable at this point.

Calcium-derived RADIESSE can be a reasonable option for deeper wrinkles or larger defects. Perlane® or JUVÉDERM Ultra Plus have similar cost and longevity, and may be preferable in some patients.

Artefill is a permanent filler. It is basically a plastic beads suspension. Permanent results sound good, until you realize that the problems you might have with it are permanent as well. Considering the risk of nodules, migration over time, and interaction with laser devices, I would probably stay away from its use at this time.

Sculptra is a synthetic compound which leads to collagen production, which is just another term for scar tissue. The uncontrolled proliferation of scar tissue means the result can be difficult to predict, including lumps that can be impossible to remove without surgical excision. I would caution about its use as well.

RADIESSE, Artefill, and Sculptra should not be used in the lips as they can produce contour irregularities and nodules.

– Dr. Stella

Q: Dear Dr. Stella,
I love my BOTOX injections that I have been getting the last few years. It definitely makes a huge difference, especially around my eyes where I seem to have the most lines. I still feel that it could be improved though. Do you have any other suggestions for lines and crepiness around the eyes?

– Claudia, Ballard, WA

A: Dear Claudia,
There are many techniques we use to improve the area around the eyes. As you know already, BOTOX injections in Seattle are great for reducing the lines and wrinkles in that area. In addition to that, we utilize a special technique to further improve this area. It is, however, top secret, so you will have to come and talk to me about it personally! Restylane or JUVÉDERM injections can improve the appearance of hollowness, and once again, a special technique is used to further improve the skin texture. Finally, CO2 fractional resurfacing with ActiveFX™ has added tremendously to our treatment arsenal in this delicate area.

– Dr. Stella

Q: Dear Dr. Stella,
My eye area seems to age me most. What are some treatments that can help me look less tired and improve that entire area?

A: Hello,
We have many options to improve or erase the signs of aging. Daily use of sunscreen, moisturizer and an anti-oxidant will help maintain youthful skin. Once you start developing lines around your eyes, BOTOX injections can soften lines and delay age-related changes in the skin. Fillers, such as Restylane or JUVÉDERM can dramatically improve the appearance of lower lid bags and dark circles. Laser resurfacing can further improve the appearance of lines and help create more collagen. Further down the road, eyelid surgery (blepharoplasty) in Seattle can give you a more youthful, rested look by removing and tightening the excess skin and repositioning fat around your eyes.

– Dr. Stella

Q: Dear Dr. Stella,
I would like permanent lip filler so I don't constantly have to get injections done. Is there an implant for lips that you would suggest?

– Roslyn, Seattle, WA

A: Dear Roslyn,
Lip augmentation is a highly individualized procedure that has to be tailored for each patient. Injectable fillers and implants serve similar purposes but they do it in different ways. We can usually shape the lips much better using the injection technique, especially for the patients who have "difficult lips," very small lips, multiple wrinkles, or a combination of these. The implants currently available are best for incremental volume enhancement. We are using FDA approved silicone rubber tube shaped implants that are able to adjust well to the lip shape and size.

– Dr. Stella

Q: Hello Dr. Stella!
I am a busy professional and I have little time for myself, let alone maintaining my beauty regimen. My work hours are long during the week and it is impossible for me to take time off to heal from any procedures. If I wanted to do several sessions of IPL (Intense Pulsed Light) and some Restylane in my lips, how could I do that without missing work for the swelling and redness to go away?

– Bronwyn, Redmond, WA

A: Dear Bronwyn,
We had this question come up so many times before. Many of our patients work very hard, so we do our best to accommodate their busy schedules. Many patients do the procedures on Thursdays or Fridays to give themselves the weekend to recover from swelling and occasional redness that can happen after a Restylane injection or an IPL treatment.

– Dr. Stella

Laser Questions

Q: Dear Dr. Stella,
I was a total sun-worshiper all through high school and college. Six years ago, at 25, I stopped tanning and am pretty religious about wearing sun block every day. In the past year, I have noticed freckles and age spots popping up everywhere on my chest, face and hands. I have tried skin lighteners, and they have helped some, but what can I do to alleviate them altogether?

– Alicia S., Seattle, WA

A: Dear Alicia,
I am glad to hear you are taking better care of your skin now. To repair the damage you will probably need a combination of good skincare products, skin bleaching agents, and photo rejuvenation treatments. Treatment with photo rejuvenation machines such as IPL (Intense Pulse Light) can significantly improve the skin tone and texture. This treatment has minimal downtime, and several treatments are usually recommended, depending on the patient. It is important to see a qualified physician to have your skin checked. Continuous protection from the sun and daily use of sunscreen are important factors in maintenance of healthy skin.

– Dr. Stella

Q: Dear Dr. Stella,
I am 34 and starting to get several sun spots on my chest and face. What is the best procedure to alleviate them and how much should I expect to spend?

– Ingrid, Tacoma, WA

A: Dear Ingrid,
While there are many treatments to improve the look of sun damaged skin, IPL (Intense Pulse Light) remains one of the best treatment modalities for early changes. It is important to minimize further damage, reduce sun exposure and use good sunscreen and antioxidants. At your consult we usually go over this and other options. Depending on the extent of the damage, it might take several treatments and the cost will range from $400 to $2000.

– Dr. Stella

Q: Dear Dr. Stella,
I had bad acne in my teens and 20's, and I have been left with deep scars on my cheeks and forehead. What is the best procedure to improve the appearance of my scars?

– Justin, Seattle, WA

A: Dear Justin,
There are different types of acne scars, and they require different approaches to treatment. We utilize a combination of surgical excision, dermabrasion, fillers, and laser therapy. An exciting new development in this area is a fractionated CO2 laser treatment. ActiveFX is currently the best laser on the market, as it allows deep and narrow penetration of the laser beam with minimal surface involvement and stimulation of collagen build-up and remodeling with impressive results.

– Dr. Stella

Q: Dear Dr. Stella,
I am 42 and I have a lot of sun damage, fine lines and wrinkles, sun spots and several acne scars on my cheeks. I have tried microdermabrasion, but that hasn't given me the results I want. What would you recommend?

– Helen, Gig Harbor, WA

A: Dear Helen,
There is usually no single treatment that can fix all of our problems, and most patients would benefit from a well chosen treatment combination. However, you sound like an ideal candidate for fractional resurfacing. Fractional resurfacing has become one of the most important developments we have seen in cosmetic surgery over the past couple of years. It leaves intact bridges of skin in between the treatment spots and allows for rapid healing and recovery. ActiveFX is one of the new lasers that has the capacity for differential size and depth of the treatment spots and thus allows us to adjust it precisely for each patient. It allows us to minimize the risks and downtime of traditional laser resurfacing, and still achieve excellent results with one treatment.

– Dr. Stella

Ear Surgery Questions

Q: Dear Dr. Stella,
I really look forward to reading your column each month and it prompted me to write in.

I am a 30 year old male and I feel pretty confident in my looks but I have always been a little self conscious about my ears. I used to get teased as a kid and called "Dumbo". What can I do to correct this and how much down time should I expect?

– Kevin G., Redmond, WA

A: Dear Kevin,
The procedure to correct prominent ears is called otoplasty. It is a relatively small surgical procedure and usually takes an hour or two. The results are immediate and very rewarding for both the surgeon and the patient. Women and men feel more secure and don't feel the need to cover their ears anymore. You can expect several days with a fluffy dressing for ear protection and a week or two of tenderness. Most patients take several days off work or school. We will discuss the specifics of your case at the consultation.

– Dr. Stella

Q: Dear Dr. Stella,
My earlobe piercing has stretched over the years and now I am not able to wear my favorite diamond earrings. Can you just stitch it up to make it smaller?

– Holly, Lake Forest Part, WA

A: Dear Holly,
This is a common issue that is really easy to fix. We cannot stitch it up, but we can do a small repair procedure to fix your earlobe and an enlarged piercing hole. It takes about half an hour, and then we can re-pierce it in about a month. We can even fix the really overstretched earlobes that are seen so frequently now.

– Dr. Stella

Q: Dear Dr. Stella,
I have a keloid scar on my ear from a piercing. I have heard it can come back after it is removed. Is that true?

– Mimi, Issaquah, WA

A: Dear Mimi,
First, you have to come in for a consult to see whether you have a true keloid. True keloid scars can be very difficult to treat. They indeed can come back after being removed, sometimes multiple times. Combining the surgical treatment with steroid injections and occasionally other options can offer you a higher chance of success. Other scars are usually much easier to treat by doing a revision, dermabrasion, and sometimes steroid injections.

– Dr. Stella

Facelift Questions

Q: Dear Dr. Stella,
I have been hearing a lot lately about mini facelifts. Can you tell me the difference between that and a full facelift?

– Rory, Bellevue, WA

A: Dear Rory,
Mini facelifts indeed have become very popular over the past several years. In our clinic, it is one of the most common procedures that we do. In general there is less extensive dissection than with the regular facelift, and subsequently smaller price tag, shorter recovery and less downtime. Frequently these procedures can be done under local anesthesia in the office. We can still combine it with other procedures, such as eyelid lifts, BOTOX, and Restylane injections and laser treatments. The effects of a mini facelift can be less pronounced than a regular facelift, and many patients actually prefer this. As a note of caution, different doctors can perform very different procedures and call them mini facelifts, so sometimes you don't know what you are getting. I would recommend going to an experienced Board Certified Facial Plastic Surgeon.

– Dr. Stella

Non-Surgical Procedure Questions

Q: Dear Dr. Stella,
I have what they refer to as the "turkey neck" and want to get rid of it. Is Thermage® or some of these skin tightening lasers going to alleviate it?

– Claudine, Bellingham, WA

A: Dear Claudine,
"Turkey neck" is one of the most common problems I deal with. Thermage treatment can offer you improvement, but it is usually minimal. There is a range of procedures that can address this, it depends on your skin type, age, and severity of the laxity. The procedures range from laser treatment, to thread lifting, mini facelift, and full facelift. I recommend a consultation as the first step to address this. We can discuss different options and choose the treatment that is the best for you.

– Dr. Stella

Facial Implant Questions

Q: Dear Dr. Stella,
I would like to have more of a high cheek bone and wonder if a filler is better that an implant?

– Nicole, Sammamish, WA

A: Dear Nicole,
While facial beauty remains an elusive content, high cheek bones are the single feature that most of the beautiful faces have in common. Depending on your facial bone structure, you may benefit from cheek implants. If you are not sure about the potential improvement, getting a filler injection can give you enough of an oomph to help you make up your mind. "If you like the improvement, implant placement is usually the best and most cost-effective way to go.

– Dr. Stella

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