Ask The Expert
We advise and serve hundreds of patients each year, answering common and uncommon questions related to all aspects of facial plastic surgery procedures and facial aesthetics. While every patient’s needs are unique, below we’ve compiled some frequently asked questions that may be of interest to you.
How Do I Choose a Facial Plastic Surgeon?
Selecting the right facial plastic surgeon for you requires research and there are several ways to go about it. Below are several tips to help you make an informed choice for any facial cosmetic procedure you’re considering from a facelift to rhinoplasty to skin treatments.
- Seek referrals from those closest to you including family and friends who have had successful procedures from a board certified facial plastic surgeon. Your primary physician is a wonderful resource. Ask him or her which facial plastic surgeons they are familiar with and recommend.
- Use the Web wisely while we don’t recommend selecting a facial plastic surgeon solely by surfing the Web, visiting the Web sites of recommended surgeons is a smart research technique. High quality Web sites provide information about the doctor’s training and expertise, offer a variety of before-and-after shots demonstrating their skill, address financial considerations and overview office procedures.
- Meet and greet visit with prospective facial plastic surgeons in their offices for a consultation. This will allow you to discuss your desires and goals for cosmetic surgery, and determine your comfort level with the surgeon.
For more tips, visit American Academy of Facial Plastic and Reconstructive Surgery Web site.
Acne Issues
Botox and Injectables
Facelifts
Implants
Facial Procedures for People of Color
Policies, Procedures and Financial Considerations
Which Procedure is Right For Me?
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Acne Issues
Submitted by Thomas...I have acne scars from my teenage years. What can I do to get rid of them?
Unfortunately, scarred skin from acne or other injuries to the skin can never be made to be "normal". The skin is simply different. It is missing normal anatomic structures that we cannot replace. However, if your acne is no longer active and you have not used Accutane for at least one year, laser resurfacing can improve the appearance of your skin and hopefully allow you to feel confident about your facial appearance. I do not recommend dermabrasion (quite different from microdermabrasion), but this is an alternative therapy for facial scarring as well. If the scars are very deep, subcision and filling with Restylane (a skin volume filler) is indicated. A consultation would be required to determine a specific treatment plan for you.
Submitted by Joy...Can cosmetic surgery erase acne scars?
Unfortunately, scars from acne or other types of skin injury are permanent changes to the skin's architecture. Scarred skin is fundamentally different than unscarred skin. However, laser resurfacing, excision of deep, ice-pick scars and filler injections can often make scars appear much less noticeable. Additionally, there are mineral based cosmetics we can recommend that will help camouflage an area without making it look like you are wearing heavy makeup or concealer.
Submitted by Grace...When I was young I had acne and now I have a lot of deep pores. What can be done to smooth them out?
Keeping your pores clean with a professional, well-done facial and good home care is the first step. Microdermabrasion can provide temporary improvement in your skins appearance, and the addition of Intense Pulsed Light (Photofacial) can potentially provide some long-term improvement in pore size. However, oilier skin, which is more prone to acne in the first place, often has larger pores. The good news is that oily skin looks more youthful longer than drier skin types.
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Botox
Submitted by Dana...I would like to try Botox treatments between my eyes...on average, how many treatments are needed, at what intervals and what is the cost per treatment?
Botox is the treatment of choice for wrinkle reduction between the eyebrows. It delivers exceptional patient satisfaction the first time it is used. The onset of action is about four days. The medicine will get more effective in smoothing lines in this or any other facial area that we treat over the following week to 10 days. The effects usually last between four and six months, at which time you will have to redo the treatment to maintain the desired results. Botox is a wonderful technique in my aesthetic armor. However, the quality of the results are directly related to the experience, judgment and technique of the injector. At the Emory Facial Center, I perform all Botox and skin filler injections personally. In fact, I have been selected by the company that makes Botox to instruct fellow physicians through out the United States on the proper use of their product. In my hands, Botox not only permits me to soften lines and wrinkles, but also to truly sculpt the face. Botox costs range from $200 to $400 per area depending on the amount of Botox I need to use and the number of areas we are treating. Treating multiple facial areas enables us to offer multi-site discounts.
Submitted by Janice...Would Botox injections help reduce frown lines on the sides of my mouth?
Advanced Botox injectors such as myself do use Botox to help with the frown lines on the sides of the mouth, but this area often needs volumetric fillers as well to accomplish a significant correction. A personal consultation would clarify what therapies are best in your particular case.
Submitted by Elizabeth...I had a baby two months ago and I am still breastfeeding. Is it safe to have Botox injections at this time?
Botox is a wonderful therapy for unwanted facial lines cased by excessive facial muscular activity. Botox also permits me to "sculpt" a face to promote facial attractiveness. However, it should not be performed if the patient is either pregnant or breast-feeding. Enjoy your baby and see me after he/she has been weaned.
Submitted by Andrea...I have very dark under-eye circles. I do not have any under eye bags, just the opposite. The area is concave with a facial line that borders and accentuates them. Is there any procedure out there that will help me?
Absolutely there is! This area you speak of is called the tear trough. It is an area that I particularly like treating because it has such a powerful aesthetic impact on facial appearance, and the correction is simple. The area needs volume to fill the hollow and soften the transition from eyelid area to cheek. This is a very important aesthetic zone when trying to improve appearance and promote youthfulness. The volumetric filler of choice in my practice today is Restylane, which can be injected in minutes and will lead to about one year of correction before it needs to be done again. You should be off all aspirin products, non-steroidal anti-inflammatories (Advil, Motrin, Nuprin, Naproxyn, etc.), Vitamin E, and all herbal supplements for two weeks before and after treatment to reduce bruising. You can also start taking Arnica (found in health food stores) one week before treatment to mitigate bruising. However, this area will bruise and swell after treatment regardless, and you should plan on wearing makeup in this area for one week following treatment as a cover up.
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Facelifts
Submitted by Alicia...What is a "Lifestyle Lift" and do you perform this procedure?
The "Lifestyle Lift" is a marketing term, not a medical term. I have seen it applied to a very limited facelift in which:
- no true neck lift is performed, only a small amount of lateral cheek tightening;
- a skin-only eyelid lift is done; and
- the procedure is performed under local anesthesia in an office setting, which means that the patient is fully awake during surgery.
The procedure has been touted as taking only one hour and allowing patients to get back to work the next day. In my opinion and experience, such marketing claims are based on ideal or optimal scenarios that are not obtainable for every patient: the procedure itself can take several hours, and the recovery time until a patient can comfortably return to work can be a week or more. I am also concerned that procedures described as "Lifestyle Lifts" may be made available in a setting that provides the same limited procedure to all patients without an individualized assessment of a patient's needs and objectives. In some instances, the doctor performing this type of limited procedure may not see the patient until moments before the procedure is performed. I strongly suggest that anyone considering this procedure obtain a second opinion and not simply use price but also honesty, artistry, individualized analysis and attention, and surgical expertise as a guide when making such an important decision. Buyer beware!
Submitted by Terri...I have been using Restylane and Botox for two years with good results. Now I am considering a facelift. Would the Botox and Restylane interfere with the surgery?
Absolutely not. Botox and Restylane are most often used as line and wrinkle reduction therapies in the upper third of the face and around the mouth area which complement a facelift, a procedure intended to enhance the lower third of the face, jaw-line and neck area.
Submitted by Tony...I am a 60-year-old man and would like to get rid of my "turkey neck." What is involved in that procedure?
You have two options to fix the problem. With either procedure, the excess skin is removed and the deep neck tissues are contoured and tightened. The first option is a traditional lower face/neck lift, which places the scars under your chin and around the contours of your ears and along the hairline behind your ears. This operation is often the best option since the scars are well hidden and it addresses not only your neck but the cheeks, jowl and jaw line. The other operation is called the grecian urn neck lift. It is appropriate when excess skin, rather than a heavy neck, is the overriding problem and the individual is not concerned about improving their facial appearance, only their neck. This is a direct excision of the neck skin with the scar placed in the midline of your neck. Most of this scar is not easily seen as it lies under your chin but a portion of the scar can be seen lower in your neck, particularly while it is healing. After six to 12 months, as the scar fully matures, it becomes much less noticeable. This operation is simpler to perform, easier to recover from, gives a fantastic neck contour, and is half the price of a traditional face/neck lift. The final decision as to which operation is best for you can only be made during a personal consultation. Click here to see some examples of these procedures.
Submitted by Karen...Do you perform the so-called "Lunchtime Lift" and what is your opinion of this procedure?
The lift you speak of is a very non-specific, non-medical term. I perform several different procedures on a regular basis including stringlifts, ultralifts, grecian urn neck lifts, and extended SMAS (Please ask Seth to tell us what this acronym stands for
) facelifts in order to rejuvenate the face and neck. They range in terms of indications, invasiveness, recovery time, expected results and cost. There is no reputable facial plastic surgeon who will promise to provide surgical facial rejuvenation, regardless of technique, and get you back to work the next day. It is simply untrue. Buyer Beware!
Implants
Submitted by Laurie...I am a 45-year-old woman considering having my upper and lower eyes "done". I do not smoke and I am in pretty good shape. What kind of recovery time can I expect and how long must I wait before I face the public?
Eyelid rejuvenation surgery provides a significant aesthetic improvement with minimum down time. In fact, I believe eyelid surgery provides patients the "best bang for their buck" when rejuvenating someone's face. Research documents that when others look and communicate with you it is your eyes on which they focus. In my practice, an upper and lower eyelid "lift" will require about one week of true recovery. That is, absorbable sutures are present on the upper lid and occasionally on the lower lid (I usually remove the fat that causes puffiness away via the inside of your lower eyelid and thus no sutures are required) for that period of time. You will have minimum wound care and be able to go out on Day 2. You will be instructed to "take it easy" and not lift more than 10 pounds and limit your exercise to walking for the first week and then, over the next three weeks, you will gradually increase your activity until you are back to your baseline at four weeks. If laser resurfacing is done as part of your procedure, the first week requires regular wound care and will necessitate that you "hide". You may require cover up makeup for several weeks before you are comfortable with your appearance. Regardless of what specific procedures you have, you should look presentable to return to normal activities after one week, and by six weeks you should look great and feel completely self confident in your appearance.
Submitted by Natalie...I have sort of a "flat face". I need cheeks and face contouring. Is that possible?
Yes. Facial volumetric contouring can be accomplished with implants or injectable long-lasting collagen stimulants such as Sculptra or fat injections. Typically, facial implants are the procedure(s) of choice and several different materials are available. These are surgical procedures and require about a week of true healing. The selection of the implants' size and type and the placement of facial implants do require excellent judgment and experience, and I would encourage you to have a personalized consultation as this is not an aesthetic decision that should be made by an inexperienced surgeon.
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Implants
Submitted by Cheryl...I had a chin implant 12 years ago and I have never been happy with the results. Can the implant be replaced or removed after this long?
Yes, chin implants can be revised or removed at any time. Depending on the material used, it may be more or less difficult, but the implant can be removed. There are many different styles of implant available today. Depending on your needs, the proper implant can be placed with the intent of making you happy.
Submitted by Caren...Is there a permanent procedure that will make lips fuller?
Lip enhancement is possible with lip implants that will provide lip volume enhancement and can be placed under local anesthesia in an office setting in about one hour. The products I currently use include Soft Form and Advanta. Both provide a permanent, fuller, natural appearing lip. However, implants do not give me the same degree of artistic control that injectable fillers provide. If I need to enhance overall lip contour, currently, I will use Restylane to define and balance the lip aesthetic. This will provide about six months of enhancement before it has to be redone. Whatever you do, never have fat injections into your lips. This procedure is very unpredictable and is not recommended.
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People of Color and Facial Procedures
Submitted by Rhonda...Can people of color have cosmetic surgery?
People of all races can enjoy the benefits of cosmetic facial surgery. The specific risks are reviewed with each patient prior to surgery and often these risks may vary slightly according to one's ethnicity, but cosmetic surgery can be performed safely in just about anyone. Of course, if you have a history of keloid scar formation, which is scarring that is raised, thickened and goes well beyond the borders of the injury, this may preclude elective surgery as an option. However, I can tell you that many individuals, particularly people of color, have been told that they have a keloid scar from some injury or procedure in the past, when that is not the case. Therefore, I would recommend having it looked at by an expert before making any decisions regarding facial cosmetic surgery. Finally, laser skin resurfacing, dermabrasion or a deep chemical peel is rarely indicated, but never appropriate if the patient has dark skin. The risk of permanent color change to the skin is simply too great.
Submitted by Brenda...I am a 30-year-old African-American woman with acne scarring. I have had microdermabrasion and chemical peels from my dermatologist with little results. Is a laser procedure an option for black skin? My complexion is medium brown.
No, unfortunately laser skin resurfacing will expose you to excessive risk of skin color changes, either permanent dark areas or light areas. I cannot recommend it for the problem with your skin coloration.
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Policies, Procedures and Financial Questions
Submitted by Dianne...How much do you charge for a consultation?
Dr. Yellin sees patients at the Emory Facial Center, 993-C Johnson Ferry Road, Suite 215, Atlanta, located at the junction of GA 400 and I-285. A personalized facial aesthetic consultation, discussing all aspects of facial enhancement from skin care to surgery, lasts about one hour and costs $100. You may schedule an appointment with Dr. Yellin by calling 404-303-0101.
Will insurance cover the cost of my facial plastic surgery?
Most health insurance providers do not cover elective cosmetic facial cosmetic surgery procedures. Reconstructive and medically necessary procedures may be covered. We advise you to contact your health insurance provider to inquire about coverage options.
Submitted by Beth...I know that in some teaching hospitals, patients can get on a waiting list to have student doctors perform certain procedures at a reduced cost. Is there a similar process for facial plastic surgery at Emory? If so, how do I get a consultation?
At the Emory Facial Center, it is important to stress that under no circumstance does a student doctor or resident ever operate on my cosmetic patients. I do all surgery personally. However, you can have a facial plastic surgery resident perform your surgery at Grady Hospital for a substantially reduced cost relative to my fees. I recommend that you contact Grady Hospital and make an appointment with the Otolaryngology Department, mention that you are interested in facial cosmetic surgery and that you would like an appointment when the facial plastic surgeon is in the clinic. Good Luck.
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Which Procedure is Right For Me?
Submitted by Elaine...I have spider veins on my face and neck. Can a facial plastic surgeon help with this problem?
Yes. However, the key point is that you must make sure the surgeon you choose has the proper laser and the knowledge and experience to use it safely. KTP and pulsed dye lasers are frequently employed to treat these problems. For fine spider veins or generalized facial redness, Intense Pulsed Light (IPL) is the treatment of choice.
Submitted by Jocelyn...I think I am getting bags under my eyes. What is the easiest and least painful way of getting rid of them?
"Bags" are often caused by small pockets of fat protruding forward causing puffiness under the eyes. If this is your problem, the simplest approach is to remove the excessive fat but leave enough fat behind to create a normal contour to the lower lid area. I accomplish this in the most minimally invasive way possible. The most direct approach to these fat pockets is from the inside (pink) area of the eyelid. A small stab incision is made over each offending pocket (there are up to three pockets in the lower lid that need addressing) and the fat is simply teased from the surrounding tissue and removed. If the skin of your lower lid is wrinkled or loose, a laser can be used to tighten this area and leave no scar at all once it has healed. It is a very elegant procedure and one with high patient satisfaction.
Submitted by Sandra...I am a 55-year-old woman, but I look more like 45. I do have some fine wrinkles around my eyes and lips. Would chemical peels or laser resurfacing work for me? What is the difference between these two procedures?
As you describe your issues, resurfacing, which is what you are referring to, does not jump to my mind as the first line of therapy. Laser resurfacing uses a single wavelength of intense, collimated light, which has been chosen to interact with the water in your skin to vaporize the outer layers of the skin, tighten the tissues and stimulate your own collagen to plump the lines and wrinkles in your skin. Chemical peels use acids of varying strengths to accomplish similar things, but in my opinion, with much less specificity and control.
Submitted by Rachel...Is it best to have cosmetic surgery in your 40s, 50s or 60s? Should you wait until you really need it or should you start when you first notice signs of ageing?
Chronological age is never the determining factor for deciding when facial rejuvenation surgical procedures are appropriate. What is important is the severity of the particular aesthetic concern and how much it bothers you. A decision to have aesthetic surgery should never be made based on other people's concerns, for example, pressure from a spouse. When rejuvenating one’s face, it is frequently the case that you are trading skin laxity for surgical scars. Therefore, you should have enough "going on" to justify such a trade.
However, I believe that maintenance, that is, small procedures done when needed are the best way to maintain attractiveness. This avoids drastic change, which is often more noticeable. Well-performed aesthetic facial surgery should enhance your appearance, not telegraph to others what you have had done. Additionally, if you "need" something done, why not get it done when it first bothers you? You will then have the enjoyment of your procedure for that much longer. Also, the younger and more elastic your skin, often the better the results overall. Finally, having a procedure like an eyelid tuck or a face and neck lift will not effect your ability to have it done again, let's say 15 years later, if it becomes necessary.
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