Plastic and Cosmetic Surgery
New York Plastic Surgeon
Charles K. Loving, Jr., M.D.
Face Lift
Today, the term “face lift” comprises several different procedural options for a patient, from the lifting or reshaping of one or two features to full-face and neck rejuvenation. A facelift is technically known as a rhytidectomy-the removal of rhytides, or wrinkles. Current techniques, however, allow for much more than the erasing of surface lines. The structural effects of aging can now be softened and obscured by removing excess fat, tightening underlying muscles and redraping the skin of the face and neck. Dr. Loving consults with each face lift patient so as to determine the appropriate procedure or procedures. He understands that many patients want the more youthful aspect offered by plastic surgery, but fear that they may radically alter their appearance and look like they “had work done.” Most patients do not want an obvious change in their faces, only the fresher look and feel their skin and features had in former years.
Since patients differ in their aesthetic desires, Dr. Loving offers a variety of treatment options. Forehead lifts, neck lifts, eyelid surgery, nose reshaping, collagen and botox injections, chemical peels, laser resurfacing and dermabrasion are all considerations for the man or woman who wants to revitalize his or her facial appearance. A patient may choose one or more of these services in order to achieve his or her desired result. Some patients only want to soften the signs of stress, fatigue and worry that have crept into their features and do not so much want to look younger but rather healthier. With Dr. Loving, these patients will develop a conservative procedural plan that is mindful of age-appropriateness while emphasizing vitality.
Other patients want to rediscover the lineaments and textures of their youth. Dramatic improvement is their goal. Their consultations may lead to more extensive plans of surgeries and non-surgical treatments, which may be performed all at one time or in stages.
Surgery
Face lift patients are usually in their forties to seventies. Prospective face lift patients must have medical clearance before the operation and must thoroughly advise Dr. Loving of their medical histories, their medications and their skin's healing and scarring tendencies. Patients must follow the specific instructions given them by Dr. Loving concerning eating and drinking, smoking and taking or avoiding certain vitamins and medications. For patients who are concerned about incision sites, Dr. Loving will provide a careful explanation of expected placement of incisions and stitches.
Surgery is usually performed in Dr. Loving's operating facility at 17 E. 84th Street, though patients may opt to have the procedure done in a hospital.
Facial plastic surgery is usually performed under ”twilight“ anesthesia, which avoids the more serious implications of general anesthesia. General anesthesia is an option, however, for those patients who prefer it. Whether the operation is performed on an inpatient or outpatient basis, under ”twilight“ or general anesthesia, it is necessary for a companion to escort the patient home after surgery and to be available for assistance for the next day or two. Convalescence for a full facelift is usually about 2 weeks, though individuals differ in their healing abilities according to their ages and general states of health. Throughout the surgery and healing process, Dr. Loving and his staff are ready to answer questions and address concerns. Extensive examples of Dr. Lovings facial work, including all of the face lift options, may be viewed in the photo albums kept in his office library.
To request more information or to schedule a personal appointment with Dr. Loving, please call 212-472-0900.
Eyelid Surgery
The eyes are often the most telling facial features in terms of both emotions and environmental influences. The skin and muscles around the eyes are among the most delicate in the body. They are also among the most exposed and most frequently used. As a result, indications of aging, stress and sun damage usually appear first around the eyes.
The signs of stressors such as time, smoking, sunlight, long-term sleep-deprivation, alcohol, overwork or simply strong feelings, take different forms on the tissue surrounding the eyes. In some men and women, fat deposits accumulate in the upper and lower eyelids, giving the eyes a perpetually puffy appearance. Fat deposits can also gather under the eyes and look like permanent sleep-deprivation circles. Sometimes, the muscles of the skin above the eyes weaken and the skin folds over the lids, making the eyes seem only half-open and imparting a fatigued or bored look to the face. Occasionally, these changes can even negatively impact on vision, though for most people, they are simply cosmetically undesirable.
Blepharoplasty, the medical term for eyelid surgery, removes fat deposits and excess skin and muscle from one or more areas around the eyes. Following the normal lines and creases of the eyelids and the underlying contours of the bones around the eyes, Dr. Loving then redrapes the skin to create a natural but more youthful appearance in the eye area. He closes the incisions with very fine sutures, and because most of the incisions are in the hidden creases or corners of the eyes, this procedure leaves almost no visible scars. Blepharoplasty can be performed on just the upper lids, on just the lower lids, or on both simultaneously. The degree to which the skin is smoothed or tightened can also be varied according to the patient's wishes.
Special Cases
Some patients who are still quite young have fat deposits settle around their eyes but have no significant loss in their skin's elasticity. Their eyes appear puffy, but not droopy. In these cases, no skin is removed, only the fat deposits. Incisions are made on the inside of the lids where they leave no visible scars, fat is removed with fine forceps, and the incisions are closed with dissolving sutures. The skin then contracts by itself over the area from which the fat was taken.
Blepharoplasty can also add an upper eyelid crease to Asian eyes. Photographic examples of each type of blepharoplasty can be viewed in Dr. Loving's office by patients who are considering the procedure.
Surgery
As with other cosmetic surgeries, a thorough consultation with Dr. Loving is required. This consultation will give the doctor a picture of your medical history, your overall health and lifestyle and your cosmetic desires.
Blepharoplasty is usually performed in Dr. Loving's operating room under “twilight” anesthesia. If the patient wishes, however, the operation can be done in a hospital and under general anesthesia. Depending on the areas operated upon, the surgery will take between one and three hours. A companion must accompany the patient home. When the anesthesia wears off, the eyelids may feel tight and sore, but discomfort is usually mild and can be controlled with pain medication prescribed by Dr. Loving. For the first few days after the operation, the patient should keep his or her head elevated and use cold compresses to minimize swelling and bruising, the extent of which varies from patient to patient. Stitches will be removed two days to four days after the operation, and concealing eye makeup may then be worn to cover any bruises. Most people feel ready to return to public life in five to seven days, though they must refrain from strenuous activities for about two weeks. As with other kinds of plastic surgery, final cosmetic results take a few weeks to appear, but for most people they are permanent.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
Surgery of the Nose
The nose, because of its position and prominence, is one of the most decisive features in the overall aesthetic of a face. Rhinoplasty, the surgical reshaping of the nose, is one of the most common of all plastic surgery procedures. Dr. Loving's extensive experience allows him to offer many options to the patient who wishes to alter the form of his or her nose. Rhinoplasty can address the entire structure of the nose, or it can reshape only one of its parts, such as the tip or bridge. The nose can be made larger, smaller, narrower or simply straighter. The span of the nostrils can also be altered, as can the angle between the nose and upper lip.
Such changes in the shape of the nose can have minor or dramatic effects on a patient's looks, depending on his or her features and objectives. Alteration of one or a few aspects of the nose can bring a new and subtle sense of balance and harmony to the face. Alternatively, the nose can be almost entirely reshaped, thereby substantially changing a patient's looks. Rhinoplasty can also be performed in conjunction with other rejuvenating surgeries, such as blepharoplasty or a facelift. In these cases, the goal of the surgery is to correct the changes in the shape of the nose that have occurred with age, such as drooping of the nasal tip, an overall widening of the nose or a “fleshy” appearance. Choosing from among these options involves careful thought and patience from both the patient and the surgeon.
Most people recognize in their noses certain family traits. It is often said that a person's nose “has personality”, a descriptive phrasing that reveals the psychological implications of the nose and of any contemplated changes to it. Dr. Loving understands that for this and other reasons, reshaping the nose often involves emotional, as well as aesthetic, considerations for a patient. As with every other procedure, rhinoplasty requires a careful and thorough consultation between Dr. Loving and the patient so as to determine both what is desired and what is possible insofar as the natural shape of the nose and the rest of the face are concerned. Good communication between patient and doctor is necessary to ensure that the doctor understands the patient's wishes and that the patient has realistic expectations.
Special Cases
Asian patients may desire improvements in nasal height and bridge elevation. They may also want changes in nostril width and thinning of the nasal tip.
Surgery
Patients seeking rhinoplasty must have completed their growth spurt, after which the adult form and placement of their features are evident. For girls, this means waiting until they are about 14 or 15, while for boys the age is usually 17 or 18. Patients should be healthy and psychologically stable. They must tell Dr. Loving about all medications and vitamins they take and about any specific medical conditions.
Rhinoplasty is usually done in the operating room within Dr. Loving's office, though a patient may choose to have it done in a hospital. Anesthesia can be local or general, according to a patient's wishes. The operation usually takes an hour or two, and after it, a companion must take the patient home. Most rhinoplasty incisions are hidden inside the nostrils. Occasionally, small incisions are made at the base of the nostrils. When the surgery is completed, a splint may be applied to the nose and, if needed, nasal packs or soft plastic splints will be placed in the nostrils to protect the nose's new shape. These will be removed after a few days. Pain following the operation is usually mild to moderate and easily controlled by pain medication prescribed by Dr. Loving. In the majority of cases, patients feel normal and can return to their public lives in a week. Visible swelling and bruises are usually gone after seven to ten, when the new shape of the nose begins to emerge. It is important for patients to understand, however, that the final, desired result of the surgery will only be completely evident after a month or two, when the skin has had time to conform to the new structure and shape of the nose.
Examples of rhinoplasties performed by Dr. Loving can be seen in the photo albums of his work which are kept in his office library. To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
Cheek and Chin Augmentation
A receding chin and/or poorly defined cheekbones can throw off the proportions of a face. Using augmentation techniques, Dr. Loving can increase the projection of the chin and cheekbones. The procedures improve the relationship between the other features of the face and result in a more pleasing aspect and profile.
Many patients choose to have chin and/or cheek augmentation at the same time as other rejuvenating procedures, such as a browlift or facelift so as to lessen the feature-blurring effects that often come with age. Chin and cheek augmentations can be done at any age. They are appropriate for both male and female patients who want to increase the definition in their faces and change the contour of their jawline without affecting their bite or jaw function.
Chin augmentation can be achieved by moving the chinbone or by inserting an implant, usually via an incision on the inside of the mouth. Cheekbones are heightened by placing implants over them, also through an incision in the mouth or, in certain cases, through the lower eyelid.
Surgery
As with all other cosmetic surgeries, chin and cheek augmentations require a consultation with Dr. Loving and medical clearance. Augmentations are fairly simple procedures, which are performed in the doctor's operating facility under “twilight” anesthesia. Pain after surgery is minimal and easily controlled with pain medication. Patients are usually up and about the same day as surgery, and can return to work in a few days.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
Ear Shaping
Otoplasty, or ear shaping, is the surgical alteration of ears that protrude more than normal or are large compared to other facial features. This procedure is relatively simple and can be done at any age. Adult patients sometimes find that as they age, their ears become more prominent in a way they find undesirable. Otoplasty addresses this concern and can be performed alone or in conjunction with other rejuvenating procedures.
Children who are candidates for otoplasty are advised to have the procedure performed at the age of five or six, when the ears are almost fully developed. Otoplasty is tolerated well by young patients, and many parents feel that it is best for the child to have the surgery before entering school, where the teasing of other children can potentially result in psychological trauma.
Surgery
Following a consultation with Dr. Loving, the patient will verify that he or she is in good overall health. Child patients may need medical clearance from their pediatrician. Otoplasty is usually performed in Dr. Loving's operating room under either “twilight” or general anesthesia.
Repositioning of the ears is accomplished by making small incisions behind the ear. A small amount of skin is removed and cartilage is recontoured so as to best position and, if necessary, reshape the ear. The ear fold is thereby restored, which makes the ear lie flat against the head. Incision sites are usually entirely concealed in the natural skin crease behind the ear.
A bandage is worn for a few days following surgery while the ears heal in their new, more natural position. Pain following the operation is minimal. Children should take care for the first few weeks not to knock against their ears while playing. Adult patients can return to work in a week or less, though they should not engage in strenuous activities or contact sports for several weeks.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
