Jaw Line Improvement

Frequently among non-Caucasians, the jaw line is prominent and is out of proportion to the rest of the face. This is in contrast to Caucasians, who tend to be deficient in this area and require implantation. With non-Caucasians, the traditional treatment has been to grind away the outer portion of the jaw to narrow the face. The recent improvements in this area have been nonsurgical treatments using botulinum A or B, also known as BOTOX® and Myobloc. We have used this for many years and have treated hundreds of patients with this technique. We have found it to be favorable and, in some cases, preferable to surgery with almost minimal risk compared to an operation.

Eyes

The difference between non-Caucasian and the Caucasian eyelids lies in the position of the eyelid fold. Although half of the non-Caucasian population does have a fold in the area above the eyelashes, about 50% of the population does not. There is a difference between the configuration of the fold in those non-Caucasians with an eyelid compared to the eyelid of a Caucasian. When considering the surgical techniques to place a crease, it is important for both the patient and the surgeon to understand that the goal of surgery is not to westernize a non-Caucasian face but to create a natural crease that looks non-Caucasian. The non-Caucasian eyelid typically starts at the crease very close to the eyelashes and then, as it gets further away from the nose, the crease gets larger and larger until the midpoint of the pupil, at which point the fold runs parallel to the eyelid margin. A Caucasian lid crease is slightly different in both shape and size. Caucasian lids typically taper closer to the eyelashes as the fold goes out laterally so that it is more of an upside-down “U” shape rather than a parallel shape to the lid lash. When placing a crease, a configuration needs to correspond with that found naturally in non-Caucasians or, otherwise the eyelid does not look normal. Also, the Caucasian lid crease is about 20% larger than an non-Caucasian eyelid crease.

There are two common methods for placing an eyelid crease. One is called the suture method in which small stab incisions are made along the proposed crease line and then several sutures, numbering between one to four sutures, placed along the proposed crease are tied and buried underneath the skin without cutting the skin. The advantage of this method is that the fold is very natural and there is minimal surgery involved. The disadvantage of this procedure is that frequently the suture can break and lead to a loss of the fold. In addition, many patients have a small pre-existing crease, resulting in a double crease. In the second technique a full cut placed along the proposed fold line. Various amounts of tissue are removed and the skin fold is stitched to the underlying deep tissues to create a permanent fold. A preferred variation of the incision technique is the Flowers’ anchor blepharoplasty in which a small amount of muscle is removed along with the skin and then the fatty layer underneath the muscle is also trimmed. The skin is then sutured to the underlying cartilage and any small pre-existing folds or wrinkles are smoothened as part of the procedure. By clearing out some of the fatty tissue, there is not any puffiness that frequently occurs when this tissue is left behind. Also, small creases can be enlarged without creating a double fold, which can happen if the appropriate tissues are not removed.

A relatively new suture technique called the “Double Suture and Twisting Method” (DST) for non-Caucasian eyelid surgery has been developed in Japan which, although is a suture method, has a very low breakage rate. The procedure was introduced to North America in 2001. Dr. Lee was able to obtain training in this technique and is now the only North American plastic surgeon directly trained in this unique suture technique.

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Nose

The goal of the surgery is not to create a Caucasian nose, but to create a nose that is compatible with the non-Caucasian ethnic group. Typically, this means that the bridge begins slightly lower on the face than in a nose, for example, that is typically found on Greek statues. The tip of the nose also tolerates slightly less definition and less projection. The material used typically is silicone for the bridge, although other materials such as Porex or Gore-Tex can be used. The silicone plastic bridge has been used for over fifty years and has withstood the test of time in terms of safety. This silicone implant is not the free silicone gel that was associated with breast implants, but is rather a plastic tissue that does not dissolve into the tissues. Some people have advocated using autogenous tissue, that is, using your own tissues from your rib, skull, or ear, but there is inadequate tissue in most non-Caucasians to build an appropriate bridge. In addition, harvesting material from these areas involves a larger operation than many people are willing to undergo. The tip of the nose, on the other hand, frequently is treated using one’s natural tissue, either from the ear or from the septum located inside the nose. There are patients who have had a previous injection of free silicone into the nose. The patients that have had this done are at a slightly higher risk for problems such as infection or malposition of the implant after the operation.

Chin Surgery

The contour of the chin can be improved for better balance to the face, especially on the side view or in photographs. Frequently, the nose and chin are treated at the same time because the nose and chin balance each other, thereby obtaining a better proportion. However, sometimes the chin is addressed by itself. The face is analyzed by dividing the face into upper, middle, and lower thirds on a frontal view. On the lateral view, the chin should project in line with the general plane of the face. Frequently, a deficient chin can be corrected by placing an implant through the inner surface of the lip. Material used include Silastic, Gore-Tex, and Porex, although other materials can be used.

Cheek Surgery

The prominent cheekbone can be treated by shaving the bone or pushing it inward and approached through an incision inside the lip or behind the hairline. The best candidates for this procedure are generally patients with a narrow face except for a wide cheek area. The most common types of problems encountered are unevenness of the two sides, either before or after surgery.

Laser Tattoo Liner and Hair Removal

A MedLite IV laser is one of the advanced lasers using ND:YAG technology. This laser is effective for removing tattoos as well as removing unwanted hair in patients with a medium-tone skin, such as frequently found in non-Caucasians. More than one treatment may be needed for permanent results.

Upperface

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Rejuvenation

Coming Soon