Ear, Nose and Throat (Otolaryngology) – Head and Neck Surgery

Facial Plastic and Reconstructive Surgery FAQs

The following are some of the most frequently asked questions about Facial Plastic and Reconstructive Surgery we received at Mount Sinai.

Q: What is Facial Plastic and Reconstructive Surgery?
A: The practice of facial plastic and reconstructive surgery encompasses a broad spectrum of procedures and treatments intended to improve or enhance certain aspects of the face, head and neck. This ranges from state-of-the-art techniques to handle the most complex reconstructive surgeries to cosmetic treatments and surgeries to enhance facial appearance, beauty and youthfulness.

Q: What is the difference between facial cosmetic and reconstructive surgery?
A: Facial plastic surgery encompasses reconstructive and cosmetic surgery of the head and neck. Reconstructive surgery is done for patients that have suffered an appearance-altering trauma, such as an accident or through the removal of skin cancers and/or head and neck cancers, or for patients who have congenital conditions, such as a cleft lip or a birthmark. Cosmetic surgery aims improve certain physical features, and includes procedures, such as rhinoplasty (a reshaping of the nose), face lifts, and liposuction.  

Q: Is facial plastic surgery safe?
A: The relative safety of surgery for a particular patient is judged on an individual basis. Risk factors such as serious health conditions, age and social habits are taken into consideration. Taking the individual nature of all medical care into account, facial cosmetic surgery has superlative safety record. As these are elective procedures, safety is our foremost priority. Surgeons at Mount Sinai’s Division of Facial Plastic and Reconstructive Surgery perform all procedures in Mount Sinai’s operating facilities, including our state-of-the-art, fully accredited, hospital-based ambulatory surgery center. 

Q: I look older than my age. What can I do?
A: The process of aging and our appearance relative to our age results from numerous factors. While some of these reflect our own individual aging process, many of these relate to lifestyle factors that can cause our skin to age more quickly. Common ‘environmental causes’ of premature aging include prolonged sun exposure and smoking. Prevention tactics, such as adequate sunscreen use and smoke cessation, are the best lines of defense.

There thousands of treatments, creams, medicines, etc. that seek to slow or reverse facial aging (notice the advertisements that ‘pop-up’ when browsing the internet). While many of these hold little value there a number of well tested and proven treatments that can rejuvenate the aging face. Surgeons at Mount Sinai’s Division of Facial Plastic and Reconstructive Surgery are at the forefront of advancing treatment for facial aging. For patients seeking non-surgical treatments the use of BOTOX, injectable fillers (Restalyne, Juvederm, Sculptra, etc) and lasers have revolutionized facial rejuvenation. They provide reliable results with minimal downtime. For patient seeking more permanent results, surgery remains the best choice. Common procedures include face and neck lifting, upper and lower eyelid blepharoplasty, brow lifting, and facial liposuction. The capacity for surgery to dramatically reverse the signs of facial aging, while maintaining a natural appearance, is unparalleled.

Q: How long will the results last?
A;The two rules to keep in mind when considering the how long any cosmetic treatment will last are: 1. Different treatments last different lengths of time and 2. Different patients will have different lengths of results, depending on the treatment they undergo (as the saying goes “results may vary!”).

BOTOX and injectable fillers are not typically permanent treatments. BOTOX usually lasts between three and six months. Injectable fillers can last from six months to years depending on the filler used and the location injected. Surgery is typically longer lasting. The changes made during rhinoplasty last a lifetime. Surgery to address facial aging, facelifts, blepharoplasties, etc. can typically be expected to last from 5-15 years.

Q: I broke my nose. What can I do to fix it?
A: The nose is the most prominent feature on the face. A broken nose can often be diagnosed based on a clinical exam. In fact, most patients complaining of a broken nose are keenly aware of the change in the appearance of their nose and/or increased problems with nasal breathing. X-rays are well known for being unable to accurately detect nasal fractures. CT scans can be more useful but are usually only needed to fully evaluate the face for any other broken bones or injuries. While many patients are unhappy with the appearance of their nose after it has been fractured, the nasal obstruction that often results can be especially bothersome and will often drive them to seek medical attention.

Once diagnosed, there many options treatment for broken noses. In the early period after the injury the bones can sometimes be manually pushed back in place (this can be done either in the office or operating room). This can help patients avoid surgery, put the final result in terms of appearance and nasal breathing can be wanting. Once the bones have begun to heal surgery to re-fracture and reposition the nasal bones and cartilage is needed. The best treatment plan is one that takes into account the manner and pattern of injury along with the patient’s expectations. When these are all appropriately managed, good results usually follow. 

Q: What are my options if I don’t want surgery? What are Botox and fillers?
A: BOTOX is a ‘relaxing agent’ produced from sterile derivatives of Botulinum Toxin. It works to improve or prevent facial lines and wrinkles that are caused by over active or tense facial muscles. In addition to treating facial aging, BOTOX is also used in the treatment of Facial Nerve Paralysis.

Fillers are injectable substances that are used to replace lost volume in certain areas of the face. They treat creases and wrinkles along restoring facial volume that is often lost as we age. The Federal Drug Administration (FDA) approved fillers are a constantly changing. Surgeons at Mount Sinai’s Division of Facial Plastic and Reconstructive Surgery use fillers that are all FDA approved. These include: Juvaderm, Restylane, Radiesse, Voluma, and Sculptra.

Q: Can a laser procedure help me?
A: Laser skin resurfacing (also called lasabrasion or laser peel) is a procedure in which a surgeon uses a laser to precisely remove the epidermis (top layer) of damaged skin, while promoting the growth of collagen in the dermis (lower layer). The procedure is used to improve issues such as wrinkles, acne scars, and liver spots. Laser resurfacing may cause a short-term reddening or increased sensitivity of the skin, but the results could last several years. Laser resurfacing does not always have to be performed on the entire face. It can be used selectively to treat lower eye lid aging and deep lines and wrinkles around the mouth. 

Q: How is skin cancer treated? What is reconstructive surgery after skin cancer?
A: Skin cancer can be treated with the surgical removal of the cancerous site through procedures such as Mohs Surgery. While the resulting wound could sometimes heal on its own, plastic or reconstructive surgery may be used. The reconstructive procedure could be performed in conjunction with the cancer removal surgery or within a few days, and techniques include primary closure (a pulling together and suturing of the surgical wound), grafting (the use of skin from elsewhere on the body to cover the wound), and flap reconstruction (the removal of skin near the incision site).

Q: What are my options for treating facial nerve paralysis?
A: Facial nerve paralysis can result from a variety of causes ranging from trauma to conditions, such as Bell’s palsy. Facial nerve paralysis can range in severity from the loss of tone or selected to facial movements to complete loss of facial movement on the affected side with resulting facial drooping and inability to close the eye, placing patients at risk for eye injuries and even blindness. Patients recovering from facial nerve paralysis may develop involuntary facial movements, known as ‘synkinesis.’ These movements can be uncomfortable and socially unacceptable. Surgeons at Mount Sinai’s Division of Facial Plastic and Reconstructive Surgery offer a wide range of treatment options for patients suffering from facial paralysis, including occupational/physical therapy, Botox treatments, nerve grafting, eye lid surgery, facial slings, and muscle transfer surgery.