Q/A: Am I too old for rhinoplasty?

Question: Are you ever too old get a nose job? I am in my 60s and have always hated my nose. I just never had the nerve to do anything about it. I am wondering if it is too late.


Dr. Marotta's response: You’re certainly not too old for a nose job. I frequently perform rhinoplasty on patients in their 60s and older. Age is generally not as much a concern as your physical health. As long as your in good health, you’ll be an excellent candidate. Your nose may be a concern even more for you now because the nose ages just like the rest of our face. With age the nasal cartilages and skin tend to weaken resulting frequently in a “hook” nose appearance with a drooping tip and more prominent bump. These changes can be corrected with rhinoplasty. Recovery is relatively quick with rhinoplasty with most people returning to activity in about a week. As long as your in good physical condition, age is not a factor in healing or recovery.

Nose surgery (Rhinoplasty) is a procedure to reshape the nose in order to give it a more pleasing look and sometimes correct breathing problems. Septorhinoplasty is generally considered one of the most difficult operations and an area in which Dr. Marotta has particular expertise and training.

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Q/A: I have a lot of sagging of my neck skin but I don't want a facelift. Anything else I can do?

Long Island Cosmetic Surgeon, Dr. Marotta Response: The only procedure that is truly effective in eliminating sagging neck skin is a well done face and neck lift. In addition, sagging in the neck can be due to more problems than just skin. Sagging muscle, glands and excess fat can all deleteriously effect the aging neckline. Some problems with the aging neck are more than skin deep and only surgery can correct all these issues. For minimal skin laxity in the neck, I have found fractional ablative CO2 laser, the Active Fx (Ultrapulse Encore) to be the most effective non-surgical treatment for wrinkled neck skin. It improves skin texture, fine horizontal wrinkles, and tightens neck skin.

Q/A: At 31, I have developed signs of premature aging with hollow eyes and sunken cheeks -- Should I have fillers, fat injections or a midface lift?

Fillers like restylane, juvederm, radiesse or perlane can be very effective in restoring midfacial volume in the cheeks and restoring youthful fullness in a young person who feels they have prematurely aged. Hyaluronic acid fillers like restylane or juvederm are currently the only safe fillers in the periorbital region but must be done by an experienced injector. Artful injection is required to create a natural looking eyelid/cheek junction. Alternatively, microfat transfer can provide more lasting improvement that is softer but requires more downtime than fillers. I think either would be appropriate for you from what I can tell from your picture. I usually reserve an endoscopic midface lift for patients with fuller cheeks that show evidence of drooping like hollow eyes, a deep nasolabial fold or buccal fat herniation. An endoscopic midface lift with fat repositioning of the orbital fat, buccal fat, and malar fat pads can be very effective in these situations to restore facial volume and lift a sagging face.

Q/A: What is the best age for a facelift?

While there is no ideal age for a facelift, patients who are younger or who have less severe facial aging do tend to get more complete improvement or correction from facelift procedures where sometimes no signs of facial aging are apparent following a mini facelift, endoscopic forehead and midfacelift or deep plane facelift. The patients of more advanced age with more facial aging with poor skin turgor/elasticity usually require skin resurfacing like laser, chemical peel or dermabrasion in addition to full facial surgery to optimize their results and approach their goals.

Q/A: Is it risky to have a third revision facelift?

Having a third revision facelift is not inherently "risky" but certainly you should do your homework and choose an excellent surgeon who is capable of addressing the precise anatomic issues that are causing your problems in the safest way possible. Fat transfer can be an excellent adjunct to a revision facelift and help to correct contour problems. It is difficult to say what procedures would address your concerns without photos but especially with revision surgery there is no substitute for a thorough physical exam.

Q/A: Should I have punch excision for my acne scars?

I find most people have a combination of various types of scars that may require varied surgical techniques including punch excision, punch elevation, subcision, punch grafting and standard excision. I agree with your decision to do laser following and I have had good success with following up 6 weeks after punch excision with the Ultrapulse CO2 Total Fx laser. Good luck!Long Island Acne Scarring Treatment Dr. James Marotta offers a variety of treatments and may be used in conjunction with one another to achieve maximum results; treatments include: Laser Treatments, Microdermabrasion, Dermabrasion, Intense Pulsed Light (IPL), Chemical Peels and Filler Injections.

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Q/A: Fillers or facelift for marionette lines, sagging around mouth, looking sad?

Question: Due to 30lb weight loss I have sagging in the marionette line area. Its not too bad but it bothers me that I look sad. I talked to a plastic surgeon about a lower lift. He said this would also help my jaw line. What would this entail. Is the recuperation difficult. I am 48. Would juvederm help to hold off the surgery for awhile? Can it help the neck? I have already had my eyes done and rhinoplasty so surgery isn't new to me.

Dr. Marotta's response: Both fillers like Juvederm and a facelift can help marionette lines and sagging or looking sad around the corners of the mouth. You would probably get the most improvement in marionette lines doing both because they work by different but complementary mechanisms. A facelift will tighten drooping skin, fat and muscle and fillers can help finish the job by filling in areas of skin with depleted collagen. Fillers will not help the neck at all and only a facelift helps to tighten neck skin. The recuperation from a facelift varies by technique and surgeon. Bruising and swelling usually lasts for a 10-14 day period with most patients returning to work in 10 days.

Q/A: Will I have more wrinkles when fillers like Restylane, Juvederm or Radiesse dissolve?

Long Island Cosmetic Surgeon, Dr. Marotta's response: This is a common question that patients have following filler treatments. The general feeling by most physician's is that fillers don't make the skin or wrinkles worse after they've dissolved. In fact there is some scientific evidence that suggests that the slight skin stretch with fillers may cause collagen production by fibroblasts (collagen producing cells) and make skin/wrinkles better long term. This has yet to be proven. But even barring this effect the skin has a tremendous capacity to expand and contract and any permanent irreversible stretching from fillers is highly unlikely. In my own practice, I think patients are the same if not better after the filler dissolves.

Q/A: Sagging around corners of mouth and jawline, fine lines around the mouth

Question: What should I do about sagging around mouth and jaw?I'm noticing sagging around mouth and jaw, small fine lines around my mouth, and a slight sagging around mouth and jaw.

Dr. Marotta's Response: Sagging around the mouth and jaw occurs as a result of weaking of the facial ligaments and drooping of the cheeks and facial tissues that begins early in the aging process. Smile lines or nasolabial folds that run from the corner of the nose to the corner of the mouth and labiomandibular folds or marionette lines that run from the corner of the mouth toward the mandible can be the result. This can be seen in even as early as the late 20s or early 30s. Fine lines around the mouth, smoker's lines, lipstick lines or now "waterbottle" lines occur as a result of repetitive pursing and loss of collagen and elastin. There are both surgical and non-surgical options for these problems. For the sagging around the mouth and jaw an endoscopic midface (cheek) lift with buccal fat repositioning can help elevate the sagging tissues of the cheek that are pushing on the corner of the mouth and jaw creating the folds. Microfat transfer into the folds helps lessen them even more. For fine lines around the mouth fractional CO2 laser resurfacing, dermabrasion or chemical peel work quite well and offer more lasting improvements. Non-surgical options include fillers like juvederm, restylane, radiesse or perlane to mask the folds around the mouth and jawline and to augment or volumize the cheeks. Botox can be used to elevate the corners of the mouth by injecting the depressor anguli oris muscle. Fine lines around the mouth can be alleviated with Botox and fillers as well.

Q/A: Correction of restylane lump under eye

Question from Denmark, Europe: I will try to make it as brief as possible. I got restylane under my eye 4 years ago. 1st time was great. 4th time he injected way too much. Thats now 2 ½ years ago. I still got a huge lump under my skin under right eye. If i try to massage it, it is a very hard lump and about 1-2 cm long beneath the skin. I'm so so tired of this saggy look. I'm only 28 years old. I don't want to see that doctor again. What should i do? Could this be scar tissue? Or what do you think?

Dr. Marotta's response: Restylane can persist for quite a while even years under the eyelids presumably because of lack of significant movement of this area. Good technique is critical to achieving good results in the eyelid region and should only be done by physicians with advanced training and years of experience in injectable filers like Restylane. The good news is that the Restylane can be easily dissolved with an enzyme called hyaluronidase (generic) Vitrase (brand name). Find a doctor who performs this procedure and the lump will be gone. Good luck!Restylane® Cosmetic Dermal Filler Dr. Marotta can use Restylane® to treat: Nasolabial folds (lines that extend from the corners of the nose to the corners of the mouth), Melolabial folds (lines that extend from the corners of the mouth to the sides of the chin), Nasojugal groove (gives a "Non-surgical" lower eyelid lift), Fine lines around your mouth ("lipstick lines"), Enlarge, enhance, and define the lips and improve facial contours by filling in depressions or hollow areas

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Q/A: What kind of lift is best to take care of nasolabial problems?

Question: What kind of lift is best to take care of nasolabial problems? lifestyle lift and Quick Life, Slift. Which one takes care of nasolabial problems?

Dr. Marotta's response: The facelift techniques you mentioned have little if any effect on the nasolabial folds. The most effective facelifting technique to improve the nasolabial folds is the endoscopic midface lift. Adding microfat transfer to the nasolabial folds during the endoscopic midface lift provides additional benefit and the best long improvement in the nasolabial folds. Fillers like restylane, juvederm, or perlane can correct nasolabial folds as well, but of course are temporary and don't have the benefits for the other parts of the face that endoscopic midface lifting and fat transfer offer.

Q/A:Options for Cheeks following extreme weight loss

Question: I am a 36 year old man who desires a more youthful appearance. I've gone from 400-200-280 pounds in 20 years time. After researching all of the procedures, the only one I trust is the smas lift. Am I being closed-minded towards the endoscopic procedure? From my photo, would fillers work?

Dr. Marotta's Response: Generally SMAS procedures have little in any effect on the cheeks. From your pictures, Microfat transfer would be your best option for your cheeks and lower eyelid region. Other options to address the lower eyelid and cheeks include fillers like Restylane or Juvederm, collagen stimulators i.e. Sculptra or Cheek implants. If you have hanging or excess neck skin from your profound weight loss indeed a SMAS facelift would be best to address that area but not your cheeks.

Q/A: Cheek lift and other options for patient in their 20s

Question: I am 23. I have droopy cheeks, extra skin/fat in the jowl/chin area, and visible lower eye whites. When I smile these issues are accentuated. Would a cheek lift address these issues and how do I find facial surgeons who have extensive experience on younger patients?

Dr. Marotta's Answer: I have a lot of experience with cheek lifts or midface lifts in younger people and my preferred technique is the endoscopic forehead/midface lift with buccal fat transposition. Midfacial aging does begin to occur in the mid to late 20s. But generally mid to late 30s is the minimum age I would consider for this procedure. Sounds like your issues may be somewhat congenital or skeletal since you have them at such a young age. Adding volume whether with microfat transfer, fillers, sculptra or cheek implants is probably the way to go at your age but difficult to tell without a thorough evaluation. Adding volume with one of these methods can give you the same look as having a lift with less trouble.

Q/A: Acne scars - Fillers

Question: Can a boxcar type of acne scar with smooth edges be filled via an injection of sorts?

Long Island Cosmetic Surgeon, Dr. Marotta's reply: The answer is maybe. It really depends on how tethered or attached the scar tissue is at the base of the scar to determine whether fillers like restylane, juvederm or radiesse would be effective in raising the depressed areas of your scar. Sometimes combining subcision, a procedure where scar tissue is released with a small needle or knife, with fillers is more effective than fillers alone for tethered scars. Silicone can be very effective as a filler in even the most tethered scars but you need to seek out a very experienced injector and realize this treatment is "off-label" (non-FDA approved). Other treatment options for the acne scar you described include surgical excision, punch elevation, punch skin grafting, and fractional CO2 laser with the deep fx and active fx.

Dr. Marotta on WMJC 94.3

Dr. Marotta was featured on WMJC 94.3 talking about sun protection and ways to reverse sun damage.

Click the link below to hear the radio interview.

Dr. Marotta is a dual board certified facial plastic surgeon in Long Island, NY and has attained his education and training at some of the finest institutions in the world. He attended Columbia University and graduated as president of the medical honor society at SUNY Stony Brook School of Medicine. He trained at Yale University in head and neck surgery and was consistently recognized as the top head and neck surgeon in the program. Dr. Marotta then completed additional subspecialty training as a fellow in facial cosmetic and reconstructive surgery at one of the leading facial plastic fellowships in the country.

http://c1-preview.prosites.com/10424/wy/media/943WMJC-Interview.mp3