Facial Cosmetic Surgery Guide - Cleveland Clinic

Cosmetic Artistry. Clinical Excellence.

When you choose Cleveland Clinic Cosmetic & Plastic Surgery Center,

you can be confident that our surgeons are board-certified and have

been leaders in the field of facial cosmetic and reconstructive surgery.

By collaborating in a multidisciplinary setting, they offer you the highest

level of care in a wide variety of core cosmetic surgery and medical

specialties. Multidisciplinary collaboration ensures that your team

consists of specialists in many disciplines who coordinate care to meet

your individual needs.

Our physicians, who have significant experience in all areas of aesthetic

plastic surgery including facial cosmetic surgery, cosmetic breast surgery,

and body contouring procedures, are supported by the long-standing

reputation of a world-class medical facility. Every year since 1990,

U.S.News & World Report has recognized Cleveland Clinic as one of

the top hospitals in America.

Facial Cosmetic Surgery Guide

COntinuEd

Beautiful YounO OnE Will EvEr knOW, unlESS yOu WAnt thEM tO.

A natural-looking, rejuvenated appearance is made possible by the skilled and experienced multi-disciplinary team at the Cleveland Clinic Cosmetic & Plastic Surgery Center. to help in your decision-making process, this guide covers all of our facial cosmetic surgery procedures, introduces you to our renowned surgeons and answers questions you may have.

How to CHooSE A SurGEon

you’ve spent a lot of time thinking about your expectations of facial cosmetic surgery and considering various procedures. Below are some tips to help you find a qualified center and surgeon.

1. look for a center that has a good reputation, that employs board-certified physicians and surgeons in the core cosmetic specialties, and whose sur-geons have practicing privileges at nearby hospitals.

2. Be sure that if emergency hospitalization becomes necessary, you can be admitted to a hospital quickly for appropriate care. Most elective cosmetic surgery procedures are done on an outpatient basis, so it is a good idea to call the center and ask about this.

3. determine whether the center is certified by the Joint Commission, which accredits nearly 16,000 healthcare organizations and programs in the united States – everything from hospitals to nursing homes to outpatient surgery facilities.

4. verify that the surgeon who will do the treatment or dermatology proce-dure is board-certified in one of the core cosmetic surgery specialties, otolaryngology (ear, nose and throat surgery) or ophthalmology. Board cer-tification signifies that a physician has the knowledge, skill and experience required to provide quality patient care in a given specialty. you can verify board certification status using online resources offered by the American Society of Plastic Surgeons, the American Board of Plastic Surgery and the American Academy of Facial Plastic and reconstructive Surgery.

5. Ask the surgeon for photographs of his or her work. Most plastic surgeons keep a portfolio of “before and after” images. Most feature their best cases, but you can choose the surgeon whose results you like best.

6. Consider the surgeon’s experience. how long has he or she been perform-ing this procedure? is the latest technique being used? does the surgeon have special training in the use of a technique or new technology? how many of the procedures that you are interested in has he or she performed in a given period? in general, the more experience the surgeon has in per-forming a certain procedure, the better the results.

7. Make sure that your questions have been answered. have you been informed of possible risks, side effects and recovery time associated with the surgery? Obtain as much information as you can about the procedure and discuss your expectations with your surgeon.

8. Be sure the center offers thorough preoperative assessment and proactive postoperative follow-up. this should be part of the overall package, regard-less of the procedure being performed.

ResouRces foR moRe infoRmation

the Joint commission jcaho.org

ohio Department of Health odh.ohio.gov

american association for accreditation of ambulatory surgery facilitiesaaaasf.org

accreditation association for ambulatory Health careaaahc.org

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ClEvElAnd CliniC | FACiAl CoSmEtiC SurGEry GuidE

clevelandclinic.org/renewyou

FACiAl CoSmEtiC SurGEry ProCEdurES

Board-certified surgeons at the Cleveland Clinic Cosmetic & Plastic Surgery Center offer refined cosmetic nose surgery techniques that can enhance your appearance.

nose ResHaping (RHinoplasty)

Cosmetic nose surgery, or rhinoplasty, can improve the appearance and propor-tion of your nose. nose surgery also may improve breathing. the procedure can change your nose’s profile, overall size, tip, bridge and nostrils.

the best rhinoplasty outcomes are achieved when functional concerns are balanced with aesthetic ones. A narrow nose with poor breathing is not a desirable surgi-cal outcome. When the nose is in proper proportion to other facial features, the patient’s facial harmony and self-confidence are enhanced. Achieving this harmony is based on careful examination of the nose in the context of the entire face.

Because cosmetic nose surgery is such a highly individualized procedure, the best results are achieved through a thorough consultation with your cosmetic surgeon. Skin thickness, bone structure, breathing difficulties and ethnic back-ground are important factors to be considered in discussions with your surgeon prior to surgery. Because of the interrelated nature of the nose to the face, many patients with weak chins (lack of chin projection) have a chin augmentation (or genioplasty) in conjunction with rhinoplasty to create a better balance of features.

your surgeon will examine the structure of your nose, both externally and inter-nally, to evaluate nose function and form and make specific recommendations. the surgeon will take photographs of you and discuss the options available. using state-of-the-art modern imaging technology, preoperative planning is done with the patient. Computer images are morphed into potential postoperative results, allowing the patient to become an active participant in the decision-making process. Based on in-depth communication in this planning phase, your surgeon will explain how the nasal structures, including bone and cartilage, can be sculpted to reshape the nose for the desired results.

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Patient before cosmetic nose surgery (top) and three months after cosmetic nose surgery (bottom).

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face lift (RHytiDectomy)

in the early days of cosmetic surgery, face lifts consisted of skin tightening only. Most modern face lift techniques today consist of tightening both the skin and the tissue beneath the skin in the cheek and the neck. there are many techniques. no matter the technique, however, the principle is the same: tightening of the deeper structures allows less tension to be put on the skin, which may lead to a longer term result.

With most face lift procedures, a drainage tube is inserted during surgery. this will be removed a day or two after surgery. All sutures are usually removed within five to 10 days following surgery. Surgeons generally recommend that patients avoid vigorous activity and arrange for post-surgery support from family and friends.

recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are well concealed in natural skin creases and along the hair-line or, if necessary, by makeup until total healing has occurred. Bear in mind that the aging process continues after surgery and that some relaxation of tissues will occur in the first few weeks.

minimally invasive cHeek lift (peRcutaneous miD-face lift)

A mid-face lift, also called a cheek lift, addresses one of the early signs of aging – sagging of the cheeks and the surrounding area. One of the newest approaches to this procedure is the minimally invasive percutaneous mid-face lift (PMl). developed by Cleveland Clinic facial aesthetic surgeons, PMl can be done with local anesthesia with light sedation. it is an outpatient procedure that takes only about 20-30 minutes to complete and patients are generally fully recovered within a week. And, unlike any other face-lifting procedure, the results are adjustable or reversible, if necessary.

neck lift

A neck lift offers a smoother and more toned appearance to skin under the chin and neck areas. newer, less invasive procedures offer shorter operative times, quicker recoveries and can result in significant improvement in the neckline without requiring the extensive surgical dissection of a traditional face lift. the procedure is significantly less expensive than a traditional face lift.

neck lift surgery can be performed in a variety of ways. typically, an incision is made in front of and behind the ear. the edge of the sagging neck muscles is identified and pulled up and secured. the resulting excess skin is removed behind the ear hiding the incision. An alternate method popularized by Cleveland Clinic surgeons involves creating an incision under the chin and tightening the underlying muscle without removing skin and without the need for an incision in front of the ear. Procedures are usually performed in half the time of a typical face lift, and patients generally recover within one week to 10 days and usually can return to work after the first week with only minor bruising.

Patient before face lift (top) and two years after face lift (bottom).

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EyElid And Brow liFtS

eyeliD suRgeRy (uppeR liD BlepHaRoplasty)

this procedure is aimed at removing excess skin and fat in the upper eyelids. it typically is done under local anesthesia combined with conscious sedation (“twi-light sleep”) and has one of the most rapid recoveries of any facial plastic surgery procedure. the entire procedure takes approximately 45 minutes to an hour and the pain is minimal in most cases. Some minor swelling and bruising may last a few days, and most patients are completely recovered after a week. these proce-dures may be combined with brow lifts to achieve the best effect.

eyeliD suRgeRy (loweR liD BlepHaRoplasty)

this procedure addresses the puffiness of excess fat and the wrinkling of excess skin in the lower eyelids. For those patients with excess fat and little or no excess skin, the procedure can be performed by making the incision inside the eyelid (transconjunctival), avoiding a scar on the skin. For those patients with excess skin and fat, an incision is made just below the eyelashes, where it can be well hidden.

your surgeon will use an endoscope (a pencil-like camera device) inserted through a different incision, where the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance.

Patient before brow lift (top) and six months after brow lift (bottom).

Patient before cosmetic eyelid surgery (top) and six weeks after cosmetic eyelid surgery (bottom).

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BRow lift

Also called a forehead lift, this procedure corrects a low-positioned or sagging brow, smooths furrows across the forehead and between the brows, and helps restore a more youthful appearance

A forehead lift can be done in a number of ways. the conventional “open” method involves making one continuous incision starting at ear level and moving up around the hairline. the incision is usually made well behind the hairline to hide the scar.

Cleveland Clinic Cosmetic & Plastic Surgery Center surgeons offer innovations in forehead lift procedures including the use of smaller incisions and endoscopic technology to both elevate the eyebrows and reduce frown lines.

With the endoscopic lift, instead of making one long incision, your surgeon will make about three to five shorter incisions in the scalp, where an endoscope (pencil-like camera device) is inserted into one of the incisions. this will allow the surgeon to view the tissues and muscles from a screen and perform the pro-cedure in a minimally invasive way.

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eaR ResHaping (otoplasty)

Ccosmetic ear surgery can improve the shape, position or proportion of the ear. it can correct a defect that is present from birth, an ear shape that becomes more noticeable with development or misshapen ears caused by injury.

the ear is a complex composite structure of skin, cartilage and even small muscles organized into a defined 3-d shape. Abnormalities in any of these com-ponents can result in a noticeable change in the shape of the ear. Careful analysis of the nature of the abnormality is probably the most important step in perform-ing any remodeling procedure.

Once a defined preoperative plan is formulated, the procedure consists of altering the ear cartilage by suture and scoring (cartilage cutting) techniques. A dress-ing is placed over the ear for five days to help reduce the normal swelling that occurs. the results are immediate and lasting.

Patient before cosmetic ear surgery (left) and six

months after cosmetic ear surgery (right).

Patient before cosmetic ear surgery (left) and six

months after cosmetic ear surgery (right).

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Botox®

Botox is a drug that is used to weaken specific muscles that are responsible for producing unwanted folds and wrinkles around the eyes, mouth and forehead regions. the drug acts only at the site of injection and thereby has an excellent safety profile. Within a few days of the injection, laugh lines and vertical creases in the face will softly fade away. the effect lasts an average of three to four months before re-treatment is necessary. the injections are most effective for crow’s feet, vertical creases in the brow and lines in the forehead. Botox also can be used to raise the eyebrows (chemical brow lift), raise the corners of the mouth or correct minor sagging in the neck. the procedure is done in the office and most patients return to work/daily activities immediately, avoiding the cost and time of facial plastic surgery.

inJectaBle filleRs, like Restylane®, JuvéDeRm® anD peRlane®

As we age, the sagging of midfacial fat and skin results in the formation and deepening of folds around our mouths. Similar folds also develop between the corner of the mouth and the chin. As this process progresses, the folds become deeper. traditionally, a lift procedure is done to address this problem, but an office-based alternative now is available. injectable fillers are a close relative of a naturally occurring substance in the body that is responsible for maintaining the fullness of our soft tissues. Fillers can be injected to fill in the folds and return the area around the mouth to a much more youthful appearance. this short proce-dure can be done in the physician’s office and, like Botox therapy, has little down time associated with it. On average, injectable fillers last six to 12 months before the body naturally reabsorbs the material.

oFFiCE-BASEd ProCEdurES

numerous injection-based procedures are now available to help reduce the signs of aging. these treatments can be done in a short office visit with little to no downtime or recovery period. these procedures are often ideal for individuals who are not quite ready for facial plastic surgery or whose busy lifestyles make it difficult for them to take time off for a cosmetic procedure.

Patient before Juvéderm

injection (top) and after Juvéderm injection (bottom).

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Daniel alam, mD

Section head, Facial Aesthetic and reconstructive Surgery Staff Surgeon, Facial Plastic and reconstructive Surgery head & neck institute

appointed: 2002

medical school: Johns hopkins university

Residency: head and neck Surgery at harvard Medical School

fellowship: Facial Plastic and reconstructive Surgery at university of California los Angeles Medical Center

Board-certified and member of the American Academy of Facial Plastic and reconstructive Surgery. dr. Alam’s practice encompasses the entire range of facial plastic surgery, including face lifts, eyelid and brow lifts, neck lifts, otoplas-ty, rhinoplasty, injectables and more. dr. Alam combines traditional cosmetic procedures with state-of-the-art minimally invasive techniques.

location(s): Main Campus 9500 Euclid Avenue, A71 Cleveland, Ohio 44195 216.444.6691

Beachwood Family health and Surgery Center 26900 Cedar road Beachwood, Ohio 44122 216.839.3740

mEEt our SurGEonS

Cleveland Clinic Cosmetic & Plastic Surgery Center surgeons are well

known for their achievements, including performing the first near-total

face transplant in the united States. Many of our surgeons have

a specific area of clinical focus, giving us expertise and breadth in

all areas of cosmetic and reconstructive plastic surgery.

Our multidisciplinary team will work closely with you to define your goals

and expectations and to offer the most appropriate procedure to ensure

your total satisfaction. during your consultation, your surgeon will go

over all the questions you may have about your individual situation.

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steven BeRnaRD, mD

Staff Surgeon, department of Plastic Surgery dermatology & Plastic Surgery institute

appointed: 2006

medical school: Case Western reserve university School of Medicine

Residencies: Plastic and reconstructive Surgery at university of Pittsburgh Medical Center, Pittsburgh; General Surgery at university hospitals, Cleveland

fellowship: hand and Microsurgery at university of Pittsburgh Medical Center

Board-certified by the American Board of Plastic Surgery, dr. Bernard’s specialty interests include the full range of cosmetic surgery, including all facial proce-dures, surgery of the breast, microsurgical breast reconstruction, hand surgery, cleft lip and palate surgery, and microsurgery. dr. Bernard has developed innova-tions in surgical techniques and has received numerous honors in recognition of his professional achievements.

location(s):

Main Campus 9500 Euclid Avenue, A60 Cleveland, Ohio 44195 216.444.4646

Westlake Family health Center 30033 Clemens road Westlake, Ohio 44145 440.899.5555

Risal DJoHan, mD


appointed: 2003

medical school: Finch university of health Sciences, Chicago Medical School

Residencies: General Surgery at Catholic health Partners, Columbus hospital

fellowship: Plastic Surgery at university of Chicago hospitals; Aesthetic Surgery at Cleveland Clinic

Board-certified by the American Board of Plastic Surgery and American Board of General Surgery, dr. djohan’s specialty interests include facial cosmetic and plastic surgery, including facelifts (rhytidectomy), and cosmetic nose surgery (rhinoplasty), as well as Botox® and injectable fillers. Additionally, his interests include cosmetic and reconstructive breast surgery, liposuction, tummy tucks (abdominoplasty) and microsurgery.

location(s):


Strongsville Family health Center 16761 SouthPark CenterStrongsville, Ohio 44136 440.878.2500

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micHael fRitz, mD

Staff Surgeon, Facial Plastic and reconstructive Surgery head & neck institute

appointed: 2003

medical school: the Ohio State university

Residency: Otolaryngology/head and neck Surgery at Cleveland Clinic

fellowship: Facial Plastic Surgery at the university of Minnesota

Board-certified and a member of the American Academy of Facial Plastic and reconstructive Surgery, dr. Fritz’s practice encompasses the entire range of facial plastic surgery, including face lifts, eyelid and brow lifts, neck lifts, otoplasty, rhinoplasty, injectables and more.

location(s):


independence Family health Center 5001 rockside rd, Crown Centre iiindependence, Ohio 44131 216.986.4160

maRk HenDRickson, mD

Section head, hand Surgery Staff Surgeon, department of Plastic Surgery dermatology & Plastic Surgery institute

appointed: 1995

medical school: Georgetown university School of Medicine

Residency: General Surgery at tulane university hospital and Clinics, new Orleans; Craniofacial and Microvascular Surgery at MiEMS Shock trauma Center, Baltimore

fellowship: Plastic and reconstructive Surgery at Johns hopkins hospital, Baltimore; Maxillofacial Surgery at MiEMS Shock trauma Center, Baltimore; hand Surgery at Curtis hand Center at union Memorial hospital, Baltimore

Board-certified by the American Board of Plastic Surgery, dr. hendrickson’s specialty interests include facial plastic and cosmetic surgery, including face lifts (rhytidectomy), neck lifts, forehead lifts, body contouring, cosmetic injectable fillers, fat injections, Botox® and breast reduction surgery.

location(s):


Solon Family health Center 29800 Bainbridge roadSolon, Ohio 44139 440.519.6800

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RaymonD isakov, mD


appointed: 2006

medical school: Chicago Medical School

Residency: General Surgery at Cleveland Clinic

fellowships: Plastic Surgery at Cleveland Clinic; Aesthetic Facial Plastic Surgery at Zeeba Clinic, Cleveland

Board-certified by the American Board of Plastic Surgery, dr. isakov’s practice encompasses the entire range of cosmetic and reconstructive procedures, with a specialty in facial cosmetic surgeries, including face lifts, eyelid and brow lifts, otoplasty, rhinoplasty, injectables, breast augmentation, and breast reconstruction.

location(s):


Solon Family health Center 29800 Bainbridge roadSolon, Ohio 44139 440.519.6800


p. Daniel knott, mD

Associate Surgeon, Facial Plastic and reconstructive Surgery head & neck institute

appointed: 2006

medical school: university of California-San diego

Residency: Otolaryngology/head and neck Surgery at Cleveland Clinic

fellowship: Facial Plastic and reconstructive Surgery at university of California los Angeles Medical Center

Board-certified by the American Board of Otolaryngology/head and neck Surgery and board-eligible by the Academy of Facial Plastic and reconstructive Surgery, dr. knott’s practice encompasses the entire range of facial plastic surgery, including face lifts, eyelid and brow lifts, neck lifts, otoplasty, rhinoplasty, injectables and more.

location(s):



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aRmanD lucas, mD


appointed: 1993

medical school: dartmouth Medical School

Residency: General Surgery at Berkshire Medical Center, Pittsfield, Mass.

fellowship: Plastic Surgery at Cleveland Clinic (included training in maxillofacial surgery)

Board-certified by the American Board of Plastic Surgery, dr. lucas’s practice encompasses the entire range of cosmetic and reconstructive procedures, with specialty interests in facial cosmetic surgery, body sculpting, breast surgery and reconstructive surgery. dr. lucas has been named one of America’s top docs for seven consecutive years and is the recipient of three Golden Scalpel Awards.

location(s):



JennifeR lucas, mD

Staff Surgeon, department of dermatology dermatology & Plastic Surgery institute

appointed: 2010

medical school: northeastern Ohio universities College of Medicine

Residency: dermatology at Cleveland Clinic

fellowship: Mohs Surgery at Cleveland Clinic

Board-certified by the American Academy of dermatology, dr. lucas specializes in Botox®, cosmetic injectable fillers including hyaluronic acid, laser treatment procedures, vein treatment (sclerotherapy), and eyelash growth treatments (latisse®).

location(s):


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fRancis papay, mD

Chair, dermatology & Plastic Surgery institute Section head, Craniomaxillofacial Surgery

appointed: 1992

medical school: northeastern Ohio universities College of Medicine

Residencies: Plastic and reconstructive Surgery at Cleveland Clinic; Otolaryngology at Cleveland Clinic

fellowship: Craniomaxillofacial/Pediatrics at Primary Children’s Medical Center, Salt lake City, utah

Board-certified by the American Board of Plastic Surgery and the American Board of Otolaryngology, dr. Papay specializes in the entire range of plastic surgery pro-cedures and has performed thousands of cosmetic facial procedures throughout his career, including face lifts, eyelid and brow lifts, neck lifts, otoplasty, rhino-plasty, injectables and more. he is recognized as one of America’s top docs in plastic surgery.

location(s):


Westlake Family health Center 30033 Clemens road Westlake, Ohio 44145 440.899.5555


Julian peRRy, mD

Cole Eye institute

Appointed: 2000

medical school: Columbia university College of Physicians and Surgeons

Residencies: Wills Eye hospital, Philadelphia

fellowship: Ophthalmic Plastic and reconstructive Surgery at Jules Stein Eye institute, university of California los Angeles

Board-certified by the American Academy of Ophthalmology, dr. Perry’s specialty interests include aesthetic facial surgery including cosmetic eyelid surgery (bleph-aroplasty), Botox®, cosmetic facial surgery, laser resurfacing, and ophthalmic plastic and reconstructive surgery.

location(s):


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J. vicente poBlete, mD


appointed: 2010

medical school: university of virginia School of Medicine

Residencies: General Surgery at St. vincent’s hospital and Medical Center, new york Medical College, new york; Facial Plastic and reconstructive Surgery at new England deaconess hospital – harvard Medical School, Boston

fellowships: hand Surgery at Columbia-Presbyterian Medical Center, Columbia university; Cosmetic Surgery at Plastic Surgery Center of the Pacific, honolulu

Board-certified by the American Board of Plastic Surgery and the American Board of General Surgery, dr. Poblete’s specialty interests include cosmetic and facial plastic and reconstructive surgery.

location(s):

Avon lake Family health Center 445 Avon Belden road, Suite B-4 Avon lake, Ohio 44012 440.930.6800

Elyria Family health and Surgery Center 303 Chestnut Commons drive Elyria, Ohio 44035 440.366.9444

silvia RotemBeRg, mD


appointed: 2006

medical school: Faculdade de Medicina do ABC Medical School, Sao Paulo, Brazil

Residencies: Plastic Surgery at university hospitals; General Surgery at university hospitals, Cleveland

fellowships: Plastic Surgery at Cleveland Clinic; Aesthetic Surgery at Cleveland Clinic

Board-certified by the American Board of Plastic Surgery, dr. rotemberg specializes in aesthetic plastic surgery, including surgical and non-surgical facial enhancement, body contouring after significant weight loss, cosmetic surgery of the breast and abdomen, and liposuction.

location(s):



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RanDall yetman, mD

Section head, Breast Surgery, department of Plastic Surgery dermatology & Plastic Surgery institute

appointed: 1983

medical school: university of Miami Miller School of Medicine

Residencies: Plastic Surgery at new york hospital Cornell Medical Center; General Surgery at Montefiore Medical Center, new york

fellowships: hand Surgery at Cleveland Clinic

Certified by the American Board of Plastic Surgery, dr. yetman’s practice encompasses the complete range of cosmetic and reconstructive surgery, with specialty interests in cosmetic facial surgery, breast surgery, breast reconstruction, microvascular surgery and melanoma. he is a recipient of a national top doctor honor from Ladies’ Home Journal and a national Best doctors award from Redbook magazine.

location(s):



James zins, mD

Chair, department of Plastic Surgery dermatology & Plastic Surgery institute

appointed: 1983

medical school: university of Pennsylvania School of Medicine

Residencies: Plastic Surgery at hospital of university of Pennsylvania; General Surgery at hospital of university of Pennsylvania

fellowships: Craniofacial research at hospital of university of Pennsylvania; Maxillofacial at hospital for Sick Children, london

Certified by the American Board of Plastic Surgery, dr. Zins is recognized as one of America’s top docs in plastic surgery. his practice encompasses the entire range of plastic surgery procedures, with a specialty in cosmetic facial procedures including face lifts, eyelid and brow lifts, otoplasty, rhinoplasty and injectables. dr. Zins popularized the minimally invasive neck lift at Cleveland Clinic.

location(s):


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10-PSX-010

FACiAl CoSmEtiC ProCEdurES wEB CHAtS

to read web chat transcripts featuring Cleveland Clinic Cosmetic & Plastic Surgery Center surgeons discussing many of the facial procedures covered in this guide, visit clevelandclinic.org/health/chatreg.

For morE inFormAtion

For more information about all cosmetic surgery procedures, to schedule a consultation with one of our specialists and more, visit Cleveland Clinic Cosmetic & Plastic Surgery Center online at clevelandclinic.org/Renewyou.

Facial Cosmetic Surgery Guide - Cleveland Clinic

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