Frequently Asked Questions

Selecting a facial plastic surgeon should begin with a consultation. This personal consultation is your time to explore your specific needs and concerns. It's crucial to find a surgeon you are comfortable with and who will address all your questions and concerns. When considering plastic surgery of the face, technical expertise is vital, as is artistic skill, because this area requires a keen sense of both.

Several resources are available, including the Internet, referrals, and advertising. However, a surgeon's reputation and referrals from satisfied patients are of utmost importance. A surgeon's credentials are very important. You can start by talking with the surgeon's office staff or the surgery center/hospital where the surgeon has operating privileges.

Another way to assess the surgeon's skill level is to review before-and-after pictures of actual patients. These should be readily available during your consultation.

When skin is young, its collagen structure is intact, keeping it supple and hydrated. This means that facial lines from expressions like smiling or frowning disappear quickly. However, as we age, this collagen network deteriorates, diminishing our skin's capacity to smooth out lines and wrinkles. While surgery can correct loose skin, laser skin resurfacing and chemical peels are used to smooth wrinkles and improve skin tone and color. In addition, daily skin care helps to maintain youthfulness and postpone surgical options. Many skin care products offer advanced ingredients that improve collagen levels and skin elasticity. Choosing quality skin care products and SPF is essential in warding off the signs of aging.

When considering facelift surgery, it's important to assess the aging changes in the lower two-thirds of the face. As we age, the skin loses elasticity, muscles begin to atrophy and lose tone, and bone mass diminishes. This process results in the formation of sagging skin along the jawline, deepening nasolabial folds, and looseness of the skin and excess fatty tissue in the neck.

Facelift surgery specifically addresses these issues by tightening the jowls, reducing nasolabial folds to some extent, and tightening the neck skin while removing excess fatty tissue. However, facelift surgery does not affect the eyes, brows, or corners of the mouth, which must be addressed with other surgical procedures.

Incision placement in facelift surgery is crucial. Scars should be maximally camouflaged without altering the shape of the ear or changing the hairline. Attention to detail is essential to avoid adverse effects on the outcome. This is where a surgeon who specializes in facial plastic surgery has an advantage.

The procedure begins with a small incision under the chin for access to the neck for liposuction, removal of excess fatty tissue, and tightening of loosened neck muscles or noticeable muscle bands. All other incisions are hidden in the hair above and behind the ear, with incisions taken inside the ear for maximal camouflage instead of in front of the ear, which can leave noticeable scars.

After complete neck liposuction and muscle tightening, the surgeon goes deeper to tighten the supportive tissues beneath the skin. This “deep plane” approach allows for a smoother, more natural look with longer-lasting results.

After your procedure, a soft gauze dressing will be placed around your head to decrease bruising, prevent bleeding, and protect the incisions. This dressing will be removed the following morning, and our staff will shampoo your hair. No further dressing will be needed, and you can shampoo your hair as usual the next day. Most of the stitches used are dissolvable, and any that haven't dissolved after seven days will be removed. If you have staples in the incisions within the hair, they will be removed in seven days. Makeup may be applied the following day if desired.

Swelling and bruising are usually minimal and diminish within the first week or two. Pain is typically very minimal. Some areas of the cheeks may have numbness for several weeks or months, and you may experience some tightening in the neck, which will loosen with time. Most people return to work after two weeks, although some patients have returned as early as seven days.

We prefer to follow our patients very closely postoperatively. Follow-up appointments will be scheduled for one day, seven days, fourteen days, one month, three months, six months, and one year after surgery. These follow-up appointments are individualized for our out-of-town patients. We also recommend that each surgery patient be put on a skincare maintenance routine by one of our medical aestheticians to ensure long-lasting results.

The eyes are one of the most noticeable facial features and play a crucial role in our overall appearance. Excess drooping skin of the upper eyelids and excess fatty tissue and skin in the lower eyelids can create a heavy or tired look. Eyelid surgery helps alleviate this appearance by removing excess skin, muscle, and fatty tissue. Tightening the skin of the lower eyelids can be achieved either surgically by direct excision or also through the use of lasers or chemical peels. Eyelid surgery does not address brow heaviness, which is corrected with a brow or forehead lift. Typically, the shape of the eye is not affected unless specific reasons to do so are present.

Upper eyelid surgery involves an incision placed carefully within the crease of the upper eyelid for maximum camouflage. The amount of excess skin is precisely measured preoperatively with the patient in the sitting position. After removal of the excess skin, a small strip of muscle may also be removed, along with small fatty deposits. The incision is then closed with very fine stitches.

When removing fatty tissue below the eyes, two approaches are possible. A transcutaneous skin-muscle flap approach with an incision just below the lower eyelid lash line can be used for access to the fat deposits and this provides a great way to also excise excess skin of the lower eyelid.

In some patients, external skin incisions can be avoided. This approach, termed a transconjunctival blepharoplasty, involves everting the lower eyelid and using a laser to make an incision inside the lower eyelid down to the excess fatty pads, which are then re-contoured. The laser allows for precise, nearly bloodless surgery, minimizing bruising and swelling.

No stitches are required on the inside of the lower eyelid for the transconjunctival approach, as this incision will heal on its own within three to four days. If an external incision is used, termed the transcutaneous skin muscle flap approach, stitches will be removed at the one week visit.

Laser skin resurfacing is often used to tighten the skin of the lower eyelids and crow's feet. This method not only tightens the skin but also smooths the lines of the lower eyelids and crow's feet area.

The forehead and eyebrows play a prominent role in the upper one-third of the face. They are crucial in facial expression and overall facial character. Heavy or drooping eyebrows can create a tired look, and the shape of the eyebrows can suggest various expressions, such as cynical or inquisitive looks. A brow or forehead lift involves elevating the brows to a more youthful and natural position.

There are several surgical approaches to brow or forehead lifting. The most commonly used approach is the endoscopic forehead lift. Other approaches include, pretrichial, coronal, mid-forehead and direct brow lift. Your facial plastic surgeon can suggest which approach is best for you based on the degree of correction desired, the height of your frontal hairline, and the aging changes of the overlying skin. Both Drs. Ron and Alex Caniglia believe the endoscopic approach to be the “gold standard” for most patients, as it provides outstanding results with minimal downtime and nearly invisible scars without altering the hairline.

The incision placement depends on the selected procedure. Those with a very low frontal hairline may opt for a coronal forehead lift, which involves an incision placed several centimeters back in the hairline. If one has an extremely tall or high forehead, they may be a candidate for a pretrichial forehead lift, involving an incision at the hairline to avoid raising it further back. In this approach, a special bevel or back-cut is made along the incision line to bury hairs underneath and in front of the scar, allowing them to grow up through and in front of the scar for maximum camouflage.

For men who have lost hair and have deep horizontal wrinkles in the forehead, a mid-forehead lift is often performed, placing the incision within one of these deep horizontal creases. A direct brow lift involves placing an incision just above the hairs of the brow, though this is rarely indicated. A newer approach involves the endoscopic forehead lift, performed through several small incisions placed within the scalp using special endoscopes and cameras for visualization.

Regardless of the procedure chosen, the ultimate goal is the same: raising the eyebrows and releasing the muscles of the brows that cause creases or lines in the forehead.

No other feature on the face exhibits such varied characteristics and differences among individuals. Some noses are long, others are short, some are wide, some are narrow, and some have a prominent hump. Nasal tips may be long and drooping or raised and pointed. Additionally, some noses may be crooked due to previous nasal fractures.

Your facial plastic surgeon can help you evaluate your nose in relation to the rest of your face. A computer imager is often used to provide precise measurements and illustrate possible outcomes of nasal surgery. Several views will be used by your surgeon, including a frontal view, a side or profile view, an oblique or 45-degree angle view, and a base view revealing the nostrils. Your surgeon will also evaluate your chin, as a small chin on profile can make the nose appear larger. In some cases, a simple chin implant can bring the profile into better harmony.

Your facial plastic surgeon has spent years studying the anatomy and dimensions of the face and the relationship of the features to one another, making them highly qualified to determine the best surgical procedure for you. Nasal surgery can involve a change in the external appearance of the nose (rhinoplasty), or it can be functional in nature, requiring straightening of the septum or middle strut inside the nose and addressing the turbinates within the nose to improve nasal breathing.

Several procedures are available for altering the shape or size of the ears. Some ears protrude too much and require setting back closer to the head, while others may be too long or have overly redundant earlobes. Additionally, some people suffer from torn earlobes, often due to wearing pierced earrings.

Surgery to pin back the ears is commonly performed on children as they begin their school years. This procedure involves removing a small ellipse of skin on the backside of the ear. The delicate cartilage of the ear is then sculpted and set back to create a more natural appearance closer to the head. The stitches used to close the incision are dissolvable.

Cheekbones play an integral part in overall facial harmony. Underdeveloped cheekbones can create a flat or expressionless face. Placement of cheek implants (malar and submalar) is often performed through incisions just underneath the upper lip on both sides within the mouth. Through this incision, a pocket is created over the cheekbone, and the chosen implant is placed. The stitches used to close the incision are dissolvable. Swelling and bruising are usually minimal, and most patients can return to work within a week.

An alternative to facial implants for improving underdeveloped cheekbones or the midface is injectable fillers. Hyaluronic acid fillers, including Juvéderm, Restylane and Revance products, are a very safe and effective option.

Lips are not immune to the aging process. Because lips are large muscles, they atrophy or shrink with age. Full, sharply defined lips are a sign of youth. Several techniques are available for lip enhancement. Some involve filler materials, such as Restylane®, Juvéderm®, Revance, Radiesse™ (formerly known as Radiance™), and fat. Although not permanent, these fillers provide an immediate, soft, natural lip enhancement.

If one desires permanent lip fullness, there are several surgical options. A subnasal lip lift, with an incision hidden at the base of the nose can increase red upper lip show and diminish signs of upper lip aging. A surgical lip advancement can be also performed on the lower or upper lip. In this procedure, a small excision of skin above or below the lip is done, allowing the red portion of the lip to advance outward. If the corner of the mouth droops downward, incision angles can be adjusted to perform a corner of mouth lift. The fine stitches used are removed after seven days, and makeup may be applied the following day. Permanent makeup applied any time after six weeks often enhances the overall surgical result. Injectable fillers can be used after surgery to further augment surgical results.

Skin care and treatments encompass a wide range of procedures, from daily skin care to light chemical peels, medium and deep peels, microdermabrasion, microneedling, and various laser skin resurfacing procedures performed by aestheticians. When evaluating one's skin, it is important to address the amount of sun and age damage. This includes assessing the number and depth of facial lines, the looseness of the skin, and any blemishes or color variations.

Chemical peels involve using varying strengths of acids to peel away the top layers of skin, allowing smoother, regenerated skin to emerge. Peels come in three basic strengths: light, medium, and deep. Light and medium peels are often performed by aestheticians for routine skin maintenance. Deeper peels often yield better and longer-lasting results. Light peels commonly use Glycolic and Salicylic acids, medium peels use Trichloroacetic Acid, and deep peels use Phenolic Acid.

Another form of skin resurfacing is dermabrasion, which uses high-speed, rotating diamond burrs to remove the top layers of damaged or scarred skin.

The newest technique available today for improving skin appearance is laser skin resurfacing. The most common laser used is the Carbon Dioxide (CO2) Laser. Modern pulsed lasers, such as the Ultrapulse Encore, provide increased safety and precise depth control, which are often lacking in some chemical peels and dermabrasion. This laser can perform lighter fractionated laser treatments (Active/Deep FX) and adjust to higher settings for deeper wrinkles.

Most light and some medium peels can be performed without anesthesia. Deep chemical peels, dermabrasion, and laser skin resurfacing are often best performed under intravenous sedation. Postoperative care can vary among surgeons. Some prefer to occlude the skin with a bandage, while others use ointments and creams to keep the skin lubricated during healing. With medium and deep peels, dermabrasion, and laser resurfacing, it is usually recommended to wait two weeks before applying makeup. Redness may persist for up to two to three months or longer in some cases. However, special camouflage makeup can be used after a few weeks, allowing a return to work.

Skincare begins with a proper evaluation by a qualified aesthetic provider. Your facial plastic surgeon will recommend a skin care regimen that may include treatments and a daily skincare protocol. It is important for patients to use quality, medical-grade products for lasting results. The Caniglia MD Skincare line is an excellent option for those looking to improve their overall appearance and target problem areas. Key ingredients to look for in skin care products include natural extracts, retinol, hydroquinone, AHAs and BHAs, and a good SPF.

Yes, the procedure known as neck liposuction can address excess fatty tissue in the neck, which causes a heavy or double chin appearance. This area is often addressed during facelift surgery. Liposuction is performed through a tiny incision just underneath the chin, using a small cannula to remove the excess fatty tissue with suction.

However, neck liposuction alone may not be sufficient for some patients, as skin looseness plays a critical role in the overall result. If the skin has lost elasticity, the excess skin must be removed, and the underlying tissues tightened, as in a facelift/necklift. Your surgeon can evaluate this for you. Healing time is very quick with neck liposuction only. A dressing is applied overnight and removed the following morning, and patients often return to work within a few days.

Your chin plays an important role in the composite facial symmetry and harmony of your face. Your surgeon will evaluate your chin specifically from the profile view. A vertical line is drawn downward from the edge of the lower lip. Your chin should meet this line. If the chin does not meet this line, it is considered weak, creating the illusion of a larger nose and a shorter neckline. Some people, on the other hand, have a prominent chin. Chin augmentation is commonly combined with nasal surgery and/or facelift surgery. Some patients may need a reduction mentoplasty or surgery to reduce the size of the chin.

The chin implant can often be placed through a small incision just underneath the chin or through an intraoral incision behind the lower lip and within the mouth. Numerous shapes and implant materials are available today. Your surgeon will assist you in customizing the one that best fits your needs.

There are three types of anesthesia that can be used. The first is local anesthesia, which involves an injection of numbing medicine to anesthetize the area being worked on. This is typically used for minor procedures. The next type is oral sedation, where the patient takes several pills to relax and sedate them, often combined with local anesthesia. This method is also used for minor procedures. Lastly, there is intravenous (IV) conscious sedation, involving sedation administered intravenously for a deeper level of relaxation. It’s common for the patient to take oral sedatives an hour and a half before the IV sedation to help relax and maintain a steady state of pain-free anesthesia.

All our anesthesiologists at Caniglia Facial Plastic Surgery are board-certified and will monitor you throughout your procedure using state-of-the-art equipment found in hospitals.

Unsightly scars can affect one's overall appearance and self-image. While a scar can never be completely removed, it can often be camouflaged to become barely perceptible. The chosen procedure depends on the scar's location and orientation. Wide, depressed scars or those running against the relaxed skin tension lines often require surgical excision and re-closure to improve the scar into a fine line. Other techniques that may be used in conjunction with scar revision surgery include skin-resurfacing methods like microdermabrasion, microneedling, and laser skin resurfacing, which help to smooth and contract scars for better camouflage.

Soft tissue fillers are injectable materials used to fill in deep wrinkles, traumatic scars, acne scars, and other skin depressions. Some commonly used fillers include Restylane®, Juvéderm®, Revance, Radiesse™, and fat.

• Restylane®, Juvéderm® and Revance are cosmetic dermal fillers made of non-animal-based hyaluronic acid, which is a natural substance in the human body. They restore volume and fullness to the skin, correct moderate to severe facial wrinkles and folds, and enhance lips.
• Radiesse™ is a synthetic compound composed of calcium hydroxyapatite, a natural substance in the body. It provides immediate results that may last for a year or more.
• Collagen is a gel-like substance derived from purified human or animal tissue. Since animal-derived collagen is recognized as a foreign substance by the body, it requires skin testing before use and is eventually absorbed, lasting from three months to a year.
• Fat injections tend to last longer than collagen, with up to 50% of each injection potentially being maintained permanently. These often require local anesthesia and/or light sedation.
• Gortex™ is a synthetic implant used to enhance facial features like cheeks, chin, lips, and sometimes the nose. It has very low reactivity or rejection rates, and although it is permanent, it can be easily removed if desired.

Drs. Ronald and Alex Caniglia utilize advanced surgical techniques and products to enhance healing. For all facelift procedures, they use Tisseel VH, a natural fibrin sealant, to minimize bleeding and reduce post operative bruising, eliminating the need for surgical drains and pressure dressings. Additionally, all patients receive Arnica Montana, a natural homeopathic medicine that reduces post-surgical bruising and swelling.

Each surgical patient is also given a maintenance protocol by one of our attending aestheticians and receives pre- and post-surgery skin care kits to promote a better surgical experience and maintenance for their enhanced face. These products, combined with Drs. Ron and Alex Caniglia's precise surgical techniques allow patients to return to normal activities much sooner.