Dr. Irvine has been featured in Forbes , South Bay Magazine, and RealSelf News discussing trends and innovations in facial plastic surgery.
Dr. Irvine operated alongside Dr. Paul Nassif on the hit television show Botched during her training in 2016 and 2017 and can be found operating on complex revision cases in seasons 4 and 5.
Dr. Irvine has published numerous articles in peer reviewed journals and textbooks. Topics include novel facial nerve procedures, management of challenging facelift and revision rhinoplasty surgeries, postoperative protocols for patients with thick skin, and more.
Check out before and after images of nose surgeries performed by Dr. Irvine here.
- Primary Rhinoplasty
- Revision Rhinoplasty
- Functional Rhinoplasty
- Ultrasonic Rhinoplasty
- Preservation Rhinoplasty
- Nasal Fractures
Rhinoplasty (also known as a nose job) is a very rewarding and popular procedure. A rhinoplasty can change the shape of the nose, bringing it into harmony with the rest of the face to dramatically improve the overall facial appearance. In order to provide the most precise and aesthetically pleasing results, Dr. Irvine does the majority of her rhinoplasties using an open technique. A small, well-hidden incision is made at the bottom of the nose on the columella, between the nostrils. Dr. Irvine uses a structural rhinoplasty approach. This means that she utilizes patients’ own cartilage to reshape the nose while supporting it to ensure long-lasting cosmetic and functional improvements.
Dr. Irvine has performed hundreds of rhinoplasties over the past six years. She received highly specialized training in rhinoplasty and revision rhinoplasty, having worked with rhinoplasty specialist Dr. Paul Nassif on some of the most difficult cases in the world while filming for his television show Botched. This unique experience combined with her attention to detail and perfectionism make her an excellent rhinoplasty surgeon.
During the consultation, Dr. Irvine takes the time to listen to patients’ goals. She performs a thorough nasal examination to understand each patient’s unique nasal anatomy. Using computer software, she creates a picture of what the nose will look like after surgery and makes sure that she and each patient are on the same page.
Recovery after rhinoplasty usually takes about 1-2 weeks. After this time, most patients return to work. The scar under the nose may remain red for approximately six weeks. Swelling lasts for two years but most of the swelling is improved within the first three months after surgery.
Profile views before and 3 months after primary rhinoplasty surgery
A revision rhinoplasty is performed to correct imperfections, irregularities, or difficulty breathing after prior nasal surgery or surgeries. The goals of revision rhinoplasty are to make the nose look natural and aesthetically pleasing and to improve breathing. Because the nose is a three-dimensional structure composed of bone and cartilage covered by skin, healing can be unpredictable as the skin contracts around the underlying framework. Dr. Irvine’s structural rhinoplasty approach corrects these problems, improving breathing while making patients look better at the same time.
Dr. Irvine received highly specialized training in revision rhinoplasty, having spent one year with rhinoplasty specialist Dr. Paul Nassif, operating on hundreds of the most difficult cases in the world while filming for his television show Botched. This unique experience combined with her surgical skill, attention to detail and perfectionism make her an excellent revision rhinoplasty surgeon.
Recovery after revision rhinoplasty usually takes about 1-2 weeks. After this time, most patients return to work. The scar under the nose may remain red for approximately six weeks. Swelling lasts for two years but most of the swelling is improved within the first three months after surgery.
Many patients have difficulty breathing through their noses but do not want to dramatically change the appearance of the nose. Often, patients have been told that they have a deviated septum, which is when the internal cartilage and bone that separate the two nostrils (septum) is obstructing one or both nostrils. Sometimes simply correcting a deviated septum improves breathing sufficiently. However, in many cases nasal obstruction is more complex and is due to narrowing of the internal and/or external nasal valves. In these cases, a functional septorhinoplasty is often the best option. During this surgery, Dr. Irvine uses a patient’s own cartilage to create grafts that open the airway. Sometimes these grafts will alter the appearance of the nose slightly, usually for the better, and the goal is always to ensure that the balance and harmony of the nose with the rest of the face is maintained.
Dr. Irvine’s extensive training in the structural septorhinoplasty approach makes her uniquely positioned to balance the cosmetic and functional demands of this surgery to create excellent results.
Recovery after functional rhinoplasty usually takes about 1-2 weeks. After this time, most patients return to work. The scar under the nose may remain red for approximately six weeks. Swelling lasts for two years but most of the swelling is improved within the first three months after surgery.
Before and 6 weeks after a functional septorhinoplasty performed solely to improve nasal airway breathing.
Tip swelling will continue to resolve and scar will continue to improve over the next 10 months.
Before, 6 weeks after, and 4 months after functional open septorhinoplasty surgery
Ultrasonic Rhinoplasty
The use of powered ultrasonic instruments is one of the newer and most exciting advances in rhinoplasty surgery. In this technique, the nasal bones are precisely contoured by using powered instruments that vibrate at specific frequencies to remove unwanted bone. The overlying skin, soft tissue, and blood vessels on the nose are not disrupted by this technique. This leads to little or often no bruising at all. When necessary, the nasal bones can be precisely cut using the ultrasonic technique. This technique is also used for septoplasty surgery, allowing careful and atraumatic removal of bony deviations in the septum that block the airway.
Nasal Fracture Treatment:
Another important advantage of using powered ultrasonic instruments is the ability to perform rhinoplasty surgery on patients who have had recent nasal fractures. Traditionally, after a nasal fracture, aside from resetting the bones right away, a full rhinoplasty was not performed for 6-12 months. With the use of ultrasonic rasps and blades, the delicate nasal bones can be treated, reset, and a full rhinoplasty performed shortly after a nasal fracture has occurred. This has the advantage of allowing patients to return to work and school sooner without having to live with an injured/broken nose for months.
Before and 4 weeks after ultrasonic rhinoplasty surgery
One of the latest new/old trends to circle back in rhinoplasty surgery is the preservation rhinoplasty. Preservation rhinoplasty simply means that all or a part of the bridge of the nose (the dorsum) is not taken down or separated. Instead it is “preserved” during surgery and work is done underneath or deep to a preserved roof of the nose. Usually this means that the lines that determine the nasal shape from the front (called the brow-tip aesthetic lines or dorsal aesthetic lines) are not interrupted. Leaving these lines intact can lead to a lower risk of nasal contour discrepancies many years down the line.
Although it is billed as “less invasive,” the group of techniques called “preservation rhinoplasty” still often require fracturing the sides and the superior part of the nasal bones. The advantage is that by leaving the front of the bridge of the nose as it was prior to surgery, we have one less variable to worry about as the nose heals. In addition, these techniques can still improve the nasal airway and often do so without widening the middle part of the nose (the middle vault) too much or at all.
Am I a candidate for preservation rhinoplasty?
You might be a candidate for a preservation rhinoplasty if:
- This is your first rhinoplasty surgery
- Your nose is straight, or mildly or moderately deviated to one side
- You have not had significant trauma to your nose
- You have a small or medium sized dorsal hump on your nose that you would like to have taken down
If you would like to learn more about this and other techniques that Dr. Irvine uses for her nasal surgeries, please call us at 424-225-1280 or request an appointment here.
Nasal Fractures
As both an otolaryngologist and facial plastic surgeon, Dr. Irvine has extensive experience treating all types of nasal and facial fractures.
In general, trauma that involves the bony part of the nose (the upper third) can be fixed in the immediate post-injury period. If a nasal fracture has displaced the nasal bones laterally (visibly moved the nose to one side causing a crooked appearance), it is best fixed with a closed nasal reduction. This can be performed within the first 5 hours of the injury or between 5 and 14 days after the injury. A closed nasal reduction involves simply moving the bones back to the midline and resetting them without making any internal or external incisions.
Traditionally, injuries that affect the cartilage of the nose (the lower two thirds of the nose) have only been addressed at a later date, usually 6-12 months after the injury. This practice was adopted in order to give enough time for all the nasal swelling to resolve, to be able to see contour irregularities in the nose that may not be obvious at the time of the injury. However, newer studies and Dr. Irvine’s own experience have demonstrated that in certain situations, it may be okay and even preferable to perform a complete rhinoplasty, addressing the nasal bones and the cartilage, at the time of the injury. Using powered ultrasonic instrumentation facilitates this. Dr. Irvine can delicately address nasal fractures without disrupting the framework of the nose, even when fractures are still mobile.
Regardless of the intervention chosen, treating displaced nasal injuries promptly is beneficial. Numerous studies have shown that even when the outcome of an immediate closed nasal reduction is not perfect, and even when a second surgery is still required, having an initial closed nasal reduction improves outcomes of secondary surgery.
Thus, Dr. Irvine and most urgent care and emergency room physicians encourage evaluation by an otolaryngologist or facial plastic surgeon within one week of nasal injury.
Otoplasty is a cosmetic surgery to correct the shape of the ears or to make them appear less prominent. This is a very rewarding surgery because correcting prominent ears can significantly improve self esteem, especially in young people and children. Each ear is unique, but prominent ears are usually caused by an incompletely formed antihelical fold and excess conchal bowl cartilage (the top picture below illustrates a more defined antihelical fold and reduced conchal bowl size one year after otoplasty surgery.) In addition, some patients have prominent ear lobules, requiring removal of the extra soft tissue from the bottom third of the ear. Dr. Irvine uses incisions only on the back of the ear so that once the ears are healed the incisions are well hidden and virtually imperceptible.
Dr. Irvine uses several techniques to pin ears back, including: Mustarde sutures to form an antihelical fold (to keep the top of the ear further toward the head), conchal bowl cartilage excision (to set the middle part of the ear back), Furnas sutures (to pin the middle part of the ear back further), and a soft tissue flap (to use the soft tissue on the back of the ear to cover the sutures, reducing the risk of extrusion, and to hold the ear back more firmly than just sutures alone.) When needed she will also suture cotton bolsters to the conchal bowl to prevent fluid accumulation and provide an extra measure to keep the ear pinned back.
Otoplasty can be performed under local or general anesthesia. A bandage is worn around the head for 3 to 5 days after surgery. An elastic headband is worn at all times for 2 weeks after surgery and then at night for 6 weeks after surgery. Swelling of the ears lasts about a week and most patients return to work by 3 to 7 days after surgery.
Earlobe repairs are done to make the earlobe more aesthetically appealing after trauma, such as after a pulled or heavy earring causes the ear lobe to stretch or tear. Dr. Irvine performs a quick in-office procedure to repair the ear. If desired, the ears can be re-pierced 1-2 months after the procedure (as demonstrated in the below pictures, taken before ear lobe repair and 2 months after ear lobe repair, immediately after re-piercing by Dr. Irvine.)
There is no downtime to this procedure, and patients can return to work and activities the same day.
A facelift (also known as rhytidectomy) is a powerful procedure to lift and reshape the lower face and neck to restore it to a more youthful and pleasing shape. As we age, the skin and underlying tissue of the face and neck begin to drop and lose volume. This can change a youthful heart shaped face into a more square or rectangular shaped face. In addition, the neck muscle, called the platysma muscle, becomes thinner and begins to separate, leading to vertical neck bands.
A facelift elevates and anchors deep tissues and skin in the lower face and neck. This can improve the appearance of jowls, loose skin in the lower neck and face, and platysmal bands that create vertical lines in the neck. It can also improve the contour of the middle portion of the face, called the midface. The goal is to achieve an overall more pleasant, refreshed, and youthful appearance. Because everyone ages differently and has different goals for facial rejuvenation, Dr. Irvine uses an individualized approach to analyze and correct age-related changes. Facelift incisions are well hidden in natural skin creases and hair bearing areas in front of and behind the ears. Often, a laser skin treatment is recommended in conjunction with a facelift to improve the results, tighten skin, and help with the fine lines that a facelift does not treat.
Recovery after facelift usually takes about 2 weeks. After this time, most patients return to work. The scars may remain red for approximately six weeks to three months. Swelling can last anywhere from 2 to 6 weeks depending on individual anatomy and physiology.
With age, the position of the eyebrow can drop, leading to hooding of the skin above the upper eyelid. Peripheral vision can be impaired by this excess tissue. There are many methods used to correct a droopy brow. Botulinum toxin (Botox®, Dysport®, or Xeomin®) injected in the muscles that depress the eyebrows can help to naturally and subtly raise the brows. This is temporary and generally lasts around 3 to 4 months. A minimally invasive surgical technique, the endoscopic brow lift, uses between 2 and 5 small incisions just behind the hairline to lift and suspend the eyebrows permanently. In older patients and in men, a direct brow lift, removing skin just above the eyebrows, can lift the brows and the carefully placed scar can be hidden at the top of the eyebrow.
Recovery after brow lift usually takes about 1-2 weeks. After this time, most patients return to work. Swelling and bruising can last anywhere from 2 to 4 weeks depending on individual anatomy and physiology.
When considering facial rejuvenation or facial reshaping surgery, it is important to consider the face as a whole. The lower cheeks contain pockets of fat called buccal fat. Buccal fat can become more prominent with age, weight gain, or due to genetic factors. Buccal fat removal takes out a portion of this fat in order to reshape the face, making it appear more youthful, sculpted, and heart-shaped. It is performed through incisions in the mouth, with no visible external scars. This can be done under local or general anesthesia.
Recovery after buccal fat removal usually takes a few days. Patients can return to work the day after or within the first few days of surgery. Swelling can last up to 1-2 weeks depending on individual anatomy and physiology.
Botox® and other neuromodulators such as Dysport® and Xeomin® can be injected into the upper face and neck to reduce the activity of muscles of facial expression. This can reduce the appearance of dynamic wrinkles, or wrinkles that appear when the face moves. Common areas to inject are the glabella (between the eyes), forehead, periorbital area (crow’s feet), and platysma (the muscle causing vertical neck bands). In addition to immediate wrinkle improvement, these treatments slow new wrinkle formation by reducing or eliminating certain facial movements. Neuromodulators are temporary and their effect generally wears off by 3 to 4 months. Some patients have expressed concern that once they start treatment, they cannot stop. In fact, Botox®, Dysport®, or Xeomin® injections do not need to be continued indefinitely. Even an occasional injection, such as once a year, will provide some anti-aging benefit and help to prevent new wrinkles from forming and deepening. Most of the fillers done in the office today are made of hyaluronic acid. This is a naturally occurring substance that we have in our bodies. Hyaluronic acid gives tissues elasticity and volume. As we age, we lose hyaluronic acid, and this contributes to the appearance of deep lines and wrinkles. Hyaluronic acid fillers can be used in many areas of the face including the temples, cheek bones, midface, nasolabial folds, lips, chin, and jaw to create a more pleasing facial shape or to restore a more youthful shape. Dr. Irvine uses only hyaluronic acid fillers. These are metabolized by the body and usually last between 6 months and 2 years, depending on the exact filler used. Dr. Irvine uses different fillers in each area of the face, depending on patient anatomy and goals.
Fillers are injected in the office using only topical and/or local anesthesia. There is no down time and patients can return to work immediately with the caveat that no make up can be worn over the injection sites until the following day.
Fat grafting or fat transfer involves removing fat from the abdomen, flanks, inner, or outer thighs, and placing it in the face. As we age our faces lose volume in specific fat compartments in the temples, midface, and lower face. Some of this volume can be restored using temporary hyaluronic acid fillers, but sometimes patients elect to have a more permanent surgical solution by using their own fat to provide a more youthful facial shape. Dr. Irvine does this under general anesthesia or moderate sedation in order to make patients as comfortable as possible. It is often done at the same time as a facelift to improve the overall result. Approximately 40 to 70% of the transplanted fat survives, and after fat grafting, the aging process continues, meaning that the face may continue to lose fat as part of the natural aging process. Therefore many patients may desire a second fat grafting procedure approximately 1 to 2 years after their first one.
Swelling and bruising of the fat injection sites usually lasts 1-2 weeks depending on patient age and the amount of fat injected. After this time patients can return to work.
CO2 fractional laser resurfacing is a powerful tool to tighten loose skin and reduce the appearance of fine lines and wrinkles. Dr. Irvine uses a fractional ablative CO2 laser for her resurfacing procedures. This creates controlled thermal injury to the skin, stimulating the body’s natural collagen production, and filling in deep lines and wrinkles.
CO2 laser resurfacing treats wrinkles which are present at rest and also treats the vertical lines around the mouth and wrinkles in the lower face that cannot be safely addressed with neuromodulators like botox® alone. A laser treatment can be done in the office using topical numbing cream, or it can be done in the operating room under general anesthesia. It is often performed at the time of a facelift to address the fine skin lines that cannot be improved with a facelift alone. Patients may require several treatments to achieve the desired result. It is critical to be on a good skin care regimen before and after a laser treatment and to avoid all sun exposure before and after. During a consultation with Dr. Irvine, she will discuss whether this powerful treatment is right for you and your skin type.
Recovery time varies based on the intensity and depth of the laser and ranges from 1-2 weeks. Slight redness of the face can last for 3-4 months.
Microneedling is a minimally invasive procedure in which tiny needles are placed in the skin to safely stimulate collagen production. Dr. Irvine uses the FDA-cleared RejuvaPen NXT® which uses several tiny (33 gauge) needles to make controlled micro-perforations in the superficial layer of the skin. This stimulates the body’s own healing process to begin, leading to the deposition of collagen. Dr. Irvine also places platelet-rich plasma (PRP) on the skin. The microneedles allow the PRP to penetrate deeper, stimulating further improvement in skin texture and scars. A medication called tranexamic acid can also be used with microneedling to improve the appearance of hyperpigmentation and melasma. The downtime after microneedling is minimal, with redness and swelling lasting approximately 3-4 days.
A facelift (also known as rhytidectomy) is a powerful procedure to lift and reshape the lower face and neck to restore it to a more youthful and pleasing shape. As we age, the skin and underlying tissue of the face and neck begin to drop and lose volume. This can change a youthful heart shaped face into a more square or rectangular shaped face. In addition, the neck muscle, called the platysma muscle, becomes thinner and begins to separate, leading to vertical neck bands.
A facelift elevates and anchors deep tissues and skin in the lower face and neck. This can improve the appearance of jowls, loose skin in the lower neck and face, and platysmal bands that create vertical lines in the neck. It can also improve the contour of the middle portion of the face, called the midface. The goal is to achieve an overall more pleasant, refreshed, and youthful appearance. Because everyone ages differently and has different goals for facial rejuvenation, Dr. Irvine uses an individualized approach to analyze and correct age-related changes. Facelift incisions are well hidden in natural skin creases and hair bearing areas in front of and behind the ears. Often, a laser skin treatment is recommended in conjunction with a facelift to improve the results, tighten skin, and help with the fine lines that a facelift does not treat.
Recovery after facelift usually takes about 2 weeks. After this time, most patients return to work. The scars may remain red for approximately six weeks to three months. Swelling can last anywhere from 2 to 6 weeks depending on individual anatomy and physiology.
With age, the position of the eyebrow can drop, leading to hooding of the skin above the upper eyelid. Peripheral vision can be impaired by this excess tissue. There are many methods used to correct a droopy brow. Botulinum toxin (Botox®, Dysport®, or Xeomin®) injected in the muscles that depress the eyebrows can help to naturally and subtly raise the brows. This is temporary and generally lasts around 3 to 4 months. A minimally invasive surgical technique, the endoscopic brow lift, uses between 2 and 5 small incisions just behind the hairline to lift and suspend the eyebrows permanently. In older patients and in men, a direct brow lift, removing skin just above the eyebrows, can lift the brows and the carefully placed scar can be hidden at the top of the eyebrow.
Recovery after brow lift usually takes about 1-2 weeks. After this time, most patients return to work. Swelling and bruising can last anywhere from 2 to 4 weeks depending on individual anatomy and physiology.
When considering facial rejuvenation or facial reshaping surgery, it is important to consider the face as a whole. The lower cheeks contain pockets of fat called buccal fat. Buccal fat can become more prominent with age, weight gain, or due to genetic factors. Buccal fat removal takes out a portion of this fat in order to reshape the face, making it appear more youthful, sculpted, and heart-shaped. It is performed through incisions in the mouth, with no visible external scars. This can be done under local or general anesthesia.
Recovery after buccal fat removal usually takes a few days. Patients can return to work the day after or within the first few days of surgery. Swelling can last up to 1-2 weeks depending on individual anatomy and physiology.
Botox® and other neuromodulators such as Dysport® and Xeomin® can be injected into the upper face and neck to reduce the activity of muscles of facial expression. This can reduce the appearance of dynamic wrinkles, or wrinkles that appear when the face moves. Common areas to inject are the glabella (between the eyes), forehead, periorbital area (crow’s feet), and platysma (the muscle causing vertical neck bands). In addition to immediate wrinkle improvement, these treatments slow new wrinkle formation by reducing or eliminating certain facial movements. Neuromodulators are temporary and their effect generally wears off by 3 to 4 months. Some patients have expressed concern that once they start treatment, they cannot stop. In fact, Botox®, Dysport®, or Xeomin® injections do not need to be continued indefinitely. Even an occasional injection, such as once a year, will provide some anti-aging benefit and help to prevent new wrinkles from forming and deepening. Most of the fillers done in the office today are made of hyaluronic acid. This is a naturally occurring substance that we have in our bodies. Hyaluronic acid gives tissues elasticity and volume. As we age, we lose hyaluronic acid, and this contributes to the appearance of deep lines and wrinkles. Hyaluronic acid fillers can be used in many areas of the face including the temples, cheek bones, midface, nasolabial folds, lips, chin, and jaw to create a more pleasing facial shape or to restore a more youthful shape. Dr. Irvine uses only hyaluronic acid fillers. These are metabolized by the body and usually last between 6 months and 2 years, depending on the exact filler used. Dr. Irvine uses different fillers in each area of the face, depending on patient anatomy and goals.
Fillers are injected in the office using only topical and/or local anesthesia. There is no down time and patients can return to work immediately with the caveat that no make up can be worn over the injection sites until the following day.
Fat grafting or fat transfer involves removing fat from the abdomen, flanks, inner, or outer thighs, and placing it in the face. As we age our faces lose volume in specific fat compartments in the temples, midface, and lower face. Some of this volume can be restored using temporary hyaluronic acid fillers, but sometimes patients elect to have a more permanent surgical solution by using their own fat to provide a more youthful facial shape. Dr. Irvine does this under general anesthesia or moderate sedation in order to make patients as comfortable as possible. It is often done at the same time as a facelift to improve the overall result. Approximately 40 to 70% of the transplanted fat survives, and after fat grafting, the aging process continues, meaning that the face may continue to lose fat as part of the natural aging process. Therefore many patients may desire a second fat grafting procedure approximately 1 to 2 years after their first one.
Swelling and bruising of the fat injection sites usually lasts 1-2 weeks depending on patient age and the amount of fat injected. After this time patients can return to work.
CO2 fractional laser resurfacing is a powerful tool to tighten loose skin and reduce the appearance of fine lines and wrinkles. Dr. Irvine uses a fractional ablative CO2 laser for her resurfacing procedures. This creates controlled thermal injury to the skin, stimulating the body’s natural collagen production, and filling in deep lines and wrinkles.
CO2 laser resurfacing treats wrinkles which are present at rest and also treats the vertical lines around the mouth and wrinkles in the lower face that cannot be safely addressed with neuromodulators like botox® alone. A laser treatment can be done in the office using topical numbing cream, or it can be done in the operating room under general anesthesia. It is often performed at the time of a facelift to address the fine skin lines that cannot be improved with a facelift alone. Patients may require several treatments to achieve the desired result. It is critical to be on a good skin care regimen before and after a laser treatment and to avoid all sun exposure before and after. During a consultation with Dr. Irvine, she will discuss whether this powerful treatment is right for you and your skin type.
Recovery time varies based on the intensity and depth of the laser and ranges from 1-2 weeks. Slight redness of the face can last for 3-4 months.
Microneedling is a minimally invasive procedure in which tiny needles are placed in the skin to safely stimulate collagen production. Dr. Irvine uses the FDA-cleared RejuvaPen NXT® which uses several tiny (33 gauge) needles to make controlled micro-perforations in the superficial layer of the skin. This stimulates the body’s own healing process to begin, leading to the deposition of collagen. Dr. Irvine also places platelet-rich plasma (PRP) on the skin. The microneedles allow the PRP to penetrate deeper, stimulating further improvement in skin texture and scars. A medication called tranexamic acid can also be used with microneedling to improve the appearance of hyperpigmentation and melasma. The downtime after microneedling is minimal, with redness and swelling lasting approximately 3-4 days.
Upper blepharoplasty (upper eyelid lift) – As we age, excess skin and fat can begin to droop in the upper eyelid, making the eyes appear smaller, tired, and sometimes even obstructing vision. An upper blepharoplasty removes excess skin and fat from the upper eyelids and can also help to hold up fat from the brow area. This gives the eyes a natural, more youthful, bright, and open appearance.
Recovery from an upper blepharoplasty usually takes about 1-2 weeks.
Lower blepharoplasty (lower eyelid lift) – Lower eyelid “bags” or puffiness can be caused by pseudoherniation or pooching of fat from inside the orbit outward. This can be corrected with surgery. The fat causing the bags can be removed and/or repositioned, suturing it lower over the cheek to fill in the hollow that appears below the fat. This can dramatically improve overall facial appearance, making patients appear rejuvenated and well-rested.
Recovery from lower eyelid surgery takes a little bit longer than upper eyelid surgery. Depending on the technique used, bruising and swelling usually last about 1-2 weeks.
With age, the position of the eyebrow can drop, leading to hooding of the skin above the upper eyelid. Peripheral vision can be impaired by this excess tissue. There are many methods used to correct a droopy brow. Botulinum toxin (Botox®, Dysport®, or Xeomin®) injected in the muscles that depress the eyebrows can help to naturally and subtly raise the brows. This is temporary and generally lasts around 3 to 4 months. A minimally invasive surgical technique, the endoscopic brow lift, uses between 2 and 5 small incisions just behind the hairline to lift and suspend the eyebrows permanently. In older patients and in men, a direct brow lift, removing skin just above the eyebrows, can lift the brows and the carefully placed scar can be hidden at the top of the eyebrow.
Recovery after brow lift usually takes about 1-2 weeks. After this time, most patients return to work. Swelling and bruising can last anywhere from 2 to 4 weeks depending on individual anatomy and physiology.
The lower eyelids can develop hollow areas which accentuate the appearance of lower eyelid bags and dark circles and make the eyes appear tired. Dr. Irvine uses hyaluronic acid fillers to fill in these hollows and improve the appearance of the under-eye hollows without surgery. Select patients are good candidates for this procedure. These can be performed in the office with topical and/or local anesthesia only, and there is no down time. Patients can return to work the same day, with the only caveat that no make up can be worn over the injection sites until the following day.
Lip augmentation can be performed using surgical and non-surgical techniques. Hyaluronic acid lip filler injections are the most popular form of lip enhancement. These can be injected in the office in under 30 minutes and results last anywhere from 4 to 12 months depending on the type and amount of filler used and individual patient anatomy. Fillers can provide a fuller, pouty appearing lip. They can also help temporarily reverse age-related volume loss in the lips.
Bruising and swelling after lip filler injections usual last 3 to 5 days and patients can return to work and their normal activity immediately.
The so-called “ideal” lip proportion is a 2:1 ratio of the height of the lower lip to the height of the upper lip. As we age, the upper lip becomes longer. Restoring a more youthful lip contour can be accomplished in a number of ways:
- Lip filler to try to increase the height of the upper and lower lips
- Upper lip botox to try to lift the upper red lip and shorten the white lip by paralyzing the orbicularis oris muscle (the muscle that allows us to close the mouth and pucker)
- Lip lift to surgically remove several millimeters from the upper lip to shorten and slightly evert it (flip it out slightly)
The lip lift procedure is a great option for someone who has either tried filler and is no longer interested in annual visits for more filler or found that their lip filler migrated or made their lips look or feel heavier. It is suitable for anyone who is looking for a more permanent option for lip augmentation.
A lip lift is performed under local anesthesia only. It involves numbing shots around the upper lip and mouth, similar to going to the dentist. Patients can drive themselves home. The recovery involves a variable amount of swelling of the upper lip for about 3-4 weeks. The scar is located just under the nose and fades over time, with most of the visible scar becoming nearly invisible by 6 weeks. Scar revision treatments such as micro-needling with platelet-rich plasma (PRP) and lasers can be done as well to make the scar nearly invisible.
The so-called “ideal” lip proportion is a 2:1 ratio of the height of the lower lip to the height of the upper lip. As we age, the upper lip becomes longer. Restoring a more youthful lip contour can be accomplished in a number of ways:
- Lip filler to try to increase the height of the upper and lower lips
- Lip lift to surgically remove several millimeters from the upper lip to shorten and slightly evert it (flip it out slightly)
- Upper lip neurotoxin (BotoxÒ, DysportÒ, or XeominÒ) to try to lift the upper red lip and shorten the white lip by paralyzing the orbicularis oris muscle (the muscle that allows us to close the mouth and pucker)
The lip flip is a great option for someone who wants an easy procedure that is relatively inexpensive ($90-$170 depending on the number of units used) and provides predictable results with no downtime. The lip flip involves placing anywhere from 6-12 units of neurotoxin in the orbicularis oris muscle. Over the ensuing 5-14 days, the upper lip becomes slightly weakened (it may be difficult to pucker or to use a straw), the vertical upper lip lines are softened, and the upper lip flips outward exposing more of the red lip to make the red portion of the upper lip look bigger and therefore the upper white part of the lip therefore look shorter. It is great for people whose upper lip tends to “disappear” with smiling.
The lip lift effect lasts anywhere from 1-4 months depending on each person’s metabolism and how much they move their upper lip. The procedure can be repeated every few months. The mild noticeable upper lip weakness generally only lasts about a month and disappears before the positive effect of the neurotoxin wears off.
Achieving balance between the upper middle and lower thirds of the face is critical to achieving the best cosmetic surgical results. Often, a recessed chin can make the nose look more prominent than it really is or can make the skin of the neck look looser or more “saggy” than it really is. A chin implant can correct these imablances. The implant is placed through a small incision under the chin, well hidden in a skin crease. Dr. Irvine performs chin implants under general anesthesia and, when indicated, combines them with a rhinoplasty or a face and necklift.
Recovery generally takes 1 week, after which patients can return to work. Swelling and bruising usually last 2-3 weeks.
Sometimes dimpling and irregularities in the chin are the result of activation of muscles in the chin, such as the mentalis muscle, that can be treated with botulinum toxin (Botox®, Dysport®, or Xeomin®). This can make the chin appear smoother and less wrinkled.
Bruising and swelling after chin botox injections is minimal but can last 3 to 5 days if present. Patients can return to work and their normal activity immediately following injections.
Hyaluronic acid fillers can be injected into the chin to add volume and to bring the chin into proportion with the rest of the face. This creates a temporary change that can simulate a chin implant. Dr. Irvine uses Restalyne Lyft® or Juvederm Voluma® to add projection and definition to the chin.
Bruising and swelling after chin filler injections is minimal but can last 3 to 5 days if present. Patients can return to work and their normal activity immediately following injections.
Unsightly scars in the head or neck region due to previous trauma or surgery can often be revised to hide them in natural skin creases. Scar revision can usually be done in the office under local anesthesia. In addition, hypertrophic scars or keloids can be excised and treated with injections of steroids or 5-Fluorouracil in the office. The head and neck are the most common locations for skin cancer to occur. Excision of cancer in this delicate region often involves Mohs micrographic surgery, performed by a specially trained dermatologist. After cancer removal, Dr. Irvine uses many specialized techniques to reconstruct the lost tissue using surrounding tissue or using grafts from more distant sites. She has the training and skills to reconstruct all types of tissue including mucosa, cartilage, bone, skin, and soft tissue in this delicate and intricate region of the body.
As a board certified head and neck surgeon and a fellow-ship trained facial plastic surgeon, Dr. Irvine has extensive experience in cancer surgery and in facial reconstruction procedures throughout the entire head and neck.
Dr. Irvine can remove benign birthmarks or moles in any region of the head and neck. The incisions used to remove these moles are oriented in the most cosmetically-pleasing way to hide the scars as much as possible. We are pleased to offer award-winning skinbetter® science skincare products at our Manhattan Beach Office. Please contact us to find out more. Skin better science products can also be purchased directly using the following link:
HTTPS://SKINBETTER.PRO/DRLESLIEIRVINE
Microneedling is a minimally invasive procedure in which tiny needles are placed in the skin to safely stimulate collagen production. Dr. Irvine uses the FDA-cleared RejuvaPen NXT® which uses several tiny (33 gauge) needles to make controlled micro-perforations in the superficial layer of the skin. This stimulates the body’s own healing process to begin, leading to the deposition of collagen. Dr. Irvine also places platelet-rich plasma (PRP) on the skin. The microneedles allow the PRP to penetrate deeper, stimulating further improvement in skin texture and scars. A medication called tranexamic acid can also be used with microneedling to improve the appearance of hyperpigmentation and melasma. The downtime after microneedling is minimal, with redness and swelling lasting approximately 3-4 days.
