American Academy of Facial Plastic and Reconstructive Surgery

My friend just got her nose done

Question: Should I have a rhinoplasty?

Answer: That question is a bit open ended. Obviously, rhinoplasty is not something you just dive into. You should base your decision upon long-term thinking and desire rather than a short-term whimsical idea. If you have functional breathing problems or other issues, you might get part of the procedure covered by insurance. The best thing to do is to discuss this desire with a board-certified facial plastic surgeon who is skilled at helping you achieve your cosmetic desires but also by either improving or maintaining your nasal airway. Since facial plastic surgeons have as much knowledge inside as outside the nose, they are well skilled to help you achieve all of your nasal goals.

I’ve been reading about cosmetic injections and I wanted to know…

Question: Are cosmetic injections permanent?

Answer: Some cosmetic injections can be permanent; others are temporary.  Most common cosmetic injections like hyaluronic acid (Restylane, Juvederm) are temporary injections.  However, silicone microdroplets can be used for permanent corrections, most commonly for lip augmentation and acne scarring.  However, this method is considered “off-label” as it is FDA cleared for retinal detachments.  Using silicone safely is based on a discussion with a specific doctor’s philosophy and experience.  Another permanent injectable is polymethylmethacrylate (PMMA), marketed as Artefill.  A certain percentage of this product is made of bovine (cow) collagen that is partially absorbed and used as a vehicle for delivery of the product to ensure that it is smooth and does not migrate.  Finally, fat grafting can be considered a permanent injectable by those who are experienced at delivering fat.  If fat is not placed in small microdroplets it can look lumpy.  Since it is truly a “graft”, it needs blood supply to survive.  In experienced hands fat transfer is permanent minus a small percentage that can be absorbed.  There are other permanent injectables that are approved for use outside of the United States but that are illegal for use in the U.S.  Since this Academy is a U.S. based organization and the author of this post is from the U.S., I shall refrain from commenting on the safety, limitations, and efficacy of these other non-approved products.

My kid keeps getting bullied at school because of his ears.

Question: Is 12 too young for otoplasty surgery?

Answer: Not necessarily.  Most ears have reached almost their adult size by 6 years of age, which for me I would consider the lower limit of acceptability.  In fact, at times if you want this covered by insurance 12 years of age is sometimes the cut off age for when it may no longer be considered a deformity and then be classified as a cosmetic procedure.  You should check with your insurance carrier if your insurance covers it and your surgeon you choose also accepts insurance.  Many surgeons do not accept insurance for otoplasty so make sure both parties do.  The other reason that 6 years of age is oftentimes considered the lowest limit of acceptability is that children under 6 years of age have a harder time handling the necessary postoperative instructions and related care.  In short, they are liable to mess up the results if they are too young or go through too much psychological trauma, as they cannot handle the recovery.  However, the opposite is also true: if you wait too long and the child feels ostracized or teased at school, there can also be detrimental psychological effects.  I would encourage an open discussion with your child to see where the motivation is and whether he or she has been affected by the ears rather than the parents being the motivating factor.  As you can see, the best course of action oftentimes is an open discussion with your child and with your prospective surgeon when deciding on having an otoplasty at a younger age.