Facial Surgery Procedures

San Francisco Bay Area Facial Plastic Surgery in Walnut Creek, California

Eyelid Lift | Blepharoplasty

Blepharoplasty, also know as an eyelid lift, is one of the most frequently performed plastic surgery procedures. Bay Area Blepharoplasty patients may benefit from eyelid surgery if their upper eyelids are heavy with redundant skin, or if the lower eyelids are baggy and full.

Upper eyelid surgery (upper blepharopalsty) is most frequently perfromed to remove excess skin. When the skin is blocking upward gaze or peripheral vision, sometimes insurance will help cover the cost. Without visual impairment, the procedure is considered cosmetic. Lower eyelid surgery (lower blepharoplasty) is usually performed to remove excess fullness in the lower lid. The presence of excess upper eyelid skin makes the lid look heavy, and gives a tired appeaance.

Lower eyelid fat makes the eyes look puffy and sad. Removal of the excess upper lid skin and lower eye bags gives a rejuventated rested appearance. For information on eyelid surgery, please visit our blepharoplasty page.

Nose Surgery | Rhinoplasty

The nose is the central landmark of the face, and the appearance of the nose can set the mood for the entire face. Rhinoplasty surgery is cosmetic plastic surgery designed to carefully change the shape of the nose. If you are bothered by the shape of your nose, San Francisco Bay Area Rhinoplasty surgeon, Joseph A. Mele, MD, can provide you with expert guidance. It begins with a personal consultation appointment and computer simulation to explore your options. Many options exist, and no two noses are the same. Ethnic variations can be maintained, or minimized, depending on your goals. For information on nasal surgery, please visit our rhinoplasty page.

Face Lift | Rhytidectomy

Despite modern medicine's best efforts, nothing can replace a well performed facelift to minimize the appearance of facial aging for the carefully selected patient. Small to moderate wrinkles will respond to facial fillers like Restylane, Juvederm, Perlane and Radiesse, and animations lines will respond to neurotoxins like BOTOX Aesthetic and Dysport. Dr. Mele offers a full line of cosmetic procedures for his San Francisco Bay Area Plastic Surgery patients. As facial lines deepen, and the skin becomes lax, the facelift can help provide enhanced correction, with longer duration. Dr. Mele is expert in many styles and methods of rhytidectomy, and can tailor the approach to your specific needs. For information on facelift surgery, please visit our rhytidectomy page.

Neck Lift

Does extra fat or loose, sagging skin beneath your chin make you feel self-conscious? Are you looking for a simple way to increase your self-confidence and take years off your appearance? A Neck Lift may be the right answer for you. During this relatively simple procedure, the plastic surgeon removes the excess skin and uses liposuction to remove fatty deposits under the chin. When indicated, the neck muscles are also tightened. The final result is a firmed and more toned appearance.

Neck Lifts can be performed as an isolated procedure or combined with other facial plastic surgery procedures. Since the eyelids, face and neck tend to age in concert, Eyelid Surgery (Blepharoplasty) and Face Lift Surgery (Rhytidectomy) are often combined to maintain facial harmony.

To find out if neck lift is right for you, please contact our office, in the San Francisco Bay Area city of Walnut Creek, today.

Brow Lift

Deep-set expression lines above the nose as well as wrinkles in the brow can make you look tired, sad, angry, or simply years older than you really are. If Botox is no longer doing the trick, or if you are looking for longer lasting results, there is a solution. The Brow Lift is a cosmetic procedure that can lift and smooth the skin across the forehead, reduce or eliminate your frown lines and raise a saggy brow that gives a heavy, tired look to the upper eyelids. By attenuating the wrinkles, years are immediately taken off your appearance.

There are two basic approaches to the brow lift: the Open Brow Lift and the Endoscopic Brow Lift. Dr. Mele is expert in both techniques, and can discuss the unique benefits that each can offers during your consultation.

Endoscopic Brow Lift - The obvious advantage of this approach is a drastic reduction in incision length. Small incisions are made within the hair that allow for the introduction of a small endoscopic camera, and other specially designed instruments. This makes is possible to elevate the brow and dramatically reduce forehead wrinkles. While smaller incisions allow for a more discrete approach, there are some limitations inherent to the endoscopic brow lift, that may guide Dr. Mele to recommend the more traditional open brow lift approach.
Traditional Open Brow Lift - For the open brow lift, Dr. Mele first makes a careful incision within the scalp hair, to avoid any visible scarring. this allows the excess wrinkled forehead skin to be removed, and lifts and tightens the skin and muscles of the forehead. The result is a fresh, smooth appearance, and reduction of both the transverse forehead rhytids (wrinkles) and the frown lines. The open brow lift allows for greater reduction of both the wrinkles and brow sagging. The open brow lift is often chosen when it is felt that the endoscopic brow lift will not provide adequate correction.
Open Brow Lift Anterior Hairline Approach - For patients with a very high hair line, and thus a large forehead, the traditional open brow lift may result in an excessively elvated hairline, and further enlargement of the forehead. A variation of the open brow lift, the anterior hairline browlift, is utilized to treat the brow without elevating the hairline. This technique utilizes an incision along the anterior hairline to bring the hairline forward. An anterior hairline brow lift can reduce forehead wrinkles and elevate a sagging brow, as effectively as the traditional open brow lift; however, by advancing the anterior hairline, the amount of forehead skin is reduced and the height of the forehead is reduced.
Direct Brow Lift - The direct brow lift is the least frequently used, but the most effective method to raise the brow. For patients with severe brow ptosis, sagging of the brow that interferes with vision, direct excision of the skin above the eyebrow is performed. The scar can be placed along the upper border of the eyebrow, or can be hidden in the deeper folds of the male forehead. The primary goal with the direct brow lift is functional improvement of vision rather than cosmetic improvement of the upper forehead. Carefully placed incisions can give excellent cosmetic results at the scar.

To learn more about brow lift, please contact our Walnut Creek Plastic Surgery practice today.

Otoplasty (Ear Surgery)

Ears are another prominent feature that tend to draw people's attention. When the ears are unusually large or protruding, the attention can lead to feelings of insecurity, especially for young children vulnerable to taunting by peers. Otoplasty, commonly referred to as ear pinning, can correct this problem by reshaping, or when necessary, removing excess cartilage, and then suturing the ears back more closely against the head.

Otoplasty can be performed at any age, but it is one of the few cosmetic plastic surgery procedures that is frequently performed on children. By five years of age, the ear size approximates the adult ear size, otoplasty can be performed safely at an early age with good predictability.

To learn more about otoplasty, either for yourself or your child, please contact our San Francisco Bay Area Plastic Surgery office today.

Lip Augmentation

Have you ever wished you could have fuller, more shapely lips? Now you can. Dr. Mele offers a full line of injectable fillers, as well as a wide range of surgical corrections. Many of the current options in lip enhancement are outlined below:

Lip Enhancement with Injectable Fillers

Injectable fillers allow for rapid results, usually with minimal downtime. The wrinkles are literally filled, with immediate improvement. But, dermal fillers do not just fill. Fillers provide structural support to the skin, reinforcing it and decreasing the folding that occurs with normal facial motion. Modern fillers also promote collagen growth, leading to longer lasting results.

Collagen®The original injectable filler was Collagen®. It was developed in the 1970's right here in the San Francisco Bay Area by researchers at Stanford University. Further development by the Collagen Corporation produced Zyderm® and Zyplast®, the first collagen implants. Collagen® was hugely successful, as it was the only product of its type for decades. Most patients tolerated the products well, but often there was disatisfaction with its longevity (one to three months). The original Collagen® was derived from bovine collagen. Due to slight differences in the bovine collagen's structure, 1-3% of patients would develop an allergic reaction. A small skin test was required, four weeks prior to the first Collagen treatment, to avoid treating sensitive patients, and causing a larger allergic reaction on the face.

Hyaluronic Acid (Restylane®, Juvederm® & Perlane®)Collagen has been replaced by Hyaluronic Acid (HA) as the filler of choice, for several reasons:

Extremely low risk of allergic reactions
No need for a skin test and waiting period
Longer lasting results (three to twelve months)
Softer feel, especially important for lip augmentation
No need to over correct (over plump)
HA is a clear gel not bright white like Collagen
Softer HA gel is more forgiving and easier to inject

You may know Hyaluronic Acid (HA) by its brand names: Restylane®, Juvederm® and Perlane®, to name a few. Like its predecessor, collagen, HA is a naturally occuring component of our skin and joints. The main reason HA replaced collagen is because it lasts longer. For lip augmentation, Hyaluronic Acid products provide superior results from the onset. Whether your goal is to increase the size of your lips, or you are simply trying to reduce lip lines and migrating lipstick, HA's give a longer lasting and softer result. Hyaluronic Acid fillers are soft but tough, and can also be used for the treatment moderate to deep lines of the face.

Radiesse® is another dermal filler currently available. It is made of another substance naturally found in the body, small spheres of calcium hydroxylapatite. These tiny, bone-like crystals cause your body to react, and wall them off with your own collagen. The longevity of Radiesse® is about the same as the HA fillers, but since individual results can vary, one product may last longer than the other for an individual. Radiesse® can give a firm result, and is best used for treating the deeper lines that extend from the sides of the nose to the corners of the mouth. Radiesse® is not usually used for lip augmentation for fear of firm nodules developing in the lips.

Fillers are used to temporarily create fuller lips. It is unlikely that we will ever truely have a permanent filler. As we age, our lips atrophy and facial lines get deeper, and more volume is required to maintain the desired results. For additional information on dermal fillers see the skin page. More information on lip enhancement with fillers, and lip augmentation before and after pictures, are available on Dr Mele's San Francisco Plastic Surgery Blog here: Lip Augmentation San Francisco (Lip Enhancement): Fillers

Surgical Lip Enhancement

For those looking for a longer lasting solution, Dr. Mele also offers lip augmentation surgery. Several specialized procedures are available:

Lip Implants (Natural)
- Dermal Grafting - Dermal grafting remains the gold standard for lip augmentation. A piece of your skin is prepared and fashioned into a custom implant to match the desired lip augmentation. Skin can be utilized from other procedures where skin is normally removed (Face Lift, Breast Lift, Tummy Tuck...), or discretely removed from hidden areas or even from previous scars. During the procedure, Dr. Mele makes small incisions at the corners of your mouth. He then gently inserts custom-formed subdermal implants within the lips. Proper placement of incisions can often allow your own lip tissue to spread more fully, resulting in more stunning, luscious lips.
- Fat Grafting - Fat can also be used as a filler for the lips. Fat removed by Liposuction can be prepared for injection. The fat is used like any filler to add volume. Care must be taken to inject long thin rows of fat cells to enhance the chances that the grafts will take. If the fat graft does not take, volume will be lost, and it is possible that firm nodules may result. With the advent of reliable Hyaluronic Acid (Restylane®, Juvederm® &Perlane®) and the sucess of dermal grafting, fat grafting to the lips has become less popular. It is still used for deep facial wrinkles and to correct traumatic indentations elsewhere on the body.
- Stem Cell Grafting - Recently, it has been suggested that stem cell enhanced fat grafts will enhance fat graft survival and decrease the risk of calcified nodules forming. Early work is encouraging, but what is not often disclosed is that all fat grafts are high in stem cells. More stems cells are found in fat than bone marrow. It is unclear if adding additional stem cells will have the desired effects, and the long term consequences of depositing the stem cells are not yet know.
- More information on lip enhancement with implants, and before and after pictures are available on Dr Mele's San Francisco Plastic Surgery Blog here: Lip Augmentation San Francisco (Lip Enhancement): Implants
V-Y Lip/Mucosal Advancement (internal scar) - Thin lips can sometimes be enhanced by rearranging the lips' mucosa. The mucosa on the inside of the lip can be pushed forward with a minor surgical procedure to provided added lip fullness. V-Y lip advancement can often performed comfortably under local anesthesia. Not everyone is a candidate for this type of procedure. A more detailed description, and before and after pictures, are available on Dr Mele's San Francisco Plastic Surgery Blog here: Lip Augmentation San Francisco (Lip Enhancement): V-Y Flaps
Lip Advancement (external scar) - When the pink vermilion of the lip is very small, sometimes lip augmentation alone will not be sufficient to obtain the desired results. To increase the amount of vermilion that shows, lip advancement surgery may be the answer. Lip advancement involves making an incision along the border between the red vermilion of the lip and the adjacent skin. The desired amount of skin is removed, and the pink vermilion is advanced outwards to increase the vermilion show and the apparent size of the lips. More details, and before and after pictures, are available on Dr Mele's San Francisco Plastic Surgery Blog here: Lip Augmentation San Francisco (Lip Enhancement): Lip Advancement
Lip Implants (artifical) Many artificial implants have been made available for lip enhancement. Most have come and gone. The lips are soft and mobile, and most artificial implants do not feel or move like natural lips. This leads to palpable edges on the implants in the lip, and restricted lip motion seen most often during a full smile. Artificial implants can erode through to lips causing infections and the need for removel. While many people have had good results with artificial implants, better alternatives are currently available. Perhaps development of new materials will change this in the future. Silicone injections fall into this category also. While silicone injections seems wonderful at first, too many patients suffer long term disfigurement from this type of lip augmentation. Despite years of trials, silicone injections are not FDA approved and are not recommended by any of the leading American Plastic Surgery Societies.
More information on lip enhancement with implants, and before and after pictures are available on Dr Mele's San Francisco Plastic Surgery Blog here: Lip Augmentation San Francisco (Lip Enhancement): Implants

To find out more about various lip augmentation options, consider calling and scheduling a consultation appointment, or contact Dr. Joseph A. Mele, Board Certified Plastic Surgeon for the Greater San Francisco Bay Area, for more information.

An introduction to lip enlargement is also available on Dr Mele's San Francisco Plastic Surgery Blog here: Lip Augmentation San Francisco (Lip Enhancement): Introduction

Chin Augmentation Before and After Photos (Augmentation Genioplasty or Chin Implants)

Chin Implants and Cheek Implants

Sometimes all that is needed to give a face added contour and balance is a little bolstering in the areas of the chin or cheekbones. Facial implants can provide this added definition to the face.

Chin Augmentation - Chin implants help strengthen the jaw line, bringing definition to the lower portion of the face. A strong jaw can balance a strong nose. Chin augmentation can compliment or diminish the need for Rhinoplasty
Cheek Augmentation - Cheek implants can give needed contour and improve overall facial symmetry. Our facial implants are custom designed to suit the natural shape of your face and are placed through small, discreet incisions. Cheek augmentation can compliment a lower eyelid Blepharoplasty, and provide support for the lower eyelid.

To find out if facial implants might be the right option for you, please contact Dr. Joseph A. Mele, Board Certified Plastic Surgeon for the Greater San Francisco Bay Area, for more information.

Expert Cosmetic Plastic Surgery by Board Certified Plastic Surgeon, Joseph A. Mele, MD, in the San Francisco East Bay Area city of Walnut Creek, serving Northern California including: Pleasant Hill, Lafayette, Alamo, Moraga, Orinda, Concord, Danville, San Ramon, Pittsburg, Antioch, Brentwood, Oakland, the greater San Francisco Bay Area and beyond.