Surgical Procedures

Aging face
The human face is intricate and beautiful.  Facial features with its many nuances and details give us our individuality and sense of self.  As a facial plastic surgeon, Dr. Vartanian has specialized knowledge of the face - from skin to the underlying tissues and facial bones.  The appearance of the face can be influenced by a number of factors, including heredity (our parents), lifestyle (sun exposure, smoking, chronic dehydration), health status (diabetes, hormonal fluctuations), and the inevitable ravages of time.  The general categories of visible facial skin aging relate to photoaging (sun damage), hyperkinetic lines (wrinkles that appear with muscle activity), and depreciation of skin surface quality, and gravitational aging of deeper structures. 

Dr. Vartanian has created a system to scientifically analyze the face.  This method called Facial Analysis & Cutaneous Evaluation System (F.A.C.E.S) can accurately identify facial areas that can benefit from improvement.  Based on accurate diagnosis facilitated by this method, he can then recommend different treatment options. Available treatments are discussed during a private and confidential consultation process. Some of the treatments involve no surgery, minimal recovery times, and yet surprisingly effective results. Dr. Vartanian combines the latest plastic surgical techniques with medical grade skin treatments to achieve optimal facial rejuvenation goals.  Also Dr. Vartanian can recommend skin care products based on your skin characteristics and designed to optimize the overall appearance and health of your skin.

Facelift
Surgical treatments have evolved tremendously in the last decade.  The “pulled look “ or “wind tunnel” appearances of some facelifts performed elsewhere are completely unacceptable to Dr. Vartanian. A facelift should restore youth to the face without looking artificial.  With careful use of skin closure techniques, advanced skin glues, and minimal tension at the incision site we can achieve almost “invisible” incision lines.    Dr. Vartanian’s preferred facelifting technique is the deep plane method, which he has adapted from Dr. Frank Kamer.  Using the deep plane facelift technique, Dr. Vartanian safely repositions the deeper tissues to their original pre-aging position, allowing a natural redraping of the overlying tissues and skin.  This is often combined with other minor procedures like neck liposuction, facial fat injections and other neck contouring techniques for optimal results.  Thus, effective facial rejuvenation is achieved producing a subtle, completely natural, and younger look.  The neck area can be dramatically improved and is often one of the highlights of a successful facelift. In certain cases, Dr. Vartanian uses another type of facelift technique called the SMAS-lift.  Based on his training and accurate knowledge of facial anatomy, he performs both facelift methods with maximal safety and optimal cosmetic benefit to the patient.  In Dr. Vartanian’s opinion, both techniques produce great results in properly selected patients.  Dr. Vartanian also performs revision facelift surgery, where unattractive facelift results and scars performed elsewhere are repaired and corrected.   Often ear lobe size and position can also be corrected during such corrective surgery. In summary, with thorough knowledge of multiple facelift techniques, Dr. Vartanian can recommend the customized technique that will best achieve the your individual facial rejuvenation needs.

Mini-Facelift
For some patients, Dr. Vartanian can perform his mini-facelift procedure.  In this procedure, very small incisions and advanced endoscopic techniques are used to renew and reverse the signs of facial aging. In the right candidate, the mini-facelift procedure can yield great results with quick recovery (over a weekend) and decreased downtime.  Almost all incisions used in the mini-facelift are placed in creases and non-visible areas, thus eliminating any signs of surgery. 

Midface Lifting Procedures
With the use of advanced endoscopic techniques, Dr. Vartanian performs the much asked for mid-face lift, a procedure that elevates the midface and cheeks.  By vertically elevating the cheeks he can restore a more youthful appearance.  He is one of a select group of surgeons to perform endoscopic mid-face lift procedure without making any skin incisions on the face (or around the eyes).  Small incisions are placed in the scalp (in hair) or underneath the upper lip (sub-labial) – both of which are invisible when completely healed.  Using endoscopes (small video cameras) and special endoscopic instruments tunneled underneath the deep facial tissues, advanced facial plastic surgery can performed without making visible facial incisions.  The result in the properly selected patient is a rejuvenated, natural, and healthy appearance without any signs of surgery.  

Eyelid Rejuvenation
The eyes have been described as the windows to the soul.  The youthful eyes contribute significantly to our sense beauty and vitality.  An important goal of facial plastic surgery is to draw attention to the eyes.  Makeup artists attempt to accentuate the eye and cheeks during their facial artistry.  Unfortunately, the eyes are also one of the first areas of the face to show signs of aging.  A combination of factors can combine to create unattractive features around the eyes.  In some cases, excess upper eyelid skin and bulging bags under the eyes can present in individuals as early as in their twenties.  Fine wrinkles of the side of eye, (also known as crow's feet) usually present in individuals in their late twenties and early thirties.  Cosmetic problems around the eye can be difficult to cover-up with makeup and can impart a tired or unhappy look.

Lower eyelid bags can often be corrected and “cleaned up” without any skin incisions.  In most cases, small incision placed through the inside of the lower eyelid can be used to rejuvenate lower eyelid bags.  Through small incisions placed in the inside of the lower lid, the lower eyelid fat can removed without cuts on the skin.  The skin under the eyelid can be also be rejuvenated using chemical peels or laser resurfacing.  In some cases, excess lower lid skin can be addressed by conservative removal of the extra skin to improve the appearance of the lower eyelid skin.

Dr. Vartanian uses the latest eye surgery techniques to ensure natural, non-operated eyelid rejuvenation results.  When properly carried out, blepharoplasty can eliminate the fatigued or tired look common to the aging eyes and bring a great deal of satisfaction to the individual.  Often blepharoplasty can be combined with other skin rejuvenating procedures like chemical peels for optimal outcomes.  

Dr. Vartanian also performs advanced eyelid plastic surgical procedures.   Based on patient preference, Asian eyelids can be enhanced by creation of subtle double-lid look or by eliminating extra upper lid fullness.  The many varieties of the “Asian” eyelid require careful attention to patient request, facial features, and to achieving optimal symmetry.  Dr. Vartanian also uses the minimal incision suture asian eyelid fold creation technique. 

Dr. Vartanian can repair complex eyelid problems resulting from droopy upper lids (ptosis repair), poor lower lid support (retraction/ectropion repair), and correction of scarring from previous eyelid surgery.  Some individuals may experience obstructed vision from overly redundant upper eyelid skin.  In such cases, blepharoplasty or other procedures can become a medical necessity and may be reimbursable by third party payers (such as your insurance carrier) when visual field obstruction can be clearly documented.

Blepharoplasty (eyelid surgery) can also be combined with procedures designed to elevate the brows (endoscopic browlift) or in conjunction with facial rejuvenation (facelift, face peel).   There are limitations to improvements achieved through eyelid surgery - as in any medical procedure.  Fine wrinkles of the lateral crow's feet area will not gain an appreciable benefit from blepharoplasty alone and may be better treated with other modalities (like Botox or skin resurfacing). These and other details are discussed in depth during your personalized consultation with Dr. Vartanian.

Lower Eyelid Fat Repositioning
Dr. Vartanian also performs lower eyelid fat repositioning, where extra lower lid fat is moved down to “fill-in” depressions under the eyes (tear-trough deformity).   In select cases, this procedure can be used to replace the youthful look that has been taken away by the appearance of lower eyelid bulges.   This procedure can also be used in patients who have deep sunken depressions under their eyes.  In selected cases, patients who may have had deep sunken eyes even during their youth can benefit from this procedure.

Endoscopic Browlift
Well-placed brows give the eyes and face an understated elegance and beauty.  The lowering of eyebrow position occurs to differing degrees in all individuals.  Brow position is highly individual and varies based on facial features, eye shape, and eyebrow shaping habits (like plucking).  Generally eyebrow position is lower in men and higher and more arched in females.  The perpetual dynamic forces of facial muscles, effects of gravity, and aging cause the eyebrows to descend.  Many people seeking rejuvenation surgery may not be aware of the contribution of sagging eyebrows' to their appearance.  As the brows fall they push the extra skin into the upper eyelid causing a crowded look to the eyes. The aged brow appears heavy, thickened, and deep creases set in between the brows.  All this can lead to an unattractive look that can impart an angry or unhappy look.  In some people lowered brows can also contribute to a constantly tired look.  Often the presence of excess upper eyelid skin may be better addressed by performing a browlift.  For some women with sagging brow, plucking or reshaping their eyebrow to higher and higher positions is one early adaptation to the lowering of their brows.  Upper lid fullness can also obscure the lashes.   Dr. Vartanian’s minimal incision endoscopic browlift can be used to elevate the brows to a natural younger position and reduce forehead line and wrinkles.   Dr. Vartanian uses the latest in endoscopic surgery techniques to elevate the brow without any visible incisions.  The beauty of endoscopic brow lift is the complete lack of visible facial incisions.  Using several small incisions placed on top of the head in the areas covered with hair, endoscopes (small cameras) and specialized endoscopic instruments are used to elevate the brows.  Thus, without any visible skin incision the brows are elevated from their previously lowered position.  Dr. Vartanian bevels and angles the hair incisions and performs a careful closure to prevent hair loss at the incision site.  During this type of surgery, furrows and line in the forehead and between the eyebrows can also be reduced.

For some regular Botox user, endoscopic brow surgery can eliminate their need for forehead Botox injections for years to come.  For such patients, a browlift may be a more cost-effective option than regular botox injections.  By using advanced endoscopic techniques, with a thorough knowledge of the forehead, and gentle surgical techniques, bruising and recovery times are often reduced to a few days.  During your consultation, Dr. Vartanian can explain various aspects of browlift surgery, expected outcomes, and factors relating to surgery.

Neck Enhancement
Loose skin, muscle, and accumulated fat under the chin can lead to an unattractive sloppy appearance.  Relaxation of neck muscles can result in vertical bands running from the chin to the base of the neck.  Neck fat also tends to descend and pooch out with aging.  The fat under the chin is often hereditary and much less affected by dieting, fitness regimes, or weight loss.  In certain cases, younger patients can benefit from enhancement of the neck.  Careful microliposution can be used to improve the jaw line, neck and under the chin.  Older individuals who have undesirable excess fat and flaccid neck muscles may require a neck lift or a facelift.  Various degrees of neck problems can be improved.  Dr. Vartanian’s necklift is a minimally-invasive procedure can often be performed with minimal downtime and without the need for anesthesia.  Neck enhancement can sometimes benefit from chin augmentation.   Dr. Vartanian can discuss various options that can be used to improve the unattractive neck.  Computer imaging can be used to demonstrate likely effect of some proposed surgical improvements.  Advanced computer imaging used by Dr. Vartanian can be also used to determine the approximate amount of change in neck or chin contour that may be desirable.

Rhinoplasty (Nasal Surgery)
Rhinoplasty is the medical term for surgery of the nose.  Rhinoplasty can be performed for cosmetic purposes, to improve nasal breathing, or to repair the injured nose.  Dr. Vartanian’s goals in rhinoplasty are to improve the nose so that it looks natural, allows for normal breathing, and one that is in beautiful harmony with the individual’s facial features.   

Nasal surgery is the most demanding plastic surgery procedure.  Described by leading facial plastic surgeons as “an operation of millimeters”, it requires exacting attention to detail and thorough knowledge of the nose and its healing properties.   Dr. Vartanian training background involved working with some of the best rhinoplasty surgeons in the world including: Drs. Dean Toriumi, M. Eugene Tardy, J. Regan Thomas, Gary Burget, and Frank Kamer.

The approach to each nose and face is customized, avoiding the cookie cutter, turned up noses that we sometimes see.   At your visit, certain changes can be demonstrated on our computer imaging screen.  It also allows the Dr. Vartanian to understand exactly what you have in mind in regards to your cosmetic goals.    Dr. Vartanian explains, “When a patient comes to me, I evaluate and treat them as if they were a member of my family.  When I perform rhinoplasty on a patient, I plan approaches and choose techniques to ensure the best long-term result.”  

Given this background and his extensive experience with a variety of noses, Dr Vartanian applies precise techniques to achieve symmetric, predictable, and beautiful results that look natural.   Moreover, his training in nasal surgery allows him to treat both the inside and outside of the nose with safety and utmost competence.  He lectures and teaches about nose surgery to other doctors locally and in national meetings.  Additionally, he has written numerous articles about nasal surgery.

Dr. Vartanian spends two-thirds his time performing primary rhinoplasties (first time nose surgery) and the other one-third correcting complex problems from previous surgery elsewhere (revision surgery).   During your consultation he will discuss in depth your individual features and your nasal improvement goals.   Each nose is different and requires a unique approach.  Using either a closed or an open rhinoplasty approach, Dr. Vartanian can improve noses without changing the desirable and unique characteristics of the patient’s nose, face, or ethnic features.

Revision Rhinoplasty
As an expert nasal surgeon, Dr. Vartanian is frequently asked to evaluate patients requesting revision rhinoplasty.  Advanced rhinoplasty techniques are used by Dr. Vartanian to restore and repair noses damaged by previous surgery performed elsewhere.  Rhinoplasty is performed to improve nasal breathing or correct previous surgical problems.  In some cases, all or a portion of the surgery may be covered by third party payers (such as your insurance company).   Dr. Vartanian can reconstruct previous operated noses using your own cartilage obtained from inside the nose, extra cartilage found in the ears, or rarely from the rib area.  Generally, in tough revision cases an “open” (or external) rhinoplasty approach is chosen.  Thus, facilitating the placement of cartilage grafts and rebuilding the nose from base up.  Dr. Vartanian will use spreader grafts to improve function and aesthetics of the middle part of the nose.  Various cartilage grafts can be used to strengthen, fill, and better define deficient areas of the nose.   For certain cases Dr. vartanian may also harvest rib cartilage to rebuild a collapsed nose.

After Rhinoplasty…
After a typical rhinoplasty surgery the patient go home the same day.  If desired or from out of town, you are welcome to spend the night at one of our recommended aftercare facilities.  Dr. Vartanian does not routinely use nasal packing as to maximize post-operative patient comfort.  Bruising is minimized by the application of various intra-operative techniques, the use smaller customized instruments, and pre-operative herbal medications.  Following surgery most patients are pleasantly surprised on how good they feel.  Pain is usually minimal and less than 20% of patients have a need to take thair pain medications.  Most patients can go back to work in less than 5 days. Nevertheless, we recommend you to limit exercise or strenuous activity for 2-3 weeks after surgery.   We recommend no contact sports for at least four to six weeks after surgery.  Heavy bruising and significant swelling are uncommon, but can occur and be present for an extended period of time – and fortunately go away with time.  It is a good idea to take a week off from work or school to rest and relax after surgery.  Our office can coordinate many aspects of your surgery and other accommodation needs.

Chin augmentation
A weak chin may be undesirable and can give the appearance of a larger nose or a shorter neckline.  In males a recessed chin may lead to a false perception by others of timidness or weakness.  By augmenting the chin, we can give overall balance to the face.  Dr. Vartanian explains, “Like a picture frame, the well-proportioned chin can frame the face and give it definition and balance.”   An underdeveloped chin is often not recognized by the patient.  Using computer imaging software we can demonstrate the effects of making the chin bigger or smaller.  Although frequently done as an isolated procedure, chin augmentation can place the finishing touches on other facial surgery.  In some cases, the use of chin implants can accentuate the overall improvements experienced from a rhinoplasty or facelift.  Patient satisfaction after chin implantation is usually very high and recovery times minimal.  Like other surgical procedures, further details can be obtained during your consultation with Dr. Vartanian.

Scar revision
The goal of scar revision is to transform an unsightly or obvious scar into a well-camouflaged thin line that is less noticeable.  Various scars may need to be treated differently depending on the nature of the scar.  Hypertrophic (large) and keloid scars can sometimes be treated quite successfully depending on their location and history.  Skin type and individual healing characteristics may affect scar or keloid revision results. Almost all scar revisions are done on an outpatient basis and can be followed up with dermabrasion for maximal cosmetic results.  For certain scars, newer laser and light-based devices can be used to decrease scar visibility.  Depressed scars (like acne scars) can be filled with dermal fillers.  Almost any unsightly facial scar can be improved. 

Ear Correction Surgery (Otoplasty)
Prominent protruding ears can look unnatural and can become subject to public commentary.  By three to four years of age, children begin to recognize differences in their ears from that of their peers. Often unfortunate remarks like “dumbo ears” or “bat ears” are sometimes used to describe the prominent or protruding ear.  However it is not until six to ten years of age that these negative descriptions begin to leave psychological scars.  Children and adults with prominent ears may become hypersensitive about their ears and suffer from poor self-image. By some estimates, prominent ears affect approximately 5% percent of Caucasian children, higher in some ethnic groups. Usually children are born with prominent ears and often it is a familial trait.  Through a minor surgical procedure the ears can be set back to a natural position. There is very little discomfort and children can resume a fairly normal schedule within a week.  There is no risk to the patient’s hearing from otoplasty.  It is best to undergo this procedure around five to six years of age or older. At this age the ear has achieved at least 90% of it adult size and children seem to be more cooperative than in the subsequent several years.  Most importantly, the intervention is early enough to prevent the damaging effects of potentially cruel social remarks.  Incision lines are hidden behind the ears and are essentially invisible. Adults undergoing this procedure can usually return to work in a couple of days.  Dr. Vartanian combines several well-established techniques to provide natural and long-lasting ear correction results.  Click here to see Dr. Vartanian’s article on ear reshaping surgery. 

Hair Transplantation
Loss of hair can occur in both men and women.  Most are familiar with male pattern alopecia, or "male pattern baldness."  This type of hair loss is hereditary in nature and may be acquired from either parent.  Less dramatic hair loss is experienced by many men in their 30’s leading to receding triangular areas can also be addressed with hair transplantation with great natural results.

Male pattern baldness is believed to occur due to the action of a hormone called dihydrotestosterone (DHT), which is derived from testosterone. Some medications attempt to reduce hair loss or even stimulate re-growth by inhibiting the action of this hormone. Unfortunately, medications usually do not restore the hair to the density desired by many patients. In cases where the patient wants hair replacement, surgical hair restoration may be a valuable option.

Dr. Vartanian only performs the state of the art in hair transplant surgery using the INVISA-graft technique.  This involves dividing the grafts into follicular units graft, then implanting individual hairs to create the most natural hairline appearance. Two of the main surgical options available today are hair transplants and scalp reduction surgery (or hairline advancement).   Hair transplant involves harvesting a strip of hair from the back of the scalp, dividing the strip into small grafts, and then inserting the grafts into areas of baldness or thinning more anteriorly on the scalp. These grafts, when placed into an area of baldness, continue to grow just as they did in their previous position.  One factor that makes hair translplantation, “an art” is the individual angle at which hair follicles are placed in to create a natural hairline and hair flow.   We also plan our transplant approaches to accommodate for possible hair loss in the future, so that the transplanted patient always maintains a natural appearing hairline for years to come.

Hair transplant surgery can usually be done with local anesthesia and/or with mild sedation.   Patients are generally quite comfortable during and after the procedure, and can go home on the day of surgery.  Sutures used in the back of the scalp are removed after one week.  Patients may experience mild swelling and crusting of the wounds, but these symptoms usually resolve over the first week.  Most patients are able to return to work within one to two days. 
The newly transplanted hairs will begin growing about 10-12 weeks (3 months) following surgery.  To appreciate the full effect of the hair transplant may take four to six months.  Results are often dramatic and patient satisfaction high.  Nevertheless, patients may require several sessions in order to achieve their desired hair coverage.  Individual recommendation can be made during your confidential consultation with Dr. Vartanian.