Corrective Procedures

After decades in practice, I’ve seen many new patients who have had prior cosmetic surgery elsewhere – sometime many surgeries – that have failed to achieve the look they want or even exacerbated the issue they wanted to fix. The wrong procedure or an ineffective technique will produce unnatural looking result and can even age the face rather than return it to a youthful shape and proportions.

Some of the most common problems I see include:

One-size-fits-all implants that don’t align with the facial skeleton – Traditional implants are designed to be used in common procedures and fit an average face. But no two facial skeletons are the same, so surgeons must shape the implant to the dimensions of their patient’s face to ensure a precise fit. A poorly chosen implant might be too prominent for the individual’s sex, age, and proportions or look “stuck on” instead of integrated into their facial topography. Instead, I custom-design bespoke implants using CT scans to map each patient’s facial skeleton.

A generic button implant was too large for this patient’s face and protruded unnaturally from her jaw.

Custom-crafted implants are tailored to the contours of the patients face.

Exaggerated browlifts that age the face – There is a common perception that because gravity causes skin to droop with age, the brow also drops over time. A brow lift, therefore is expected to reverse this sign of aging. But the truth is more nuanced than that, so I see many patients who have had an aggressive brow lift designed to restore a youthful appearance that instead leaves them with an unnatural “pulled too tight” look. In fact, youthful brows are low above the eye and as muscles lose tone over time the inner aspect tends to rise and the outer aspect begins to droop. To return the brow to a truly youthful position, I selectively lower the rising inner brow and raise the drooping outer edge.

The difference in brow shape between a 20-30 year old (left) and a 50-60 year old (right).

           Before browlift revision surgery                            Post browlift revision surgery

Conventional blepharoplasty techniques that create an unnaturally round eye – Eyelid shortening procedures are designed to remove excess skin that has lost elasticity and sagged over time. They can have the unintended consequence, however, of changing the natural shape of the eye. Youthful eyes typically have a narrow opening with an upward tilt from the inner to outer corner of the eye. To maintain or recreate that shape, I typically use the bridge of bone canthopexy technique to achieve the proper tilt and anchor it to bone, rather than soft tissue, so it retains the proper positioning over time. In some patients, I also address structural deficits – the true underlying problem causing their aesthetic issue – with custom implants to provide more structure for the soft tissue and prevent lid descent.

This patient previously had an aggressive lower lid blepharoplasty resulting in lower lid descent. It was corrected by scar release and subperiosteal midface lift.

This patient had an exaggerated downward tilt of her eye shape – she desired a more almond shaped eye with an upward tilt. Such a significant change is difficult to accomplish with standard techniques, so a more sturdy, reliable technique – the bridge of bone canthopexy – was chosen for her surgery.

Orthognathic surgery that corrects dental issues but creates aesthetic ones – Orthognathic surgery is used to correct malocclusion, the condition in which a patient’s teeth do not fit properly within their jaw. Typically, the jaw is too small for the teeth, so surgeons will break the lower jaw and reposition the pieces of bone to create more space. If no new bone is added in between those pieces, however, it can create an asymmetrical or even lumpy external appearance. I correct such gaps in the bone with custom implants designed from CT scans of the patients face. That technology allows me to create truly bespoke results, tailored to the individual’s needs.

Custom implants addressed the asymmetry and gaps in the lower jaw that resulted from prior orthognathic surgery.

When cosmetic and reconstructive surgery has negative outcomes, it can be devastating to the patient physically and mentally. I’m proud to utilize my years of experience, research, and pioneering techniques to give my patients seeking revision surgery back their confidence and their looks.

To schedule a consultation and discuss revision surgery, email info@dryaremchuk.com or call (617) 726-5280.