Rhinoplasty - By Dr Jonathan Pontell

Many people are not comfortable with the shape, size, or alignment of their nose. For some, imperfections can cause feelings of self-consciousness and emotional distress. But there is a way to have the nose you've always wanted. Cosmetic nose surgery, or rhinoplasty, can improve the proportion and aesthetics of the nose by reshaping the underlying cartilage. At Dr. Jonathan Pontell's office in Media, Pennsylvania near Delaware and Philadelphia, rhinoplasty gives patients the ability to change the shape and size of their nose and to improve upon aesthetic flaws. Some patients also undergo rhinoplasty after serious trauma or an accident that necessitates facial reconstruction surgery. Depending on your specific goals, rhinoplasty can alter the shape and/or size of the bridge, tip, or nostrils, as well as increase or decrease the size of the entire nose. Our patients often find that after rhinoplasty surgery, they feel a renewed sense of confidence about their appearance, and are even proud of their new nose.

• Before Rhinoplasty Nose Surgery
• The Rhinoplasty Procedure
• Rhinoplasty Recovery

Before Rhinoplasty Nose Surgery

Before undergoing cosmetic nose surgery, patients first meet with our facial plastic surgeon, Jonathan Pontell, at our Media, Pennsylvania office near Delaware and Philadelphia. Rhinoplasty patients should be certain to discuss all their goals for the shape and size of their new nose and ask any questions about the procedure during this initial appointment. During this initial appointment, Dr. Pontell will use digital computer imaging to demonstrate how the nose may appear after surgery, so that patients can feel confident that they share the same aesthetic goals with Dr. Pontell.

During this consultation, Dr. Pontell will also explain some of the risks of rhinoplasty. Although the occurrence of complications is rare, patients should fully understand the potential risks of plastic surgery before undergoing any kind of facial cosmetic surgery. Some of these risks include nose bleeds, a negative reaction to anesthesia, infection, broken blood vessels on the skin's surface, scarring, or over- or under-correction. To schedule a consultation, contact our Media, Pennsylvania office near Delaware serving the communities on the Philadelphia Main Line. Our rhinoplasty surgeon will sit down with you to discuss all your options, and answer any questions you have.

Blepharoplsty By Dr Jonathan Pontell

Another Happy Patient of Dr Jonathan Pontell

Dear Dr. Pontell,

I recall at my first consultation with you, that in response to my concern about looking overdone, you said that “you wouldn’t know how to do that”. That statement gave me the confidence to move ahead with my plans for lower facelift and eyelid lift surgery, in spite of the apprehension. Your quiet self-assurance was very encouraging.

You have tremendous surgical skills. Absolutely no one including my family and close friends, has been able to tell that I had work done. They just think that I look great ( and I do too).

Because I work in the beauty business, I understand the anxiety that men and women can have about their appearance and the level of scrutiny that can result. You were always supportive and available to answer my questions, before and after the procedures, and knowing that you would be there for me was comforting.

My husband is looking forward to your help in getting rid of what he refers to as his “bulbous nose”. We wouldn’t even consider another surgeon.

Thank you so very much, and looking forward to seeing you again soon.

Rebecca B.

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Facelift By Dr Jonathan Pontell

Facelift Surgery —

As men and women age, the breakdown of collagen, repeated facial movements, gravity and the environment all begin to take their toll on the face and skin, causing fine lines, wrinkles, and sagging skin to appear on the forehead and around the mouth and eyes. Some people try to combat the signs of aging with professional skin care treatments that may improve the skin's elasticity and texture. Although these treatments can improve the appearance of the skin, often skin care treatments alone don't provide the dramatic results that some patients hope to achieve. A facelift, performed byfacial plastic surgeon Jonathan Pontell at his office near Philadelphia and Delaware, or local surgery centers and hospitals, can reduce wrinkles on the face and around the forehead, mouth, and eyes. At The Aesthetic Facial Plastic Surgery Center, a facelift gives patients a refreshed and rejuvenated look without making them appear over-processed. Visit our facial plastic surgery gallery to see the youthful results of some of our facelift patients have achieved. Jonathan Pontell, M.D. is an experienced facial plastic surgeon who has mastered several advanced forms of advanced facelift surgery. At the Philadelphia-area office of Dr. Jonathan Pontell, there are several exciting options for facelift surgery that can be tailored to your individual needs. Dr. Pontell will assess your face and skin type and help determine what procedure will be best for you.

Eyelid Lift Part 5-What To Expect After Surgery

Author: Jonathan Pontell, MD

Medically Reviewed On: November 17, 2009

What To Expect After Surgery

After surgery there is usually minimal pain, and it is easily controlled with a mild pain reliever such as Tylenol with codeine. For the first day and a half after the surgery, I ask that patients place gauze pads soaked with ice water on the eyes, and replace them every twenty minutes while awake. This keeps discoloration and bruising in the eye region to a minimum, and is soothing to the patient. I also have patients keep their eyes moist with saline eye drops and antibiotic ointment for at least one week after surgery.

The black and blue usually resolves by the end of the first week. Removing stitches from the eye region usually takes place five to seven days after the surgery. The incisions heal very quickly in the thin eyelid skin and are usually very difficult to see after the first month. Any redness around the incisions can be camouflaged with makeup immediately after the stitches are removed.

Post-surgery activities
It is important for patients to avoid strenuous activities for the first two weeks after surgery in order to limit the possibility of postoperative bleeding. It is also important for patients to sleep with their head elevated on a few pillows for the first week, to allow gravity to aid in reducing swelling.

Surgical Risks

All surgery is associated with risks. For patients who do not have significant medical problems, the risks are minimal. Any surgery can result in an infection, a bleeding problem or an allergic reaction to anesthesia medications, but these problems are extremely rare.

Overaggressive excision of skin can lead to difficulty with eyelid closure and dry eyes, and post-operative bleeding can cause pressure on the eyes and decreased vision. These complications are extremely rare in experienced hands.

Surgical Costs

The surgical fee for blepharoplasty varies from doctor to doctor and cost will depend on the extent of the surgery. A range of $3000 to $5000 is typical for upper and lower blepharoplasty.

Occasionally, when the upper eyelid skin excess is significant enough that it obstructs vision, insurance will cover the cost. If the procedure is done for purely cosmetic reasons, it will not be covered by health insurance.

Eyelid Lift Part 4- Techiniques

Author: Jonathan Pontell, MD

Medically Reviewed On: November 17, 2009

Blepharoplasty Techniques

There are a number of different techniques in blepharoplasty.

The upper eyelid
The standard approach to the upper eyelid is through an incision in the eyelid crease, which camouflages very well after surgery. Through this incision, excess upper eyelid skin, muscle and fat are removed to give a tighter, smoother upper eyelid.

The lower eyelid
The lower eyelid can be approached through an external incision immediately under the lashes or through an internal incision inside the lower eyelid, which is called the transconjunctival approach. The external incision allows the surgeon to remove excess skin and muscle as well as excess fat. The incision inside the lower lid is useful when the only problem is excess fatty tissue-not excess skin or muscle. An upper and lower blepharoplasty takes about two hours.

The browlift
If a browlift is done at the time of an eyelid lift prodedure, the browlift is done first. Doing the browlift first allows the surgeon to remove the correct amount of upper eyelid skin, as raising the brows decreases the amount of upper eyelid skin

The browlift requires a few small incisions hidden in the scalp hair. The surgery is performed with very specialized instruments and a tiny video camera, called an endoscope, which allows the surgeon to watch the procedure on a video screen. In addition to raising the brows, the browlift gets rid of the deep vertical creases between the brows and the horizontal creases across the forehead.

Once the browlift is completed, excess skin, muscle and or fat are removed from the upper and lower lids to give a smooth eyelid contour.

Some visual examples of blepharoplasty, before and after surgery:

Eyelid Lift Part 3-Surgery Location

Author: Jonathan Pontell, MD

Medically Reviewed On: November 17, 2009

Surgery Location

There are a number of different settings where this surgery can be performed, including hospital operating rooms, surgicenters and outpatient office operating rooms.

If patients are having surgery performed in an office operating room, they should make sure that the anesthesia is administered by a licensed anesthesiologist or nurse anesthetist, and that all of the same monitoring equipment present in a hospital operating room, such as EKG and blood oxygen level monitors, will be in the office for their surgery.

Eyelid Lift Part 2-The Consultation

Author: Jonathan Pontell, MD

Medically Reviewed On: November 17, 2009

When examining the patient for an eyelid lift, I look at the eyes, forehead and brows. I examine the eyes to determine if there is excess skin, fat and/or muscle around the eyes. I also test to see if there is any laxity of the lower eyelid, which may need to be addressed during the surgery to prevent the lower eyelid from being pulled down.

To achieve optimal results, I often recommend that patients get a browlift in addition to an eyelid lift. The brows can be repositioned to their original, youthful position at the same time as the eyelid surgery.

Computer imaging
I use computer imaging to show patients the cosmetic changes that are possible, and how they will look. It is important to note, however, that the computer-simulated photographs are only an estimation of the desired outcome. Although the actual result usually approximates the computer-simulated images quite closely, no surgeon can guarantee to what extent this will be the case.

Eyelid Lift Part 1

Author: Jonathan Pontell, MD

Medically Reviewed On: November 17, 2009

The Consultation
Surgery Location
Blepharoplasty Techniques
What To Expect After Surgery
Surgical Risks
Surgical Costs

It has been said that the eyes are the windows to the soul. Whether or not this is true, the eyes are certainly one of the major focal points of the face. Changes caused by aging can lead to a tired, unrested appearance and detract from the beauty of the eyes. Blepharoplasty, or "eyelid lifts", as they are more commonly called, can result in a more refreshed, well-rested, youthful appearance.

As we age, eyelid skin tends to sag and fatty tissues around the eye begin to bulge, causing bags under the eyes. As the eyelid muscle thickens, ridges and creases develop around the eyes as well. Eyelid lifts are usually performed for cosmetic reasons, but occasionally the upper eyelid skin becomes so droopy that it obstructs vision and in these cases, eyelid surgery is done to correct this problem.

As a cosmetic surgeon, I perform countless eyelid surgeries. Below, I describe the process of getting an eyelid lift, from the initial decision to get the surgery, through the recovery process.

The Consultation

Anyone considering an eyelid lift should see a board certified surgeon from one of the following surgical specialties: facial plastic surgery, otolaryngology/head and neck surgery, ophthalmology, or general plastic surgery. The surgeon should have extensive training and experience with eyelid surgery, and it is advisable to request to see examples of before-and-after photographs of the surgeon's work. It is also a good idea to speak with some of the surgeon's prior patients. Doing your homework before you decide to go ahead with the procedure will help ensure that you receive the best care possible.

Assessing patient goals
The consultation gives the surgeon an opportunity to listen to the patient describe his or her goals. As a surgeon, I want to know that the patient has thoroughly examined his or her own reasons for wanting the surgery, and I want to make sure that the patient has realistic expectations.

Eye assessment and surgical plan
The consultation also includes an eye examination, and the development of a surgical plan. I ask about the patient's general health and then about any problems with the eyes such as dry eyes or visual problems. During the exam, I test visual acuity, eye movements and tear production.