Plastic Surgery
Plastic surgery can not only change your appearance but can also boost your self-confidence and help you look as young as you feel. Whether you want to reshape your nose or breasts, smooth wrinkles and tighten sagging skin, remove excess fat, or correct a problem resulting from surgery, birth defects or the effects of aging, the wide array of procedures available at our office can help you achieve the appearance you desire.
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Facelift
 If I have a specialty, it is the Facelift.
Patients frequently ask, "What technique do you use- SMAS, deep plane, short scar, MACS-lift.?" The answer is, "Whatever technique the patient needs." To have only one technique at your disposal calls to mind the adage, "If you have a hammer, the whole world looks like a nail!"
The truth is that every patient is different, with an aging pattern all his/her own, with a unique skin type, with a particular pattern and color of hair, individual medical issues/medications and personal expectations. An experienced surgeon has many tools available, not just hammers, and chooses the combination of techniques and procedures that best suit that patient. I have performed every conceivable facelift procedure, and try to choose what is best for each patient.
Dr. Thorne's technique
That being said, there are certainly procedures I use and others I do not. My philosophy of facelifting, like my philosophy on all cosmetic procedures, is to do as LITTLE as possible to give the patient the result he/she seeks. The goal is NOT to do as much as one can think of. This approach of minimal intervention for maximal results leads to more consistent results, fewer complications, and is least likely to result in an "operated look."
The technique I use most often consists of skin undermining, vertical elevation of the posterior SMAS and platysma, suspension of the cheek fat, and selective liposuction and lipoinjection. I do NOT redrape the skin vertically. I do not like the appearance of neck skin pulled up on to the face-the neck skin has different pigmentation, different creases and belongs in the neck! I frequently combine the procedure with elevation of the outer part of the brow only. See section on browlifting. I hate conventional browlifts, which tend to make people look older, stranger and surprised.
Goal of facelifting
The goal in facelifting, for most patients, is to make the patient look like herself/himself, just a crisper version. An occasional patient wants/needs a more dramatic change but this is the exception, not the rule.
Harmony and avoiding the "facelifted look."
Almost every patient tells me that they don't want a "facelift look." What do they mean? In addition to avoiding over-correction in any area, the key is to keep the face looking harmonious as a whole. If one part of the face is out-of-synch with the rest of the face, it does not look natural. It looks artificial or "man made." An occasional patient will ask me to correct only the neck. I rarely agree to such a request because I fear creating disharmony-a tight neck with uncorrected jowls! Not a good look. My goal is to make you look BETTER, more harmonious than when you started, not to create a disharmonious, operated appearance. I would rather have your friends say, "She looks great," than say, "She had a facelift!"
To see before and after images, please click Facelift.
To read Dr. Thorne's facelift chapter in The Plastic Surgery Book, please click Plastic Surgery Book
For more information, please click here.
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Brow Lift
Traditional browlifts are based on the idea that if your whole brow is lifted straight up, you will look better. Try it in the mirror. Do you look better? Probably not. You probably look surprised or strange.
Now try this. Look in the mirror and raise slightly just the outer part of the brow. What do you think? Most people love the way they look. Raising the outer part of the brow tends to eliminate the extra skin in the outer corner of the upper eyelid and rejuvenate the whole orbital area.
If you look in magazines at attractive people, especially attractive women, the outer corner of the eyebrow is AT LEAST as high as the inner corner. That is the key. As we age the outer corner of the brow sags. If the whole brow is lifted the same amount, the outer corner is STILL sagging relative to the rest of the brow. The traditional browlift just raises the abnormal brow to a higher level where it is more obvious! If, however, the outer part of the brow is lifted by itself (or is lifted more than the rest of the brow), it often has a marvelous effect on the area around the eyes.
The lateral browlift is performed through a small incision on each side about one inch behind the hairline in the temple.
Now, I admit, there are exceptions to every rule and men are very different from women, but the guidelines above are generally helpful. Other incisions and techniques are used in special circumstances such as a patient whose brow is very low all over or in a balding male patient. I would be happy to discuss these special circumstances with you.
For more information, please click here.
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Blepharoplasty (Eyelid Surgery)
 Eyelid surgery has changed significantly in recent years. The traditional method involved excision of skin and fat from both the upper and lower eyelids. The problem is that excess skin and fat are not the only consequences of aging and, in many patients, they aren't the problem at all.
It is impossible to discuss blepharoplasty without considering the brow position so I encourage you to read the brow section. After all, when we see a person whose eyes appear attractive, it is probably the whole orbital region that looks attractive.
New concepts
It has become clear that one of the consequences of aging in the upper eyelid region is more than stretched skin; it is deflation. Fat is lost over time and the brow and upper eyelids, which were full in youth, become emptier. The brow that used to have more shape and projection, becomes flatter against the head. The result is apparent excess upper eyelid skin.
Dr. Thorne's upper eyelid technique
The procedure involves the traditional removal of skin and fat but is more conservative than in the past. In addition fat is frequently ADDED to the brow region to give it some shape and too take up some of the apparent excess skin. As mentioned above, the outer part of the brow is often elevated as well.
Dr. Thorne's lower eyelid technique
There is tremendous variability in the lower eyelid procedure. Some patients require removal of fat only. Other patients require removal of fat and skin. Some patients also require either the addition of fat or the redistribution of fat into the trough below the eyelid bags, at the junction of the lid and cheek. Finally, some patients require a resurfacing procedure to the eyelid skin to improve the texture and eliminate some of the fine wrinkles.
To see before and after images,
please click Eyelids.
For more information, please click here.
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Rhinoplasty (Nasal Surgery)
Rhinoplasty is my favorite operation in Plastic Surgery.
The impact that subtle changes in the nose can have on overall facial appearance as well as the complexity of nasal anatomy makes rhinoplasty the most fascinating procedure in cosmetic surgery.
What are you looking for in your rhinoplasty? Everyone is different and every nose is different, but there are a few things that MOST people have in common. Most patients want to look more elegant or more handsome, but they don't want people to say, "Hey, that person had a nose job." They want the nose to fit the face so that other people are attracted to the whole face, not the surgery! The other thing almost all female patients say is, "I don't want a tiny, turned up nose."
Goals
The goal of the rhinoplasty consultation is to determine what you, the patient, want and to determine to what extent it is surgically achievable. The goal of the surgery, then, is to deliver the changes that you and I have agreed upon in the pre-operative visits.
Technique
Rhinoplasty technique has changed over the last two decades. The current philosophy is to preserve more nasal tissue and more nasal function than in the past. The shape of the nose is determined primarily by bone in the upper part of the nose and cartilage in the nasal tip. These structures are modified surgically in order to change the shape of the nose.
Breathing problems
Patients who have difficulty breathing are examined to determine if anything surgical can be done to improve the situation. If so, your insurance company may help with the cost of the airway portion of the procedure. They will NOT help you with the cosmetic portion of the procedure.
To see before and after images, please click Nose.
For more information, please click here.
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Otoplasty (Ear Surgery)
 I do more otoplasty and ear surgery than anyone in the New York area. Why?
When I started my practice in 1989, no one in New York was an expert in ear surgery. I began with the reconstruction of ears on children who were born without ears (a condition know as Microtia). Not only has that become a fascinating specialty in itself, it led to hordes of patients interested in other ear issues: prominent ears, large ears, ears with unusual folds and shapes, ears with tumors, ears with defects from trauma or piercings, ears with problems related to previous surgical attempts, and ears that were distorted from facelift surgery. As a result, I became the ear expert in New York.
Most patients who desire otoplasty have ears that are normal or near-normal in shape but are prominent; in short, the ears stick out too far. Prominent ears vary from slightly prominent (just prominent enough to affect the choice of hair style) to profoundly prominent (an obvious deformity to anyone who sees the patient).
The goal of otoplasty is to produce an ear that is normal; that is, to create an ear that is set back sufficiently but not excessively, and one that lacks any visible scars or sharp, artificial edges. Finally, like surgery on the face as a whole, the ear should be setback harmoniously, with each part of the ear in the correct position relative to the other parts, not set back, for example, in the upper two thirds but with a persistently prominent earlobe.
Most otoplasty procedures are performed through an incision in the crease behind the ear where they are completely hidden. The correct contours are created by folding the cartilage using sutures or incising/removing cartilage as necessary. In cases of ears that are also excessively large or unusually shaped, an incision is sometimes made just inside the outer rim of the ear, where it is hidden under the overhang.
I usually place a soft, bulky dressing to protect the ears for a few days post-operatively. When that is removed, no further dressings are required. I suggest that the patient wear a headband at night for a month or so, just to prevent the ear from bending forward during sleep and ruining our hard work!
To see before and after images, please click Ears.
For more information, please click here.
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Chin Surgery
Chin surgery is one of the most interesting and powerful procedures in cosmetic surgery.
The chin is extremely important in the appearance of the face and has an effect on how other parts of the face are perceived. For example, a big chin makes the nose look smaller and a small chin makes the nose look bigger.
Most patients can be helped with a chin implant. This is a simple, dependable procedure that can be performed in the office under local anesthesia. Implants are made from various artificial materials but I prefer to use silastic implants in most cases. The implant can be inserted either through an incision in the mouth or an incision under the chin. While it might seem logical to use the incision in the mouth to hide the scar, the risk of infection is higher when this is done and therefore I usually recommend an external incision. The scar is almost invisible in the long run.
There are some circumstances where an implant cannot be used. An implant will only increase the prominence of the chin. It will not correct a chin that is too long or too short and it will not correct an asymmetrical chin. In these situations an osteotomy is performed. The chin is cut and moved into the correct position. This procedure requires general anesthesia but is still an outpatient procedure.
To see before and after images, please click Chin.
For more information, please click here.
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Breast Augmentation
 Saline vs. silicone? Under the muscle vs. over the muscle? Incision around the nipple vs. in the armpit or below the breast? Aren't there a lot of decisions? Not really. I will explain my approach to Breast Augmentation.
Silicone vs. Saline. As a general rule, silicone gel filled implants are softer and feel more natural than saline implants. I think they are the implant of choice for most patients. Saline implants are easier to insert, are adjustable in size on the OR table, and are cheaper. They are inserted in a deflated state, like an empty zip lock bag, whereas silicone implants are pre-filled and therefore require a slightly larger incision for insertion. Admittedly, breast augmentation has become slightly more complicated since the FDA approved silicone gel implants last year, after a decade-long moratorium. During the past decade the only option in most cases was that of inflatable saline implants. Now there are two options: saline or silicone.
Under or over the muscle. Another variable is the location of the implant. Implants can be placed on top of or deep to the pectoralis major muscle.
The submuscular plane is usually preferred for three reasons:
- It is easier to obtain an accurate mammogram if the implants are under the muscle.
- The muscle provides an additional layer of tissue to disguise the implant so the augmented breast feels like a breast.
- The chance of the implant becoming too firm because of scar tissue (capsular contracture) is less if the implant is placed deep to the muscle.
Choice of incision. Implants can be inserted through an armpit incision, an incision around the areola or an incision in the fold under the breast. The choice is usually up to the patient although there are certain situations that lend themselves to one choice or the other. For example, I prefer not to use an inframammary incision when augmenting small breasts because the incision tends to be visible. Similarly, if the inframammary crease requires manipulation during the procedure (raising or lowering), I prefer a periareolar incision. Finally, if the patient has normal shaped breasts with small areolae and is committed to saline implants, an armpit incision is often chosen.
Size. The goal of augmentation is to provide the patient with the size she desires. On the other hand, smaller implants will look more like breasts, feel more like breasts and move more like breasts. It stands to reason that if an augmented breast is composed of more implant than breast tissue, it will feel and act more like an implant. On the other hand, if the augmented breast is composed of more breast tissue than implant, it will almost certainly feel, look and act like a breast.
To see before and after images, please click Breast Augmentation.
For more information, please click here.
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Breast Reduction-Breast Lift (Mastopexy)
All breasts that are large enough to require reduction, also require a "lift." On the other hand, there are many patients who desire a breast lift (known as a mastopexy) without a reduction. Finally, there are patients who desire a lift plus enlargement of the breasts (a so called augmentation/mastopexy).
Mastopexy
Sagging or droopy breasts can occur in a number of circumstances. Some patients develop breasts with imperfect shape during puberty, for no known reason. Other patients start with breasts of "normal" shape but then develop ptosis of the breasts related to pregnancies, weight loss or aging. The mastopexy procedure is designed to move the nipple/areola complex higher on the breast, and to reshape the breast to varying degrees depending on the extent of the ptosis. In milder cases this can be accomplished with an incision around the areola. In moderate cases mastopexy requires an incision around the areola and a vertical incision from the areola down to the inframammary fold. Finally, the droopiest breasts require the incisions described above for moderate ptosis, plus a horizontal incision in the fold under the breasts.
Breast Reduction
Breasts requiring reduction vary tremendously in size. The amount removed from an enlarged breast can vary from half a pound to four pounds per breast. Unlike most other types of surgery that fit into the category of cosmetic surgery, breast reduction is sometimes "covered" by insurance. This does not mean that the insurance will pay every penny, but that insurance reimbursement may cover some of the patients' expenses. Most breasts can be reduced with an incision around the areola plus a vertical incision from the areola to the fold. Only the largest breasts also require the horizontal incision in the fold under the breast.
Augmentation/mastopexy
Some patients, as stated above, desire both a lift of the breast plus an enlargement of the breasts. This is usually, but not always, related to deflation of the breasts after breast-feeding. This procedure involves everything that is mentioned under "Breast Augmentation" plus everything mentioned above under "Mastopexy." In some cases it may be safest to perform the procedure in two stages; that is, place the implants first and come back at a second stage and do the mastopexy.
To see before and after images, please click Breast Reduction.
For more information, please click here.
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Liposuction
 Liposuction is technically the simplest procedure in Plastic Surgery.
The idea is that areas of excess fat are removed using a stainless steel cannula (a little bigger than a pencil) attached to suction.
For the right patient, liposuction can be extremely rewarding. The ideal patient is close to his/her ideal body weight but has isolated areas of undesirable contour. In women this is usually the lateral thighs (saddle bags) or lower abdomen. In men the most common area of complaint is the flanks (love handles).
There are some misconceptions about liposuction:
- "Liposuction is not safe." In reality, the procedure is extremely safe with an extremely low complication rate.
- "Liposuction is a treatment for being overweight." This is not true. Liposuction is a treatment for someone who has lost weight and is down to or near his/her ideal body weight.
- "Liposuction will help my cellulite or excess skin." It is important to understand that liposuction will not improve cellulite and will not remove excess skin. There is no reliable treatment for cellulite and surgical removal is necessary for excess skin.
Just because liposuction is easy to perform does not mean that it doesn't have to be done slowly and carefully. If fat is removed from the underside of the skin it can lead to irregularities. If too much fat is removed from an area it can lead to depressions that are almost impossible to correct.
To see before and after images, please click Liposuction.
For more information, please click here.
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Abdominoplasty (Tummy Tuck)
A tummy tuck can be a great operation.
As many people discover, all the exercise in the world cannot eliminate excess skin from the lower abdomen. After pregnancy or weight loss, the abdominal skin frequently does not contract back to its original contour, leaving excess skin with stretch marks. Exercise will strengthen the abdominal muscles and is good for your back and your psyche, but it will never make the extra skin go away. In those cases we recommend a tummy tuck.
Like any operation in Plastic Surgery, the technique (incision, length of procedure, recovery etc) varies depending on the patient. A thin woman who has a little extra skin above her pubic area is totally different from a large male patient who has lost 150 pounds.
Traditional abdominoplasty is associated with a number of unsightly problems: long, ugly scar, boxy abdominal shape without a waist, unnatural belly button, and a pubic area that is too high and too large.
I prefer to accentuate the waist, attempting to make the abdomen look longer, not shorter, and to make the incision as low as possible. I also try to close the skin under slightly less tension in the center of the abdomen, so that the scar is finer and the mons area is not pulled up too high. If the pubic area is pulled up too high it also makes the abdomen look shorter. Not a good look.
Abdominoplasty can be an enormously satisfying procedure for the patient and the surgeon, restoring in many cases an almost ideal abdominal shape.
To see before and after images, please click Tummy.
For more information, please click here.
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