Other Facial Procedures

When you are not yet ready for face lift surgery, but still want facial rejuvenation beyond what cosmetics or facials can achieve, non-surgical options including BOTOX® cosmetic, facial fillers, and collagen stimulators are available to achieve this. Performed in combination, these injectable procedures are commonly called the “liquid facelift” or “non-surgical facelift,” and are performed at our Minneapolis Plastic Surgery, LTD. office without surgical recovery or down time.

For those patients seeking non-surgical improvement in the submental (“double chin”) area, recently FDA-approved (April, 2015) Kybella™ is a non-surgical option that requires no incisions and no anesthesia, and permanently removes unwanted fat in the under-chin area. Multiple injections are performed in a short in-office procedure that takes no more than 20 minutes, though several sessions, at one-month intervals, are necessary for maximum results. Though as costly or even more costly than surgical removal of fat in this area, some patients who refuse anesthesia or do not want surgery, are good candidates for this minimal-downtime (swelling, possible injection bruising, and mild discomfort for a few days) treatment that permanently removes the excess fat in this area. Kybella™ is not yet FDA-approved for fat elimination in other areas of the body, and we do not endorse Lipodissolve, mesotherapy, or other non-FDA approved formulations being used by some practitioners for fat removal by injection.

Facial laser resurfacing

Facial laser resurfacing is performed at MPS by our plastic surgeons, and can be an aggressive dual-wavelength, general anesthetic, skin, wrinkle, and acne scar rejuvenation via our third-generation dual-wavelength (CO2/Erbium:YAG) Derma-K™ laser. More mild and less-dramatic improvements in fine lines, sunspots, and superficial skin damage can be obtained without general anesthesia and less downtime via Carillon Clinic’s Erbium:YAG laser. For more information click on this link to laser resurfacing in the Skin Procedures section.

Other facial cosmetic surgeries that can be considered include necklift, lower face lift, or platysmaplasty, submental (under the chin) fat removal via liposuction or direct excision, chin augmentation with solid implants, cheekbone enhancement, facial volume restoration or enhancement via fat grafting, permanent lip enlargement, earlobe repair or treatment of protruding ears (otoplasty), and transgender facial cosmetic procedures (facial feminization) including brow reduction, rhinoplasty, chin reduction, tracheal shave (Adam’s apple reduction), and laser hair removal.

The following will be discussed in more detail in the text below this list.

BOTOX® Cosmetic Injections

BOTOX® injection is a straightforward and safe office procedure that takes approximately 10 minutes. BOTOX® injections target specific muscles responsible for causing frown lines and “crow’s feet” wrinkles, relaxing and diminishing them for several months at a time. Once the muscles are at rest, the skin wrinkles become smoother and less visible.  Common areas of treatment are frown or “worry” lines between the eyebrows (also called the1’s, 11’s, or 111’s), crow’s feet, and forehead lines. BOTOX® treatments take effect in several days and last two to six months. Side effects are very unlikely, but are possible. The most common side effect is bruising, but even that is rare, and can be minimized by avoiding aspirin or ibuprofen for 2 weeks prior to receiving BOTOX; when bruises from the injections occur, they are usually tiny and can be concealed by most makeup.

BOTOX® Cosmetic derives from a natural, purified protein that is produced by a bacterium, Clostridium botulinum. This purified protein, when used in tiny quantities by experienced injectors, is safe and effective. In 1949, scientists from London discovered that BOTOX® injections blocked muscular action. A San Francisco ophthalmologist first used BOTOX® injections to treat eye disorders in humans in 1981. BOTOX® Cosmetic works by irreversibly binding to the receptors in the muscle fibers that contract and cause lines or creases.  New receptors form constantly, which is why the results of BOTOX® injections last for different lengths of time in different patients. Freshly prepared BOTOX® Cosmetic is essential for the best and longest response; at Minneapolis Plastic Surgery, LTD. and Carillon Clinic, LTD. we use multiple vials of BOTOX® Cosmetic daily, so it is always freshly-prepared. (That is also why we never have “Botox Party Fridays” or “Bargain Botox Mondays!”)

BOTOX® injections are used for other non-cosmetic conditions, especially neurological disorders, including neck spasms, involuntary facial spasms, eye muscle disorders, and some migraines. Cosmetic uses include treatment of facial wrinkles, frown lines, forehead creases, reduction of crow’s feet, and rejuvenation of the aging neck. BOTOX® injections can also block sweating, and can reduce migraine headache triggers.

Most patients compare the injection sensation of Botox® Cosmetic to a bug bite or bee sting, but this discomfort is temporary, and can be reduced by pre-treatment with ice packs. Most patients go right back to work or daily activities immediately after the procedure. Makeup can be (re)applied immediately after treatment.

Eighty percent of patients have maximum response by day 30. Most patients see improvement in several days to two weeks. BOTOX® treatment results last up from two to six months and on average for four months.

Cost of Botox

Botox® Cosmetic at Minneapolis Plastic Surgery is injected by our plastic surgeons, who are Expert Injectors™ in the top 2% of all Botox accounts in the country. This assures you of not only an injector who is intimately aware of the surgical anatomy of the injected facial muscles, but also “fresh,” properly-reconstituted (not diluted) Botox, since we use multiple vials per day. We charge $12 per unit; frown line treatment averages 20 units ($240), and “crows feet” periorbital lines 15 units (7.5 units per side) for a total of  $180.


Facial Fillers: JUVÉDERM®, Radiesse®, Sculptra®, and Voluma™

People seeking to reduce the appearance of early signs of facial aging, such as facial creases and wrinkles, are pleased to learn that it is not always necessary to undergo a face lift, eyelid surgery or brow lift , or other surgical operations in order to improve these areas. Facial fillers are now available that can be easily injected into creases and lines to diminish them and restore a youthful smoothness and fullness to the face. These injectable fillers can also be used for lip enlargement and to improve the appearance of recessed scars. The results are immediate and there is no down time—patients see the improvements in their facial appearance right away.

These fillers are injected by our doctors and do not involve surgery, so there is no need to wait for healing to occur, and the contour improvements are immediate, though not permanent. They are long-lasting, however, and many patients enjoy their results for many months. The most popular fillers are the HA (hyaluronic acid) fillers JUVÉDERM® Ultra, and JUVÉDERM® Ultra Plus, or their lidocaine-containing counterparts JUVÉDERM® Ultra XC and JUVÉDERM® Ultra Plus XC; the benefits last 6-12 months. Hyaluronic acids occur naturally in our bodies, and HA fillers are the same substance in a clear injectable gel that requires no allergy testing and has few side effects. Restylane® and Perlane® are HA products made by another manufacturer, and are otherwise nearly identical to the Juvederm® HA  products.

Longer-presence fillers such as Radiesse® can last 1-2 years; this product is used for deeper facial folds (such as the nasolabial folds or marionette lines below the corners of the mouth).  Radiesse® can also be used for the pre-jowl areas to smooth the jawline, for chin or cheek area enhancement, and in other (non-fine-line) areas. Radiesse® consists of calcium-based hydroxyapatite microspheres suspended in a water-based gel; after injection it acts as scaffolding for your own collagen production. The product is gradually absorbed over a year or longer, providing long-lasting natural results as the new collagen your body forms is left behind.

Weight loss, illness, or aging can also cause loss of facial volume, and youthfulness can be restored by use of fat grafts, Voluma™, or Sculptra® injections. None of these replaces the need for facelift or other procedures designed to tighten and remove excess or sagging skin, but can provide wonderful enhancements prior to and in conjunction with these surgeries.

Voluma (JUVÉDERM Voluma™ XC) is a modified hyaluronic acid (HA) filler designed for longer-term deep facial volume restoration. The effects, when injected skillfully and in sufficient amounts, can provide 1-2 years’ duration of age-reducing “lift” and volume rejuvenation. Several syringes may be necessary for maximum results, and can cost anywhere from about 1/4 to 1/3 the cost of a traditional surgical facelift (but without having to undergo surgery). Results are not the same as surgical face lifts for patients that are more appropriately surgical candidates, but not every patient is a candidate for or wants surgery. Now there are non-surgical alternatives that can still provide improvement.

Sculptra® is more correctly considered a collagen bio-stimulator rather than a “filler;” it is comprised of poly-L-lactic acid, which is a synthetic material used in dissolvable sutures and as an injectable for over a decade throughout the world. This facial injectable works gradually in a series of treatments (average 3 over several months, depending on the severity of the contour to be corrected) to give noticeable results that are seen gradually, and can last for up to 2 years or more. 1-4 sessions may be needed for maximum rejuvenation, as a reinforced collagen structure is created and fullness and volume restored in the treatment areas. Sculptra® does not contain human, animal, or bacterial components, does not require allergy testing, and acts as a natural collagen stimulant by the body after injection. Initially, temporary fullness is seen from the saline-reconstituted product injections, the fluid portion of which is reabsorbed overnight; massage distributes the bio-stimulator evenly, and maximum effect is seen in several weeks. Repeat sessions are generally scheduled at 3 week minimum intervals until maximum improvement is reached. Similar to Voluma™, Sculptra® costs can range from about 1/4 to 1/3 the cost of a surgical facelift, but without the surgery! As with Voluma™, results are not the same as a surgical facelift, and do not last as long as surgery, but provide a nonsurgical option for patients who do not wish or are not candidates for surgery.

Costs for HA Fillers, Sculptra, and Voluma

HA fillers are about $550 per 1cc, which treats one area, depending on wrinkle severity and patient goals; additional syringes are $450 each. Voluma and Sculptra costs are about $900 per syringe or vial, with slightly lower costs for subsequent syringes or vials. Most patients will have the best results with two or more syringes or vials, depending on individual requests.

Please schedule a consultation with Minneapolis Plastic Surgery, LTD. to speak with our plastic surgeons and determine whether your aesthetic concerns can be improved with one of these non-surgical injectables.  Our American Board of Plastic Surgery-certified plastic surgeons can also explain to you the differences between the products and recommend the best plan to achieve your goals.

Platysmaplasty (Neck Lift)

The neck is one of the first highly visible areas of the body to show age. This is because the skin of the neck is thin, delicate, and easily affected by the process of aging, gravity, and sun exposure. With time, loose neck skin can make the platysma muscles in the front of the neck noticeably apparent as raised bands or vertical skin folds. Through a small incision under the chin, these muscles can be tightened through the platysmaplasty procedure to define and lift the neck, creating a younger, more slender look. Other terms for variants of this operation include corset platysmaplasty or neck lift, and usually include neck fat removal under the  chin (submental direct excision) or liposuction.

Liposuction or direct fat excision of the neck is sometimes used in conjunction with platysmaplasty to reduce the fat causing a double chin. Because having loose neck skin, sagging platysma muscles, or excess fat in the neck is often a telltale sign of aging, our doctors are often able to take years off a patient’s appearance by addressing the exact neck concerns directly. Some patients have a combination of neck fullness or excess fatty tissue and a retrusive or “weak” chin; this can be seen in young patients as well as older ones. In these cases, fat removal and placement of a chin implant via the same incision used to remove the excess fat allows the neck’s skin to redrape and sculpt the jawline, chin, and submental area beautifully.

Cost for Platysmaplasty

Basic costs for platysmaplasty average $5300, but the exact costs are determined by specifics of the procedure required, and the time needed for the procedure. Exact cost quotes are available at the time of complimentary consultation by our ABPS-certified plastic surgeons. Cash discounts and financing options are available.

Fat Grafts (Dermal-fat Grafts)

Fat grafting offers the opportunity for patients to transfer small amounts of living fat to other areas of their body where more fullness is desirable, such as the under eye region, cheeks, lips, and in some facial creases. Indentations or contour irregularities after trauma or other surgery can also be improved with fat grafts, which provide long-lasting living tissue from a patient’s own cells.

For permanent lip enhancement, use of dermal fat grafts (de-epithelialized skin or scar collagen to which a few fat cells may still be attached) allows a strong, uniform, living tissue graft of a patient’s own dermal collagen to be placed via inconspicuous intraoral incisions into the upper, lower, or both lips. This operation can replace periodic filler injections, while avoiding firmness or lumpiness seen in some cases of too-aggressive lip enlargement injections.  Living tissue heals, is soft and natural, allows nerve regrowth for normal sensation, and is permanent. Large grafts do not survive, so smaller relatively subtle enhancement is achieved, but can be repeated after healing is complete for additional fullness.

In the fat graft injection procedure, our surgeons first remove fat from a donor area such as the abdomen, being careful not to damage the fat cells. The fat to be removed for grafting cannot be gathered through traditional liposuction (too traumatic to the fat grafts), though liposuction may be used in combination with fat grafting for body contouring purposes. The fat to be used for grafting is injected carefully into the desired areas.  Both harvest and grafting can be done under local anesthesia if desired, or combined with other surgery while under anesthesia.

After fat grafting, swelling is visible, but gradually diminishes, as only 30-50% of the grafted fat cells survive long-term.  The rest of the fragile fat cells and fluids are reabsorbed over several weeks, leaving only the living cells.  Injecting too much fat does not improve results; it simply increases the number of cells that do not survive. Thus, more than one fat grafting procedure is usually necessary to produce the desired results, but it is worth it for many patients to achieve long-term results using their body’s own resources.

Otoplasty and Earlobe Repair

Ears that are enlarged, protruding, or deformed can be the target of relentless teasing, both in childhood and adulthood. Some children can withstand the teasing, but many others develop a self-consciousness or loss of self-esteem that can follow them for life. Otoplasty (“ear pinning”) is a procedure performed on both children (age 4 and up in most cases) and adults that can reduce the abnormal protrusion, minimize certain parts of the ears, and otherwise correct the appearance of many ear abnormalities. The results of this surgery are extremely natural-looking and the scars are usually concealed on the backside of the ear; it is highly unlikely that anyone would ever suspect that the ears had been operated on.

A gauze head bandage is applied for two days, and head elevation is recommended for 2-3 weeks after surgery, along with avoidance of strenuous activities or exercise.  Sutures are removed after 7-10 days; children may have absorbable sutures.  During the day nothing other than reduced activity is needed, but at night a headband or sweatband and shower cap or rain bonnet (to keep the headband on) is necessary to prevent inadvertent bending of the corrected (still-healing) ear cartilages as the patient turns and rolls in his or her sleep.  This night-time headgear is worn for a month to reduce the risk of losing the internal sutures that hold the ears in their new position.  Re-stitching can be necessary in up to 10% of patients.  Infection or bleeding is rare, but either can have serious cosmetic impact.  This risk can be reduced by taking antibiotics, keeping the ear suture lines clean, wearing the night-time band, and avoiding aspirin or ibuprofen-containing medications for two weeks before and after surgery.

Earlobe repair is a common surgery for those who have torn earlobes (stretched pierce or complete tear) due to earrings or gages. Depending on how the earlobes are damaged, the procedure will differ, but the repair most often involves making tiny incisions adjacent to the torn area and suturing the earlobe together so that the trimmed edges heal as one. The procedure is done under local anesthesia, takes about 15 minutes per earlobe, and heals with minimal risk of bleeding, infection, or unsatisfactory scarring.  After the repaired earlobe heals for 6 weeks, our plastic surgeons perform complimentary ear piercing so that you may wear earrings again. Gaged (stretched) earlobes can also be repaired, but may involve more work depending on the size of the gage and amount of stretched earlobe skin.

Earlobe reconstruction can also be done in cases where facelift incision and closure choices have left wide, visible scars in front of the earlobe, or stretched “pixie” earlobes instead of the previous normal earlobe configuration. We have developed special techniques that are individualized to each patient’s specific problem, and can usually repair or improve upon these unfortunate situations.  We also use these methods in our own face lift patients to help avoid these problems in the first place!

Cost for otoplasty and earlobe repair

Otoplasty under local anesthesia (adults and teens) costs around $4850. General anesthesia otoplasty costs are about $6200. Earlobe repair under local anesthesia is $890 for one ear; two ear repairs cost about $1600. The costs for gaged earlobe repair are higher and are dependent upon the degree of earlobe deformity and the time required to reconstruct the earlobe(s). Exact costs are available at the time of complimentary consultation with our ABPS-certified plastic surgeons. Cash discounts and financing options are available.

Transgender Facial and Facial Feminization Procedures

For over two and one half decades, the ABPS-certified plastic surgeons at Minneapolis Plastic Surgery, LTD. have performed facial surgery for transgender patients who would like their facial features to be surgically altered to look more feminine (or more masculine). Some of the surgeries we offer include rhinoplasty, forehead (brow ridge) bony contouring, laser facial resurfacing after electrolysis, laser hair removal, and tracheal shave to reduce the prominence of the Adam’s apple. Costs for tracheal shave, for example, are about $4200.  Chin and cheek implants may also be recommended. If jaw or dental surgery is requested, we can refer you to one of several excellent oral and maxillofacial surgeons.

Our plastic surgeons and staff have worked with both female-to-male and male-to-female transgender patients for over two and one half decades, performing such procedures as transgender breast augmentation, mastectomy (top surgery), brow reduction (bone contouring), tracheal shave, rhinoplasty, laser skin resurfacing, chin reduction, and other facial or body plastic surgery. Other services offered by our Carillon Clinic, such as laser hair removal, are also helpful to many of our transgender patients. We do not perform transgender genital procedures at this time. Please contact our Minneapolis, Minnesota office for a complimentary consultation at any point in your transgender transition for a thoughtful, non-judgmental analysis of your concerns and goals. Exact costs are available at the time of no-obligation consultation, and are dependent on the procedures chosen and the time required to perform them. Cash discounts and financing options are available.

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