Rhinoplasty, Full Face Fat Transfer, TCA peel, Lower Eyelid Blepharoplasty
This patient is a 45-year-old female who is concerned about the appearance of her eyes as well as her nose. Regarding her eyes she felt as if her brow height was slightly low and provided a heavy and tired appearance to her upper eyes. She additionally felt as if she had tired dark circles beneath her eyes. Regarding her nose she was unhappy with the width of both the dorsum and tip as well as her profile view.
On examination, her brow height was felt to be only mildly low. Her lower eyelid puffiness was felt to be due to an orbital groove rather than too much fat in the lower eyelid. She additionally had skin wrinkling and pigmentation of the lower eyelids. Examination of her nose on the frontal view showed her to have a wide dorsum and tip. Lateral view showed under rotation with an increase in the columellar show and a dorsal hump.
She elected to undergo an endoscopic brow lift, full-face autologous fat transfer, lower eyelid skin excision and trichloracetic acid chemical peel and cosmetic rhinoplasty.
Postoperatively, her frontal view shows a mild but significant improvement in her brow height without causing a surprised look. Her lower eyelid tired appearance has been completely relieved by adding fat to her cheek region and lower eyelid trough. The pigmentation and skin wrinkling has also been improved through the use of the peel. The improvement in the lower eyelids is also highlighted by her oblique photos. Frontal view of the nose shows improvement in the nasal width of both the dorsum and the tip. The oblique and lateral views show good dorsal contour as well as improved rotation of the tip and reduction in the amount of columellar show. The combination of the above procedures transforms her face from harsh tired contours to well-balanced rested soft contours.
