Our Surgeries

Nose Procedures


The nose is the most defining characteristic of the face - even a slight alteration can improve a patient's appearance. In addition to having rhinoplasty performed for cosmetic reasons, it can also be done with a functional goal in mind - to improve breathing.

Understanding how the appearance of the nose relates to the surrounding face is very important. Subtle changes in the look of the nose can have a dramatic effect on the appearance of the eyes and lips, often drawing more attention to them rather than away from them. When your surgery has healed, ideally your nose will look like you were born with it...this is Dr. Wayne's goal.

It is also important to understand how changes made to the outside of the nose impact the nasal passages. Almost every modification to the cartilage and bone during rhinoplasty serves to narrow the inside of the nose. This can restrict breathing. Techniques need to be performed during the surgery to counter this tendency and make the nose breath better than before surgery.

Modifications of the bone, cartilage, fat and muscle must be made very carefully. Rather than simply removing valuable structural cartilage and bone, it is often reinforced at the same time. This creates a nose that not only looks better and breathes better but will maintain a natural look for many years.

Extensive training and experience in rhinoplasty surgery is a must for your surgeon. A background in ear, nose and throat surgery gives Dr. Wayne unique qualifications to perform this very challenging surgery.

Dr. Wayne will take pictures of you in the office and present them to you using a computer program that allows him to show you how your nose will look after surgery. This gives you the unique opportunity to influence the planning process.

Revision Rhinoplasty

The best chance of getting a perfect result in rhinoplasty is with the first surgery. Many factors contribute to the need for revision surgery on the nose. Breathing problems, pinching, twisting, lumps and bumps all may appear in the healing process. Most of these are due to surgical errors; however, some are unavoidable. Healing after surgery is very unpredictable, as the nose must adapt to the new structure formed under the skin.

Revision rhinoplasty is performed to correct unsatisfactory results from an initial nasal surgery. Sometimes the surgery is simple - requiring minor adjustments or finishing an incomplete surgery. At other times, this surgery may require more complex grafting and rebuilding of a weakened nose. Each succeeding rhinoplasty becomes more difficult, which is why an experienced, specialized facial plastic surgeon, such as Dr. Wayne, is the best choice for this procedure.

Eyes (Blepharoplasty) Upper Blepharoplasty (Upper Eyelid)

Droopy eyelids can make you look older and impair vision. During this procedure, incisions are made in the natural folds of the upper eyelid where they are nearly invisible. Preservation of fat and muscle avoids an excessively hollow or operated-on look. Blepharoplasty is often combined with a brow lift to correct the appearance of sagging eyebrows.

Lower Blepharoplasty (Lower Eyelid)

The appearance of bags in the lower eyelids can be due to bulging fat or loss of fat in the surrounding cheek. Dark circles are often caused by allergies or dark pigment. A thorough evaluation is needed to determine which of these factors is causing the problem.

Transconjunctival Fat Removal

Eyelid puffiness caused primarily by excess fat may be corrected by a transconjunctival blepharoplasty. The incision in this case is made inside the lower eyelid and excess fat material is removed. When sutures are used to close this kind of incision, they are invisible to the eye, self-dissolving and leave no visible scar.

Transconjunctival Fat Repositioning

Fat repositioning is a procedure where orbital fat is used to fill in a depression where the lower eyelid and the cheek meet. During the transconjunctival option, the fat is removed from the back side of the lower eyelid. Most of the changes that occur in the lower eyelid are due to changes in the upper cheek, namely dropping of the cheek and malar fat pad. A lower eyelid procedure is often performed at the same time as a midface lift. This provides a more natural, refreshed look than eyelid surgery alone.

Chin (Genioplasty)

To achieve a balanced facial appearance, the size of the chin (especially in its relationship to the nose) is the reason many patients make the decision to enlarge the size of their chin. This addresses the concept of facial harmony - the balance between the features.

With only a chin implant, appropriate candidates for this surgery will look much more balanced and harmonious. Often a large nose looks smaller and the neck looks tighter. Dr. Wayne prefers to use an intraoral incision to place the implant to avoid a scar under the chin. Special chin implants may be used in conjunction with neck lift surgery to improve neck harmony and balance.

Neck Lift

The aging process, weight loss or genetics can all contribute to a patient's decision to have neck surgery. A neck lift is used to tighten loose skin under the jaw and give a more defined jawline while reducing jowling.

The neck lift involves two procedures, one to remove the excess skin and the other to remove or alter the muscles. Incisions are carefully placed on the edge of the ear (tragus) and behind the ear to avoid a visible scar. Most of the pull is back behind the ear to improve the neckline without a swept back look. The neck lift is often done in conjunction with other facial procedures, including a brow lift, face lift or fat grafting in other areas.

Direct Neck Lift (Cervicoplasty)

This procedure is a less common alternative to the traditional neck lift. Instead of the tissues being lifted backward to tighten, skin and fat is removed and the neck muscles tightened. It is a simpler procedure with less recovery time, but it does leave a midline neck scar. Typically, it is a procedure chosen by older patients, especially men.

Facelift (Rhytidectomy)

As we age, the skin begins to loosen on the face and neck, resulting in crows' feet, forehead lines, jowls along the jaw and beneath the chin, as well as vertical folds at the front of the neck. A facelift can give you a healthier and more youthful appearance, as well as increase your self confidence.

Sometimes, more than one type of procedure is needed. Incisions are made in the area of the temple hair, just above and in front of the ears and continuing around the lobe. The skin is raised outward before the surgeon repositions and tightens the underlying muscle and connective tissue. Some fat may be removed, as well as excess skin. Fat will be added in certain areas around the cheekbones, mouth and jawline, rebuilding the shrunken skin support.

The most important factor when thinking about facelift surgery is how you want to look. Patients who get facelifts can often end up looking very drawn, tight and wind swept. To avoid this look it is better to be more conservative and rely on combination techniques rather than super tight skin pulling to achieve a more youthful look. Dr. Wayne will typically use fat grafting, mid face lifting, neck lifting and fat transfer blepharoplasty together with the fractionated CO2 laser to achieve the most balanced and rejuvenated look.

Mid Facelift

This is the backbone of aging face surgery. Rather than pulling the cheeks tightly back, it gently repositions fallen fat and muscle in a more vertical direction. Incisions are hidden in the hair, and no skin or scalp is cut away with this technique. This powerful procedure improves sagging brows, cheeks, deep folds around the mouth and the appearance of jowls along the jaw.

Fat Grafting

This evolutionary technique is changing the way we do facial rejuvenation surgery. Look at the face of a teenager -- full cheeks and plump skin give the look of youth, rather than tight skin. Fat grafting attempts to replace and rebuild the fat lost with aging. Fat is taken from the abdominal area via liposuction and transferred to the deficit areas of the face for a fuller, more youthful and more natural appearance.

Volumetric Facial Rejuvenation

This is rejuvenation of the face using combination techniques that stress volume rebuilding rather than simple skin tightening. The mid facelift together with fat grafting and the neck lift addresses the face in a more balanced, harmonious fashion. This is Dr. Wayne's philosophy for creating a more natural, youthful appearance.

Ears (Otoplasty)

Correcting protruding ears can lead to greater self-esteem with relative ease. Adults often decide to combine this surgery with other facial plastic surgery options. Ears can be "pinned back," reshaped, reduced in size and made more symmetrical.


An incision is made right behind the ears in the natural fold where the ear is joined to the head. The surgeon removes the necessary amount of cartilage and skin. Sometimes the cartilage is trimmed and reshaped and then pinned back with sutures. In some instances, the cartilage is not removed at all. Instead, sutures are used to keep it permanently in place.


This is a common birth defect, usually affecting one ear, but sometimes both. Patients with microtia do not have a normal outer ear. There is a nub or small nodule instead of a fully-formed ear. Correcting this condition requires about four reconstructive surgeries in a year. The new ear is grafted from human skin and a small section of a rib. Patients not only look better, but many report an improvement in their hearing, as well.