Total nasal reconstruction for badly broken noses

The nose is the center-most point of the face, and injuries to the nose can alter one's entire perception of facial balance and attractiveness. If you have a broken nose, with or without an overlying soft tissue injury, careful anatomic alignment of the nasal bones, septum, paired upper lateral and lower lateral cartilages, and skin envelope are critically important.

When I am addressing a traumatic nasal injury, I use the same type of anatomic analysis and meticulous surgical technique that I use when I am performing a cosmetic rhinoplasty or nosejob. While reconstructive nasal surgery is about returning a person to their baseline and cosmetic nasal surgery is about improving their appearance, both types of operations hinge on good surgical technique and sound planning.

If you have a nasal concern-- whether it is a broken bone, a soft tissue trauma, or an aesthetic complaint-- please feel free to contact my office at 212-452-2400 or office@LaraDevganMD.com.

The spectrum of eye rejuvenation: from injections to surgery

The eye area has the thinnest skin on the body, and for this reason, the periorbital area is one of the first places where the face shows its age.

There are a variety of options to rejuvenate the eyes, depending on your anatomic characteristics, expectations, downtime, and budget. The two principle options are injectable rejuvenation and surgery.

Injectable Eye Rejuvenation

Injectable rejuvenation of the eye area focuses on use of Botox to soften crows feet (the wrinkles on the lateral aspects of the eyes) and filler to soften tear troughs, dark circles, and hollowing under the eyes.

The main advantages of injectable eye rejuvenation are that it is fast, easy, minimally invasive, and has little downtime. The entire procedure takes under 15 minutes in most cases, and it can be done wide awake, with many patients returning immediately back to work.

The main disadvantage of this approach is that it is temporary and results are not quite as good as those that come with surgery. Botox lasts 3-4 months, and tear trough fillers last 1-2 years in most cases. For tear trough filler in particular, the injected material serves to blend and camouflage signs of aging, rather than definitively correcting excess skin or puffy fat pads.

Surgical Eye Rejuvenation

Surgical rejuvenation of the eyes is called upper eyelid and lower eyelid blepharoplasty. These operations involve using hidden incisions to definitively correct signs of aging around the eyes, such as excess folds of skin, puffy bags (fat pads), and hollowing.

The main advantage of blepharoplasty is that it is the gold standard, most effective way of treating periorbital aging. Results are very durable and long-lasting, and patients tend to be very happy.

The main disadvantages of surgery are the downtime, invasiveness, and expense associated with it. But for those who can accept these limitations, surgery creates a superior aesthetic result.

Dr. Devgan featured in The Guardian's New Documentary Series on the female body

I was honored to be invited to discuss labiaplasty in The Guardian's new documentary series on the female body. Created by Emmy-winning producer Mae Ryan and brilliant data journalist Mona Chalabi, this project, entitled The Vagina Dispatches, is a long-overdue look at the things we don't know about the female body-- sponsored by one of the world's great news organizations, The Guardian. In this episode, I discuss labiaplasty, which is one of the fastest growing plastic surgery procedures in America and one of the most popular operations in my practice. 

Click to watch The Guardian's documentary, Vagina Dispatches, Episode 1. Dr. Devgan's interview begins at minute 6:18.

The key to a modern facelift and necklift

Facelift and necklift are two of my favorite plastic surgery procedures. The face and neck are not only the seat of identity and beauty, but they contain some of the most complex anatomy and delicate tissues on the human body.

When I am addressing the concerns of a patient interested in rejuvenation of an aging face or neck, there are a few key questions that I ask myself to help me achieve natural, beautiful, and durable results:

1. What are the major issues that are concerning the patient? These could be fallen cheeks, jowls, deep wrinkles, neck bands, excess skin, or any combination of the above.
2. What are the patient's tissues like? This is an assessment of skin type, complexion, thickness, sebaceousness, tendency toward scarring, and ability to heal.
3. What are the unique anatomic characteristics that make this patient's face and neck different? Everyone has a set of qualities that give a sense of identity to their features. This could be deep set eyelids, prominent cheekbones, a beauty mark, or a baseline asymmetry-- really anything that makes you look like you.
4. In what way does the patient's overall medical status impact the proposed operation? Major medical problems, allergies, connective tissue issues, use of certain medications like steroids, and substance use all impact my operative decision making, before, during, and after surgery.

From a surgical standpoint, the major differentiating factor between a modern facelift or necklift and the old-fashioned, pulled, tight, shiny, windblown look of Park Avenue in the 1990s is a deliberate treatment of the skin and substructure of the face as two separate anatomic planes. The SMAS (muscular substructure layer of the face) and the skin (the overlying covering) must be addressed separately and systematically in order to achieve a beautiful results.

For questions about facelift and necklift, please contact my office at office@LaraDevganMD.com or 212-452-2400.

Labiaplasty for functional and aesthetic concerns

Labiaplasty (or cosmetic rejuvenation of the female genitalia) is one of the most popular procedures in my New York City plastic surgery private practice. As a female plastic surgeon, many of my patients feel comfortable discussing their most intimate concerns with me. Equally important, I am committed to giving superb surgical results to each patient in my practice. Examples of results from my actual patients are displayed at the bottom of this page.

U.S. plastic surgeons have reported a 44% increase in labiaplasty procedures over the past several years, according to the American Society for Aesthetic Plastic Surgery. This makes labiaplasty the fastest growing plastic surgical procedure in America.

WHAT IS LABIAPLASTY?

Labiaplasty is an outpatient surgical procedure designed to make the female genital area more aesthetic and comfortable. Women seek labiaplasty because they are unhappy with the way their private parts look, or because they are uncomfortable with friction caused by exercising, sexual intercourse, or wearing fitted clothes. Labiaplasty can address the inner labia (labia minora), the outer labia (labia majora), the clitoral hood, or any combination of those areas. Atrophy or sagging of the labia majora can also be addressed with filler or fat grafting. 

WHAT IS THE ANATOMIC CONCERN?

The most frequent complaint related to labiaplasty is protruding or enlarged labia minora (inner labial lips). This is also the most common reason for women to seek labiaplasty in my practice. As women get older, some experience atrophy or sagging of the labia majora (external labial lips). Occasionally, women also complain of enlargement of the clitoral hood, looseness of the perineal tissues, sagging of the labial majora, or bulkiness of the mons pubis.

Labiaplasty is tailored to your individual anatomic considerations and concerns, as each woman is different. Labiaplasty does not affect sexual sensation, enjoyment, or ability to have an orgasm. The female erogenous zones, such as the clitoris and "g-spot" are not operated on and experience no changes during the operation.

WHAT IS THE SURGERY LIKE?

Labiaplasty is done under local anesthesia with or without light sedation ("twilight"), which is always supervised by my board-certified female anesthesiologist. About 70% of my patients elect to have the surgery done under local anesthesia alone. The surgery itself typically takes under 1 hour. When surgery is complete, you will have ointment and a maxi pad placed as a dressing. If you have had local anesthesia only, you will feel fine immediately after surgery. If you have had sedation, you will feel a bit tired and you will recover in one of our private recovery room suites, where you will be able to relax, sleep, watch TV, or read a magazine. Once you are feeling fully awake and alert, usually after about half an hour, you will be able to go home the same day. 

WHAT ARE THE SCARS LIKE?

Scars for labiaplasty are hidden in locations that are not visible under most circumstances. Even when scars are closely examined, as in during intimacy or mirror examination, the female genitalia generally heals extremely well. Any scars that are present will heal in a camouflaged manner, and care is taken to design your scar placement in a buried or hidden location.

EDGE OR WEDGE?

There are two well-described techniques for performing labiaplasty that addresses the labia minora: the external trimming technique (excising the "edge" of the protruding tissue-- the edge technique) and the v-shaped surgical excision (excising a "wedge" of the protruding tissue-- the wedge technique). I am well-versed and facile in both techniques and will tailor the procedure to your individual desires. Both procedures have their role in labiaplasty, however, generally speaking, I prefer the wedge technique in most women, as I consider it to provide a superior cosmetic result.

In general, the wedge technique is considered the gold standard of labiaplasty technique, and it has supplanted the edge technique in the hands of many modern and experienced surgeons. The wedge technique is more technically challenging from a surgical perspective, and for this reason, it is less common to find a plastic surgeon to perform this procedure. However, the wedge technique is considered a superior operation in most women for several reasons:

• The Edge technique creates a linear scar along the edge of the external genitalia, which can appear scallopped or irregular when the stitches heal. The Wedge technique has a buried scar that is less noticeable and leaves the external genitalia with a smooth contour.
• The Edge technique is associated with occasional complaints about dysparunia, or pain with sexual intercourse. These complaints are almost unheard of with the Wedge technique.
• The Edge technique is more traumatic to the tissues and has an increased amount of swelling, as well as an increased risk of wound breakdown. While swelling is also present with the Wedge technique, it resolves more quickly. Wound breakdown is not common with the Wedge technique.

WHAT IS THE RECOVERY LIKE?

After surgery, you will wear a maxi pad with a small amount of ointment on it, and use ice packs for comfort. All of your stitches will be dissolvable. You will use a "peri bottle" or water bottle to cleanse yourself after going to the bathroom. When you are resting at home, I advise pelvic elevation by keeping your pelvis propped up on 1-2 pillows to help the swelling come down.

Swelling after labiaplasty peaks in the first 2 weeks. During this time frame, swelling is gravity-dependent, so you will notice that spending more time doing pelvic elevation helps the swelling decrease. Even if you are up and about right after surgery, this will not effect your long term result, although it may take a bit longer for your swelling to go away. After the first 2 weeks, swelling continues to decrease on its own. You will have about 80% of the final surgical result at 1 month after surgery and 90% after 6 weeks, although it takes a full 6 months for all swelling to completely dissipate. 

WHEN CAN YOU RETURN TO WORK AND PLAY?

You will be able to do normal activities, such as walking around the block and running an errand, the day after surgery. Depending on the nature of your job, many women are able to return to work within 2-3 days. For more strenuous types of work, this may vary. Strenuous activity is not advised for the first four weeks after surgery, although pending Dr. Devgan's recommendations for your individual case, you may be able to resume some light exercises at 2-3 weeks. You will be able to return to sexual intercourse, strenuous exercise, swimming, and normal activities after approximately 6 weeks.

WHAT IS THE NEXT STEP?

Patient satsifaction with labiaplasty is extremely high. For questions about the procedure or to set up an in-person consultation, please call our office at (212) 452-2400 or email info@LaraDevganMD.com.