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Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: It's a pretty common question. How do you fix droopy eyelids? Dr. Eric Cerrati is the Director of Facial Plastic Surgery at University of Utah Health. Dr. Cerrati, first of all, what usually brings patients to you looking for an eyelid procedure? What are some of the common themes?

Dr. Cerrati: I would say the most common thing across the board is that patients say that they feel or look tired, especially when they look at themselves in the mirror.

Interviewer: Got you. And you have a procedure that can do that. Now, is it something that you can do without surgery, or is surgery always involved?

Dr. Cerrati: So there are actually a lot of different options. There are nonsurgical options, in which case you put filler underneath the eye, you can do laser procedures to tighten the skin under the lid, and then there's a whole arsenal of surgical procedures, where we tighten the muscle underneath, we remove some of the skin, and we lift the brows, all giving a more rejuvenated or rested appearance.

Interviewer: How would you decide what is best for a particular patient?

Dr. Cerrati: It starts with the patient's concerns and what their question is. This is actually more common in males than you would think. It's very common that patients come in and just say they look tired and their colleagues are commenting, both male and female.

Another common complaint that patients will say is that it's affecting their vision, in which case the droopy eyelids can actually block some of their peripheral vision. If that's the case, we could actually send them for an objective visual field test is what we call it. They have the test. Depending on how they perform, there are certain insurance criteria and if they meet that criteria, insurance will actually cover the procedure.

Interviewer: So you can get rid of the tired look and also improve your vision, which is fantastic. It's a safety thing, really.

Dr. Cerrati: Exactly.

Interviewer: You know? And just a quality of life thing as well. So you have a conversation with them. You try to find out what their needs are as far as then determining which one of these procedures you're going to go with. How often is it possible that somebody could do nonsurgical?

Dr. Cerrati: It's difficult to say. I would say people that have more on the mild side of findings we can treat it nonsurgically. Botox Botox, which is actually common medication that we use, that you think of smoothing wrinkles on the face, but you can actually use the push/pull of muscles on the face to actually create a brow lift to give a more rested appearance to the brow. Some other nonsurgical options include, for the brow, using Botox to elevate the brow. Fillers Really not much you can do for the upper eyelid skin, but the lower eyelid you can place filler in the tear trough to help provide some volume to the under eye, which gives them more of a rested appearance, and also doing a laser procedure to tighten the skin underneath the eyelid.

As far as topical creams and those sorts of things, they do help slightly. I wouldn't say it would give the patients a long-lasting result that they're really looking for when they come to my office.

Interviewer: And when you talk about long-lasting results, how long could somebody expect this to continue to be what they want it to be?

Dr. Cerrati: So obviously, we can't stop the aging process, so it continues. But I would say for eyelid and brow revisions, usually you're talking several, several years down the road, 10-plus years.

Interviewer: And then where, if it is a surgical option . . . I'd imagine the nonsurgical happens in your clinic. What about the surgical options? Tell me more about that.

Dr. Cerrati: So the surgical options are performed either up at the main hospital, the University Hospital, or out at one of the satellite offices. When I consider eyelid rejuvenation, you have to consider the brow and the eyelids kind of as one unit. And so, if the brows are ptotic or have fallen down some, addressing the brow can create a very significant improvement in the appearance.

So if the brow is being done, usually I perform that under general anesthesia, and then the upper lids, if we're coupling that with the brow, again under general anesthesia. If it's just the upper eyelids, we can actually do that in the clinic setting just under local anesthesia. It takes maybe 45 minutes to an hour. And then the lower lids are a little bit more involved. I tend to do those back in the operating room.

Interviewer: Got you. And what kind of recovery time are we talking about? I'd imagine it varies because it sounds like the approaches vary.

Dr. Cerrati: So I tell everyone it's about a one-week recovery. At one week, all the stitches come out. Most of the bruising has resolved. Still taking it easy as far as activity-wise, but one week you're pretty much recovered and back to your normal day-to-day activities.

Interviewer: Do people generally choose not to go to work for that one-week period while they're healing?

Dr. Cerrati: Depending on what their job is, yes.

Interviewer: See if they can work remotely and maybe do that?

Dr. Cerrati: Exactly.

Interviewer: Got you. And you mentioned insurance covered it if it was a sight thing, so that's pretty good.

Dr. Cerrati: If insurance feels that the findings affect your peripheral vision, they will actually cover both the brow lift and the upper blepharoplasty or upper eye lift.

Interviewer: Tell me about how the skill and experience of the surgeon can make a difference in the outcome when it comes to this type of procedure. I mean, you do it. You also have some very talented colleagues that do it. How would somebody choose the person that they want?

Dr. Cerrati: So there's a team of surgeons, and with every surgeon, there's a team that works around them to help provide the best care here at the University. For brows, I tend to use an endoscopic approach, which is incisions hidden way back in the hairline, so that way, really minimizing the amount of scarring or any incisions on the face.

The eyelid incisions are hidden right in the natural creases of the eye. And again, all of this is tailored to the specific patient's needs and the skill the patient takes, in both aesthetics and shorten the recovery time.

Interviewer: And how could a patient make sure they're picking the surgeon that's right for them?

Dr. Cerrati: So the most important thing is the in-person consultation. It's important to come meet your surgeon, discuss with them kind of what you're hoping to achieve. You can look at some before and after pictures. And if you feel comfortable with the surgeon, that's the most important thing.

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Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: Botox and fillers, common question, what is the difference and how can they help you? Dr. Eric Cerrati is the Director of Facial Plastic Surgery at University of Utah Health. So, first of all, are Botox and fillers the same? I would say probably not, but that's why you're here. I want to find out.

Dr. Cerrati: So they're very different. Botox is a neurotoxin. And Botox, it just happens to be the trade name that everyone knows of. But actually, there's three others now that are FDA-approved, and they affect the muscles, whereas fillers are volumizing agents.

Interviewer: Okay. And how are they used differently then?

Dr. Cerrati: So, in general, Botox is used for the upper third of the face. FDA approved for three different areas, which are the horizontal forehead lines, the vertical 11s that you have between your eyes, and the smile lines outside. Obviously, there are some other off-label uses that we tend to use them for. And then, fillers are the lower two-thirds of the face. You know, I'm not a huge fan of using Botox and, you know, around the mouth or other areas, because obviously the lower two-thirds of the face is very mobile and you want to maintain that mobility.

Interviewer: So kind of give us a general rundown, what are the different types of Botox and fillers? When would you use them? What do they do?

Dr. Cerrati: So Botox, in general, so it's a neurotoxin that's injected into muscles. It takes about two to three days to take effect. I usually tell patients to give it a full seven till you kind of go to the mirror and see what it does. And on average, it lasts about three to four months. After three to four months, you're right back where you started. No better, no worse.

Interviewer: Okay.

Dr. Cerrati: Fillers, on the other hand, you know, there's a whole variety of fillers that are out there. There are permanent ones, and there are, you know, hyaluronic acid ones that are dissolvable. I tend to use the dissolvable ones just for safety because, you know, it's not a benign procedure that should be taken lightly. And the different fillers, they come in different thicknesses, you know. Some are placed deeper. Some are placed more superficial. Some last a year. Some last two years.

Interviewer: And when you say safety, what do you mean exactly?

Dr. Cerrati: With any filler injection, there's a risk of bruising and swelling. All hyaluronic acid fillers attract water to a certain degree, so that's how you get the swelling. They pick up red blood cells, and doing so, that's how you end up with the bruise. I don't consider those risks. I consider them known side effects. And there are certain things you can do to try to limit those side effects. Kind of the scary risk that people see and hear about online is more if the filler is injected in or around a blood vessel. That's why it's very important to go to someone who's very knowledgeable about the facial anatomy and where the filler is going and what we're trying to accomplish.

Interviewer: The dissolvable versus non-dissolvable, so let's just take, for example, maybe under the eye. That would be a place where you might use a filler. Is the dissolvable . . . does that mean that the results don't last as long much like the Botox and the dissolvable would last longer?

Dr. Cerrati: So the filler that I tend to use around the eye will last about a year. Again, after about a year, your body dissolves it or metabolizes it, and you're back to where you started. Under the eye tends to be an area where people will swell and bruise pretty significantly. I tend to use a cannula to try to limit that, you know. And it's also a high-risk area. Given the risk associated with the under the eye fillers, I tend to favor the dissolvable fillers.

Interviewer: Yeah. It sounds like it's a little bit more complicated than just an injection of Botox here, some fillers there.

Dr. Cerrati: Exactly. And, you know, I do all of my injections myself in the office. I just think that I can give a little bit more high-quality product to the patients if I do it that way.

Interviewer: And during either type of treatment, whether it's Botox or fillers, where does this happen? It happens in your office?

Dr. Cerrati: It happens in the office. Actually usually a pretty quick procedure, probably it takes anywhere from 5 to 15 minutes. And a lot of times, we can couple them together to accomplish, you know, full facial rejuvenation. That's where you start to get into things called liquid facelifts. You know, you can use Botox in the neckline to tighten the jaw line. There's a lot of different, you know, kind of off-label uses that you can really accomplish quite a bit with these two modalities.

Interviewer: And it sounds like the advantage of having someone like yourself do the procedure. I mean, you're a surgeon. On the surface, it might seem like it's a little overkill. But a lot of factors involved as to what to use and safety concerns, and it's a balance of outcome versus safety. I think I'm starting to understand why I would come to someone such as yourself.

Dr. Cerrati: So I tend to believe that surgeons are going to have a more thorough knowledge of the anatomy of the face and can place the fillers in the safest way possible to give the longest-lasting result. I think when you're seeing a surgeon for a complication, it's probably not the best setting.

Interviewer: We've talked before about being comfortable with the person that is doing the procedure in the terms of when it's like a facelift, when it's a surgical procedure. These non-surgical procedures with fillers and Botox, does the same thing apply? You should be comfortable with that person?

Dr. Cerrati: Absolutely. So this is very customizable for each patient. And you can think of the surgeon as, you know, someone who's trying to sculpt or mold an image that they have in their face, of how to rejuvenate a patient's face. And so the combination of Botox and fillers and what they can accomplish is very specific to what the surgeon sees and what that patient desires. And so having that conversation before doing any of the injections is very important.

Interviewer: And there are some great surgeons to choose from here.

Dr. Cerrati: Absolutely. So we have a team of surgeons here that offer this. And obviously, Botox and fillers are widely used all across the country and all over the world. But it's very important to go to someone who's well qualified and knowledgeable.

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Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: What is the difference between a mini facelift versus a normal facelift? Dr. Eric Cerrati is the director of facial plastic surgery at University of Utah Health. And Dr. Cerrati, I'm just going to guess here, I think the difference probably is, like, a mini is just a smaller version of a facelift. Am I right? Do we need to go further?

Dr. Cerrati: Kind of true, but there are some, you know, details we should talk about.

Interviewer: Okay. It's a little more complicated than what I just made it.

Dr. Cerrati: Exactly.

Interviewer: All right. So what is the difference between a mini facelift and a normal facelift?

Dr. Cerrati: So, first off, they recently did a study surveying facial plastic surgeons all across the country trying to define that exact question. And what they found with it is that there is no consensus about what the difference is except that a mini facelift has a shorter scar. As far as the techniques and recovery and those sorts of things, they all differ from surgeon to surgeon.

Interviewer: Okay. So, really, it's interesting that you've got a lot of different people, they all have different definitions. So, for the customer or the person who's coming in, it's important that maybe they ask a few additional questions to find out how that particular person defines it.

Dr. Cerrati: Exactly. So every surgeon has, you know, their own techniques that they do for facelift surgery. It used to be, back in the day, was just tightening skin. And now we've learned that, you know, a more natural, more rejuvenated look is to tighten the muscles underneath the skin. And so that layer is either, you know, pulled tighter, it's resected, and then, you know, sewn in a more suspended fashion, the ligaments of the face are at least. You know, I personally do a deep plane facelift, where I release the ligaments of the face and re-suspend it in a more natural position. So my mini facelift is essentially the same thing, just with a shorter scar.

Interviewer: Okay. And that also sounds like it could differ from surgeon to surgeon.

Dr. Cerrati: Exactly.

Interviewer: Yeah, yeah, okay. So let's back up a second here. A patient comes in. They're interested in a facelift. They come into your office. They think maybe they want a mini facelift. They don't know for sure. Where do you start this conversation?

Dr. Cerrati: So, really, patients who are going to be, you know, good candidates for a mini facelift are ones that don't have a lot of excess skin or neck skin laxity. And that's really what the extended incision allows you to do, is to remove that excess skin. You know, it tends to be underneath the neck. So for younger patients, say 40s, 50s, you know, usually you can just keep the scar kind of right around the ear and not really extend it back into the hairline, which would qualify for a mini facelift.

Interviewer: Gotcha. And what about somebody that maybe had a lot of weight and then lost a lot of weight? It sounds like maybe a mini facelift would not be the best option because you've got more skin to take care of.

Dr. Cerrati: Yeah. So that differs patient to patient. But usually, those patients have more skin laxity that needs to be addressed.

Interviewer: Okay. So, to summarize, I mean, am I getting the summary right, a full facelift is when perhaps you've got more skin that needs to be tightened versus the mini facelift where it's somebody younger, maybe somebody who hasn't gained a lot of weight, lost a lot of weight, that doesn't have as much skin to move, they could get the mini?

Dr. Cerrati: Exactly, earlier signs of aging.

Interviewer: All right. So what's the difference then in recovery time, cost? I would think a mini might be less recovery and cheaper?

Dr. Cerrati: For faces that qualify for a mini facelift, it is a little bit cheaper, and the recovery time is a little bit shorter because it's less of a recovery for the neck portion. But, you know, I usually tell all my patients it's similar recovery, in that, you know, they have a face wrap that's on for 24 hours that's taken off. I don't use any drains, whether it's a mini or a full facelift. And again, there are variations from surgeon to surgeon. If someone really has very minor signs of aging and, you know, qualifies for a mini facelift, then a slightly less aggressive technique can be used, and that would significantly reduce the recovery time.

Interviewer: And do mini facelifts tend to look a little bit more natural then too?

Dr. Cerrati: I find that the technique actually affects how natural a result looks. I find that the deep plane facelift gives the most natural look, you know, and that can be done in a very aggressive fashion or a less invasive, tailored fashion for the patient. But every procedure is customized to the patient and what their needs are.

Interviewer: All right. And you have that conversation with the patient when you come in. How long does that normally take?

Dr. Cerrati: Oh, our consults usually last anywhere from 30 to 45 minutes, and we kind of go through everything.

Interviewer: Yeah, gotcha. Okay. Let's talk about the procedure itself. Where is it generally performed?

Dr. Cerrati: I do it in the hospital setting, so here at the University of Utah, but the main hospital. And I also have an office and an operating room at South Jordan, both university facilities.

Interviewer: Is there an advantage to being able to have access to a hospital as opposed to maybe just being in a standalone clinic?

Dr. Cerrati: I think the advantages of coming to a university facility, whether it's out at South Jordan or one of our satellites locations versus the main hospital is that all the physicians within the university, you know, are board certified, very highly qualified, and you really receive topnotch care. In some private offices, you don't have board-certified anesthesiologists watching throughout the entire case. And so, you know, we really focusing on the details so that every patient gets the best possible care throughout their procedure.

Interviewer: Gotcha. And when you do a procedure with a patient, how do you and the patient then define success? So, when the procedure is done, you know, the patient is fair . . . because I would imagine this is kind of a scary thing. It could be a scary thing going in. Like, "Am I going to get the results I want?" This is, you know . . . how do you kind of work with the patient to make sure they get exactly what it is that they hoped for?

Dr. Cerrati: So I would say, across the board, facelift surgery is probably one of the highest satisfaction rates out of all facial plastic surgery procedures. But we mimic what we do by pulling on the skin and trying to give the patient idea what the jawline and what the cheeks would look like afterwards. We show them before and after pictures and try to have as detailed of a conversation as we can.

Interviewer: And then, what about the risks, because that would be something else that perhaps would be a concern? I think we kind of touched on this a little bit. Here in the university setting, you're going to have, you know, like you said, the anesthesiologist is here to make sure that that goes okay. What are some of the other risks that you look out for that you really try to mitigate?

Dr. Cerrati: So the surgical risk in the procedure, there's bleeding and infection. Obviously, we do everything we can to try to minimize those. Anytime you make an incision to the skin, there's a risk of scarring. Facelift scars, you know, we hide them as best we can behind all the little crevices in the ears. So it's all hidden in shadows. And, you know, the main risk is really that you're close to the facial nerve, you know, the nerves that innervate all the muscles of the face. You know, we are a couple, you know, layers above it, but it is within a few millimeters. So careful surgical technique and training really allow you to get the exact result that you're going for.

Interviewer: Yeah. So you really want somebody who knows what they're doing.

Dr. Cerrati: Exactly.

Interviewer: That's got the skill and does a lot of the procedures and that sort of thing. So, hopefully, this is just probably a small part of the conversation you might have if somebody actually came in for a consultation. If somebody has any more questions, where would they go at that point?

Dr. Cerrati: So I always welcome patients, you know, when we're first having this conversation, obviously, ask everything. I kind of give them my spiel kind of start to finish. And I tell them if they ever have questions, write them down, call the office, come back in, we can do another conversation. And so that way, they're fully informed, fully comfortable with proceeding. I mean, the most important thing is the patient needs to be very comfortable with the surgeon, you know, the facility, and the plan that they're undertaking.

Interviewer: You mentioned that the patient should be really comfortable with the surgeon performing the procedure. And I know there's a lot of surgeons here that perform mini facelifts and normal facelifts. Give us some just general advice on how you might be able to figure out, you know, who might be best for you because, you know, it might be you, it might be one of your talented colleagues.

Dr. Cerrati: Exactly. So there are a handful of surgeons here at the university, all very talented, come from slightly different training, but offer very good work. And that's why it's very important for the patient to have an in-person consultation. In that way, they feel comfortable with the surgeon that they're choosing.

Interviewer: And regardless of whether it's you or one of your other colleagues, are there some things that you all have in common?

Dr. Cerrati: As being part of the university, we keep abreast on all the cutting-edge technologies here, offer the most advanced facial plastic surgery procedures. And again, we all come from slightly different training, which, you know, plays to the advantage of the different care that we can offer here at the university.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with out physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: What to know if you're considering rhinoplasty to help your breathing. That's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Eric Cerrati is a plastic surgeon at University of Utah Health that specializes in cosmetic and reconstructive surgery of the face and the neck. If you have been considering rhinoplasty to help improve your breathing, we're going to answer the questions you might have right now. There are a couple of reasons why somebody might get one. One is because that they want to improve their appearance. But the other one is because maybe they have some sort of a breathing issue. So let's pretend I'm a person that has a breathing issue and I've come in to talk to you about rhinoplasty. What would you tell me as a patient at this point?

Dr. Cerrati: So there's a lot of different aspects to nasal obstruction. You can have, one, the very common one is a deviated nasal septum which is a divider inside your nose. It usually leads to unilateral nasal obstruction. But then other causes of nasal obstruction include like internal and external nasal valve collapse. And those are usually addressed more with the rhinoplasty approach than just an endonasal septoplasty.

Interviewer: All right. So rhinoplasty covers a certain particular type of breathing issue that you would have. If you have those other issues, there are other procedures?

Dr. Cerrati: Yes. Usually a rhinoplasty would correct, say, when you breathe in, if one side of your nose kind of collapses or doesn't have the support to maintain that negative pressure, rhinoplasty approach can help provide more support to the external nose.

Interviewer: All right. So beyond kind of what you just described, there are other factors that go into whether or not this would be the right procedure for my breathing problem and to know if I was a candidate.

Dr. Cerrati: So really, the best thing is a physical exam done by someone who's experienced. I would recommend, if someone's interested in a rhinoplasty or has nasal obstruction, to really go to someone who is trained in treating people with all the different types of pathology that could cause nasal obstruction.

Interviewer: And what kind of result could I expect after the procedure if I had some sort of a breathing issue?

Dr. Cerrati: So that's actually a good question. So the same way that you would have swelling on the outside of your body, say if you had a cut or a bruise or that sort of thing, you just have that same healing process and swelling that occurs inside of your nose. So a lot of times, right after the surgery, you don't necessarily have perfect breathing right away. Your inside of your nose has to undergo the same healing processes. So within a week or two and all that swelling has resolved, the goal is to have a more open airway bilaterally.

Interviewer: And generally, does it really kind of change a person's life? I mean, are they able to, at that point, breathe in a way that they haven't before ever?

Dr. Cerrati: That's the hope.

Interviewer: That's why you do what you do, right?

Dr. Cerrati: Oftentimes it has significantly improved. There is part of a nasal obstruction that can be more subjective but a lot of times, we do get a significant improvement.

Interviewer: And then if somebody has a procedure, how long does it take? You'd mention about the two weeks to start noticing some breathing improvement, but what about getting back to your life? So you go and you have the procedure, go back to work, that sort of thing.

Dr. Cerrati: Yeah. So most times, the initial recovery we tell people about a week. Usually you can have some bruising and swelling kind of externally on the face which will improve over the first week. A lot of times, you'll have a cast on your nose. Depending on what type of work you do, you may or may not want to be visible or back at work during that time. But by halfway through the second week or by the end of the second week, you're kind of back to all normal activities.

Interviewer: Got you. And then what about scars or any sort of external things that are going on after surgery? Are there any visible scars?

Dr. Cerrati: So there's actually two different approaches to rhinoplasty, one's an endonasal and one's the external rhinoplasty. So the endonasal is just all incisions inside the nose and we can address a lot of different issues with that approach. However, there are indications where an external approach is going to be better. That will involve a small incision right at the columella, right underneath the nose. It's really just a five or six millimeter incision. And after about two or three months of healing, that scar is completely invisible.

Interviewer: Got you. So really not much if anything at all, especially if it was done inside.

Dr. Cerrati: Right.

Interviewer: Yeah. You had mentioned briefly about looking for a doctor that has experience in this. Give me some more information as a patient how I could pick the right doctor for this procedure to make sure, because you're messing with my face.

Dr. Cerrati: Definitely. So I would recommend someone who is board-certified in

Interviewer: What to know if you're considering a facelift. That's coming up next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Eric Cerrati is a plastic surgeon at University of Utah Health, and he specializes in cosmetic and reconstructive surgery of the face and neck. And if you're thinking about having a face lift, hopefully we'll answer some of the questions that you might have.

So why do patients consider a facelift? What kind of leads them to making the decision that that's something that they want to pursue?

Dr. Cerrati: So a lot of times it's a patient, middle aged and they're starting to notice the jowling or the extra skin that's kind of hanging down over the chin. That's really kind of the first signs that people are looking at.

Interviewer: And when one says facelift, is it generally the jowling that we're talking about that we're fixing, or does facelift encompass other things?

Dr. Cerrati: The most common thing is facelift will redefine the jawline. That's really the main target area, under the chin and along the jaw.

Interviewer: All right. And when somebody comes in and you do an evaluation, which is what you recommend, that you see a specialist, how do you help determine if they're a candidate for it or not?

Dr. Cerrati: So first and foremost, it is an elective surgery, so the patient needs to be medically fit for the procedure. Then as you look at body habitus to make sure the patient's not having weight shifts or that sort of thing, to make sure you can get him a lasting result and something that they're happy with. And a lot of it does have to do with patient selection. You want to make sure that their hopes and wishes is something that you can accomplish.

Interviewer: Sure that what they're asking for is something that can actually be done.

Dr. Cerrati: Exactly.

Interviewer: So what can't facelifts do? Do you get patients coming to you that say, "I want a facelift," and they're trying to accomplish something that just can't be done?

Dr. Cerrati: Absolutely. There's the anatomy of the neck and the way that the neck is structured that some patients are more, say, ideal candidates for a facelift and some that are not, in which case you can't get a very defined jawline.

Interviewer: So there are a lot of different types of facelifts and ways to do a facelift. When a patient comes in and starts asking you about those different things, how do you walk them through that process?

Dr. Cerrati: So you can go through all the different types of facelifts, skin only and addressing the underlying tissues and that sort of thing. But really, all these things are not necessarily important for the patient. The patient needs to be familiar with their surgeon and make sure the surgeon has the proper credentials. And if the surgeon has the same aesthetic and can achieve the goal that the patient wants, the approach that they use isn't necessarily the most important thing.

Interviewer: Got you. So a lot of times you're kind of explaining that, I'd imagine.

Dr. Cerrati: Exactly.

Interviewer: So somebody wants to get a facelift. What does that kind of look like? I would imagine there's not a lot of preparation if they are already healthy and whatnot. They would come in, have the procedure. How long does it normally take?

Dr. Cerrati: So the procedure can last anywhere between, I don't know, say two and a half to four and a half hours. All the incisions are really hidden behind the hairline and then around the ear. After a couple weeks, those incisions are very hard to see. And for me, I do do some planning pre-operatively to try to minimize any type of bruising and to help the patient throughout the whole process. At the end of the day, it is an elective procedure and these patients do not want to feel sick and have a long, drawn-out post-operative course.

So I do a lot of things before surgery to kind of help the patient get through that and minimize. I also don't like to use drains and prolonged dressings and those type of things, so patients can really get back to their daily lives as fast as possible.

Interviewer: Is there kind of a range in there? Does it really vary depending on what procedure's been done?

Dr. Cerrati: It really varies, but usually I tell people after two to three weeks they're really back to their pre-operative status.

Interviewer: And if you go back to work, are people going to be able to see visible signs at that point that you've had something done?

Dr. Cerrati: So after about two weeks, a lot of the swelling and bruising has pretty much subsided. The incisions may be slightly red, but patients can really get back to their normal routines after two weeks. At that time they can also. . . After the first week you can really apply makeup, so a lot of it can be hidden.

Interviewer: Got you. And the results, do they last? For how long?

Dr. Cerrati: So depending on the approach, if you address the underlying deeper tissues, usually the results last about 10 years, is kind of the ballpark range. It's because the aging processing and with gravity, it's still going on. So even though you've had the procedure, the aging process continues.

Interviewer: And picking the right doctor to do a facelift is really important, because it is your face. So how does somebody know that they have somebody that is going to really do a good job for them?

Dr. Cerrati: So the number one thing I would say is the patient should do their homework. They should look to see who the surgeons are, where they've done their training and what pathway they've taken in order to get to become a plastic surgeon who's operating on someone's face.

Interviewer: Are there some certifications in general that you should kind of make sure that the surgeon has?

Dr. Cerrati: Absolutely. So is there a residency in plastic surgery that's monitored by the American Board of Plastic Surgery. A fellowship by the American Academy of Facial Plastic and Reconstructive Surgery, and that's also a board certification as well. And those are really the two main ones.

Interviewer: And it's your opinion that you should look for somebody who has both of those?

Dr. Cerrati: Either one of those.

Interviewer: Oh, either one of those?

Dr. Cerrati: Those are two separate pathways.

Interviewer: They're two separate things. Got you.

Dr. Cerrati: So for myself, I did a fellowship by the American Academy of Facial Plastic and Reconstructive Surgery.

Interviewer: And if they don't have one of those pathways, then maybe be a little cautious?

Dr. Cerrati: I would raise a red flag.

Interviewer: All right. And ask some more questions at that point?

Dr. Cerrati: Absolutely. In addition to qualifications, you should really feel comfortable with your surgeon. Even after the initial consultation you don't have a great feeling, go back and visit the office again. And just make sure before you sign up for anything that it's something that you're happy with and that you're confident that the surgeon can give you the results that you want.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

Interviewer: What to know if you're considering a cosmetic rhinoplasty. We'll talk about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Eric Cerrati is a plastic surgeon at University of Utah Health that specializes in cosmetic and reconstructive surgery of the face and neck. Dr. Cerrati, when a patient comes to you for a cosmetic rhinoplasty, what are some of the common things that they're trying to address or take care of?

Dr. Cerrati: So usually that's kind of grouped in two to three different categories. The first one is your patient who's never had a rhinoplasty before and is really trying to address maybe some family features of theirs that they want to alter, say like a bump on the nose or a wide nasal base or that sort of thing. The next group is probably someone who has had rhinoplasty in the past and as a result has had some scar contracture leading to some asymmetry, whether it's in the kind of the distal part of the nose or the nasal tip. And then the last group I would say that has . . . after rhinoplasty, you have nasal obstruction that kind of results from that, from the first surgery.

Interviewer: Got you. What about somebody who's just had a nose that's may have been dislocated through, I don't know what could happen, they got hit or something of that nature and now as a result the nose is crooked?

Dr. Cerrati: Oh no, definitely yeah. Traumatic injuries are definitely a common cause for having rhinoplasty surgery.

Interviewer: Got you. So what can you do with this type of surgery when it comes to when a patient comes in? Most of the time are you able to help address their issues, or are there some times you just really can't?

Dr. Cerrati: So a lot of times yes, we can get the symmetry back, get the nose back in the midline, and fortunately form and function kind of go hand in hand. So when we improve their breathing, we also improve the appearance of their nose. But then if it's a purely cosmetic case, where we're really just trying to alter the external appearance, I would say that patients need to be careful, that there are risks involved, and that you're trying to chase the perfect physical feature, it gets very difficult.

There are definitely patients that we tell them that we don't think it's the best idea to undergo surgery. One, if a patient's had a lot of nasal surgery and say that they're missing a lot of cartilage in their nose and would require big reconstructive case, if their nose is functioning fine and they can breathe out of both sides and that's really just a small physical feature that they're chasing, I personally don't think that's a great idea and I would not recommend surgery to that patient.

Another situation where I wouldn't recommend surgery is if a patient has unrealistic expectations or if there's something that I just won't be able to achieve a surgery.

Interviewer: So what are some of the common questions that you get when it comes to this type of a procedure that we haven't discussed so far?

Dr. Cerrati: So commonly, a lot of patients ask about a closed rhinoplasty or an endonasal rhinoplasty versus the open or external rhinoplasty. Usually patients, by the time that they're considering the surgery, have kind of googled and come across a lot of these terms. Endonasal rhinoplasty, you can address a lot of these features, external appearance, and even function with that approach. Usually when you start altering say the tip or really going for correcting fine asymmetrical issues with the nose, really an external approach gives you better visibility and allows you to really address the problem better.

Interviewer: And the internal one is more useful for . . .

Dr. Cerrati: You can still accomplish a lot of things. It's just harder to get to, say, the tip of the nose.

Interviewer: Got you. And what's the preferred method? Is it the internal version because you have less scarring, or what's the advantage of that over the external?

Dr. Cerrati: So for the patient, really they're pretty equal. It's really surgeon's preference in which way a surgeon's been trained in. Endonasal rhinoplasty was very popular say 10, 15 years ago, and most surgeons were trained that way back then. Now, kind of the external approach, the pendulum has kind of swung the other way and most surgeons now are doing the external approach. For the patient really, if your surgeon is comfortable with either approach, they can get you the same result either way. With the external approach, you do have a very small incision. However, I would tell patients that after two or three months that incision essentially heals and becomes invisible.

Interviewer: After a procedure, how long does it take to kind of get back to your normal everyday life, go back to work, that sort of thing?

Dr. Cerrati: So I tell all my patients that for the first week really to take it easy. You'll have a cast on your nose. A lot of times you'll have bruising and swelling around the eyes. At the end of that first week, the cast comes off, the bruising and swelling starts to resolve, and probably midway through the second week or the end of the second week you're really back to all your normal activities and feel pretty fine.

Interviewer: And after a procedure, a cosmetic procedure, how long do those results last? You had mentioned that sometimes things can change a little bit after you've had one and you might have to get another one. So explain that a little bit.

Dr. Cerrati: So hopefully the results last a lifetime, especially in the nose when you're addressing the underlying structures. What I see with the revision rhinoplasty is a lot of times if, say the first surgeon takes way too much of the structure of the nose, too much of the cartilage, then over time the nose will start to warp and you'll get scar contracture. And that can lead to asymmetry in the nose and also lead to breathing problems.

Interviewer: And if somebody comes in and they need additional support in the nose, how do you do that exactly?

Dr. Cerrati: So there's a couple different places where you can get extra cartilage in order to rebuild the different areas of the nose. A lot of times the most common is the nasal septum, the cartilage there itself. It's right there in the nose, and there's really no other extra incisions for the patient. Another common one is the ear, which you make a small incision in the back of the ear and really take out the cup portion of the ear. All the external structure of the ear is maintained, so there's no change in the form or the function of the ear. And then lastly there's the option of using rib cartilage. So where your rib comes around and connect your sternum, there's actually a section of cartilage there that can be used to rebuild the nose as well.

Interviewer: And when looking for the right doctor to do a rhinoplasty procedure, that would be really important. I'd imagine there's a certain level of trust that a patient wants because after all it is your face. It's the first thing everybody sees. How do you recommend finding the right doctor for that procedure?

Dr. Cerrati: So I'd recommend looking at your surgeon's training. Being board-certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery is very important. There's a lot of different paths that people can get to in order to get that board certification. For myself, I did a five-year residency in head and neck surgery, just really concentrating on operating above the shoulders. And then I did an additional year fellowship sponsored by the American Academy of Facial Plastic and Reconstructive Surgery, just operating on the face specifically.

Interviewer: So it sounds like just have a conversation with the doctor you're talking about and just ask them, "What path did you take? What preparation did you use to get here?"

Dr. Cerrati: Absolutely, and ask him how many procedures they do and you'll get an idea of how comfortable they are and kind of what their background is.

Interviewer: Yeah, and then what about the personal relationship? Like if you feel a connection or you don't, is there anything you recommend on that? I know some doctors, if you don't feel the connection with the surgeon, you should maybe look elsewhere.

Dr. Cerrati: Absolutely. I mean, you have to be comfortable. If this person's going to be operating on your face and external appearances, it's very important that you feel comfortable. So no matter how good they are or how good their credentials are, the number one thing is you need to feel comfortable with that person.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: July 17, 2019
originally published: November 7, 2017