What Is the Recovery Process after a Facelift?

middle aged woman smiling after her facelift recoveryLike all surgical procedures, a facelift is accompanied by a recovery period while your body heals. There will generally be some downtime required during the first few weeks after your procedure. Before moving forward with your facelift, it’s important to understand the recovery process and make sure you are comfortable with everything involved. Continue reading What Is the Recovery Process after a Facelift?

Blepharoplasty with Ptosis Repair

eyelid anatomy illustrationWhile aesthetic and reconstructive plastic surgery procedures are inherently different in nature, there is a strong relationship between the two. Dr. Larrabee’s extensive experience performing reconstructive surgery is a crucial reason why he’s able to deliver safe, beautiful outcomes with aesthetic procedures. This correlation is most important during eyelid surgery (blepharoplasty) and rhinoplasty procedures. In particular, Dr. Larrabee blends these skill sets when performing blepharoplasty with ptosis repair. Continue reading Blepharoplasty with Ptosis Repair

Dr. Larrabee Discusses Nonsurgical Facial Rejuvenation Options at European Academy of Facial Plastic Surgery in Amsterdam

woman on a fall day after undergoing nonsurgical facial rejuvenation treatmentsLast month, Dr. Larrabee presented the keynote lecture at the European Academy of Facial Plastic Surgery in Amsterdam. During this address, he discussed the Larrabee Center for Plastic Surgery approach to facial rejuvenation with some of the most well renowned plastic surgeons in the world. In particular, his speech focused on the nonsurgical solutions we use to restore a more youthful facial appearance. Continue reading Dr. Larrabee Discusses Nonsurgical Facial Rejuvenation Options at European Academy of Facial Plastic Surgery in Amsterdam

How Old Do You Need to Be to Have a Rhinoplasty?

woman looking at her nose in the mirror after rhinoplastyRhinoplasty is one of the most popular plastic surgery procedures performed each year. Nose surgery can have a dramatic impact on your appearance, improving the overall balance and harmony of your facial features. While you can safely undergo rhinoplasty as a teenager, it’s important to wait until your nose has fully matured before moving forward with the procedure. Continue reading How Old Do You Need to Be to Have a Rhinoplasty?

Open vs Closed Rhinoplasty

An “open” rhinoplasty involves making a small, non-linear incision in the columella of the nose- the part of the nose between the nostrils. An endonasal or “closed” rhinoplasty is all performed using incisions inside the nose. There is a significant learning curve to any rhinoplasty, but the closed approach is more difficult to learn. The open or closed approach is more than just a way to access the nose, however; certain techniques can be most optimally performed with one or the other approach while others can be well done with either. Most experienced rhinoplasty surgeons can select the best approach for your specific needs.

Open vs Closed Rhinoplasty

Problems with the nose profile or width of the bones can usually be well addressed with a closed approach. Sometimes however if there is a lot of reduction or a narrow nose “spreader grafts” are helpful to maintain the width and airway in the middle of the nose; these can be placed in a closed fashion but are most easily and precisely performed with the open approach.

Minor tip narrowing can be done with a closed approach but at least in our hands more major tip refinement and narrowing can best be done with an open approach. In more complex rhinoplasty cartilage grafts from the septum, ear, or rib may be used to support or contour the nose. There are situations where a closed approach with a “precise pocket” is the optimal way to place these grafts. There is no need in this case to suture the grafts in place and healing is faster and more predictable. Obviously, complex nose reconstructions such as the cleft lip nose are usually best done with the open approach.

Overall the closed or endonasal approach avoids the scar, is faster to perform, and heals more rapidly. We select it whenever we feel we can achieve the patient’s goals just as well as if we used the open approach. The end outcome however is most important and if we believe the open approach can achieve a better result we use it.

This is a discussion we have with the patient based on their specific goals and anatomy.

Science and Surgical Excellence

Research and surgical advances go hand in hand. We have published over 225 books and manuscripts- most to advance the art and craft of facial plastic surgery. Google Scholar provides an effortless way to keep track of publications and citations. Our profile is at – https://bit.ly/TLCSeattle. It is interesting to look at the most popular articles from our 226 citations. They are listed below but reflect the range of facial plastic surgery. Surgical Anatomy of the Face was my first major book and still my favorite. I was able to work with Kathleen Makielski, an amazing surgeon and artist, to create illustrations that clearly and beautifully demonstrated key anatomical relationships. Its popularity shows the importance of anatomy to surgeons. The second was my first major research combining my undergraduate work in mathematics and computer science with skin flap design. We used finite element analysis, an engineering technique, to examine how to best close wounds. It is an example to show why the best science is frequently found at the intersection of different disciplines. The third is one of the first papers to apply outcomes analysis to cosmetic procedures so they can be measured, and therefore our techniques improved. The fourth was an exciting study to look at gamma interferon to control poor scarring. Unfavorable scarring is probably the most important problem in plastic surgery and the study showed promise. The fifth was our clinical paper on how to treat unfavorable scarring using practical techniques. The sixth was another important anatomical study that demonstrated blood flow in the nasal tip and that the open incision didn’t significantly impact blood flow to the tip and thus was safe. The seventh was a review of our experience with 3D imaging. This is so important now in our practice with our new 3D imaging and analysis system- The Aesthetic Studio. The eighth was one of my first major papers when I was doing a lot of facial trauma and helped inform decisions on how to manage frontal sinus fractures. The ninth was my second major book, this one on facial reconstruction in which we designed algorithms to help surgeons decide which technique to use for a given defect. It has become a “go to” resource for many young surgeons. The tenth was a practical study which looked at the long-term outcomes of using demineralized bone for nasal implants. It showed these implants used to make the nose profile stronger didn’t always last well over time. Negative studies are good for patient care also!

We will keep doing good research and publishing to help our patients and improve their knowledge base of facial plastic surgery. Here are our “top ten” and a link to the rest- https://bit.ly/TLCSeattle

Global Surgical Outreach- Looking Forward to 2018

The primary mission of Global Surgical Outreach is to reduce the global burden of surgical disease through education, development of medical infrastructure, and the provision of pro bono facial reconstructive surgery both in the US and the less developed world for adults and children. We provide specialized treatment for patients who were born with cleft lip palate deformities, those who have suffered injury from war and those affected by other forms of violence including domestic violence. We believe we can best accomplish our mission by developing innovative approaches and partnering with other organizations when there is synergy.

Projects for 2018 include-

  1. Teaching a reconstructive surgery course and providing reconstructive surgery at the Black Lion Hospital in Addis Ababa, Ethiopia. This is a partnership with Seattle Anesthesia Outreach.
  2. Support the development a hospital for training in West Africa in partnership with the Foundation for Special Surgery. The hospital will be located in Accra, Ghana. Accra is a great choice as it is in a safe country with a stable government, modern infrastructure and good transportation. This surgical hospital will serve as a center where surgeons and nurses from the region can be trained while also providing highly specialized surgical care. The need for this facility is tremendous. Training surgeons locally in the region by world experts in a well-equipped facility is the way to sustainably improve healthcare delivery in Africa.

  3. Surgical hospital design by IB-Federlein Architectural design by IB-Federlein

  4. Organizing and implementing missions to Balfate, Honduras as part of the University of Washington team.
  5. Continual development of the UW Fellowship in Facial Plastic Surgery and Global Health. In addition to working on global surgical missions, the fellows will manage our blog on global health and develop a research project and publication in the area of the global burden of surgical disease.
  6. Develop a program for a twinning program between the Larrabee Center Seattle and Hangzhou China- the program of Dr. Sufan Wu. Continue the educational exchanges and mutual teaching.
  7. Provide more information to facilitate access to our program of pro-bono surgery for the victims of domestic violence.


Global Surgical Outreach is a 501(c)3 and tax deductible donations can be made at the website or by sending funds to the Larrabee Center, 600 Broadway, # 280, Seattle, WA 98122, Attn: Amy.

Your Facelift and the Stages of Life- The Beauty of Experience

One of our most frequently asked questions is- “What is the best age to have a facelift?” There is no set age that applies to everyone.

We have performed facelifts on patients from their late 40’s to their mid-80’s. Each is individualized for the patient’s anatomy and goals. In a lecture, “My Experience with 5,000 Facelifts”, I discuss the techniques described in The Art and Craft of Facial Rejuvenation. This lecture is never the same however because each time I give it I do more analysis and research to determine how to improve patient outcomes. With experience we have learned to modify our procedure to obtain the best outcome and most natural result for each patient regardless of age.

Our patients in their early 50’s are generally seeking a natural look that will reverse the early signs of aging and build a strong foundation that will last for decades. Our research has shown that facial aging is primarily the result of gravity working on a progressively thinner, dryer, and less elastic skin. These changes are accentuated by sun exposure, smoking, heredity and other factors. The deeper tissues that support the face “descend” and with further aging there is loss of fat or “deflation”. The major lesson we have learned from performing so many facelifts on patients around 50 is that they do last well for decades. The restructuring performed on the underlying platysma muscle and associated support tissue (SMAS) is strong with excellent repositioning in a vertical direction. There are occasional times (a few percent) where a small “tweak” under local anesthesia is done, but most facelift patients do the procedure once and are quite happy long-term. A few seek consultation for another facelift usually about 10-15 years after the first. The changes seen then are mainly skin aging. It is fascinating that when we do a “tuck up” facelift on these patients we usually find the deeper tissues still firm and well structured. We end up doing some very minor tightening on this deeper layer and focus on the excess aging skin. This consistent finding has made me quite comfortable recommending the facelift procedure to patients in their early 50’s knowing it will likely last a long time. There are of course individuals who simply lack good skin elasticity and age more rapidly even after a facelift. I continue to research how to identify these patients and improve their treatment outcomes.

Older patients having a first-time facelift require a larger procedure and generally have excellent results. When there is significantly more skin to remove, incision placement to minimize contour irregularities is crucial. We tighten the SMAS in these patients also and then may need to undermine more of the cheek and neck skin to allow it to drape smoothly. These patients do well, and we can maintain their facial rejuvenation with the many non-surgical methods available including Botox to treat aging signs created by muscle actions and fillers for volume loss.

In our experience, there is a large age range of patients who can benefit from an individualized facelift and within reasonable parameters no one is “too young” or “too old”. What works best in our practice is to perform our deep plane facelift on appropriate patients and then maintain it with good skin care and aesthetic services. Our facelift patients are among our most satisfied, both short and long-term.

Brand New “Aesthetic Studio” 3D System

We are excited to announce our new “Aesthetic Studio” 3D system. We have combined the innovative Microsoft Surface Studio and Quantificare 3D Software with our own graphics to develop a unique system to analyze skin and facial contours, image surgical and non-surgical procedures, and measure our outcomes precisely. This is the single most useful communication and analysis tool I have seen in my many decades of performing facial plastic surgery. Dr. Patel and I are pleased to launch this program by providing complimentary analysis sessions with the Aesthetic Studio to introduce it to our patients and friends. Each session will take about 30 minutes and will provide a skin analysis and discussion of the 3D image. We would like to thank our friends at Microsoft for facilitating the early adaption of their Surface Studio and Quantificare for their support with developing our program.

The Surface Studio was developed for artists and designers to turn their desks into a Studio. It was specifically designed for the creative process. The 28” PixelSense™ Display proivdes a huge canvas for all kinds of work. We can use it upright, or draw on it like a drafting table. The images must be seen to be appreciated.

The 3D LifeViz MiniTM system was developed by Quantificare, a French company, primarily for research in dermatology and plastic surgery. An extremely accurate but portable camera captures the 3D image which can then be viewed, analyzed, and used to simulate various treatments.

Its 3D SkinCare module enables us to evaluate and analyze the skin, generate a personalized, printed report and ultimately to enhance care and communication with our patients.

The 3D Face Shaper module allows us to guide patient aesthetic treatment choices and simulate surgical and non-surgical changes.

We can also measure changes in volume, skin texture, color, and more following our aesthetic treatments. These help us tailor our treatments to each patient and make changes as needed to provide the best results. By measuring our outcomes precisely, we can continue to improve our techniques over time.

The drawing capabilities of studio allow us in a very natural way to sketch surgical options and how we would approach a specific operation for the individual patient. We can work with their photographs or from our own graphical templates designed by our graphic artist Kate Sweeney. Kate has worked on a number of our books and articles so she understands the anatomy, as well as the aesthetic needs.

Facial Plastic Surgery is both an art and a craft. The Aesthetic Studio provides a canvas on which we can design, communicate, be creative, and really see each patient’s face.