Eyelid surgery or blepharoplasty is our most commonly performed procedure. A well done operation can immeasurably enhance appearance in general and simultaneously make the entire face appear more youthful. Dr. Larrabee performed the reconstructive as well as cosmetic eyelid procedures at Virginia Mason Clinic and did special training in these procedures at the Moorfield’s Eye Hospital in London UK. Like many procedures in facial plastic surgery, good craft must be married to a good aesthetic sense and the procedure tailored to each patient’s facial contour.
Upper lid surgery alone can be performed under local anesthesia on most patients. Youthful lids are full and not hollow. It is important in male patients not to feminize their eyelids by removing too much eyelid skin or fat. Some patients who come in for this surgery have primarily a low brow. The surgeon must make the correct diagnosis and perform a forehead lift as well as eyelid surgery if indicated. Other patients have “ptosis” which means their actual lid margin is lower and the muscle/tendon that lift the lid needs to be repaired. Other patients have eyelid folds that are asymmetric or too low. Many Asian patients, in particular, want to create or elevate their lid folds.
Because of our Seattle location and Dr. Larrabee’s work in Asia, we have considerable experience performing Asian eyelid operations. Our goals are not to “westernize” the patient’s eyes but to give them the more open look they desire and place the fold in a natural position that harmonizes with the rest of their face. Lengthy experience with many types of blepharoplasty allows the surgeon to select the right procedure for each patient.
Lower lid operations can be complex and have evolved over time. We do most fat removal from inside the lids (transconjunctival) and are conservative so we don’t get a hollow look. In some cases, rather than remove fat, it is transposed into hollow cheek areas below the lids (e.g. tear trough deformities). In many situations, laser resurfacing or chemical peels can be used to smooth and tighten the skin of the lower lid. This can decrease the times actual skin excision is necessary. The specific lower lid procedure recommended will depend on many factors, including the lid support, skin type, and muscle laxity. A good examination will permit us to make the best recommendations.
Upper and lower blepharoplasty surgery provides an excellent rejuvenation with few complications. It is usually the first procedure patients seek out. Here are a few patients who had blepharoplasty with or without other procedures.
Our most recent book is titled The Art and Craft of Facial Rejuvenation (https://amzn.to/1WqIUsu). The need for skillful craft in plastic surgery is obvious. The need for art is less obvious but equally important. Facial analysis is essential to surgical planning, and thoughtful study of a patient’s facial contour described in angles and millimeters (soft and hard tissue cephalometrics) will help set goals and improve results. We have done research and published in this all important area.
Continue reading The Art of Facial Plastic Surgery
The Northwest Rhinoplasty is “Green.”
The Northwest has a unique style in many areas including Rhinoplasty or cosmetic nose surgery. For many decades, the predominant techniques of rhinoplasty involved removing bone and cartilage to make it smaller. In many situations this led over time to pinched, unattractive noses that didn’t breathe well. Surgeons started removing less but also reconstructing key parts of the nose to maintain their strength. This often involved using added cartilage for the septum, ear, or rib. The Seattle community has been in the forefront of developing techniques that use tissue that would be otherwise excised to accomplish some of these same goals. I was honored to direct the international Facial Plastic Surgery course here in Seattle earlier in the decade and then presented some of these ideas at the next global AAFPRS course in Chicago. Basically, the cartilage in the middle and side of the nose is not removed but repositioned to preserve function and avoid a pinched nose. This is a spreader graft formed by using the patient’s adjacent cartilage. It is similar to creating an internal Breathe Right strip:
Dr. Murakami from the Mason Clinic develop another procedure where the cartilage in the tip–rather than being excised and discarded–is “turned in” on itself to give the same narrowing but more strength. This is termed a “lateral crural turn-in flap”.
Northwest patients want natural-looking noses that function well, and this “Green Rhinoplasty” that preserves tissue and avoids extensive grafts has been well received. The ideal patient is one with a significant “hump” who has not had previous procedures.
Here are some typical recent patients where these techniques were used:
This is what it looks like during the operation:
We have been learning, innovating, and teaching rhinoplasty over the years and around the world. Our conservative but natural approach has been influenced by the needs and desires of our Northwest patients, so it has been a “win-win” for both surgeons and patients.
Meryl Streep has aged quite well, and is definitely a natural beauty, but if she came to us for a consult we might recommend a balanced Blepharoplasty.
Robert Redford has aged well but has a lighter skin type more prone to sun damage, wrinkles, and discoloration. If he wished to address his sun damage we would recommend laser skin resurfacing.
Morgan Freeman has aged well, and would likely not need any type of cosmetic procedures unless he wanted to help the lines on his forehead with Botox. Darker skin is less prone to sun damage and the resultant loss of elasticity and associated aging changes.
Raquel Welch has aged very well. Good skin, youthful fullness, soft tissues, good lid and brow position, and likely good genetics! If she has had any procedures, they have done a great job as she doesn’t look overdone.
Brigitte Bardot shows the classic signs of aging. Gravity works over time on a thinner, drier, less elastic skin. Seen are jowls, neck banding, low lid fat and laxity, skin aged by sun. If seen as a consult we would recommend a Facelift, balanced Blepharoplasty, and Laser Skin Resurfacing.
Claudia Cardinale shows loss of volume in the lower mid-face, laxity of the jowls and neck with fat accumulation in the neck. If she consulted we would recommend Liposuction or Sculpture of the neck, Facelift, and Laser Skin Resurfacing.
It has been wonderful to be part of the Regensburg course in Facial Plastic Surgery over the years. Each year it becomes even better. In addition to the energy and ability of Holger Gassner, the support of the entire faculty—including residents and fellows—is impressive. It is difficult to believe that only a few years ago, Holger was a fellow with us at the Larrabee Center, and now he has launched one of the most successful facial plastic surgery centers in Europe. Our book, The Art and Craft of Facial Rejuvenation was well received and sold out early in the meeting.
As always, I like to learn as much as I teach at these meetings. One highlight for me was Janice Pastorek’s discussion of PRP (Platelet Rich Plasma). She showed some amazing results of using the patient’s own platelet rich plasma in combination with IPL (intense pulsed light) to rejuvenate the skin. I also enjoyed a presentation by Grant Hamilton from the Mayo Clinic on the importance of imaging for patient communication. He uses Photoshop and really integrates his imaging into all phases of his rhinoplasty practice. He shared a few Photoshop shortcuts which I will work into our practices in Seattle and London. I also learned some new facial reanimation techniques from Kofi Boahene. Kofi is a facial plastic surgeon at Johns Hopkins with a diverse practice who is also planning a surgical clinic in his native Ghana with the help of the Johns Hopkins Business School.
It was good, as always, to work with and learn from my friends and colleagues from around the world. Peter Hilger, Norm Pastorek, Jon Sykes, Minas Constantinides, Pietro Palma, Miriam Boenisch, Fazil Apaydin, Santdeep Paun, and the wonderful German faculty, who are all talented surgeons and professors. A special moment was an after-dinner talk by Claus Walter, MD (featured in the top photo for this post). Claus is a true pioneer in facial plastic surgery and, at 86 years old, is still innovating. He provided me an article on a new composite graft from behind the ear that contains both bone and cartilage. He is truly amazing.
I am always sorry to leave my family and practice to travel for these meetings, but, in the end, I not only come home excited with new ideas, but also feel confident that our center continues to work at the cutting edge of plastic surgery.
And—it is good to be missed!!
Read his JAMA article on the GBSD https://larrabeewayne.wpengine.com/elibrary/
Dr. Larrabee is known for his “Northwest Rhinoplasty” which preserves tissue whenever possible and simply rearranges it – it is thus a “Green” Rhinoplasty.
His facelift technique emphasizes vertical vectors or pull on the deeper structural tissue fixed to strong anchoring points. This gives natural and long lasting results. The technique is described in his book: The Art and Craft of Facial Rejuvenation.
Below is Dr. Larrabee’s introduction to the meeting. You can also view the site here: https://bit.ly/1VfRZWy
Dear Friends and Colleagues,
These are the most exciting times for scientific change in the history of facial plastic surgery. These changes are global with each region of the world contributing unique insights and developing innovative techniques. The rapid advancement of non-surgical procedures is also a global phenomenon. New aesthetic paradigms, combined with novel devices and products, create novel opportunities to combine surgical and non-surgical treatments. In four magical days in May we will bring together the best facial plastic surgeons in the world to teach and discuss with you every aspect of the specialty from advanced aesthetic procedures to state-of-the-art reconstructive techniques. The program will be very interactive, featuring panel discussions by world leaders in each specialty area in addition to “hands on” courses, didactic lectures, free papers and keynote presentations. The entire spectrum of our wonderful specialty will be covered from lasers and fillers to specific surgical procedures. As always, rhinoplasty will be a core topic throughout our meeting. The last international meeting in Rome was, for me, the most educational in my career. With the same ingredients – a global faculty, interactive sessions, and fantastic organization by the president- this scientific program will meet and may even perhaps surpass the educational standards we reached in Rome. Please join me in Rio for this sentinel meeting in the history of our specialty. We all have events in our lives we remember for their social as well as scientific significance. This will be one of those events. You simply must attend. I would like to thank Dr. Patrocinio and his organizing committee. They have done an amazing job to create this meeting for us. See you in Copacabana!
President, International Scientific Committee
Our annual Patient Appreciation Day arrives with spring on Thursday, April 21. It has become my favorite event of the year as it is a chance to meet and thank our many patients past and present. Last year, we celebrated the 25th Anniversary of the opening of the Larrabee Center. About this time, our church asked me to put down some thoughts for one of their publications on the gifts we have been given. Mine have been many!
The Spirt has blessed me in many ways- especially in my eight children, deep friendships, and the opportunity to perform meaningful work. I was given–through no effort of mine–the heart, mind, and hands of a surgeon. And, I was fortunate to be born an American in the middle of the 20th century when even the child of a widow with five children and few resources could realize his dreams.
I have been given the satisfaction of reconstructing patients with cancer, cleft lips, injuries, and more. I have received the joy of knowing these patients as individuals with all of the complexities inherent in the human condition. I have been blessed with unparalleled opportunities to reach out to victims of domestic violence, wars, and natural disasters. These experiences are life altering and a gift beyond measure.
But the gifts of the spirit are like a pebble dropped in a clear pool. Wave after wave of ripples carry the spirit outwards. My children learned early (from many weekend visits to care for patients) the satisfaction those visits brought and the gratitude the patients gave in return. They absorbed while traveling on cleft missions to Latin America or Asia the desperate material poverty and simultaneous spiritual richness in the people we helped.
Another wave of ripples flows from the many fellows and other students we have taught over the decades. They go out to heal and teach and create their own “ripples” in this wonderful saga of life.
Another wave begins in my practice at the Larrabee Center. We celebrated our 25th Anniversary last week. As I looked around the room at so many wonderful friends and colleagues, I can only use the word blessed once more. All of us have found and created a family where we can serve, love, and grow with each other over time.
Martin Luther King often spoke of the “beloved community.” We are all part of this community and can feel only awe that we have been able to touch and be touched by so many wonderful patients, colleagues, family members and friends.
Have you been having a hard time getting rid of those bulges and stubborn pockets of fat? If you have committed to a new fitness program in the new year and want to improve your figure, don’t overlook the benefits of body contouring procedures that can help you get and maintain the results you want. We offer both liposuction and CoolSculpting at our practice to target some of those problem areas. We can reshape and sculpt your body to help you achieve your ideal silhouette within a few short months. Make an investment in yourself this year with a plastic surgery plan that is completely personalized for you.
Non-Surgical Body Contouring with CoolSculpting
CoolSculpting is an innovative body contouring procedure that works by freezing away fat cells permanently. It is a non-surgical treatment that can target problem areas such as the flanks, outer thighs, and abdomen in just one session. If you are bothered by excess fat in these problem areas, but aren’t ready to undergo surgery, CoolSculpting may be the ideal treatment for you.
Results are gradual as the fat cells are crystallized after being frozen and then eliminated from the body naturally. Most patients see significant results within a couple of months after treatment. As long as you are relatively healthy and maintain a healthy lifestyle, you can expect to see significant results within months of a single session. A single CoolSculpting treatment can reduce body fat by up to 20 to 30 percent in the target area, so you may need to undergo a series of treatments to get the results you want.
Our body contouring procedures can be very effective for enhancing your silhouette. Say goodbye to stubborn fat for good with a CoolSculpting or liposuction procedure. Schedule your body contouring consultation today.
Dr Larrabee accepted the AMA’s highest public service award for the Face to Face program to assist victims of domestic violence with pro bono surgery. He has done fundraisers to support the program at Jazz Alley and Bake’s Place with jazz and poetry readings. Sam Hamill, an internationally known poet, dedicated a poem “Fourteen Stitches” to Dr. Larrabee in his recent book Dumb Luck.
Breast augmentation via fat transfer is a procedure that offers a very natural-looking breast enhancement, combined with the benefits of reduced fat in the part (or parts) of the body where liposuction is performed.Continue reading Breast Lipofilling in Seattle