Facial Plastic Surgery

Surgical Procedures

Corrective Eyelid Surgery

Eyelids, like other face and neck areas, may develop wrinkles and bulges from either heredity or aging. Pouches, both at the inner part of the upper lids and in the lower lids, are generally due to increased pressure caused by accumulations of fat above and below the eyes. Such excess fat and excess skin are removed in the eyelid procedure. Upper lid correction is performed at the same time as lower lid surgery. The operation takes about one and a half hours and is usually performed under monitored sedation supplemented with local anesthesia in our office surgical suite. Patients generally experience early return to daily routine.

There is usually little or no pain in the postoperative period. Each operation is followed by varying degrees of swelling and discoloration, which usually subside within ten days. By this time, too, the thread-thin upper eyelid skin scars can be camouflaged by makeup. The lower eyelid procedure is performed with thread like incisions. The upper eyelid incision line gradually blends in well with the surrounding skin and, after several weeks, becomes perceptible only on close scrutiny. Corrective surgery of aging eyelids is frequently performed in combination with face lift, nasal, or eyebrow surgery.

Corrects the "Droopy" Look

Generally, a small incision is made in the front scalp area. Drooping eyebrows are frequently one of the first signs of aging. Sometimes excess skin hanging from the upper eyelid may be partially due to a low eyebrow. This may also cause the upper lids to bulge and descend until they seem to lie on the eyelashes themselves. Any of the procedures that correct sagging eyebrows may be performed under sedation anesthesia in the office surgical suite. Patients may return home with few restrictions on activities.

The Face Lift

The face lift both improves wrinkling caused by loose skin and lifts or tightens the fatty face and neck tissues, which tend to sag increasingly with advancing years.

It has become the second most popular cosmetic operation because, as life spans increase due to medical advances combined with better nutrition and exercise, many aging men and women find that they look older than they feel.

The operation may be done for two reasons:

  • to slow the advance of aging, helping relatively young individuals, say forty or younger, appear to stay young; or
  • to help one who is already well wrinkled to appear younger.

The amount of improvement from surgery depends on the degree of wrinkling. If wrinkling is significant, results may be dramatic. If sagging is just starting and the operation is an attempt to keep the patient looking young, the improvement may be more subtle, causing friends to remark that the patient looks "less tired" and "more alive."

The greatest benefit of the face lift—one that justifies the procedure being performed on patients in their forties as part of a preventive maintenance program—is that the patient can maintain a youthful appearance for the rest of his or her life simply by having periodic "tuck-ups" every few years, as is done by Hollywood personalities.  These relatively minor procedures are usually followed by very little swelling and discoloration.  However, they cannot be done without the initial face lift.

In the majority of cases, the face lift result will last from six to ten years. Although no operation can permanently prevent aging, the individual never looks as old as he or she might have if the operation had not been done. The actual duration of improvement cannot be predicted accurately, but depends upon the skin condition of each patient. If the skin's degenerative process is very rapid (often a result of tobacco, alcohol, or excessive sun exposure), wrinkling and sagging will occur more quickly.

The face lift operation is performed in our office surgical suite under "twilight" anesthetic, supplemented with local anesthesia along the incision lines. Patients generally go home the same day.

Hair is never cut or shaved in the temporal region or behind the ear in preparation for surgery. The procedure consists of redraping and tightening facial tissue and removing excess skin. A pressure dressing is applied after surgery. Hair may be washed two days later.  Staples in the hairline are removed seven or eight days after surgery. Stitches along the ear-facial line are removed after four or five days. Hair usually covers the resulting thread-thin scars immediately.

In some people, fat gradually develops below the chin to make a "double chin." This mound of fat obliterates the ideal chin-neck line and contributes to the appearance of aging. Other people have "turkey gobbler" necks, consisting of fat and loose skin that runs from the chin to the base of the neck.

Most double chins may be effectively improved or eliminated with supplemental liposuction. A short incision is made in the crease below the chin, excess fat is removed, and the skin of the upper neck is tightened. There is negligible postoperative discomfort, and the scar becomes obscured.

When supplemental liposuction alone is insufficient, a face lift may also be performed. This is particularly appropriate for sagging jowls or a "turkey gobbler" neck. The face may seem tight for a while after the bandages are removed, but it softens with time. The face does not, however, appear "stretched" or "plasticized." In a short time, the scars become inconspicuous except on close scrutiny.

Finally, it should be understood that the face lift operation will not eliminate small vertical creases about the lips, bulging or excess eyelid skin, or horizontal forehead creases. These areas require separate procedures that may be combined with the face lift.

Before After Before After

Cosmetic Surgery for the Nose

Rhinoplasty attempts to correct deformities and breathing difficulties of the nose. The surgeon reshapes and arranges bone and cartilage, removing any excess and occasionally augmenting the nasal structure with additional cartilage as necessary. There are many cases in which breathing difficulty occurs as the nose becomes progressively more disfigured because of aging or previous trauma. Some patients also have deformities inside the nose that impair breathing, cause headaches, or create sinus trouble that cannot be satisfactorily corrected without simultaneously straightening the external nose.

The surgical work is performed on the inside of the nose, and frequently a small incision is made on the outside of the nostril divider, which essentially leaves no scar. However, in the infrequent case when the nostril must be reduced, an incision is made where the nostrils join the upper lip area. This incision is placed in a natural fold so the scar becomes practically invisible in a few weeks.

Rhinoplasties are usually performed because people want to look better. They would like the shape and size of their nose to be in harmony with the rest of their features. People in business or fashion, for example, are motivated by economic or career considerations. Breathing difficulties that accompany cosmetic deformities are corrected during the same surgery. Such surgery is therefore functional as well as cosmetic.

Surgery for the nose is performed in our office surgical suite, or hospital outpatient surgery and patients go home the same day. Actual surgery takes from two to three hours, and additional time is needed for preparation. General anesthesia is utilized and the patient is monitored at all times during and after the procedure. Following surgery, a small Teflon "cast" is applied with underlying tape to the nose. Rarely is packing inside the nose used. Ice compresses are applied to the eyes for a short time after surgery in order to reduce any swelling and discoloration. Upon discharge, patients receive easy-to-follow instructions for home care. Patients are advised to be up and out of bed the day after surgery, resting no more than three hours in bed.

The dressing on the nose is removed in our office about five to seven days after surgery. When the cast is removed, the nose may appear at first to have a slightly exaggerated "turn-up," the result of bandages and swelling. Three to five days after cast removal, the nose begins to approximate its eventual shape, and any swelling becomes barely discernible.

At the end of one week, most swelling and discoloration around the eyes have disappeared in ninety percent of our patients. Some slight swelling of the nose, which the patient feels more than can be seen, is present, but it steadily diminishes over a few weeks. This swelling may be more noticeable in the morning and becomes less so as the day progresses. The thicker the skin, the longer it takes for the nose to attain its final shape. It may be about a year before the last one or two percent of swelling is gone. This does not usually bother the patient or detract from the improved appearance.

Since surgery is frequently performed on the septum (the partition in the middle of the nose), there may be minimal nasal blockage for a few days after surgery owing to crusts and swelling. However, no intranasal packing is used after surgery.

After the nasal dressing is removed, patients visit the office a few times during a two-month period so that our staff can monitor progress. During this time, patients must be careful to avoid injury to the nose, to protect it from prolonged exposure to direct sunlight, and to refrain from wearing eyeglasses, which may cause pressure on the sides of the nose. Eyeglasses can be suspended from the forehead with a piece of clear adhesive tape. Patients may gently clean the outside of the nose and use cosmetics.

To avoid strain, patients are advised not to lift heavy objects for at least two weeks after the operation. There is usually minimal postoperative discomfort, and most patients require a minimal pain medication.

Limiting factors in rhinoplasty include the facial contour and shape; skin texture and thickness; inclination of the chin, lips, and forehead; and the depth of the angle between the forehead and the nose; the patient's height; and the skin's healing potential.

It is technically difficult to correct some noses that have been severely injured in contact sports or accidents. We try to make the correction in one operation and succeed in the vast majority of cases, but sometimes a short additional procedure is required.

Before After Before After

Cosmetic Surgery for the Chin

Very often correction of a receding chin is recommended in connection with nose surgery. A receding chin, particularly when accompanied by a slanting forehead, causes the face to look as though it tapers to a point if only a nasal cosmetic procedure is done.

The surgery, done under general or intravenous sedation, is performed upon patients of adolescent age and older. Chin surgery is generally done in the office surgical suite. A minimal external scar beneath the chin is placed in a natural fold and becomes a barely noticeable line. The chin implant used is of an extended type, which contours the jaw line for enhanced cosmetic appearance.

Cosmetic Surgery for the Ears

Otoplasty is the procedure used to "pin back" or reposition protruding ears closer to the head. Local anesthetic is used for adults and teenagers, while a general anesthetic is preferred for youngsters, usually older than age 6. This procedure is performed in our office surgical facility and patients go home the same day with very little post-operative pain.


Non Surgical Rejuvenation

Decreasing Wrinkles

This is an injection treatment to decrease the appearance of wrinkles around the eyes, between the eyebrows, forehead and upper lips.  The number of injections at the area treated will depend on the wrinkle severity.  The wrinkle reduction begins about one week after injection and will last from four to eight months.

Click Here to Learn More about our Botox treatment

Restylane, Silk, Lyft, Juvederm, Volbella, Voluma

As we age, our facial skeleton loses some of its natural projection, and the facial soft tissues lose collagen and succomb to the effects of gravity.  Hyaluronic acid HA fillers have become the standard injectable filler for facial rejuvenation due to safety, cost, and amazing results.  Facial fillers can be used to treat sunken cheekbones, grooves under the eyes (tear trough), or lack of lip definition.  DOCTORS TIP: Prior to your appointment, avoid alcohol several nights before, avoid supplements such as fish oil and garlic which may cause bruising, and we recommend taking arnica and bromelain.  All of these measures will decrease chances of having bruising.

Dubuque ENT is committed to providing full service facial skin care to our patients, and we are excited to bring advanced laser skin rejuvenation to Dubuque. The Palomar Icon from Cynosure and Lightmed KTP 532 platforms are some of the most advanced laser skin systems available.

Click here to learn more about our Laser Skin Rejuvenation

The surgeon's goal is to replace an unsightly or disfiguring scar with a better scar, one which is fine-line, level with the surrounding surface, about the same color as the adjacent skin, and which causes no contracture or pull on the surrounding area. The surgeon wants to produce a scar that is as inconspicuous as possible. Acne scarring and pock marks and small lip wrinkles are now treated by peels, laser resurfacing and aggressive daily skin care.

Kybella™ is a first in class treatment that permanantly dissolves fat from the submental area (under the chin) without surgery.  It is FDA approved, and the doctors at Dubuque ENT are proud to be the first in the area to provide this amazing treatment.  Deoxycholic acid, the active ingredient in Kybella™ is a natural substance found in the body, and works to destroy fat cells.  The treatment is performed with several small injections into the fat tissue under the chin.  Over the next several days, the fat cells are dissolved, and the body then clears them and experiences tightening in the area over the next month.  A series of 2-3 treatments are required.

Chemical Removal of Wrinkles

Some effects of aging that cannot be treated with the face lift are best eliminated by the chemical face peel. These effects include the fine “spider web” wrinkles in dry, weather-beaten skin, transverse forehead creases, and vertical wrinkles of the upper and lower lips.

An entire face peel may be performed in our office treatment room. Segments of the face, such as the lips or eyelids, may be peeled alone, or may be treated along with any facial surgery at the end of the procedure.

Aesthetic Skin Treatments

Patty Herther R.N. B.S.N. and Marcia Fiegen L.E. are our professional skincare team. Together, they offer years of experience and expertise in a fun and caring environment to meet your skincare needs.

Using a diamond coated device, microdermabrasion is used to remove heaped up dead skin cells that accumulate due to the aging process. This can be used often to improve the texture and radiance of the skin, and to enhance the effect of cosmeceutical products.

Dermaplaning is a procedure that uses a sharp device to remove the upper layers of skin that have accumulated on the surface. It helps to leave the skin more refreshed, and increases the effects of the cosmeceutical products.

Chemical peels come in all shapes and sizes. They are used to remove the more stubborn top layers of skin that cause texture and color abnormalities and fine lines. They leave the skin looking more youthful and refreshed, and have minimal downtime or recovery. At Dubuque ENT, we utilize professional peel products that are stronger and more effective than those sold through beauty supply companies. Our skincare specialists can determine the type of peel that best suits your skin and your goals.

Microneedling has become one of the most popular procedures for rejuvenating the skin. Numbing cream is appled to make the procedure painless. A microneedling pen is used to rapidly oscillate tiny needles into the skin surface to a specific depth. This "micro wounding" stimulates the body's natural healing response, increasing the levels of youthful collagen into the skin. There is minimal downtime with this procedure. Coming soon, we will also offer PRP or Platelet Rich Plasma with this procedure. Ask about it at your next appointment!

Medical Grade Skincare

Patty Herther R.N. B.S.N. and Marcia Fiegen L.E. are our professional skincare team. Together, they offer years of experience and expertise in a fun and caring environment to meet your skincare needs.

"Advanced skincare backed by science".

Physician grade cosmeceutical products, made in the USA.

Most popular products:

  • A.G.E Interrupter
  • C.E. Ferrulic - Antioxidant serum
  • Purifying Cleanser
  • AOX eye gel
  • AGE eye complex
  • Retinol

"Advanced Skincare recommended by physicians". Physician grade cosmeceutical products, made in the USA.

Most popular products:

  • Intellishade tinted moisturizer
  • Nectifirm
  • Tea Amine eye complex

"A globally recognised and loved professional skincare brand built on science, beauty, and care". A physician grade cosmeceutical brand based in South Africa. A revolutionary new treatment which may now be performed at home. Microneedling uses ultra-fine needles to gently create small pores in the skin that triggers the body's own healing and rejeuvinating process, stimulating production of collagen and elastin. The procedure also allows for better penetration of cosmeceutical products.

Most popular products:

  • Cosmetic Gold Roller
  • Environ Step Up System

Beauty with Brilliance.

We are proud to offer Jane Iredale. This is a high-end makeup line including mineral-based coverupas. Our skincare specialists can color-match your skin to find the perfect fit.

The Tria Anti Aging Laser brings the power of laser skincare to the privacy and comfort of your own home. This laser is the first home device to use fractional laser technology, which creates micro treatment zones of tissue regeneration within the skin.

At Dubuque ENT, our surgeons treat both cosmetic and reconstructive issues of the face and neck. We offer wrinkle treatments such as Botox and Dysport, filler treatments such as Restylane and Juvederm, in addition to a range of cosmetic surgical procedures such as Rhinoplasty, Rhytidectomy (facelift), Blepharoplasty (eyelid tuck), brow lift, neck lift, submental liposuction, and otoplasty (ear pinning). 

We have two highly trained facial plastic surgeons to meet your needs. Dr Herther completed his training in Otolaryngology at University of California San Francisco, and also completed a prestigious one-year fellowship in Facial Plastic and Reconstructive surgery. He is double-board certified to practice facial plastic surgery by the American Board of Otolaryngology, Head & Neck Surgery and American Board of Facial Plastic and Reconstructive Surgery. 

Dr. Givens completed his residency in Otolaryngology, Head & Neck Surgery at the University of Utah where he took a special interest in Facial Plastic and Reconstructive Surgery. He completed rigorous training in facial plastic surgery under the direction of Dr. Steven Mobley, a nationally renowned facial plastic surgeon. He is board certified to practice facial plastic surgery by the American Board of Facial Plastic and Reconstructive Surgery and The American Board of Otolaryngology, Head & Neck Surgery. 

Nonsurgical procedures 

  • Botox and Dysport 
  • Restylane and Juvederm 
  • Chemical Peels 
  • Lip Enhancement 
  • Dermabrasion 

Surgical procedures 

  • Rhinoplasty (nasal surgery) 
  • Rhytidectomy (face lift) 
  • Blepharoplasty 
  • Brow lift 
  • Otoplasty 
  • Earlobe repair 
  • Neck lift 
  • Face and neck liposuction 
  • Chin augmentation 
  • Reconstructive procedures 
  • Septoplasty 
  • Chin augmentation