Aviva Plastic Surgery & Aesthetics

Revision otoplasty is often more challenging than performing ear surgery for the first time, but it can also be incredibly rewarding.

Unlike primary otoplasty, revision surgery must work around changes from a previous operation. Scar tissue, altered cartilage, changes in anatomy, and the loss of normal tissue planes can all make surgery more technically demanding. In many cases, the goal is not simply to “do the surgery again,” but to understand why the original result fell short and develop a thoughtful plan to improve it.

This patient came to us after a prior otoplasty elsewhere. While his first surgery had improved the prominence of his ears, he still felt the final contour did not reflect the natural and “more contoured” appearance he had envisioned.

Our approach to revision otoplasty begins with listening. We carefully evaluate the existing anatomy, discuss what is realistically achievable, and tailor the surgical plan to each patient. Often small, precise refinements can make for a meaningful difference in facial harmony.

Revision surgery requires experience, patience, and an appreciation for both anatomy and aesthetics. While no revision can erase every sign of prior surgery, thoughtful reconstruction can often achieve a more balanced, natural-looking result.

Swipe to see this patient’s transformation.

Every patient is unique. Individual results will vary.

Healing after surgery is a carefully orchestrated process, influenced by countless biological factors working together to restore healthy tissue. We believe that thoughtful recovery is just as important as thoughtful surgery, and that exceptional results begin with exceptional healing.

Hyperbaric oxygen therapy (HBOT) is a medical treatment in which a patient relaxes inside a pressurized chamber while breathing nearly 100% oxygen. Under these conditions, oxygen dissolves into the bloodstream at much higher levels than it can under normal atmospheric pressure, allowing more oxygen to reach healing tissues throughout the body.

Why does this matter after surgery?

Oxygen is essential for many of the body’s healing processes, including collagen synthesis, new blood vessel formation (a process called angiogenesis), and tissue repair. These are all critical components of recovery following facial plastic surgery.

For many patients undergoing facial rejuvenation procedures, including deep plane facelift and neck lift surgery, we recommend hyperbaric oxygen therapy beginning before surgery and continuing through the early postoperative period as part of our comprehensive recovery protocol.
(Photo by Ron Lach)

A beautiful result is about more than the technical aspects of surgery; it’s about thoughtful planning and the healing journey that follows.

This lovely, health-conscious patient came to us with a deep understanding of facial aesthetics and a clear goal: to address an elongated philtrum, improve the visibility of her upper lip, and elevate downward-turning corners of the mouth that made her face appear more tense.

Her treatment included a central upper lip lift (bullhorn lip lift) and bilateral corner lip lifts.

Swipe through to see her journey:
• Before surgery
• Immediately after surgery
• Six weeks after surgery, immediately following CO2 laser resurfacing to further refine her scars
• Six months after surgery, with a nearly fully healed result

She loves that her lips and face now feel more balanced, relaxed, and more “at ease.” Her elevated mouth corners are further complemented by ongoing Dysport treatment to the DAO muscles (the muscles that pull the corners of the mouth downward).

As part of carefully planned and customized perioral rejuvenation, a lip lift procedure restores balance, improves lip show, and enhances the harmony of the entire lower face.

Healing takes time, and beautiful results continue to evolve for many months after surgery.

As facial plastic surgery experts, we spend much of our time helping patients restore what time and sun exposure have taken away. But some of the most important work we can do happens long before someone ever walks into an operating room.

A few evidence-based habits we encourage:

☀️ Wear sunscreen every day and reapply every two hours when outdoors.
☀️ Wear broad-rimmed hats and sun-protective clothing.
☀️ Avoid tanning beds entirely.
☀️ Be cautious about trends like the “Barbie Shot” (Melanotan), which remains poorly studied and may carry risks we do not yet fully understand.

We sometimes underestimate the importance of antioxidants. Sun exposure creates oxidative stress in the skin, contributing to collagen breakdown, pigmentation, and premature aging. A diet rich in colorful fruits and vegetables and the thoughtful use of topical antioxidants—such as vitamin C and vitamin E—can help support overall skin health and complement, but never replace, diligent sun protection.

Many adults also benefit from vitamin D supplementation, particularly when practicing consistent sun protection. Emerging research even suggests that very high-dose vitamin D may help reduce some of the inflammatory injury associated with a significant sunburn, although this should not be viewed as a substitute for prevention.

And in patients at high risk for recurrent non-melanoma skin cancer, vitamin B3 (nicotinamide) has been shown to reduce the development of new skin cancers.

Beautiful skin is healthy skin.

The goal isn’t to fear the sun. It’s to enjoy life outdoors thoughtfully and protect the skin you’ll live in for the rest of your life.

Thick-skinned rhinoplasty patients are often told that there is “only so much” that can be achieved with surgery.

While it’s true that thick skin presents unique challenges, thoughtful planning and careful management can make an enormous difference.

This lovely 63-year-old patient came to our practice bothered by the size of her nose, the lack of definition in the tip, and the thick, wrinkled texture of the skin over her nasal bridge. Together, we discussed not only what surgery could accomplish, but also the importance of optimizing her skin.

Because she has particularly thick and oily nasal skin, we worked closely with her Dermatologist to use isotretinoin (Accutane) before and after surgery as part of her treatment plan. In select patients, this can help improve skin quality and potentially reduce the scarring and prolonged swelling that thick-skinned rhinoplasty patients often experience.

She is shown here just 2 months after surgery, very early in the healing process, especially for someone with thick skin. Even so, she already shows a smaller, more refined nose with improved tip definition and softer skin texture.

One of the things we love most about rhinoplasty is that it isn’t just about reshaping structure. It’s about understanding our patients, respecting the limitations that anatomy presents, and creating a thoughtful plan that gives someone the best opportunity to heal beautifully.

We can’t wait to see where she is at one year and beyond.

Many of our labiaplasty patients tell us the same thing after surgery:

“I wish I had known this sooner.”

Labiaplasty is a deeply personal procedure that is often surrounded by unnecessary embarrassment, misinformation, and anxiety. We created this post using real themes and feedback we hear from patients every week in hopes of making the conversation a little easier.

Whether your concerns involve comfort, exercise, clothing, intimacy, appearance, or simply wanting to learn more, know that you’re not alone—and that these conversations are much more common than many people realize.

A forehead that feels too tall is often less about the forehead itself and more about overall facial proportions.

This lovely patient came to our practice seeking a more balanced relationship between her hairline and the rest of her facial features. She underwent hairline lowering (forehead reduction) surgery and is shown 1 week after treatment.

Hairline lowering surgery can create a meaningful improvement in facial harmony without changing what makes a patient look like themselves.

As with many facial plastic surgery procedures, the best results are often the ones that are felt before they are noticed.

There is a certain beauty in doing the right treatment—for the right patient—done in the right way.

This patient, a 29-year-old professional in Atlanta, came to see us after years of considering lip enhancement. She had explored consultations before, but never quite felt ready to move forward. Together, we chose a thoughtful, conservative approach with lip filler, designed not to change her, but to refine what was already there.

She is shown here 2 weeks after treatment: still entirely herself, just a touch more polished, balanced, and confident.

That’s the goal. Not transformation for the sake of it. Not chasing trends.
Just knowing when something can make a subtle, meaningful difference.

This week, we are celebrating our medical assistants, Olivia and Camryn, as they wrap up their year with Aviva Plastic Surgery. Last spring, they began their gap year with us to gain clinical experience—and over the course of the year, they became an integral part of how we care for our patients and how our team functions day to day.

They showed up with curiosity and drive, and quickly grew into roles that touched every part of the practice—from patient care and surgery to aesthetics, anesthesia, monitoring, and safety, and just as importantly, the human side of medicine.

Olivia and Camryn cared for our patients with kindness and presence. They supported one another. They made our practice better. And along the way, they taught us, too—about TikTok trends, the latest in virtual medical school interviews, NCAA track, college football—and all the little cultural moments that keep the vibes good and strong.

Between cases, workouts, and long days, Olivia and Camryn also completed the demanding and highly competitive process of applying to medical school—earning multiple acceptances, a remarkable accomplishment in itself.

It is bittersweet to see them go. They are bright, thoughtful, creative, and deeply capable young people—exactly the kind of people we hope will go on to become excellent and caring physicians. Camryn is headed toward a future in Orthopedic Surgery. Olivia is planning on Pediatrics (though we may be placing a few bets on Pediatric Anesthesia).

We are thankful for their hard work, and we are so proud of them. And we cannot wait to watch their paths unfold.

Filler and surgery don’t always need to compete.
But they do need to be understood.

Many patients considering procedures like lower blepharoplasty, lip lift, chin augmentation, or facelift have had filler placed in the past. The question often arises:
Should it be dissolved before surgery?

The answer is not one-size-fits-all.

If filler appears natural, well-placed, and well-integrated—without signs of migration, lumpiness, or superficial placement (such as a bluish Tyndall effect, often seen under the eyes)—it can often be left in place.

But when filler begins to disrupt natural anatomy—creating fullness where it shouldn’t be, blurring contours, or sitting too close to the surface—it is usually best to dissolve and reset before moving forward.

This process can take time.
Some hyaluronic acid fillers are more resistant to dissolving than others, and more than one dissolving session may be needed to return the face to a natural baseline.

Not all filler behaves the same. Not all filler can be dissolved.

Hyaluronic acid filler, even when placed many years ago, may still be present.
Imaging studies have shown that these materials can persist far longer than expected—sometimes for years.

Permanent or long-lasting fillers, such as silicone, Radiesse, and Bellafill, cannot be dissolved.
If they become visible, irregular, or inflamed (forming siliconomas), they are best treated with surgical removal.

Similarly, fat grafting behaves more like a permanent filler.
If contour irregularities develop, they can be addressed surgically or, in select cases, with targeted injectable treatments of deoxycholic acid.

Occasionally, filler is addressed at the time of surgery—either dissolved or carefully removed—if it interferes with surgical precision.

The goal is not simply to remove or keep filler.
The goal is to create the cleanest, most natural foundation for surgery. Because ultimately, better structure leads to better outcomes. And every decision along the way should be thoughtful, individualized, and guided by expertise and experience.

Not more.
Not less.
Just right.