Daniel Casso, MD, FACS

Experience, Compassion & Results

2020 Nasa Parkway #260 | Nassau Bay, TX 77058 | Phone: 281-333-3500 | Fax: 281-333-9455 | dancasso@drcasso.com

Facial Cosmetic Surgery

Facelift

Facelift

Problem.

Deep facial or neck wrinkles, loss of skin tone in the face and neck, deep creases between the base of the nose and the corners of the mouth, prominent jowls, vertical neck bands.

Who is a candidate?

  • A person who feels they have a tired or aged appearance.
  • A person with a loss of youthful chin and neck contours.

Procedure description.

Typically, Dr. Casso makes incisions within the hairline above the ear that extend around the earlobe and end in or below the hairline behind the ear. After the incisions are made, the skin and subcutaneous tissues of the face and the neck are undermined. The deeper layers are lifted and tightened also. This so-called deep plane face lift allows for more complete and long lasting facial rejuvenation than older, skin-only face lifts. Excess fat is often removed in the neck. Tightening of neck muscles may require a small incision under the chin. Finally, the facial skin is redraped, and excess skin is removed.

The face lift can be subtle or more dramatic, depending on the extent of skin laxity, fat excess, and neck muscle prominence. The procedure is done under general anesthesia, and an overnight stay at CHRISTUS ST. JOHN HOSPITAL is often suggested.

Recuperation and healing.

When the patient awakens from surgery, there will be dressings covering the head and neck, which are usually removed the following day.

The mild initial discomfort can be alleviated with oral medications. Daily showers and shampooing may be resumed the day after surgery. Sutures are removed within 10 days, and bruising and swelling will decrease to acceptable levels in 14 to 21 days. Most swelling resolves in four to six weeks, but continued improvement is apparent for several months.

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Neck Lift

Neck Lift

Problem.

Significant skin laxity in the neck, prominent platysma muscle bands, lax jowls.

Who is a candidate?

Anyone whose lax "turkey gobbler" neck gives them an aged or tired appearance, but who is not ready for a full face lift.

Procedure description.

This procedure is performed under general anesthesia at CHRISTUS ST. JOHN HOSPITAL. Incisions are made at the base of the earlobe, extending into the crease behind the ear, and into the scalp. The neck muscles are tightened through a short incision placed under the chin. Lax jowls are tightened with sutures. Excess skin is removed behind the ears.

Recuperation and healing.

Most patients go home the day of surgery. Small drain tubes are typically removed the next day. Sutures are removed within ten days. Bruising and swelling resolve within 2 to 3 weeks.

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Endoscopic Brow Lift

Endoscopic Brow Lift

Problem.

Forehead sags or brows hang too low and too close to the eyes. There may be deep vertical furrows (frown lines) between the eyebrows, and horizontal wrinkles on the forehead.

Who is a candidate?

  • Individuals who desire a more youthful and rested appearance of the forehead and upper eyelids.
  • Individuals with sagging forehead skin and brows that are unattractive.

Procedure description.

Performed on an outpatient basis under general anesthesia, incisions for the forehead lift are usually made behind the hairline. The endoscopic technique allows for use of small incisions within the hair; endoscopic visualization allows for accurate dissection, and modification of frowning musculature, while reducing the likelihood of scalp numbness which is common with older brow lift techniques (coronal brow lift). During the procedure, forehead tissues are lifted and repositioned, and the muscles that cause frown lines are weakened. Firm fixation helps ensure long-lasting results.

Recuperation and healing.

Initial discomfort is controlled with oral medication, and patients leave the hospital with their head wrapped in dressings which are removed on the first or second day following surgery. Sutures are removed within 10 days, and most swelling or bruising is gone in 10 to 14 days.

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Blepharoplasty

Blepharoplasty

Problem.

Upper or lower eyelid skin that is sagging, wrinkled, or interfering with vision.

Who is a candidate?

  • A person who has lost his or her youthful eyelid appearance.
  • People with puffy pouches of fat in the upper or lower eyelid that creates a sad or tired appearance.

Procedure description.

To remove the excess fat and skin, incisions are made where the natural crease should be in the upper lids and just below the lash line in the lower lids. The excess fat and skin are removed. Lax lower lid muscle is tightened. Fat may be repositioned to correct an aging hollow in the lower eyelid ("tear-trough deformity").

In a case where there is only excess fat in the lower lids, the fat can be removed through an incision made inside the lower lids. This process leaves no external scars.

Lower eyelid lifts are done on an outpatient basis with IV sedation and local or general anesthesia. Upper eyelid surgery may be performed in the office under local anesthesia with oral sedation only, if desired.

Recuperation and healing.

The sutures are removed within three to five days. Bruising will last about two weeks, while swelling will disappear over several weeks.

Eye makeup is permitted shortly after removing the sutures, and contacts may be worn when comfortable, usually between seven and 10 days.

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Rhinoplasty

Rhinoplasty

Problem.

A nose that is cosmetically unattractive or not in harmony with other facial features. Who is a candidate?

  • An individual who desires a more attractive nasal shape.
  • Anyone desiring their nose to be better proportion to other facial features.
  • An individual who has an abnormal nose appearance because of birth defect, injury, or disease.
  • An individual with a nose that has large nostrils.

Procedure description.

In-office computer imaging is extremely valuable in assessing the problem. Nose reshaping surgery (rhinoplasty) is performed on an outpatient basis under general anesthesia.

In this procedure, Dr. Casso makes an external incision across the columella (the strut between the nostrils). Bones, cartilage, and soft tissue are then reshaped, and excess cartilage is removed or reshaped with fine sutures. Sometimes, the nasal bones are fractured in a controlled fashion to narrow the nasal bridge. A bony hump can be smoothed during this procedure. A closed or endonasal rhinoplasty employs incisions inside the nose only. Large nostrils can be reduced with tiny incisions at the outer base of the nostrils.

Recuperation and healing.

With the initial discomfort controlled with oral medication, Dr. Casso will often send the patient home with an external cast or splint in place. If septal surgery was also performed, the nose may have internal nasal splints. The external cast or splint is usually removed in one week, and most of the swelling and bruising subsides progressively over two to three weeks. External sutures, if any, are removed in four to six days.

Semi-final results are evident in three months, and the final results are evident in six to 12 months, which is the period necessary for complete tissue softening.

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Septoplasty

Problem.

Nasal obstruction (difficulty breathing) because of developmental or post-injury crookedness of the nasal septum.

Who is a candidate?

  • Individuals in whom correction of the nasal obstruction will result in an ability to breathe better.

Procedure description.

The deviated nasal septum is corrected by Dr. Casso in an outpatient operation performed under general anesthesia. During the procedure. Dr. Casso will partially remove and/or straighten the crooked cartilage.

Recuperation and healing.

After the operation, the nasal passages are splinted. The splints are removed in five to seven days. Generally, there is minimal bruising.

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Chin Augmentation

Chin Augmentation

Problem.

Small or receding chin or one that looks weak in proportion to the face.

Who is a candidate?

  • Individuals who desire an improved profile.
  • Individuals who feel a more attractive jawline would create a better balance between the chin and other facial features.

Procedure description.

Computer imaging is extremely helpful in assessing the problem and simulating the intended results. Dr. Casso will make an incision inside the lower lip or under the chin. An implant will be inserted during the procedure, which is performed on an outpatient basis under sedation and local or general anesthesia.

Recuperation and healing

A small dressing is placed over the chin after the surgery. Any initial discomfort is controlled with oral medication. Swelling, tenderness, and possible numbness gradually subside within a month or two.

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Otoplasty

Otoplasty

Problem.

Ears that stick out too far from the side of the head or ears that have an unusual or undesirable shape.

Who is a candidate?

  • Individuals over age five who desire ears with normal folds and shape.
  • Individuals who want ears with normal protrusion from the side of the head.

Procedure description.

Ear pinning is performed under sedation and local or general anesthesia. Incisions are made behind the ear, and internal sutures are applied to the cartilage, resulting in a natural ear fold. Excess cartilage may be removed. There is some mild post-operative discomfort which is controlled with oral medication.

Recuperation and healing.

The desired results will be evident in 10 to 20 days after surgery. To properly protect the ears, patients will be required to wear a head band at night for a few weeks after the first dressing is removed. Contact sports should be avoided for about one month.

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