Active Member
Stephen M. Warren, MD, FACS
Dr. Stephen Warren is a board-certified plastic surgeon practicing in New York City, New York. Dr. Warren specializes in facial plastic surgery with a focus on aesthetic, reconstructive, and pediatric plastic surgery.
Schedule A Consultation
Special Notice
Meet Dr. Stephen Warren
Procedures Performed
Botulinum Toxin
Brow Lift
Cheek Augmentation
Chemical Peels, IPL, Fractional CO2 Laser Treatments
Chin Augmentation
Chin Surgery
Cleft Lip and Palate Repair
Cosmetic Surgery & Computer Imaging
Craniosynostosis
Dermal Fillers
Ear Surgery
Endoscopic Technique
Eyelid Surgery
Facelift
Facial Implants
Injectable Fillers
Lip Augmentation/Enhancement
Neck Lift
Orthognathic Surgery
Rhinoplasty
Scar Revision
Skull/Facial Bone Reconstruction
Ask a Surgeon
Dr. Stephen Warren participates in the ASPS Ask A Surgeon service. View responses to public questions below.
Vermilion Border Scar
Cleft Lip and Palate RepairMember Response:
The white roll is interrupted with a slightly wide, depressed scar. Since the scar is only 3.5 months old, I would recommend waiting upwards of 12 months or more to allow the scar to remodel. Interruptions in the white roll can be easily corrected in a relatively short, albeit important procedure. There is no particular biologic window of opportunity to correct the white roll scar, but ages 2-5 years can be challenging because the child is old enough to perturb the healing tissue, but to young to follow instructions.
Endolift Scars
Wound CareMember Response:
The size and location of your incisions indicates that your surgeon made poor choices. You should follow Dr. Obi's advice and see a ABPS certified surgeon in the United States. There are good surgeons in your area. Wound care takes weeks and multiple follow-up visits. It would be wise to seek your care locally.
Scar tissue inside lip removal
Lip Augmentation/EnhancementMember Response:
While a steroid injection is rather unlikely to resolve the scar, it is also unlikely to have any untoward consequences. If you were hesitant to have it excised, you could try the steroid and when it failed, you might be less reluctant to move on to excision. In sum, scars like this are best treated by excision.
mild ptosis: eyelid surgery &/or brow lift to make eye area more symmetrical?
Eyelid SurgeryMember Response:
You have orbital dystopia. The left orbit is inferiorly displaced relative to the right. This results in pseudo-ptosis of the upper eyelid. That is to say, your left eyelid is down because your left eye is posteriorly and inferiorly positioned. Finally, your left eyebrow is slightly low. You could be treated with unilateral brow lift and elevation of the left eye. Once the eye is up and forward, you could reassess the position of the left eyelid.
Midface shortening
FaceliftMember Response:
Vertical maxillary excess can be treated by a LeFort I impaction. This is a common, but a relatively large procedure. You should see a plastic surgeon to discuss your concerns.
Chin implant revision - do I need to take it out and wait 6 months?
Chin SurgeryMember Response:
Without infection or an impending mucosal/skin erosion, I cannot think of a good reason to stage the implant exchange. Removal and simultaneous replacement is the way to go. See another surgeon and get another opinion.
Can scar tissue be removed from lip?
Lip Augmentation/EnhancementMember Response:
Hi- This type of scaring on the vermillion (dry red part of the lip) and mucosa (wet red part of the lip) is quite common. We see it in trauma cases like yours, but we also see after cleft lip repair. Laser could unfortunately never solve this problem as you've learned. The lip, however, can readily be improved with a relatively small surgical procedure to reduce the scar tissue, realign the vermillion, and remove the hypopigmented area. You should get connected with an ASPS certified plastic surgery who specializes in facial or cleft surgery. It should be a relatively easy fix. Good luck!
Biofilm and risks
Breast Implant RemovalMember Response:
It is convenient for the surgeon to leave the capsule in place, but I believe this does the patient a disservice. The capsule should be removed with the implant. Whether it is "biofilm" or BIA-ALCL, if it was in the capsule, it's still in you. Now, of course, the odds of either being present in the capsule are low, so you could play the odds and leave the capsule alone. If you can't "play the odds" then have the capsule removed.
Second lefort 1 for more advancement?
Orthognathic SurgeryMember Response:
After a LeFort I/BSSO, if the occlusion (i.e. bite) is good, a surgeon cannot selectively re-advance the midface without disturbing the occlusion. To obtain more midface advancement, a surgeon would have to re-advance the upper and lower jaws. Assuming that the occlusion is satisfactory, a patient would be far better off using midface and/or mandibular implants to selectively augment the skeleton. I've done this many times in my own patients and in patients referred to me. Typically, I find that patients with unsatisfying midface advancement after a LeFort I really wanted midface advancement above the level of the LeFort I segment. I point this out to my patients before LeFort I surgery and, unfortunately, I sometimes have to point this out to patients referred to me after their procedure with another surgeon. In sum, a post-LeFort I/BSSO patient with satisfactory occlusion should identify which areas remain insufficiently treated and consider implant augmentation.