PROCEDURES

FACE AND NECK

Face & Neck

As we age the structures of the face undergo atrophy and also gravitational changes. Facial rejuvenation is one of Dr. Ivey’s areas of expertise. In milder cases replacing the lost fat with fat grafting may be all that is needed to restore the appearance. 

In more severe cases, repositioning the deeper structures of the face and neck may be required.  This is sometimes called a “deep plane” or SMAS facelift.  The goal is to provide a natural appearing result, define the jawline and neck, and to provide a refreshed and natural appearance.     

Dr. Ivey performs Deep Plane Lower Face/Neck Lift, Mini face lifts, SMAS facelifts, and with and without skin excision.  The amount of definition in the neck is a matter of personal preference and at the consultation the goals of the operation will be discussed fully.   By using cutting edge techniques an “operated” or unnatural appearance can be avoided.  Men and women from all of the Hawaiian Islands including Oahu, Kauai, Maui, Molokai, and the Big Island benefit from Dr. Ivey’s facial rejuvenation expertise.

 

eyes

Eyes and Brow (Blepharoplasty)

There are certain anatomical features that youthful eyes and brows display. The goal is to restore the patient’s once beautiful features that may have been lost over time. By paying close attention to these subtleties, a natural and non-operated appearance can be obtained. Dr. Ivey performs a variety of upper and lower blepharoplasty techniques and brow lifting including endoscopic. This can be combined with fat grafting or fat transposition in order to give a well rested, refreshed appearance. As the eyelids age, the fat pads tend to herniate or “push out”. This gives a tired appearance on the lower lids. On the upper eyelid, the medial fat pads tend to herniate and the central fat pads tend to involute. Dr. Ivey finds it helpful for you to bring pictures of your eyes from your younger years in order to get an idea of what needs to be restored. Eyelid surgery and some kinds of brow lifting surgery are performed in our office OR under local anesthesia. Men and women from all of the Hawaiian Islands including Oahu, Kauai, Maui, Molokai, and the Big Island come for surgery of the eyelids and brow.

 

Nose Reshaping (Rhinoplasty, Septoplasty, Nasal Valve Surgery)

The nose is often said to be the centerpiece of the face.  It provides balance to the other facial features.  In some cases it can be distracting and take away from the overall beauty of the face.  Dr. Ivey performs cosmetic and reconstructive surgery of the nose.  This includes surgery to make people breathe better.  We know that nasal breathing has major benefits including filtration of particulate matter from the air and humidification.  Therefore, when operating on the nose for cosmetic reasons the goal is also to make breathing through the nose more effective.   

Endonasal Rhinoplasty (“scarless” rhinoplasty) Dr. Ivey’s preferred approach is to perform the rhinoplasty in an endonasal or “closed” fashion.  In this approach no incisions are made on the skin and dissection is not carried out in areas that are not being worked on.  This is also sometimes referred to as scarless rhinoplasty – though there are small incisions made on the inside of the nose. With endonasal rhinoplasty you can expect a quicker recovery time with less swelling overall.  With more severe nasal deformity an open approach is indicated. 

FACE AND NECK

Orthognathic Surgery (Upper and Lower Jaw Surgery) and Chin (Genioplasty) 

Orthognathic Surgery (Upper and Lower Jaw Surgery)
Malpositioned teeth or jaws can result in several problems. Chewing can be impaired, the lower lip can be strained due to excess vertical height of the jaw, mouth breathing, sleep apnea, and facial aesthetics can be compromised. A “gummy smile”, a crooked jawline, a “weak” chin, a severe “overbite” or “underbite” may be signs of skeletal abnormality that can be corrected with jaw surgery. Often these issues can be treated with orthodontic or soft tissue treatment alone.However, some patients will need a combination of orthodontics and surgery to have an optimal outcome.

Chin (Genioplasty)
The chin is a critical part of the face and can enhance or restore the facial profile. The aesthetics of the nose, chin, jaws, and neck are interrelated and should be evaluated together. Changes in one area can affect the other so it is important to have a comprehensive evaluation. Moving the chin forward improves the facial profile and can also improve the contour of the neck. It can also help balance a strong nose. Dr. Ivey is fully equipped to treat the bony and soft tissue deficiencies or excess of the facial skeleton. Osseous Genioplasty An osseous genioplasty can address both vertical and horizontal abnormalities of the chin. It provides a natural (using your own tissue – no implant) and permanent result. A major benefit of osseous genioplasty is that it does not have the risk of infection that an implant does and once you heal it is all your own tissue. This is also a great option for facial feminization or gender confirming surgery. Dr. Ivey is especially qualified to perform genioplasty surgery. Chin Implant If only a small horizontal augmentation of the chin is needed Dr. Ivey is able to use an implant, fat grafting, or even hyaluronic acid filler to provide an acceptable aesthetic result. The results last from 1 year to permanent depending on what method is used.

FACE AND NECK

Lips

Full lips are a sign of beauty and youth. As we age we lose volume in our lips and the upper lip can lengthen. Hyaluronic acid filler is an excellent choice for lip augmentation, as well as using “nano-fat” harvested from your own tissues. Lip Lift is a procedure that is performed in the office under local anesthetic. The distance between the nose and the upper lip is then shortened in order to expose more of the red lip. This can correct a lengthened upper lip due to aging or a congenitally long upper lip and unlike lip filler it creates a permanent result.

Ears (otoplasty and ear reconstruction)

Prominent ears occur in approximately 5% of the caucasian population. It can be a source of distress and decreased self-confidence. It is the most common congenital ear abnormality. The procedure can be performed as early as 5 or 6 years of age. Otoplasty is also performed in adults and can be performed in the office under local anesthesia. In children it requires general anesthesia. Ear Molding When newborns have ear deformities, there is a window of time (~up to 3 months – but sooner is better) when the cartilages can be corrected. This is due to the circulating estrogens from the mother. By using small pieces of moldable plastic and tape the ears can be shaped to a more normal appearance.

FACE AND NECK

Breast

Breast Augmentation (Implants or fat)
Many women desire to improve or enhance the appearance of their breasts. Some wish to have a more natural appearance and others desire a more augmented look. During your consultation, Dr. Ivey will review the various options with you and use 3D Vectra imaging to make sure your goals are both realistic and safe. Breasts can be augmented with implants or by fat transfer by harvesting fat with liposuction from unwanted areas. There are a variety of options for incision placement and location of the implant (above or below the pectoral muscle). Above all, communication is key and Dr. Ivey will spend the time necessary to give you the best result possible. Dr. Ivey has a true passion for surgery of the breast.

 Breast Lift (Mastopexy)
It is no secret that as women age or after childbirth the breasts tend to sag. A breast lift, also called a mastopexy can correct ptosis or sagging of the breasts. The aim of the procedure is to reshape the breast and lift the nipples into a more forward-facing position. It is sometimes possible to also give more fullness in the upper part of the breast by repositioning your breast tissue during mastopexy. Breast lifting can range from a circum-areolar (around the nipple only) or “donut” lift, vertical scar only lift, and finally a full “anchor lift” in more severe cases. Keeping scars minimal while maximizing the lift is always the goal. This can also be combined with breast augmentation (implant or fat) in the right candidate. Please schedule a full consultation with 3D imaging in order to visualize your result. 

Breast Reduction
Many women suffer from heavy and sagging breasts that can cause back pain, neck pain, rashes, and even infections. Often one breast is quite larger than the other. Breast reduction is a safe procedure that is proven to relieve these symptoms by reducing the size of the breast and re-shaping them into a more aesthetic and lifted form. Dr. Ivey’s approach is tailored to the individual patient. He uses a variety of different incisions and techniques to optimize symptom relief while also consistently producing beautiful breasts. Please come to our office to see patient examples. Schedule a consultation to learn more. Male Breast Reduction (gynecomastia surgery) Gynecomastia can occur during the normal hormonal shifts of puberty. Occasionally the male breast formation persists and requires surgical treatment. It can also occur from prior and current steroid use, and from many other prescription drugs. Dr. Ivey uses a combination of liposuction to define the male chest as well as direct excision to provide the most aesthetic result possible.

 

Breast Reconstruction
A breast cancer diagnosis can be an overwhelming and scary process.  Choosing the right treatment option for your cancer and reconstruction is a group effort.  Dr. Ivey will work closely with your breast cancer surgeon to provide the most optimal result possible.  The ultimate goal is to reconstruct breasts that may be even more aesthetically pleasing than the ones you were born with.    Dr. Ivey has a passion for breast reconstruction and breast cancer patients.  He has spent years training in the latest reconstructive techniques including DIEP flaps and pre-pectoral (above the muscle) implant reconstruction. If you have had prior breast lumpectomy or “breast conserving therapy” and are left with uneven breasts you may also be a candidate for breast reconstruction.  Breast reconstruction can most simply be divided into two approaches.  Implant based or autologous breast reconstruction.   

Implant-based Breast Reconstruction After mastectomy or occasionally after an aggressive lumpectomy an implant is indicated to reconstruct the breast mound.  Breast implants are currently filled with either silicone or saline.   Dr. Ivey’s preference is to place the implant on top of the muscle.  You may see this referred to as “pre-pec” or “pre-pectoral” reconstruction.  Occasionally the implant may be placed partially underneath the pectoral muscle.  Depending on your individual situation at the time of surgery it is possible to go directly to your final implant or you may require placement of a tissue expander.   

Autologous Breast Reconstruction  Autologous breast reconstruction means using your own tissues for reconstruction.  This is primarily done by using excess tissue from your abdomen or back.  Some common autologous methods of reconstruction are DIEP flap, TRAM flap, latissimus flap.  There are many nuances to these techniques and at your consultation Dr. Ivey will go over the options with you.  

Fat Grafting and “incision free” flap By using liposuction cannulas it is possible to suction fat from unwanted areas (abdomen, love-handles, thighs) and transfer the fat to the breast tissue.  This has many benefits including adding volume to breast, camouflaging the implant (to look more natural), and also potentially helping heal skin that is damaged from radiation therapy.  There are a few new methods to recruit tissue from your upper abdomen and your lateral upper flanks to build up a new breast that is 100% natural.  Please contact our office for more details. 

Nipple Reconstruction This is often the final stage of reconstruction.  By this point you have a breast mound in place with reasonable symmetry.  Using a variety of methods Dr. Ivey can reconstruct a projecting nipple if desired.  This is a minor procedure that can often be performed under local anesthesia. 

FACE AND NECK

Body Contouring 

After bariatric surgery or weight loss many patients are left with redundant skin.  This can be problematic and requires excision and “tailoring” of skin.  Dr. Ivey has significant experience with massive weight loss patients.  Some examples of body contouring procedures would be brachioplasty (arm lift), thigh lift, upper back lift, lower body lift, panniculectomy, and butt lift.  One of Dr. Ivey’s most transformative procedures for patients after weight loss is the corset abdominoplasty.  Body contouring patients visit Dr. Ivey’s clinic from all of the Hawaiian Islands including Oahu, Kauai, Maui, and the Big Island.

Liposuction is an excellent way to contour the face and body with minimal downtime.  Through small (3-5mm) incisions in the skin, suction cannulas can be introduced and excess fat can be removed.   This is a very artistic process and can be likened to sculpting the body.  Liposuction can be performed in the neck, arms, back, waist and abdomen, flanks and bra line areas, and thighs.  Smaller areas can be performed in the office under local anesthesia alone.  High definition liposuction refers to defining a patients natural anatomy further using liposuction.  Dr. Ivey’s significant experience with liposuction brings men and women from all of the Hawaiian Islands including Oahu, Kauai, Maui, and the Big Island. 

 

FACE AND NECK

Fat Transfer to Buttocks – BBL (Brazilian Butt Lift)

A Brazilian butt lift refers to transferring your own fat to the buttocks and hips.  This is done by first performing liposuction to of the abdomen, back, and flanks to decrease the waist-to-hip ratio.  Patient preferences determine the amount of fat transferred to each area.  Dr. Ivey does not perform large volume injections or use implants.  His approach is to reduce the fat in the areas mentioned and transfer appropriate amounts of fat in a safe, subcutaneous manner to the areas that are lacking.  This leads to a very natural and attractive result.  He refined his BBL skills during his time in Miami and now patients from all of the Hawaiian Islands including Oahu, Kauai, Maui, and the Big Island can benefit. 

 

FACE AND NECK

Abdominoplasty (Tummy Tuck)

The abdomen and waistline are problem areas for many people.  As we age, after weight gain or loss, or after childbirth the abdominal muscles can separate and require surgical repair.  This is called rectus diastasis.  Although Dr. Ivey believes fully in physical activity and wellness, no amount of exercise can correct the structural laxity of the tissues.   The soft tissues can be contoured with a combination of liposuction and excision of redundant skin.  The muscles are repaired and brought to the midline.  This decreases the fullness and size of the waist.   There are many variations of abdominoplasty ranging from a mini abdominoplasty to full.  Dr. Ivey’s approach is to keep the scar very low.  He has a signature method that produces an umbilicus that is very natural.  Please see us in consultation for a full evaluation to see what approach is best fit for you. 

 

 

FACE AND NECK

Labiaplasty and Vaginal Rejuvenation

Redundant or asymmetrical labia minora and/or clitoral hood are most commonly congenital and typically get worse during adolescence.  Occasionally enlargement can result from hormone or birth control treatment, pregnancy, or aging.  This can cause women to avoid intimacy or feel less confident.  It can also cause pain while wearing certain clothing.   The surgical treatments of this area include reduction and reshaping.   Vaginal rejuvenation is typically indicated after childbirth as there can be anatomical damage that occurs during vaginal delivery.  This can cause muscle separation at the perineum.  During the surgery, the muscles of the perineum are brought back to their natural location.  

FACE AND NECK

Reconstructive

Dr. Ivey is passionate about plastic surgery.  Plastic surgery is comprised of both aesthetic surgery and reconstructive surgery.  The lines that once divided aesthetic surgery from reconstructive surgery are no longer.  A reconstructive surgery should always be grounded firmly in aesthetic principles – with normal anatomy or even more aesthetic anatomy as the goal.  Aesthetic procedures are often reconstructive – what is beautiful is often what functions well.

Occasionally reconstructive procedures require more than one surgery.  It may be a combination of multiple smaller surgeries before your reconstruction is ultimately complete. Your result and how much you want to achieve is completely in your control. Dr. Ivey will be with you every step of the way.  During your reconstructive process, you may want to take months or even years off from doing any surgery.  This is all a part of the journey. 

FACE AND NECK

Non-surgical Rejuvenation 

Dr. Ivey offers a variety of non-surgical options.  The field of “cosmetic medicine” has rapidly progressed and allows patients to maintain a youthful appearance for longer than in the past.  This may help some patients avoid surgery or at least delay facial rejuvenation surgery until they are older.   Non-surgical treatments include neuro-modulators (Botox, Dysport, Jeuveau), soft tissue fillers (hyaluronic acid, fat), and skin resurfacers (peels and lasers).    Neuro-modulators (Botox, Dysport, Jeuveau) Neuromodulators are variations of botulinum toxin and the most commonly injected brand is Botox.  They all work by relaxing the facial muscles thereby reducing the appearance of wrinkles.  By varying the amount of Botox used Dr. Ivey can help you obtain a natural and refreshed look.  The effect lasts approximately 3 months and by maintaining the effect it may be possible to avoid the formation of deep wrinkles.  Hyaluronic Acid (Juvederm, Restylane, Versa) Dr. Ivey performs hyaluronic acid filler treatments.  Hyaluronic acid is found naturally in the body and is the safest available filler and also reversible.  It is used to fill your tissues in areas that you have lost fat or bony support through aging or to enhance or augment your features. Filler may be injected under the eyes to reduce a tired appearance, into the cheeks to restore lost volume or augment cheek bones, into the lips, jawline, or chin.  Occasionally a small correction of nose contour is possible by doing a non-surgical rhinoplasty injection.   The injections are not without risk and it is important to trust your face to a facial specialist with an artistic eye

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