Small Procedures, Big Differences

Dr. Roxanne Guy discusses single cosmetic outpatient procedures that can make a huge impact

“People often ask me if I look at others with a view toward what surgical procedure I would choose for them. Well, I guess I would have to confess that I do think about my work even when ‘off duty,’” says Roxanne Guy, M.D., FACS, founder of Brevard Plastic Surgery and Skin Treatment Center in Melbourne.

Here, Dr. Guy discusses single procedure, relatively short cosmetic enhancements that can be done as an outpatient and can create big changes in a patient’s appearance.


“I hear both women and men complain about looking tired, even when they’re not,” says Dr. Guy. She explains that oftentimes this is a result of excess skin of the upper eyelids that hoods the eyes and creates a less bright-eyed look. While the upper eyelids are usually the main culprit, the excess skin around the lower eyelids also can lead to a tired look.

Enter the upper eyelid blepharoplasty, or eyelid lift. This procedure is commonly performed in the office under local anesthesia with mild sedatives taken by mouth,
or is a short outpatient procedure with deeper anesthesia. The results can be amazing, creating an alert, rested, engaged-with-life look.


“Patients come to me with gorgeous looks and beautiful skin, but with a wish that their nose was somewhat more refined to match the rest of their face,” says Dr. Guy. “They may dislike their nasal ‘hump,’ or the ball-like tip of their nose or some crookedness.”

The cosmetic surgeon explains that a cosmetic rhinoplasty can create a harmonious look without necessarily changing the entire character of the face. The philosophy of rhinoplasty is to refine the nose to fit the face and the person, not to completely alter looks. Nose surgery is most often done under deeper sedation or general anesthesia at an outpatient surgery center. The changes in a patient’s outlook and confidence can be profound.


With the advent of neurotoxins – such as Botox, Dysport and the new Xeomin – frown lines and forehead lines can easily be softened. While surgical procedures such as forehead lifts and brow lifts are less common today, they can have distinct advantages over the neurotoxins, however. Surgical procedures, for example, are more permanent.

“I love brow lifts for people with very heavy brow musculature, people with brows that are low or saggy (called ptotic brows) or have lost that delicate brow arch, people with a great deal of excess skin hanging along the lateral eyebrow, or people with severe crow’s feet wrinkles,” says Dr. Guy.

The brow lift can open up the mid-face, creating a softer, friendlier, more alert and younger appearance. It is often done as an outpatient procedure at a surgery center under sedation or general anesthesia.


“When I evaluate the face for any surgery, I look at the proportions and the bone structure, as well as the overall soft tissue covering and skin,” explains Dr. Guy. “When people ask about their neck, more may be involved than loose skin or fat.”

That said, Dr. Guy says that sometimes simply adding a relatively small chin implant can create more harmony in the face and the appearance of a nice, right-angled, longer neck. This procedure can be incorporated into a facelift or rhinoplasty procedure, or can be done on its own and can provide a distinctly more beautiful neck line. It is also an outpatient and relatively short procedure.


“I would be remiss as a plastic surgeon if I did not mention the real joy and confidence building that breast augmentation can accomplish. Like it or not, the breast is symbolic of many things: sexuality, maternal nurturing, femininity and gender,” says Dr. Guy. “Some women get amazing satisfaction in enhancing that area of their body.”


“The Mommy Make-Over is traditionally a combination of breast surgery and tummy surgery, but often it is just the tummy that is causing the issue. Dr. Guy oftentimes treats slim, athletic women who have had children and are back to doing marathons, Pilates, yoga and tennis, but now have some excess stretched skin of their tummies that prevent them from wearing crop tops or two-piece swimsuits. A tummy tuck can get rid of that excess, stretch-marked skin and tighten the abdomen, enhancing the options for clothes and activities.


Patients often voice concern about being “put under,” especially for a purely elective procedure. Modern, outpatient anesthesia is safe, provided the patient is basically healthy and uses a surgery center with board-certified anesthesiologists. The surgery center should be accredited and possess all the safety features required by state laws. There are very strict rules and requirements for accreditation and for Medicare status. Beware of “office surgery,” which may seem convenient, but may not have the safety features that are essential for health, well-being and a positive outcome.

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