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Rhinoplasty

Rhinoplasty before and after photos by Sherber and Rad in Washington, DC

Rhinoplasty before and after photos by Sherber and Rad in Washington, DC

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dr ariel rad

@drarielrad

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What is “Total Face Optimization”? This is it. A face is optimized if features balance together harmoniously, beautifully and naturally as though no surgery was done
This result for my patient from New York City is all about that. Her goal was a naturally modelesque appearance yet still preserving her natural character but bringing out her central features (eyes 👁️ 👁️ and lips 👄).
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Given the extent and complexity of surgery for safety we approached this in 2 stages.
Stage 1:
* V-Line Jaw Slimming (posterior mandibles angle ostectomy)
* Chin Reduction (cortical shave)
* Endoscopic Brow Lift (“ponytail” lift)
* Bridge-of-bone Canthoplasty
* Fat Grafting to Forehead, Temples, Midface
* Upper Lip Lift

Stage 2 (1 year later):
* Deep Plane Face/Neck Lift
* Deep Neck Sculpting (gland/strap muscle redux)
* Fat Grafting to Midface, Under Eyes, Lips
* Lower Blepharoplasty Fat Transposition
* Closed Rhinoplasty
Her eyes and lips look naturally enhanced in part due to the specific procedures on them but also by reducing her lower facial frame (ie smaller jaw) which makes the eye and lips look larger by reorienting facial proportions. I always aim for small adjustments in many areas to synergize the effect without overdoing anything.
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#endoscopicbrowlift #canthoplasty #blepharoplasty #fatgrafting #v-linejawslimming #rhinoplasty #deepplanefacelift #deepplanenecklift #beforeandafter #sherberandrad

🤍I love these natural results for my lovely patient whose main goal was to resolve her heavy, drooping neck, jowls, deep marionette folds and to restore a youthful appearance. Although I usually combine other procedures, such as blepharoplasty and fat transfer, this case was purely deep plane face and neck lifting with deep sculpting.
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Although on the surface it looks like only skin was pulled up, my technique is much more complex and nuanced than this. In fact, there’s zero tension on skin which is why her scars imperceptible, there are no tension lines and her earlobes are not pulled down like “pixie ears”. The crucial steps are offloading the platysma neck muscle by deep neck sculpting (gland reduction) and also cutting the ligaments that hold tissues in place. Doing this effectively, all while navigating facial nerves branches, then allows the tissue layers to drape upwards. No tension facelifting is the key to good technique. 🔑
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Looking youthful and natural is always my aim 🎯and my “offload, release and lift” method has worked exceptionally well for the many hundreds of facelift patients I’ve treated. Patients look natural, youthful and results can last for decades.
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#facelift #necklift #deepplanenecklift #deepplanefacelift #deepnecksculpting #beforeandafter #sherberandrad

Facelift q&a
Happy Thanksgiving! 🦃

Face Optimization for my lovely patient 3 months after endo brow/midface lift, lower blepharoplasty, midface/orbital rim augmentation and closed rhinoplasty. She and I had 3 goals 🎯: (i) to bring out the most naturally attractive “version” of her, (ii) to correct under eye bags and dorsal nasal hump, and (iii) improve midface and under eye bone structure for optimal longevity of results and to facilitate “graceful aging”. 💪
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She’s in her twenties and whenever I see under eye tear trough hollows, under eye bags and flat midface in a young person it is always due to deficient bone structure 💀 rather than aging changes. Most surgeons would offer only soft tissue solutions such as lower blepharoplasty, fat grafting and midface lift — although these would give significant improvement alone, aesthetic results would be short lived if skeletal augmentation is not done. The indirect evidence of this fact is that at such a young age there’s no soft tissue droop, and so an aged appearance can only be due to deficient bone structure.
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Therefore my optimization evaluations always first start with the facial skeleton 💀 followed by soft tissue shaping. Once I’ve settled on the appropriate procedures then I determine the routes of access: in her case I used a transtemporal (incision in the temples) and transconjunctival (incision on the inside surface of the lower eyelids) to create a tunnel for placement of my porous polyethylene midface/orbital rim implants while simultaneously facilitating endo midface/brow lift, lower lid fat transposition. Fat grafting and closed rhinoplasty completed the balancing. Overall I think she looks softer, more beautiful in a natural and harmonious way and since she’s only 3 months out her results will continue to improve with time. She’s such a lovely person inside and out and I’m grateful that she allowed me to share her results.
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{A note to the “makeup/filter police”: hopefully you all calm down since she has makeup in the *before*, but not the *after* photo}.
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#facialoptimization #blepharoplasty #fatgrafting #midfacelift #rhinoplasty #facialimplants #endoscopicmidfacelift #beforeandafter #sherberandrad

Male face optimization in 3D: 🎯 my goal for this handsome young man was to create a ruggedized yet natural aesthetic. He was bothered by the round fullness of his lower face and bulging neck making him look boyish and not robust. I did a combination of deep plane lower face and neck lift with gland reduction and platysmaplasty, buccal fat reduction and lower face microliposuction and chin augmentation. Here he’s about 6 months out from surgery.
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In optimization strategies all procedures must synergize meaning that one effect enhances the other. An example is that the neck lift elongates the jawline making the chin appear more projected, thus requiring less augmentation than without the neck lift. Also reducing fullness of the lower face and neck above and below the jaw makes the jawline more defined, so there’s synergy between all procedures to have this effect on the jaw without any jaw-specific procedures.
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The aesthetic concept behind facial optimization, aka “looks maxxing” is what I call “hyperdimorphic contrast” — ultra masculine characteristics that go beyond our idea of “normal”. I’m aiming for greater contrast in feature proportions, lengths and shapes without looking altered — a delicate balance. Facial optimization is about stunning subtlety, the sum of many little details fine tuned to produce natural, plausibly deniable results. I think this is the highest expression of plastic surgery.
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#facelift #deepplanefacelift #deepplanenecklift #blepharoplasty #fatgrafting #rhinoplasty #beforeandafter #sherberandrad

I know, I know — she has makeup obviously, but nonetheless doesn’t she look stunning? 🔥 Makeup can’t replicate the power of my endo brow lift, canthoplasty, midface lift, fat grafting to forehead, temples, under eyes, upper orbit (eye sockets), midface, upper/lower lips. Some call it the ponytail, I call it face optimization 👄🔥
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If my aesthetic resonates with you, then consult with me: 202-517-7299 contact@sherberandrad.com 🫶🏻😊
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{And for the record, like many of my patients she flew in from out of town and this photo is what she sent me. She’s obviously happy so if you still feel so compelled to hate on her makeup, head tilt, “lack of confidence” for not sending a makeup-free selfie, blah blah blah then please do me a favor and unfollow}
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#facelift #deepplanefacelift #endoscopicmidfacelift #endoscopicbrowlift #fatgrafting #foxeyelift #ponytaillift #beforeandafter #sherberandrad

What are “platysmal bands” and how are they treated? First, the platysma is a thin vertical sheet of muscle that wraps around our necks and extends from collar bones to the chin and jaw. Just like any muscle, the platysma contracts and functions as a “hammock” to support deep structures. From an aesthetic standpoint, a hyperactively contracting platysma can create visible ridges of the neck that pop out especially when speaking or animating (swipe to see the video of my platysma contracting). These ridges, or platysmal “bands” are caused by dynamic contraction of some muscle fibers which causes them to “bowstring”, like pulling two ends of a loose string taut. Over time, with repeated contraction of the muscle bands, the overlying skin becomes stretched causing a permanent band to be visible at rest.
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Treatment can be non-surgical with targeted neuromodulator (like Botox or Daxxify) to weaken the bands. While this can be effective, it is a temporary effect and the bands come back if treatment is stopped. Also, it takes many units of neuromodulator to keep bands quiescent, and injections would need to be continued indefinitely, thus making it not cost effective in the long run.
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Surgery is the definitive treatment for permanent elimination of platysmal bands and is often part of my strategy in neck lifting. The strategy is threefold, as shown in the before/after photo: (i) disconnect the platysma at its base to prevent bowstringing, (ii) tighten the midline and lateral edges upwards to reorient the muscle into an angled contour, thus creating an ideal neck line and defining the jawline, and (iii) offload the platysma by deep neck sculpting (see my prior IG Live reel on this). This triple threat approach offers 100% correction, permanent results and is the most modern approach to neck lifting.
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#facelift #deepplanefacelift #deepplanenecklift #deepnecksculpting #platysmalbands #beforeandafter #sherberandrad

✈️ All the way from Omaha, Nebraska! I’ve truly enjoyed taking care of this lovely patient in her mid-40s who saw the early signs of aging approaching. She was particularly bothered by a lax jawline and “platysma bands”, overactive neck muscle threads that were worsened by under chin liposuction that she had done elsewhere. In fact, liposuction should never have been done in such a slender person as she.
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I did a “deep plane” face and neck lift with platysmotomy (cutting the platysma muscle) to counteract tight platysma bands that were evident at rest and while speaking. Platysmaplasty (tightening of the platysma muscle) defined her jawline and restored her striking features. 🔥 Fat grafting softened her features and restored volume to her midface, under eyes, temples and lips and a small touch up of her nose slimmed the shape.
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The average age range for a first facelift is mid- to late forties when early aging changes begin to be bothersome. Since tissue quality is excellent, deep plane facelifts are more effective with greater longevity of results as compared to thinned tissues in older folks. Also, face lift at a younger age means that she can now enjoy her natural results for many years to come! 💯
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#facelift #deepplanefacelift #deepplanenecklift #deepnecksculpting #fatgrafting #rhinoplasty #beforeandafter #sherberandrad

IG Live! Lower Face Aesthetics, all you need to know and more 🫶🏻

Male lower blepharoplasty, fat grafting and midface lift give a natural refresh for the eyes and all through hidden incisions inside the lower eyelids, the so-called “transconjunctival” approach.
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This gentleman lamented looking tired and aged despite a healthy lifestyle and regular exercise. Under light anesthesia I made an incision on the inside of his eyelids, dissected just below the orbicularis oculi muscle (“pre-septal” plane) to the eye socket bone (“inferior orbital rim”) to then created a pocket on the bone surface into which I transposed (shifted) the bulging fat pads. But before transposing fat I lifted the deep cheek fat and anchored it to the eye socket bone with bone tunnels. Then I draped the eyelid fat over the eye socket rim like moving a hill into the adjacent valley. One of the subtleties that I endeavor to create an full tarsal platform (the enhanced volume along the eye lash margin). I also did fat grafting to blend the lid-cheek junction and restore volume loss.
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Results are permanent as anatomy is now optimized and he’ll continue agine but from a better set point. 💯
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#facelift #deepplanefacelift #midfacelift #fatgrafting #midfacelift #blepharoplasty #beforeandafter #sherberandrad

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