True migraine sufferers tend to have visual cues, or auras that occur between 10 and 30 minutes before the onset of severe headache pain. They can see flashing lights, have blind spots, or lose vision for a short time. They may also have other symptoms that come with severe headache pain, like nausea and vomiting. While many theories exist for the cause of migraines, the most commonly accepted is the blood flow theory, which focuses on blood vessel activity in the brain.

A migraine imposter may have the same level of pain, accompanied by nausea and vomiting, but can have other causes, such as a bone spur of the septum that contacts nasal turbinates, and triggers pain.

The National Women’s Health Information Center theorizes that women are more prone to migraine headaches because they often have more job, family, and social commitments. Hormones can also be a trigger for migraines, which is often referred to as “menstrual migraines,” even though women suffer from migraines at times not connected with their menstrual cycle. (Source: National Women’s Health Information Center)

The cause of a deviated septum is trauma of some sort. It can occur as early as birth, when the baby’s face is smashed during the delivery process. As children get involved in sports, they can have injury to their nose and a resulting deviated septum. Teens and adults can be involved in car accidents, contact sports, or abusive relationships. Professional athletes are constantly exposed to potential nose trauma, which misdiagnosed can lead to shortened careers and millions of dollars lost from contracts.

This surgical procedure involves removing the deviated portion of the septum that is making contact with very sensitive structures in the nose, called turbinates. These turbinates are vascular structures that are innervated by the trigeminal nerve. They swell in response to colds, flu, and hormonal changes such as menstrual cycles. Once the contact point is removed, the pain goes away.

Septoplasty is performed in an out-patient setting, and is covered by insurance. The recovery can be in as little as two days. Patients who suffer headaches on the day of surgery are amazed to find relief upon awakening in the recovery room.

Dr. Smith has analyzed the outcomes of patients in his own practice and found that he provided relief to 90% of patients–40% cured, and 50% that reported less frequent and/or less severe headaches. The success rate in his practice is correlated to patients identified as having a deviated septum.


If the nasal bones are wide or if a hump is removed it is necessary to make cuts into the bones (osteotomies) in order to achieve the desired result.

Typically areas of the nose can be reduced to make the nose more proportioned. This areas include the tip, bones, nostrils and a dorsal hump. A deformity from trauma can be reconstructed by reducing some areas or adding cartilage grafts to other areas to make improvements.

My patients typically do not get black eyes. The nasal splint is removed in 1 week and you can go to lunch without anyone knowing you had anything done.

No. I make my incisions inside the nose. This is known as a closed approach. The few times I use an external open approach is in a severely deformed nose or a revision rhinoplasty with extensive scar tissue.

No. I prefer to use IV sedation if possible. This twilight anesthesia is very effective in providing comfort and amnesia during the surgery. Of course if you have conditions such as sleep apnea or severe gastric reflux general anesthesia would be necessary.

The splint is removed in 1 week. You should allow 6 weeks for the bones to fully stabilize. That means avoid contact sports, large crowds and the wearing of glasses. Although you will be presentable in 1 week the nose continues to change up to 1 year after surgery.


No. This surgery can be done several ways depending on your health and disposition. If you have a calm demeanor this procedure can be performed in the office with local anesthesia supplemented with a small dose of Valium. If not, IV sedation provides twilight sleep and amnesia for your comfort.

This round eye effect can occur if too much skin is removed in the presence of weak lower eyelids. The scar tissue can pull the lid and cause the whites of the eyes to show. I try to prevent this by pinching the amount of skin to be removed with forceps and marking it. I do the same for the upper eyelids to dry eyes from inability to fully close the eyes.

The sutures can come out as early as 5 days after surgery. At 7 days you can apply water based makeup and enjoy your new look.


I prefer customizing my facelift procedure to fit a patient’s specific needs. A full facelift is one that typically involves longer incisions in the temple scalp and neck and longer skin flap dissection . I find that most women can get great results from what is typically called a mini facelift. This involves shorter incisions and shorter dissection. With the proper patient, this can be performed under local anesthesia with a low dose Valium. Most of my modifications involve longer incisions behind the ear with or without liposuction of the jowls, cheeks or under the chin.

I recommend 1 week for recovery and relaxation. It is imperative that you chill the face with cool compresses, keep the head elevated to prevent excessive swelling and bruising. The sutures are removes in one week and make-up can be applied on the 9th day. Most patients can out and about in 7-10 days depending upon bruising and swelling. But some require 2 weeks. A good rule of thumb is that maximum swelling occurs on the 4th day, 70% of swelling is gone in 2 weeks and 90% in 2 months.

It is rare for the face to form keloids but it does happen. It is more common to form hypertropic or thickened scars behind the ears due to the tension of supporting the neck portion of the lift. To help minimize this risk, I suture the skin under minimal tension with dissolvable sutures. If scars do thicken they can be treated with steroids injections or steroid tape. If they are unresponsive to these therapies then a scar revision surgery is indicated whereby the scar is excised and resutured.

This surgery is similar to day light savings time. You will always look younger than you would have if you had not had the procedure. The need for a second procedure depends on how well you maintain and care for your skin with a good skin care regimen and how you age. Typically you can have another lift in 6-10 years. Three lifts over a lifetime is probably the limit.

If your skin is elastic and you have minimum fullness due to fat, liposuction of these areas may be enough to buy you some time before you need a facelift.

Chin Implant.

I was trained to use implants made from merseline mesh. It is a woven mesh that can be rolled and trimmed based on measurements taken to form customized implants. Because it is porous, the tissues grow into the implant and help secure it. Within 2-3 months the implant feels like you own chin.

I place the implant by going through the mouth. The incision is placed behind the lip and a pocket is made. The implant is soaked I antibiotic solution and placed in the pocket. The pocket is sewn closed with a dissolvable suture.

Women with low eyebrows and no forehead wrinkles benefit from a simple eyebrow lift. I prefer the temporal eyebrow lift where an incision is placed behind the temporal hairline and the outer half of the eyebrow is elevated. If there are wrinkles and sagging skin of the forehead, a forehead lift is indicated. This can be performed endoscopically or with an incision along the hairline.

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