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Category: Face

Botox Makes You Look Better…

…But can it make you feel better?

With annual sales north of a billion dollars, the makers of Botox must be doing something right. I personally inject Botox to the 11 lines, forehead, and crows feet about 5 to 10 times weekly, and it is highly effective in reducing dynamic wrinkles in these areas.

There is now significant research to indicate that botulinum toxins (Botox and Dysport) may also be effective in treating over half of patients with moderate to severe depression. As reported by Scientific American, The New York Times, and Clinical Psychiatry News, many patients receiving Botox report improvement in their mood. Why? People convey depression, anger, and fear by facial expression. When Botox impairs their ability to look angry or sad, they look better—not only in the mirror but also to those around them—making them feel more confident, youthful, and attractive.

Though it has not yet been studied, many physicians also believe that injection of facial fillers, such as Restylane and Juvederm, has similar positive effects on emotional well-being.

To the adage “you only look as good as you feel,” we must now add the converse: “you only feel as good as you look.”


Botox injection to the 11’s
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Before After


Botox injection to the forehead
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Before After


Botox injection to the crow’s feet
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Before After


Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

Nonsurgical Rhinoplasty with Injectable Fillers

I am increasingly using injectable fillers to improve nasal defects that previously required surgery. Use of Juvederm and Restylane has proven valuable in specific types of deformities involving the nasal dorsum (bridge of the nose).

Typical nasal deformities addressed by hyaluronic acid fillers:

  • Saddle nose. A saddle nose occurs when there is reduced support to the middle third of the central nose, causing it to become concave, instead of straight. (Hint: it looks similar to a horse saddle.)       Injection of filler into the concavity can make the nose appear straighter on profile.
Saddlenose correction
Saddlenose before Saddlenose after
Before After


  • Contour irregularities of the nasal bridge caused by prior rhinoplasty (nasal reshaping) surgery. Rhinoplasty surgery sometimes leads to small defects, such as localized areas of flatness or concavity. Injection of facial fillers may correct these small irregularities.


Contour irregularity on bridge of nose
before injection after injection
Before After


  • Nasal deviation caused by prior rhinoplasty surgery. A mildly twisted nose either due to prior rhinoplasty or incompletely corrected by prior nasal surgery can be camouflaged by selective filler injections, making the nose appear straighter.


Keep in mind that Juvederm and Restylane typically last 6 to 12 months, so these are not permanent solutions. However, they can certainly be repeated—and there is generally enough left in the syringe to inject other areas of the face (lips, folds, lines).

While these techniques are not a substitute for secondary rhinoplasty in the case of a large nasal deformity, subtle defects are often more easily, cheaply, and reliably treated by hyaluronic acid injectibles, particularly in patients who are reluctant to undergo yet another rhinoplasty surgery.


For more information about procedures performed, please visit

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

Liposuction of the Neck

–because no one wants a double chin

It seems like a strange area to accumulate fat.  And yet many people who are otherwise height-weight proportionate have a stubborn deposit right under the chin that makes them look heavier.  If you pose with your chin up and forward every time someone takes a photo, then you know what I’m talking about.

In the appropriate patient, liposuction under the chin can be a very effective—and cost-effective—treatment.  So who is an “appropriate patient?”  Like liposuction anywhere else on the body, neck liposuction works best in people with good skin tone.  In the absence of major weight loss, skin tone beneath the chin correlates most closely with age.

20’s or 30’s:                Your skin tone is probably fine.

Early 40’s:                   You may still be a reasonable candidate, but your skin tone is probably only fair.

Late 40’s:                    This is on a case-by-case basis.  It may be getting a little too late for liposuction.

50’s:                            Your skin tone is probably inadequate for liposuction.

As an isolated procedure, submental liposuction (liposuction of the neck, under the chin) is most effective in younger patients.  In older patients, a limited-incision neck lift or facelift may be a more appropriate procedure.

What other anatomic factors must be considered?

  1. Chin projection.  If you have poor chin projection, you may benefit from a chin implant, which will tighten the soft tissue behind the chin.
  2. Muscle anatomy: Some people with “no chin” have an anatomic variant called an obtuse cervicomental angle.  Liposuction is still a reasonable procedure, but in the absence of an anterior cervicoplasty (neck lift with muscle repositioning), an “angular” neck cannot be achieved.

Surgical sequence (about 45 minutes in the office under local anesthesia)

  1. I mark the excess fat beneath your chin.
  2. We provide laughing gas (70% nitrous oxide) to help you feel tipsy.
  3. Local anesthetic is injected to the surgical site.
  4. A small incision (about 4 mm or 1/6th inch) is made under the chin.
  5. Additional local anesthetic and saline are placed through the incision into the marked fat using a 3 mm (very narrow) liposuction cannula or hollow tube.  At this point, you will feel like a “bullfrog,” since the fluid will cause temporary neck swelling.
  6. The same liposuction cannula is now used to suction out the fluid that was just injected—plus the excess fat.
  7. The incision is closed.
  8. A contoured piece of thin surgical foam and a not-so-sexy compression garment are placed.

Postoperative recovery:

  1. Have a family member or friend drive you home.  Although the laughing gas wears off in about 10 minutes, the compression garment can be a little distracting at first.
  2. You may remove the foam and garment to shower every day.  However, the garment must be worn at ALL other times (24 hours daily) for the first two weeks.  For an additional two weeks, it should be worn most of the time (at least 16 hours daily—so you don’t have to wear it at work).
  3. You must avoid heavy lifting and strenuous exercise for at least two weeks after surgery.

Remember that the purpose of submental lipectomy surgery is two-fold:

  1. Removal of excessive fat beneath the chin.  That’s my job.
  2. Avoidance of sagging of the skin beneath the chin.  That’s your job; you must wear your compression garment, or else the surgery will be unsuccessful.

Costs may vary depending upon your anatomy and desires, but the price of a typical submental liposuction in my practice is $1750.

Before After
submental lipo before submental lipo after

Patient #1 is a 43 year old from Flower Mound who underwent liposuction under the chin

Before After
lipo of neck before lipo of neck after

Patient #2 is a 32 year old from Plano who under went liposuction of the neck below the chin


Before After
lipo under chin before lipo under chin after

Patient #3 is a 29 year old from Frisco who underwent submental liposuction


For more information, please visit or call us at 469-467-0100.

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

Earlobe Repair and Reduction: Everything You Always Wanted to Know

Repair of torn earlobes

Before torn earlobe repair


after torn earlobe repair

After (2 weeks)

Dangling or heavy earrings, babies and toddlers pulling on earrings, piercing that are too low; these are among the many causes of torn earlobes.  Sometimes the earring just droops in a stretched-out piercing site (incomplete earlobe tear).  Sometimes after years of stretching, the earlobe just splits in half (complete earlobe tear).

Regardless of the cause and severity of the tear, torn earlobes can be repaired under local anesthesia in the West Plano Plastic Surgery Center.  The cost is quite reasonable at $425 for one ear or $725 for both (assuming single, uncomplicated tears in each ear).  We have laughing gas available at no additional charge.

The skin lining of the tear is removed, and the earlobe is repaired with two to three layers of stitches (inner ear skin, outer ear skin, and soft tissue between the skin each receive a layer of stitches).  The earlobes may be re-pierced at the same time (no additional charge).  You may bring small studs with you or pick them up at the Presbyterian Hospital of Plano gift shop one floor below our office.

Beautiful earrings look much better in beautiful ears.

Earlobe reduction for large earlobes

Some people have large earlobes.  They may have simply developed that way, or they may have stretched due to heavy earrings or aging.  Regardless of the cause, the result is a dangling, distractingly large earlobe.

Earlobe reduction may be performed under local anesthesia (with laughing gas, if desired, at no additional charge).  If the earlobe also happens to be torn, this can be repaired at the same time (also at no additional charge).  In fact, sometimes the torn part of the earlobe can be removed as part of the earlobe reduction.

before earlobe reduction


after earlobe reduction

After (2 months)

Most commonly I perform removal of redundant earlobe tissue through an incision along the edge of the earlobe (Patient 2, above).  Essentially, you and I agree upon the new size and curvature of the earlobe, and this is drawn onto your ear.  Then the excess skin and soft tissue is removed—staying exactly on that line.  The intervening earlobe edge’s soft tissues are thinned, and the earlobe is repaired.  This technique primarily shortens earlobes that are too long.

before earlobe reduction wedge


after earlobe reduction wedge

After (2 weeks)                                              

An alternative method is to perform a wedge-shaped excision of redundant earlobe tissue (Patient 3, above).  This creates a vertical scar (instead of a curved horizontal one) and enables narrowing of earlobes that are too wide, as well as some shortening of length.

Either procedure works well, and we can decide together which one will best suit your anatomy and preferences.

Repair and reduction for gauged earlobes 

Gauging the ears is popular with many teens and twenty-somethings.  Unfortunately, it leaves the earlobes severely stretched and deformed.  Many patients choose to repair gauged earlobes due to the eventual cosmetic appearance or due to lack of acceptance by workplaces and the military.  Repair of gauged earlobes entails a combination of torn earlobe repair and earlobe reduction.  The thinned rim of tissue along the lower part of the earlobe is removed as a wedge excision, creating a vertical incision in much the same way as a wedge earlobe reduction procedure (see above).  The more stretched the earlobe is prior to repair, the smaller the earlobe will be after repair. For more information about gauged earlobe repair including pricing please call our office at 469-467-0100.

before gauge repair


after gauge repair

After (2 weeks)                                                      

For more information, including before and after photos of earlobe repairs and reductions, please visit or call us at 469-467-0100.

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

Dr. Friedman is the Founder and Director of the West Plano Plastic Surgery Center on the campus of Texas Health Presbyterian Hospital of Plano. He has been named Best Plastic Surgeon by D Magazine for 6 consecutive years and is the 2012 plastic surgery winner of the Best of Plano and the Best of Denton.  He has an office in Plano and serves the Frisco, Allen, McKinney, Colleyville, Grapevine, and Southlake communities.

Performing Facial Injections

I am fully aware that Botox and facial fillers are available on practically every street corner. Doctors’ and dentists’ offices, medical spas, and even beauty parlors offer injectables. Patients are routinely injected by gynecologists, dentists, nurses, aestheticians, medical assistants, and occasionally personnel with no formal medical education.  The results of the injections are variable: some are pretty good, and some are awful.

In contrast to the other injectors, plastic surgeons make their living by operating on people, not by injecting them.  I am no exception.  So why do I personally perform every injection?

Botox to glabella

botox injection plano tx


botox injection plano tx


Restylane to the nasiolabial folds

restylane injection plano tx



Because I’m good at it.  With an artistic background as a wood and marble sculptor and a medical background as a plastic surgeon, I feel better qualified to perform Botox and Restylane injections than the nurses and medical assistants in my office.  I understand the anatomy of the facial muscles better than your dermatologist—because I perform surgery on those very same muscles.  I can mark the muscles for injection based on your unique anatomy, rather than using a standardized diagram provided by the medical manufacturers.  I know that Restylane and Juvederm are not interchangeable products, and I understand when to use each.  I did not develop my knowledge through a weekend course at a hotel; instead, I developed it over 17 years as a board-certified plastic surgeon.

If I am the most qualified person in my office to perform injectables, I cannot delegate this duty to anyone else.  I really do care about doing my best for my patients, and I am compulsive about providing consistent, quality results.  Although I could hire an aesthetician or train a nurse injector, I still believe that if you want something done right, you have to do it yourself.

Ronald M. Friedman

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

Dr. Friedman prides himself on personally performing every Botox, Dysport, Restylane, and Juvederm injection.  Although ice is suitable for many patients, he believes that it is unfair to charge extra for patient comfort.  So he provides effective topical anesthetics and/or 70% nitrous oxide (laughing gas) at no additional charge.  Our practice serves the Plano, Frisco, Allen, and McKinney communities.

Please visit our website for more before and after Botox and Dysport photos and before and after Restylane and Juvederm photos of patients who have been injected by Dr. Friedman.

© 2018 Ronald M. Friedman, M.D., P.A.

Contact Us At 469-467-0100

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