Question 1

What is the post-operative care and recovery process like after rhinoplasty?

Accepted Answer

After rhinoplasty, nasal splints are inserted for one week to hold the nose in place. During this week, patients must breathe through their mouth, and while generally not painful, it can be uncomfortable. The nose will be swollen, and swelling will significantly decrease over time. Dr. Judge also recommends a specific nose taping method using trimmed Steri-Strips for the first week after the splint is removed to help reduce swelling. The taping involves placing the first tape on the nasal tip, covering the nostrils slightly, and subsequent tapes overlapping down the dorsum.

Question 2

What is Dr. Judge's opinion on CoolSculpting versus Liposuction for fat reduction?

Accepted Answer

Dr. Judge believes liposuction is superior to CoolSculpting. She notes that CoolSculpting can be expensive, require multiple rounds, cause discomfort, and carries a risk of Paradoxical Adipose Hyperplasia (PAH), where fat cells paradoxically get larger. In contrast, liposuction is typically a 'one and done' procedure that completely removes fat cells, offering a controlled and predictable way to achieve desired body shape, usually in one or two sessions.

Question 3

What is Dr. Judge's stance on Brazilian Butt Lifts (BBLs)?

Accepted Answer

Dr. Judge considers the Brazilian Butt Lift (BBL) a dangerous procedure and is not 'totally on board' with it, primarily due to the high risk of fat embolism. She explains that during a BBL, fat transferred to the buttocks can accidentally enter a large vein, travel to the lungs, and block blood oxygenation, leading to a fat embolism. The mortality rate for BBLs is 1 in 3,000, which she considers 'ridiculously high'.

Question 4

What is Dr. Judge's approach to PDO threads for facial lifting?

Accepted Answer

Dr. Judge believes PDO (Polydioxane) threads can work well in some patients, but emphasizes that correct technique and placement are key. She explains that PDO threads are meant to lift soft tissue and must be placed in a deeper plane, stopping just after the facial crease and then lifting up. If placed too superficially, they can poke out until they dissolve into collagen. She also stresses the importance of trimming thread edges deep into the skin to prevent them from poking out.

Question 5

What is Dr. Judge's philosophy and technique for neurotoxin (Botox/Dysport) injections?

Accepted Answer

Dr. Judge aims for natural-looking results with neurotoxin injections, preferring some natural facial movement while minimizing deep lines. She considers Dysport and Botox 'pretty equivalent,' with Daxofi as a close second, and generally doesn't favor other types of tox. For the glabella, she typically uses 12-14 units for a natural look (up to 20 units is possible). For the forehead, she recommends around 10 units for smaller foreheads and up to 20 for taller ones. For crow's feet, she prefers 6-8 units, and 1-2 units for a subtle lateral brow lift. She emphasizes injecting the brow arch to prevent a 'Spock brow' and advises patients to avoid hats or downward dog for two days post-injection, with normal activity resuming thereafter.

Question 6

What are Dr. Judge's considerations for breast implant sizing and placement?

Accepted Answer

Dr. Judge advises against choosing the largest implant size, especially if concerned about sagging, as larger implants tend to drop, stretch the skin, and cause more inflammation over time, leading to increased sagging. She explains that implants are typically placed either above or below the muscle (between the ribs and muscle). Initially, muscle compression can make the breast appear smaller, but over time, the muscle stretches, allowing the implant to settle and become more visible.

Question 7

What is Dr. Judge's recommended approach for under-eye concerns?

Accepted Answer

Dr. Judge considers lower eyelid surgery, specifically involving the re-transposition of eye bags and adding fat, as the 'gold standard' for achieving bright and smooth under-eyes. She emphasizes that makeup has limitations and cannot correct certain structural under-eye issues, which often require surgical intervention for the best outcomes.

Question 8

What are the most critical dangers associated with BBLs, and what specific questions should patients ask to ensure their surgeon prioritizes safety?

Accepted Answer

Dr. Judge considers the Brazilian Butt Lift (BBL) a dangerous procedure and is not 'totally on board' with it, primarily due to the high risk of fat embolism. She explains that during a BBL, fat transferred to the buttocks can accidentally enter a large vein, travel to the lungs, and block blood oxygenation, leading to a fat embolism. The mortality rate for BBLs is 1 in 3,000, which she considers 'ridiculously high'.

Question 9

How long does significant swelling typically last after rhinoplasty, and when can one expect to see the 'final' result without residual swelling?

Accepted Answer

After rhinoplasty, nasal splints are inserted for one week to hold the nose in place. During this week, patients must breathe through their mouth, and while generally not painful, it can be uncomfortable. The nose will be swollen, and swelling will significantly decrease over time. Dr. Judge also recommends a specific nose taping method using trimmed Steri-Strips for the first week after the splint is removed to help reduce swelling. The taping involves placing the first tape on the nasal tip, covering the nostrils slightly, and subsequent tapes overlapping down the dorsum.

Question 10

What is the main difference between Botox and Dysport in terms of onset, duration, and feel, and how do you decide which to use for different areas?

Accepted Answer

Dr. Judge aims for natural-looking results with neurotoxin injections, preferring some natural facial movement while minimizing deep lines. She considers Dysport and Botox 'pretty equivalent,' with Daxofi as a close second, and generally doesn't favor other types of tox. For the glabella, she typically uses 12-14 units for a natural look (up to 20 units is possible). For the forehead, she recommends around 10 units for smaller foreheads and up to 20 for taller ones. For crow's feet, she prefers 6-8 units, and 1-2 units for a subtle lateral brow lift. She emphasizes injecting the brow arch to prevent a 'Spock brow' and advises patients to avoid hats or downward dog for two days post-injection, with normal activity resuming thereafter.

Question 11

What are the specific reasons CoolSculpting is considered less effective or potentially problematic compared to liposuction for fat reduction?

Accepted Answer

Dr. Judge believes liposuction is superior to CoolSculpting. She notes that CoolSculpting can be expensive, require multiple rounds, cause discomfort, and carries a risk of Paradoxical Adipose Hyperplasia (PAH), where fat cells paradoxically get larger. In contrast, liposuction is typically a 'one and done' procedure that completely removes fat cells, offering a controlled and predictable way to achieve desired body shape, usually in one or two sessions.

Question 12

When you refer to 'structural changes' for under-eye brightness, are you primarily talking about surgical options like blepharoplasty or fat repositioning, and how do they compare to fillers?

Accepted Answer

Dr. Judge considers lower eyelid surgery, specifically involving the re-transposition of eye bags and adding fat, as the 'gold standard' for achieving bright and smooth under-eyes. She emphasizes that makeup has limitations and cannot correct certain structural under-eye issues, which often require surgical intervention for the best outcomes.

Question 13

Beyond implant size, what other factors contribute to the risk of complications or inflammation with breast implants, and how can these be mitigated?

Accepted Answer

Dr. Judge advises against choosing the largest implant size, especially if concerned about sagging, as larger implants tend to drop, stretch the skin, and cause more inflammation over time, leading to increased sagging. She explains that implants are typically placed either above or below the muscle (between the ribs and muscle). Initially, muscle compression can make the breast appear smaller, but over time, the muscle stretches, allowing the implant to settle and become more visible.

Question 14

What are the primary reasons PDO threads often 'fail' or don't deliver lasting results, and what are more reliable alternatives for facial lifting?

Accepted Answer

Dr. Judge believes PDO (Polydioxane) threads can work well in some patients, but emphasizes that correct technique and placement are key. She explains that PDO threads are meant to lift soft tissue and must be placed in a deeper plane, stopping just after the facial crease and then lifting up. If placed too superficially, they can poke out until they dissolve into collagen. She also stresses the importance of trimming thread edges deep into the skin to prevent them from poking out.

Question 15

What does Dr. Judge say about their techniques?

Accepted Answer

Most of the time, we're either placing it above the muscle or below the muscle in between the ribs and the muscle.

Question 16

What does Dr. Judge say about what they specialize in?

Accepted Answer

The doctor is not totally on board with BBLs, primarily due to the risk of fat embolism.

Question 17

What does Dr. Judge say about results?

Accepted Answer

The doctor aims for natural-looking results when injecting Botox or Dysport. The things that I like to do are really natural results and that's the thing that I do myself.

Question 18

What does Dr. Judge say about recovery?

Accepted Answer

Dr. Judge recommends a specific method for her patients to tape their nose after rhinoplasty.

Dr. Tanya Judge, MD

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