James R. Payne M.D.

This surgery may be performed under local anesthesia with intravenous sedation or under general anesthesia. All surgery is done at Dr. Payne’s MediCare and California State Certified Pueblo Nuevo Surgery Center located within his office. Incisions for the facelift operation may be placed within the temporal scalp or along its anterior distribution, in front and back of the ear, occipital scalp and sometimes under the chin. There are a number of options for different patients as to exactly which incision pattern is selected and these are discussed with the patient ahead of time. Typically these scars are mostly hidden from view and the ones which are potentially visible are generally fine and inconspicuous once they are fully healed. The subcutaneous fat, muscle, fascia and SMAS layers are modified in a facelift operation to try to improve the appearance of the cheeks, nasolabial folds, mouth, jowls, lateral orbits, temples, jawline, and in the neck. Different patients require different approaches and each operation is tailored to the requirements of the individual patient. In general, skin and soft tissue are mobilized, repositioned/lifted, tightened, and excess skin is removed.

This surgery may be performed under local anesthesia with intravenous sedation or under general anesthesia. All surgery is done at Dr. Payne’s MediCare and California State Certified Pueblo Nuevo Surgery Center located within his office. All incisions are well hidden and mostly located within the interior of the nose. These scars typically become invisible within a few months after surgery. Rhinoplasty surgery may be done closed (no external nasal incision) or open (small incision across the columella on the underside of the nose). Through these incisions the internal nasal anatomy is accessed and corrected. Surgery on the inside of the nose is aimed at preserving or improving nasal breathing. This can include modification of the septum and the structures on the lateral nasal wall such as the inferior turbinates. It sometimes includes other surgical maneuvers designed to open up the nasal passages. The external portion of the rhinoplasty includes modification of the bridge (dorsum) of the nose. Many patients have a significant dorsal hump they don’t like and which requires reduction. The nasal tip is often bulbous, large, asymmetric, and unattractive. The required work is aimed at providing a pleasing appearance of the nasal tip as well as fitting the tip to the bridge for proper balance between these two zones of the nose. The bony nasal pyramid is often narrowed in order to correct excess width of the nasal base or other problems. The length and projection of the nose can be changed. The nasal openings may be modified. Sometimes the use of cartilage, fascia, bone or other materials within the nose may be required in order to achieve the desired appearance. Big noses are reduced, small noses may be enlarged, and crooked noses straightened.

This surgery is usually performed under general anesthesia. All surgery is done at Dr. Payne’s MediCare and California State Certified Pueblo Nuevo Surgery Center located within his office. Incisions are made transversely across the lower tummy with the length of the scar depending on the amount of excess skin and soft tissue present. Some patients are candidates for a mini-tummy tuck and others require a standard tummy tuck for maximum results. The lower half of the abdominal skin and fat are then removed. The belly button is detached from the skin but left attached to the deeper tissues. It is later brought back through the skin and sewn into its new position with a different configuration than the original in order to improve its aesthetic quality. The abdominal muscles are tightened in order to help flatten the tummy and improve the shape of the waist. Liposuction and direct fat sculpting are done on the abdomen and surrounding areas as needed. Sometimes this will include a buttocks lift and fat sculpting of the back and buttocks. This latter approach provides circumferential shaping of the tummy and lower trunk including the buttocks.